New approach to H1N1 "pandemic"- recalibration - (Oct/07/2009 )

Relevant to a previous discussion are a letter and article in the most recent Brit Med Journal

see: http://www.bmj.com/cgi/content/extract/339/sep29_3/b3959
and: http://www.bmj.com/cgi/content/full/339/sep03_2/b3471

The stats not only say mortality is substantially down from previous years with "seasonal flu" - it appears H1N1 is a relatively "benign" flu.
Also in extract:
"There is also far less certainty today regarding the severity of the threat of pandemic flu. Experts are unsure that the 2009 pandemic—which the World Health Organization presently characterises as moderate6—will be any worse than seasonal flu.7 8 9 Since the emergence of novel A/H1N1, descriptions of pandemic flu (both its causes and its effect) have changed to such a degree that the difference between seasonal flu and pandemic flu is now unclear (table ).10 WHO, for example, for years defined pandemics as outbreaks causing "enormous numbers of deaths and illness,"10 but in early May, removed this phrase from the definition."

This clearly looks at the effectivley over-hyped nature of H1N! and casts doubt on the usefulness of the vaccine (esp. in risk/benefit model). The author offers a recalibration of flu to include both potential for transmission (r.g. H1N1 would be high and SARS low) as well as severity (e.g. H1N1 low, SARS high). I'm unable to reproduce here but ask folks to look at Fig 2 Proposed classification of impact of new infectious diseases.

Very interesting.

Thanks for the update George. How do you think this sits with some predictions that it will be this coming Northern winter that will really show the level of danger with swine flu?

Good catch, georgie. I too have seen reports of growing understanding that H1N1 is pretty mild in terms of mortality. Heard one suggested explanation that some degree of existing immunity in those =/> 60 removes this vulnerable group that would otherwise provide victims. The shift to younger group finds the same very young at risk but generally a more robust population.
Wonder why WHO changed its definition - I'm cynical - consider it a way to get more attention and $.

To swanny's question - the model published says it will be mild. But as much as I appreciate that someone is trying to be realistic rather than hysterically scream "Pandemic!!" to an increasingly cynical public, it is from a grad student. I am struck by the responses - none taking issue with the guy.

Nice one george. Good read. strong argument. sometimes, i think this flu is being overrated. in malaysia, most death are usually caused not primarily by H1n1 but some other disease that was present before.

hanming86 on Oct 20 2009, 10:44 PM said:

The number of confirmed pediatric deaths for H1N1 (86) already is already on par with the number of pediatric deaths from the seasonal flu last flu season (97), except, of course, our current flu season lasts 7 more months, suggesting that the death toll from H1N1 will far outweigh that of the typical flu among children. 30% of these children appear to have been otherwise healthy, though I can't seem to find the data as to how many children were otherwise healthy yet died in response to the seasonal flu. I am not saying that we should panic or all run out and be vaccinated, but ignoring the data would also be foolish. Models and predictions are great, but facts are what they are. Perhaps the risk/benefit ratio is different for those of us with children that some of these forum users.

from the CDC,

True - pediatric deaths are likely up and others down. I too couldn't find the dynmaic of underlying illness. It's not clear at this point if the overalll mortality is on the par with seasonal flu - but it probably won't be. Don't think anyone is ignoring data or suggesting such as action.