Swine Flu Parties

[indigo girl]

Swine flu: why we are party poopers

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_why_we_are_party_poo.php

Why self-infection of your family is not a smart idea:

One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.

On April 28, a user calling herself OmegaMom posted: "Just a quick note-I just got a Tweet from a mom suggesting 'swine flu parties' because the U.S. version seems to be a mild version. Can you speak to the utter insanity of doing this, please?"

I understand completely why this would be an attractive idea, and I have been asked about it by reporters and at least two colleagues, both of them smart and well informed. Given how this is being portrayed in the media and occasionally by public health officials the logic seems ironclad: the virus might return with a vengeance next flu season in a more severe form, it currently is a mild disease, and there is no protective vaccine for it at the moment and uncertainty as to when there might be or its availability. So why not take advantage of a naturally circulating "live virus vaccine"?

I can think of a number of reasons:

While clinically the virus seems to be resulting in a "mild" flu, even a mild flu is not most people's idea of a mild illness.

The hospitalization rate is somewhat higher than for seasonal flu, especially the relative number of healthy young adults and children. The hospitalized cases seem to have roughly the same age distribution as the cases in general, that is, half of them are 15 years old and younger. Few parents would consider something that sent their child to the hospital a mild illness

All this is predicated on the virus continuing to act as it does now -- or as we think it is acting now. As we pointed out in this post, we still are not confident we know how severe it is.

It could just disappear, it could become more severe or it could change in ways that make a subsequent infection possible, as with the changes we see from year to year in seasonal flu.

Given all this, you may still choose to voluntarily and knowlingly infect yourself or your family. But unless you and all your fellow party-goers are also willing to isolate yourselves for 14 days, you also may infect others.

[lamazeteacher]

Any time someone purposely infects themselves or others, there is irresponsibility regarding long range repercussions.

What started as a means of conferring lifelong immunity for children, by having them get a "childhood" illness while young when it is less likely to cause secondary illness, has been confused. No one knows if having the flu confers any future immunity; and the thinking of experts now, is that in the fiture the virus will mutate into something more severe.

The most bizarre "infection parties" I've heard about, are the HIV Ab positive people who infect others at bachanals. One would think the possibility of becoming terminallyt ill at one of those insane happenings, would lessen the pleasure......

[VivaLasViejas, ASN, RN]

Sounds like pure insanity to me.

[Multicollinearity, BSN, RN]

OK, then call me insane.... Personally, I would not mind getting this right now so I could develop some immunity. (I'm not speaking of purposely infecting children.)

Our nightmare scenario is if this swine flu follows the 1918 pattern and comes back deadly in the fall. Those who had a milder version are likely to have some immunity.

[lamazeteacher]

OK, then call me insane.... Personally, I would not mind getting this right now so I could develop some immunity. (I'm not speaking of purposely infecting children.)

Our nightmare scenario is if this swine flu follows the 1918 pattern and comes back deadly in the fall. Those who had a milder version are likely to have some immunity.

Now who wrote or told you some immunity is conferred with this H1N1 bug? No, it's not likely, in fact when it mutates, you're just as likely to be first on the list for the newer more lethal form, if you've had H1N1 (just guessing, and it's not an educated or even lucid guess).

I have it right now, and believe me, you don't want it! The sore throat is severe and lasts longer than usual prodromal symptoms, the rhinitis is like a tap left open, when it isn't turgidly blocking my airway. HA, fever and sweats make you go through nightwear too quickly, because there's no energy to do a wash, and when I try to knit, I drop stitches all the time and lose my count. Reading is out, because I can't remember what I've read (not just due to my age), and I fall asleep, which is probably good. Another goody is that friends bring me soup - but I can't open the door wide enough to talk to them. I mutter, "Put it down and leave, quick!"

[indigo girl]

http://scienceblogs.com/effectmeasure/2009/05/swine_flu_more_on_the_cases.php

I am posting this here to give some description of what the early cases looked like, and to give an idea of severity. It is quite amazing that these papers have been published so speedily. Often researchers have been hanging onto data for years particularly with regards to H5N1, bird flu thus early publication is rather surprising. And, luckily there were some surveillance studies going on at this time, another reason to thank the public health system, that they noticed something new so quickly because the importance of these cases could easily have been missed until many infections later.

There were some lucky breaks in all this, including the enhanced surveillance in the border area, the evaluation of a new diagnostic test, and the fact that CDC had recently prepared PCR primers for swine influenza requiring only minor modification to identify the new strain. While both children recovered uneventfully, it is clear patient 1 was a pretty sick little boy. 60% of the cases reported in this paper were under 18 years of age. 18% had recently traveled to Mexico, although in yesterday's CDC briefing it was said that the travel associated cases are now only 10% of the US total as sustained person to person transmission begins to take hold on US soil. The most common presenting symptom was fever (94%) followed by cough (92%) and sore throat (66%). Unusually for respiratory influenza, 25% had diarrhea and 25% vomiting.

Hospitalization status was known for 399 of the cases and amounted to 36 in the series (it has since increased). While this 9% prevalence is high, it is likely that more serious cases were preferentially tested, so we have yet to get a good fix on the severity of illness caused by this virus. Sufficient information on 22 hospitalized patients showed that 12, or about half, had underlying medical conditions that might have increased risk, but half did not, that is, they were previously healthy individuals, many of them young. There were 11 cases of pneumonia among the hospitalized. 8 wound up in intensive care, 4 had respiratory failure and 2 died.

All of these things happen with seasonal influenza, too, so it doesn't mean this is an especially virulent version of flu. It may well qualify for the much used term, "mild," in that regard, because real seasonal influenza is an inherently nasty illness.

But for these patients, half of them previously healthy and on average quite young, "mild" won't cut it as a description of what they went through. Something to keep in mind.

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

[Multicollinearity, BSN, RN]

Now who wrote or told you some immunity is conferred with this H1N1 bug? No, it's not likely, in fact when it mutates, you're just as likely to be first on the list for the newer more lethal form, if you've had H1N1 (just guessing, and it's not an educated or even lucid guess).

I have it right now, and believe me, you don't want it! The sore throat is severe and lasts longer than usual prodromal symptoms, the rhinitis is like a tap left open, when it isn't turgidly blocking my airway. HA, fever and sweats make you go through nightwear too quickly, because there's no energy to do a wash, and when I try to knit, I drop stitches all the time and lose my count. Reading is out, because I can't remember what I've read (not just due to my age), and I fall asleep, which is probably good. Another goody is that friends bring me soup - but I can't open the door wide enough to talk to them. I mutter, "Put it down and leave, quick!"

I'm sorry you are suffering. Hope you are feeling better quickly.

I've done a bit of reading about the 1918 pandemic over the years. Can't remember which book I read that said those who had the mild form in the spring seemed to be immune or get a less severe form when the deadly pandemic returned in the fall.

It's all speculative, that's true. I just know if I get actual influenza, I usually get pneumonia. And I have asthma. That's my history. I'm always first in line for the flu shot every year and I know tamiflu well. So yes, I'd rather get the "mild" form now over the summer rather than a more potent strain in the fall during my last semester of nursing school. That's my thinking. Of course this is all speculative and may not appear.

Hope you are feeling better soon.