Medications A-Z

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Cancer Vaccines

Vaccines are designed to stimulate the immune system to mount an immune response against the target in the vaccine. For instance, the flu vaccine contains pieces of the flu virus, and stimulates the immune system to make cells that fight the flu virus. The flu vaccine needs to be given at least two weeks before exposure to the flu. This is an example of a preventive vaccine. The flu vaccine can stimulate long-lasting immunity to the strain of flu used in the vaccine.
Cancer vaccines are different in that they are not preventive. Rather, cancer vaccines are therapeutic-they are used to treat the disease rather than prevent it. Like the flu vaccine, cancer vaccines are designed to stimulate the immune system to mount a response toward the target-in this case the cancer cells. Unlike flu virus which is foreign to the body, cancer cells are not foreign and generally do not stimulate a strong immune response on their own. So cancer vaccines use other substances or cells to help the immune response along.
Some of the substances in cancer vaccines are called cytokines, which act as “immune hormones.” Other substances are called heat shock proteins. Heat shock proteins and cytokines can help alert the immune system to the information about the cancer cells. This alert helps certain immune cells that are sensitive to the cancer cells to divide. This new “army” of cells will kill any cancer cell they come in contact with.
The cells that are most efficient at stimulating an immune response are called dendritic cells. Dendritic cells are a specialized immune cells found throughout the body. To make a vaccine, precursor cells are taken from a blood sample of the patient and grown in the laboratory. Information about the surface of the patient’s cancer cells is placed inside dendritic cells that are grown in the laboratory. When the cells are injected they can activate an immune response toward the cancer cells. As with cytokine and heat shock protein activation, the alerted cells divide and kill cancer cells they come in contact with.
Unlike chemotherapy cancer vaccines generally have few side effects. Here at the clinic we use all the types of cancer vaccines described above. The results achieved vary with tumor, type of tumor and stage of disease.
Cancer vaccines represent an innovative potential cancer therapy — a therapy that seeks to harness the body’s own defenses to fight the uncontrolled growth and spread of cancer cells.
The immune system has the ability to recognize the difference between “self” and “non self,” that which is and is not a naturally occurring molecule in the body. In the case of cancer, the difference between cancer cells and normal healthy cells is sometimes so slight that they go unnoticed by the immune system and no response occurs, or the immune system is overwhelmed. The body is “tolerant” of the cells allowing them to multiply in the body. Cancer vaccines seek to “break” this tolerance.
Cancer vaccines are designed to introduce molecules expressed on cancer cells into the body in a new way that awakens the immune system to respond and destroy the cancer cell. These vaccines attract immune cells such as dendritic cells that engulf the vaccine cells which include “antigens” or proteins on their cell surfaces, and then present (exhibit) fragments of these antigens. These immune cells, known as “antigen presenting cells” (APCs), then signal other immune cells to mature and attack the specific invading antigen. Lymphocytes, including helper T cells, killer T cells, and B cells, are called into action. Helper T cells release cytokines, chemical messages that recruit other immune cells, and killer T cells engulf the antigen (and the cell it is attached to) the APCs presented to it. In addition to awakening the cellular side of the immune system to the tumor cell, some cancer vaccines stimulate the humoral side of the immune system, which includes antibodies, into action as well.
Types of Cancer Vaccines
Research and development efforts are currently under way to develop therapeutic cancer vaccines for the treatment of multiple forms of cancers. Currently, there are two primary approaches being explored in the development of making cancer vaccines—the “antigen-specific” approach, and the “whole cell” approach.
Antigen-Specific Approach
The antigen-specific approach seeks to make a vaccine that stimulates an immune response to a specific antigen or antigens that are believed to be unique to a specific type of tumor. This approach may result in a highly specific antitumor response, however poses the challenge of successfully identifying the specific antigens that are most highly expressed on a given tumor. Failure to identify the appropriate antigens could result in lower or no efficacy.
One approach to developing an antigen-specific vaccine involves the removal and isolation of a patient’s dendritic cells, one type of APC. The dendritic cells are exposed to antigens that are believed to be associated with a specific tumor type, and are given time to ingest, process, and “present” the antigens. The cells are then reintroduced into the patient in vaccine form.
Whole Cell Approach
The whole cell approach uses whole cancer cells to make the vaccine, not just a specific antigen. Since whole cells express multiple—sometimes thousands of—antigens, there is potentially a greater chance of stimulating an immune response since this approach does not require choosing specific antigens which may or may not turn out to be appropriate for the patient. Cell Genesys is pursuing a whole cell vaccine approach with its GVAX® cancer vaccines.
Whole cell vaccines can be either patient-specific (made completely from the individual’s own tumor cells), non patient-specific (made from a “cell line”—tumor cells that are grown in a laboratory), or a mixture of the two. Patient-specific vaccines may offer some advantages over non patient-specific vaccines when treating cancers that involve many different cell types with few like characteristics (e.g. non small-cell lung cancer). Using the patient’s own tumor cells may increase the likelihood of creating an individualized vaccine that effectively stimulates an immune response against all cell types associated with specific form of cancer being treated.
Activating an Immune Response
While some cancer vaccines are designed to stimulate an immune response based solely on the presence of antigens, others are being developed that utilize antigens as well as cytokines to mount an attack against cancer cells. Cytokines are chemical messages that stimulate other immune cells to attack antigens. Some researchers are exploring the idea of creating vaccines comprised of cells that have been genetically modified to secrete a cytokine such as GM-CSF, interleukins, and interferons. The presence of these cytokines may potentially help “jump start” the immune system to launch a more robust and efficacious immune response.
Possible Benefits of Cancer Vaccines
In addition to providing a new treatment option for patients who have failed other therapies, clinical data suggest that cancer vaccines may offer therapeutic advantages over existing therapies:
1. Favorable Side Effect Profile: Unlike many traditional cancer treatments such as chemotherapy and radiation therapy, cancer vaccines have generally been associated with very few side effects. This favorable side effect profile may potentially enable patients to maintain a higher quality of life during the course of treatment.
2. Combination Therapy: Numerous clinical trials are being conducted evaluating the use of cancer vaccines in combination with other traditional therapies such as chemotherapy, radiation therapy, and stem cell transplantation. Combination therapies offer the potential of improving/enhancing the efficacy of these traditional treatments.
The Current State of Cancer Vaccines
Research and development efforts are currently under way at numerous organizations to thoroughly evaluate the safety and efficacy of different approaches to cancer vaccines. Currently, cancer vaccines are being evaluated in multiple human clinical trials for many types of cancer and are available only in the clinical trial setting.

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How To Prevent The Occurrence Of Swine Flu?

How To Prevent The Occurrence Of Swine Flu?

Prevention is always better and preferred than cure. Especially when it comes to the prevention of swine flu, there are many aspects to be considered. Firstly, keeping one self away from other person while traveling by maintaining a good distance while sitting or standing keeps away the bacteria. Secondly while sneezing or coughing, one must protect self by keeping a towel or a napkin against nose to prevent the inhale and spread of germs.

Shaking of hands should be avoided because of the fact that germs can easily spread from hands too. Otherwise wiping hands with a hand cleanser or a hand wash should be an immediate preference. The emphasis is, the more you care, the better for you always especially if you are a traveler or a tourist.  Apart from this, food intake should always be monitored. While traveling in a cold temperature, always cover yourself completely and never allow any little space of your body to remain uncovered.

By taking much care, you can always prevent swine flu.   Another important aspect is, try to keep yourself away from sick people because viruses are more active.

Pay lot of attention to your diet. What you are eating and what are the hygiene levels in which you are having your food. Almost every aspect of food should be given lot of attention and good care should be administered.

Apart from food, water should also be paid attention. Preferably mineral bottled water or filtered water should be considered while traveling. Because it is food and water that spreads swine flu. Therefore first care should be given in food and water and secondly, traveling care aspect which is discussed above should be followed.

No matter where you travel, you luggage, your belongings and yourself should be properly maintained in terms of hygiene. The point of emphasis is more hygiene because swine flu is a viral infection and virus spreads where there are unhygienic surroundings or premises.

All kind of remedies to prevent swine flu should be considered.  The first remedy is to check the in take of diet and secondly, keep off from sick people and take more precautionary measures while traveling.

If you can consult a physician and consider a swine flu vaccine it is more preferable. This way, you are not only safeguarding your health but also preventing the entry of it. Therefore this is an excellent practice.

Once you gain good knowledge about swine flu how it affects, what are the remedies available and how it can be prevented, you will be more careful in your workplace, travel and in your public presence.

This way, you can not only enjoy good health but can even advise people about how to protect from swine flu.  The more knowledge you gain about swine flu and take prevention, the better for you to stay healthy and fit.

 

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 WHO Says

H1N1 in post-pandemic period

The world is no longer in phase 6 of influenza pandemic alert. We are now moving into the post-pandemic period. The new H1N1 virus has largely run its course.

These are the views of members of the Emergency Committee, which was convened earlier today by teleconference.

The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza. I fully agree with the Committee’s advice.

As we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away. Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come.

In the post-pandemic period, localized outbreaks of different magnitude may show significant levels of H1N1 transmission. This is the situation we are observing right now in New Zealand, and may see elsewhere.

In fact, the actions of health authorities in New Zealand, and also in India, in terms of vigilance, quick detection and treatment, and recommended vaccination, provide a model of how other countries may need to respond in the immediate post-pandemic period.

Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics.

During the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics.

Recently published studies indicate that 20–40% of populations in some areas have been infected by the H1N1 virus and thus have some level of protective immunity. Many countries report good vaccination coverage, especially in high-risk groups, and this coverage further increases community-wide immunity.

Pandemics, like the viruses that cause them, are unpredictable. So is the immediate post-pandemic period. There will be many questions, and we will have clear answers for only some. Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the post-pandemic period.

Based on available evidence and experience from past pandemics, it is likely that the virus will continue to cause serious disease in younger age groups, at least in the immediate post-pandemic period. Groups identified during the pandemic as at higher risk of severe or fatal illness will probably remain at heightened risk, though hopefully the number of such cases will diminish.

In addition, a small proportion of people infected during the pandemic, including young and healthy people, developed a severe form of primary viral pneumonia that is not typically seen during seasonal epidemics and is especially difficult and demanding to treat. It is not known whether this pattern will change during the post-pandemic period, further emphasizing the need for vigilance.

As I said, pandemics are unpredictable and prone to deliver surprises. No two pandemics are ever alike. This pandemic has turned out to be much more fortunate than what we feared a little over a year ago.

This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile.

Thanks to extensive preparedness and support from the international community, even countries with very weak health systems were able to detect cases and report them promptly.

Had things gone wrong in any of these areas, we would be in a very different situation today

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Swine Flu death

 One more death due to Swine Flu in Orissa, death toll rises to 8

Bhubaneswar: The Swine Flu  death in the state is increasing. On Friday one Abhijit Parida (19) has been expired in Apollo Hospital here in Swine Flu . Abhijit is a resident of Cuttack Sikharpur area.

Swab of total 67 persons were tested, out of which Swab of 25 persons identified positive. Now the death in Swine Flu in the state increased to 8.

First Swine flu patient of Orissa expired in Apollo Hospital

Bhubaneswar : First Swine flu patient  ( A Doctor ) of Orissa  expired on Thrusday morning in Apollo Hospital ,New Delhi.
Dr. A.K.Banwal of Kiriburu Hospital of Keonjhar District suffered from Swine flu and  admitted to the Ispat General Hospital , Rourkela on 11 October and were underwent treatment in a separate room. But his condition were detrioting day by day. He was shifted to the Apollo Hospital of New Delhi on 18 October by a special flight and expired on Thrusday morning ( 6 am ) . The death of a Doctor by Swine flu is the first case in the Country.

Software Engineer dies of Swine Flu in Orissa 

Bhubaneswar: Breaking News! There is no respite from Swine Flu in India. A young Software Engineer became the latest Swine Flu victim. He succumbed to H1N1 at the SCB Medical College & Hospital in Cuttack.

With this, the Swine Flu death toll in Orissa has gone up to four. The victim was identified as Biswanath Ekka from Rourkela. He was admitted to SCB Medical College this morning in a critical condition. He died in the afternoon.

Biswanath Ekka had come from Hyderabad recently. He was working with a Software Development company there. It is believed that he was infected with A H1N1 virus in Hyderabad.

Four people have died of Swine Flu in the state since August 1. Two persons died in Bhubaneswar, while another person died in Cuttack.

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SWINE FLU

The H1N1 “Swine Flu” Pandemic

 

The H1N1 or “swine flu” virus, which first appeared in April 2009, has gone on to become a worldwide "pandemic." This flu season, scientists expect both H1N1 flu and seasonal flu to cause more people to get sick than a regular flu season. More hospital stays and deaths may result, which makes vaccines that prevent influenza critical for optimal health of populations.

How Is 2009 H1N1 Flu Different From Regular (Seasonal) Flu?

 

Seasonal flu viruses change from year to year, but they are closely related to each other. People who have had flu infections in the past usually have some immunity to seasonal flu viruses (their bodies have built up some ability to fight off the viruses). The 2009 H1N1 flu virus is an entirely new virus strain. It is very different from seasonal flu viruses, and most people have little or no immunity to 2009 H1N1 flu. As a result, their bodies are not prepared to fight off the virus, possibly leading to serious complications.

The H1N1 “Swine Flu” Vaccine

 

This season, 2009 H1N1 vaccines are being made to protect against the H1N1 influenza virus. The U.S. government has purchased 250 million doses of 2009 H1N1 vaccine, so anyone who wants to get the vaccine will have the opportunity to do so. Vaccine will be made available as quickly as possible as it rolls off the production lines. Limited quantities of the vaccine began shipping in early October and availability will continue to increase through the end of the year and into 2010.

Why Are Swine Flu Vaccine Supplies Limited?

 Federal officials had projected that 40 million doses would be on hand by Oct. 15, but not even 13 million doses had arrived by the third week in October. According to Dr. Ciro Sumaya, a professor at the Texas A&M Health Science Center School of Rural Public Health and a member of the U.S. Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices, the H1N1 virus did not grow as quickly as expected during the half-century old -- and often-criticized -- egg-based production technique. He went on to explain that there have also been delays in the many steps before you get a vaccine that's available -- the production, the testing, the packaging, the allocation, and distribution. A top CDC official acknowledged that production of the vaccine was lagging, with a revised goal now of 50 million doses by mid-November and 150 million by year's end.

Isn't the 2009 H1N1 Swine Flu Vaccine Too New to Trust?

 

Is the swine flu vaccine brand new? Yes and no. The 2009 H1N1 swine flu vaccine is made exactly the same way as the seasonal flu vaccine, by the same manufacturers using the same materials. What has changed is the piece of the virus the vaccine uses to prime the immune system. Every couple of years or so, a new variant of a seasonal flu virus comes along. When that happens, a "new" vaccine is made using the relevant part of the variant virus. As shown on this slide, the CDC's Dr. Terrence Tumpey recreated the 1918 influenza virus in order to identify the characteristics that made this organism such a deadly pathogen. Research efforts such as this enable researchers to develop new vaccines and treatments for future pandemic influenza viruses.
Last year, some 100 million people got the seasonal flu vaccine and no safety issues appeared. There's no denying that the virus particle used in the vaccine has never been used before and there remains a remote possibility that a serious side effect might occur. But one can calculate that this possibility will be small and the expectation that the vaccine will prevent serious illness and deaths is very, very great.

What Types of Swine Flu Vaccines Are Being Produced?

 

There are two forms of 2009 H1N1 vaccines being produced: a 2009 H1N1 "flu shot" and the 2009 H1N1 nasal spray flu vaccine. The same manufacturers who produce seasonal flu vaccines are producing 2009 H1N1 vaccines for use in the United States, and the vaccines are being made in the same way that the seasonal vaccines are made.

2009 H1N1 Flu Shot

 

The H1N1 flu shot is an inactivated vaccine (containing “killed” virus) that is given with a needle, usually in the arm. The indications for who can get the 2009 H1N1 flu shot are the same as for seasonal flu shots. The flu shot is approved for use in people 6 months of age and older, including healthy people, people with chronic medical conditions, and pregnant women.

2009 H1N1 Nasal Spray Flu Vaccine

 

The H1N1 nasal spray, given via a nasal sprayer, is a vaccine made with live, weakened viruses that do not cause the flu (sometimes called LAIV for "live attenuated influenza vaccine"). The indications for who can get the 2009 H1N1 nasal spray vaccine are the same as for seasonal nasal spray vaccine. LAIV is approved for use in healthy people 2-49 years of age who are not pregnant. The nasal spray vaccine for use in the United States is being made by MedImmune, the same company that makes the seasonal nasal spray vaccine called FluMist.

Does the H1N1 Vaccine Require One or Two Shots?

 

Kids under 10 years of age will need two doses of the H1N1 swine flu vaccine, given three weeks apart. In kids over 10 years of age, the H1N1 swine flu vaccine works just as well as it does in adults requiring only one dose of the swine flu vaccine with protection expected in eight to 10 days following the shot. This is similar to seasonal flu vaccine.
It's likely that kids will be able to get their seasonal flu shots and their H1N1 swine flu shots on the same day, although clinical trials are still looking at the issue. The inhaled FluMist version of the swine flu vaccine cannot be given on the same day a kid gets the FluMist version of the seasonal vaccine. That's because FluMist contains a live, weakened flu virus and stimulates the immune system in a different way than flu shots, which contain inactivated virus particles.

If I Think I've Had Swine Flu, Do I Need the Vaccine?

 

It's important to realize that influenza vaccine cannot give you the flu. The injected flu shot contains inactivated (killed) viruses, and the nasal spray contains attenuated (weakened) viruses and cannot cause flu illness.
If you came down with a flu-like illness since April 2009, you may have had the H1N1 swine flu. But the only way to know for sure is if your doctor took a nasal or throat swab, sent it off to a lab, and had that lab confirm the infection.
If that didn't happen, it's not safe to assume you already had the H1N1 swine flu. Especially if you're at risk of severe flu illness, it's a very good idea to get your H1N1 swine flu shot AND your seasonal flu shot. The vaccine is perfectly safe for people who actually have already had swine flu.

When to Get Vaccinated?

 

Vaccination against 2009 H1N1 should begin as soon as vaccine is available and continue throughout the influenza season into December, January, and beyond. This is because the timing and duration of flu activity can vary. Flu seasons can last as late as April or May. By early October 2009, extensive 2009 H1N1 flu activity was being reported in the United States. It's possible that there may be waves of 2009 H1N1 activity during the 2009-2010 flu season that hit communities more than once over the course of the season. While 2009 H1N1 viruses are likely to be the most common cause of influenza this season, the CDC still expects that seasonal influenza viruses will circulate and continues to recommend that people get a seasonal flu vaccine to protect against seasonal flu viruses.

Who Should Get Vaccinated?

 

The CDC's Advisory Committee on Immunization Practices (ACIP), a panel made up of medical and public-health experts, recommends that programs and providers administer vaccine to people in the following five target groups (order of target groups does not indicate priority):

• pregnant women;
• people who live with or provide care for infants younger than 6 months of age (for example, parents, siblings, and day-care providers);
• health-care and emergency medical services personnel;
• people 6 months through 24 years of age; and
• people 25-64 years of age who have certain medical conditions that put them at higher risk for influenza-related complications. 

Why It Is Important to Get Vaccinated if You Are Pregnant?

 

Every pregnant woman knows that staying healthy is the best thing she can do to ensure her baby is healthy. Pregnant women are at an increased risk for swine flu and seasonal flu because expectant mothers have decreased lung capacity and changes in how their immune system works. These changes make pregnant women more susceptible to flu-related complications, including pneumonia and acute respiratory distress syndrome, endangering both mother and baby. Influenza's potential impact on the unborn child can be very serious as well, including spontaneous pregnancy loss, fetal death, preterm birth, and birth defects. Public-health and medical professionals are urging pregnant women to get vaccinated against both seasonal and H1N1 flu to protect themselves and their unborn babies. In fact, the CDC is urging pregnant women to be among those who get the first doses made available in their communities.
Pregnant women should get flu shots -- not the nasal spray vaccine -- since the nasal spray has not been approved for use in pregnant women. Women can receive the nasal spray vaccine after they have delivered, even if they are breastfeeding.

Who Should Not Be Vaccinated?

 

There are some people who should not get any flu vaccine without first consulting a physician. These include

• people who have a severe allergy to chicken eggs,
• people who have had a severe reaction to an influenza vaccination,
• people who developed Guillain-Barré syndrome (GBS) within six weeks of getting an influenza vaccine previously,
• children younger than 6 months of age (influenza vaccine is not approved for this age group),
• people who have a moderate to severe illness with a fever (they should wait until they recover to get vaccinated) , and
• people taking certain medications that suppress the immune system should not receive the “live” form of nasal spray vaccine.

H1N1 Swine Flu Vaccine Side Effects -- Flu Shot

 

The viruses in the flu shot are killed (inactivated), so you cannot get the flu from a flu shot. Some minor side effects that could occur are

• soreness, redness, or swelling where the shot was given;
• fever (low grade); and
• aches.

If these problems occur, they begin soon after the shot, are usually mild, and usually last one to two days. Almost all people who receive influenza vaccine have no serious problems from it. However, on rare occasions, flu vaccination can cause serious problems, such as severe allergic reactions.

H1N1 Swine Flu Vaccine Side Effects -- Nasal Spray

 

The viruses in the nasal-spray vaccine are weakened and do not cause severe symptoms often associated with influenza illness. (In clinical studies, transmission of vaccine viruses to close contacts has occurred only rarely.)
In children, side effects from LAIV can include

• runny nose,
• wheezing,
• headache,
• vomiting,
• muscle aches, and
• fever.

In adults, side effects from LAIV can include

• runny nose,
• headache,
• sore throat, and
• cough. 

Is the H1N1 Swine Flu Vaccine Safe?

 

The H1N1 swine flu vaccine, both the shots and the nasal spray, are made the same way as the seasonal flu vaccine. Every year or so, the seasonal vaccine -- which includes a component based on the seasonal H1N1 virus -- is altered to match a flu virus that has changed its genetic makeup. The same kind of alteration resulted in the H1N1 swine flu vaccine and that's why the FDA approved it; they considered it just a strain change and not a brand-new vaccine.
Even so, both long- and short-term clinical trials are under way. Results from the short-term studies already are here: Other than causing the usual soreness and perhaps redness at the site of injection, the H1N1 swine flu vaccine causes no major side effects. And like the seasonal flu vaccine, the H1N1 swine flu vaccine can't be taken by everybody. The vaccine is produced in hens' eggs, so people with egg allergies cannot take the vaccine.
Will there be long-term side effects? That's not likely, but the CDC is taking no chances. The CDC and vaccine manufacturers have beefed up their safety monitoring process to look for anything unusual in people who get vaccinated against the new flu.

Will the 2009 H1N1 Vaccines Contain Squalene or Adjuvants?

 

The 2009 H1N1 swine flu vaccine will NOT contain squalene or adjuvants in the United States. This may or may not be the case in other countries.
Squalene is an oil that's a natural part of many body processes. It's widely used in cosmetics because it penetrates the skin easily without leaving an oily feel. Squalene is also used in substances called adjuvants (a substance that helps and enhances the pharmacological effect of a drug or increases the ability of an antigen to stimulate the immune system).
According to current federal plans, only vaccines without adjuvants will be used in the United States during the 2009 flu season. This includes all of the 2009 H1N1 and seasonal influenza vaccines that will be available for children and adults in both the injectable and nasal spray formulations. None of these influenza vaccines will contain adjuvants.
The 2009 H1N1 vaccines with adjuvants are being studied to determine if they are safe and effective. Experts will review these data when they are available. There is no plan at this time to recommend a 2009 H1N1 influenza vaccine with an adjuvant.

Will the 2009 H1N1 Influenza Vaccine Contain Thimerosal?

 

The 2009 H1N1 influenza vaccines that the FDA is licensing (approving) will be manufactured in several formulations. Some will come in multi-dose vials and will contain thimerosal as a preservative. Thimerosal is a mercury-based preservative that has been used for decades in the United States in multi-dose vials of some vaccines to prevent the growth of microorganisms, such as bacteria and fungi, which may contaminate them after the vial is opened.
Some 2009 H1N1 influenza vaccines will be available in single-dose units, which will not require the use of thimerosal as a preservative. In addition, the live-attenuated version of the vaccine, which is administered intranasally (through the nose), is produced in single-units and will not contain thimerosal.

Is There a Link Between Guillain-Barré Syndrome (GBS) and Swine Flu Vaccines?

 

Guillain-Barré syndrome (GBS) is a rare disease in which the body damages its own nerve cells, causing muscle weakness and sometimes paralysis. It is not fully understood why some people develop GBS, but it is believed that stimulation of the body's immune system may play a role in its development. Infection with the bacterium Campylobacter jejuni, which can cause diarrhea, is one of the most common risk factors for GBS. People can also develop GBS after having the flu or other infections (such as cytomegalovirus and Epstein-Barr virus). On very rare occasions, people may develop GBS in the days or weeks following receiving a vaccination.

The 1976 Swine Flu Vaccine Wasn't Safe. Why Should I Trust This One?

 

The 1976 swine flu vaccine was linked to safety issues. Neal Halsey, MD, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, was at the CDC in those days. "We did identify an increased risk of GBS [Guillain-Barré syndrome] in the six weeks following immunization," says Halsey. No flu vaccine since then has been linked to this risk. Halsey thinks there is the potential for the H1N1 flu vaccine to carry a risk of causing one case of GBS per million people vaccinated. "The theoretical risk of that rare complication has to be balanced against the severity of the H1N1 flu," he says. "There already have been a lot of deaths, many in otherwise healthy, normal children. There is always a real risk from the flu, and a theoretical risk from the vaccines."
The 1976 H1N1 swine flu was a very different virus from the 2009 H1N1 swine flu, which combines elements from flu viruses that evolved in birds, humans, and pigs. And unlike the 1976 virus, the 2009 bug is causing a very real pandemic.

Are H1N1 Swine Flu Shots Mandatory?

 

Swine flu shots are voluntary for most Americans. For those not in the military, there is no federal requirement to get the H1N1 swine flu vaccine.
Active-duty military personnel, National Guard troops on active duty, and civilian Defense Department employees in critical jobs will be required to get the vaccine.
Healthcare workers may be required by their employers to get vaccinated. The state of New York, for example, has mandated both seasonal and H1N1 swine flu vaccinations for all healthcare workers.

How Much Will the H1N1 Swine Flu Vaccine Cost?

 

The U.S. government purchased the vaccine from manufacturers and is providing the vaccine at no cost. The CDC has asked providers NOT to charge for administering the vaccine. Even if they do, several large insurance companies have said the costs would be covered. On October 24, 2009, President Barack Obama declared the H1N1 swine flu a national emergency.

Where Can My Children and I Get the Swine Flu Vaccine?

 

Medical practices and clinics that want to offer the H1N1 swine flu vaccine have already registered with their state health departments. You can check with your doctor to see if she or he is offering the vaccine. Because children are especially vulnerable to H1N1 swine flu -- and are especially likely to spread the disease to others -- many states will be offering H1N1 swine flu vaccinations in schools. In some states, permission slips already have been sent to parents.
Some states are also planning vaccinations at public sites. These plans will be announced locally. Different state, territory, and tribal health authorities have different plans. There is no one-size-fits-all plan; the CDC advises local health departments to adapt their H1N1 vaccination plans to local needs. That goes for retail chains as well. National retail outlets, such as pharmacy chains, may offer H1N1 swine flu vaccine in some areas but not in others.

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What is swine flu (novel H1N1 influenza A swine flu)?

Swine flu (swine influenza) is a respiratory disease caused by viruses (influenza viruses) that infect the respiratory tract of pigs and result in nasal secretions, a barking-like cough, decreased appetite, and listless behavior. Swine flu produces most of the same symptoms in pigs as human flu produces in people. Swine flu can last about one to two weeks in pigs that survive. Swine influenza virus was first isolated from pigs in 1930 in the U.S. and has been recognized by pork producers and veterinarians to cause infections in pigs worldwide. In a number of instances, people have developed the swine flu infection when they are closely associated with pigs (for example, farmers, pork processors), and likewise, pig populations have occasionally been infected with the human flu infection. In most instances, the cross-species infections (swine virus to man; human flu virus to pigs) have remained in local areas and have not caused national or worldwide infections in either pigs or humans. Unfortunately, this cross-species situation with influenza viruses has had the potential to change. Investigators think the 2009 swine flu strain, first seen in Mexico, should be termed novel H1N1 flu since it is mainly found infecting people and exhibits two main surface antigens, H1 (hemagglutinin type 1) and N1 (neuraminidase type1). Recent investigations show the eight RNA strands from novel H1N1 flu have one strand derived from human flu strains, two from avian (bird) strains, and five from swine strains.

Why is swine flu (H1N1) now infecting humans?

Many researchers now consider that two main series of events can lead to swine flu (and also avian or bird flu) becoming a major cause for influenza illness in humans.
First, the influenza viruses (types A, B, C) are enveloped RNA viruses with a segmented genome; this means the viral RNA genetic code is not a single strand of RNA but exists as eight different RNA segments in the influenza viruses. A human (or bird) influenza virus can infect a pig respiratory cell at the same time as a swine influenza virus; some of the replicating RNA strands from the human virus can get mistakenly enclosed inside the enveloped swine influenza virus. For example, one cell could contain eight swine flu and eight human flu RNA segments. The total number of RNA types in one cell would be 16; four swine and four human flu RNA segments could be incorporated into one particle, making a viable eight RNA segmented flu virus from the 16 available segment types. Various combinations of RNA segments can result in a new subtype of virus (known as antigenic shift) that may have the ability to preferentially infect humans but still show characteristics unique to the swine influenza virus (see Figure 1). It is even possible to include RNA strands from birds, swine, and human influenza viruses into one virus if a cell becomes infected with all three types of influenza (for example, two bird flu, three swine flu, and three human flu RNA segments to produce a viable eight-segment new type of flu viral genome). Formation of a new viral type is considered to be antigenic shift; small changes in an individual RNA segment in flu viruses are termed antigenic drift and result in minor changes in the virus. However, these can accumulate over time to produce enough minor changes that cumulatively change the virus' antigenic makeup over time (usually years).
Second, pigs can play a unique role as an intermediary host to new flu types because pig respiratory cells can be infected directly with bird, human, and other mammalian flu viruses. Consequently, pig respiratory cells are able to be infected with many types of flu and can function as a "mixing pot" for flu RNA segments (see Figure 1). Bird flu viruses, which usually infect the gastrointestinal cells of many bird species, are shed in bird feces. Pigs can pick these viruses up from the environment and seem to be the major way that bird flu virus RNA segments enter the mammalian flu virus population.

Figure 1.

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What are the symptoms of swine flu (H1N1)?

Symptoms of swine flu are similar to most influenza infections: fever (100F or greater), cough, nasal secretions, fatigue, and headache, with fatigue being reported in most infected individuals. Some patients also get nausea, vomiting, and diarrhea. In Mexico, many of the patients are young adults, which made some investigators speculate that a strong immune response may cause some collateral tissue damage. Some patients develop severe respiratory symptoms and need respiratory support (such as a ventilator to breathe for the patient). Patients can get pneumonia (bacterial secondary infection) if the viral infection persists, and some can develop seizures. Death often occurs from secondary bacterial infection of the lungs; appropriate antibiotics need to be used in these patients. The usual mortality (death) rate for typical influenza A is about 0.1%, while the 1918 "Spanish flu" epidemic had an estimated mortality rate ranging from 2%-20%. Swine flu in Mexico (as of April 2009) has had about 160 deaths and about 2,500 confirmed cases, which would correspond to a mortality rate of about 6%, but these initial data have been revised and the mortality rate currently in Mexico is estimated to be much lower. By June 2009, the virus had reached 74 different countries on every continent except Antarctica, and by September 2009, the virus had been reported in most countries in the world. Fortunately, the mortality rate as of October 2009 has been low but higher than for the conventional flu (average conventional flu mortality rate is about 36,000 per year; projected novel H1N1 flu mortality rate is 90,000 per year in the U.S. as determined by the president's advisory committee).

How is swine flu (H1N1) diagnosed?

Swine flu is presumptively diagnosed clinically by the patient's history of association with people known to have the disease and their symptoms listed above. Usually, a quick test (for example, nasopharyngeal swab sample) is done to see if the patient is infected with influenza A or B virus. Most of the tests can distinguish between A and B types. The test can be negative (no flu infection) or positive for type A and B. If the test is positive for type B, the flu is not likely to be swine flu (H1N1). If it is positive for type A, the person could have a conventional flu strain or swine flu (H1N1). However, the accuracy of these tests has been challenged, and the U.S. Centers for Disease Control and Prevention (CDC) has not completed their comparative studies of these tests. However, a new test developed by the CDC and a commercial company reportedly can detect H1N1 reliably in about one hour; as of October 2009, the test is only available to the military.
Swine flu (H1N1) is definitively diagnosed by identifying the particular antigens associated with the virus type. In general, this test is done in a specialized laboratory and is not done by many doctors' offices or hospital laboratories. However, doctors' offices are able to send specimens to specialized laboratories if necessary. Because of the large number of novel H1N1 swine flu cases (as of October 2009, the vast majority of flu cases [about 99%] are due to novel H1N1 flu viruses), the CDC recommends only hospitalized patients' flu virus strains be sent to reference labs to be identified.

The CDC developed a PCR diagnostic test to detect novel H1N1 virus. Photo courtesy of the CDC

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What treatment is available for swine flu (H1N1)?

The best treatment for influenza infections in humans is prevention by vaccination. Work by several laboratories has recently produced vaccines. The first vaccine released in early October 2009 was a nasal spray vaccine. It is approved for use in healthy individuals ages 2 through 49. This vaccine consists of a live attenuated H1N1 virus and should not be used in anyone who is pregnant or immunocompromised. The injectable vaccine, made from killed H1N1, became available in the second week of October. This vaccine is approved for use in ages 6 months to the elderly, including pregnant females. Both of these vaccines have been approved by the CDC only after they had conducted clinical trials to prove that the vaccines were safe and effective. However, caregivers should be aware of the vaccine guidelines that come with the vaccines, as occasionally, the guidelines change. Please see the sections below titled "Can novel H1N1 swine flu be prevented with a vaccine?" and the timeline update for the current information on the vaccines.
Two antiviral agents have been reported to help prevent or reduce the effects of swine flu. They are zanamivir (Relenza) and oseltamivir (Tamiflu), both of which are also used to prevent or reduce influenza A and B symptoms. These drugs should not be used indiscriminately, because viral resistance to them can and has occurred. Also, they are not recommended if the flu symptoms already have been present for 48 hours or more, although hospitalized patients may still be treated past the 48-hour guideline. Severe infections in some patients may require additional supportive measures such as ventilation support and treatment of other infections like pneumonia that can occur in patients with a severe flu infection. The CDC has suggested in their interim guidelines that pregnant females can be treated with the two antiviral agents.

Oseltamivir (Tamiflu) is an antiviral agent that may prevent or reduce influenza A and B symptoms. Photo courtesy of the CDC

Zanamivir (Relenza) has been reported to help prevent or reduce the effects of swine flu. Photo courtesy of the CDC

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Can novel H1N1 swine flu be prevented with a vaccine?

The best way to prevent novel H1N1 swine flu would be the same best way to prevent other influenza infections, and that is vaccination. The CDC has multiple recommendations for vaccination based on who should obtain the first doses when the vaccine becomes available (to protect the most susceptible populations) and according to age groups. The CDC based the recommendations on data obtained from vaccine trials and infection reports gathered over the last few months. The current (October 2009) vaccine recommendations from the CDC say the following groups should get the vaccine as soon as it is available:

• pregnant women,
• people who live with or provide care for children younger than 6 months of age,
• health-care and emergency medical services personnel,
• people between 6 months and 24 years of age, and
• people from the ages of 25 through 64 who are at higher risk because of chronic health disorders such as asthma, diabetes, or a weakened immune system.

Currently, the CDC is stating that people ages 10 and above are likely to need only one vaccine shot to provide protection against novel H1N1 swine flu and further suggest that these shots will be effective in about 76% of people who obtain the vaccine. New vaccine trial data showed that healthy adults produce protective antibodies in about 98% of people in 21 days. Unfortunately, the vaccine shot in children ages 6 months to 9 years of age is not as effective as it is in older children and adults. Consequently, the CDC currently recommends that for ages 6 months up to and including 9 years of age, the children obtain two shots of the novel H1N1 vaccine, the second shot 21 days after the first shot.
Pregnant women are strongly suggested to get vaccinated as stated above. Although some vaccine preparations (multidose vials) contain low levels of thimerosal preservative (a mercury-containing preservative), the CDC still considers the vaccine safe for the fetus and mother. However, some vaccine preparations that are in single-dose vials will not have thimerosal preservative, so those pregnant individuals who are concerned about thimerosal can get this vaccine preparation when it is available.
Another type of vaccine (currently named Influenza A [H1N1] 2009 Monovalent Vaccine Live, Intranasal) has been made available during the first week in October 2009. It is a live attenuated novel H1N1 flu vaccine that contains no thimerosal, is produced by MedImmune, LLC, and is sprayed into the nostrils. This vaccine is only for healthy people 2-49 years of age, and some data suggest that it is less effective in generating an immune response in adults than the vaccine injection. The dosing schedule is as follows:

• Children 2-9 years of age should receive two doses (0.1 ml in each nostril; total equals 0.2 ml per dose) -- the second dose should be given the same way about one month after the first dose
• Children, adolescents and adults, 10-49 years of age should receive one dose -- (0.1 ml in each nostril; total equals 0.2 ml per dose)

The CDC occasionally makes changes and updates its information on vaccines and other recommendations about the current flu pandemic. The CDC states, "for the most accurate health information, visit http://www.cdc.gov or call 1-800-CDC-INFO, 24/7." Caregivers should check the vaccine package inserts for more detailed information on the vaccines when they become available. This article has an updated timeline for novel H1N1 swine flu attached (see below) and provides the reader with current details about the pandemic. The following is a list of the CDC-approved H1N1 vaccines and the companies that name and manufacture them as of 10/29/09:

• Influenza A (H1N1) 2009 Monovalent Vaccine by Sanofi Pasteur
• Influenza A (H1N1) 2009 Monovalent Vaccine by Novartis
• Influenza A (H1N1) 2009 Monovalent Vaccine Live, Intranasal by MedImmune, LLC
• Influenza A (H1N1) 2009 Monovalent Vaccine by CSL Limited

The CDC says that a good way to prevent any flu disease is to avoid exposure to the virus; this is done by frequent hand washing, not touching your hands to your face (especially the nose and mouth), and avoiding any close proximity to or touching any person who may have flu symptoms. Since the virus can remain viable and infectious for about 48 hours on many surfaces, good hygiene and cleaning with soap and water or alcohol-based hand disinfectants are also recommended. Some physicians say face masks may help prevent getting airborne flu viruses (for example, from a cough or sneeze), but others think the better use for masks would be on those people who have symptoms and sneeze or cough. The use of Tamiflu or Relenza may help prevent the flu if taken before symptoms develop or reduce symptoms if taken within about 48 hours after symptoms develop. Some investigators say that administration of these drugs is still useful after 48 hours, especially in high-risk patient populations .However, taking these drugs is not routinely recommended for prevention for the healthy population because investigators suggest that as occurs with most drugs, flu strains will develop resistance to these medications. Recently, the CDC made further suggestions about the use of these antiviral medications. Dr. Schuchat, a CDC official, indicated that three modifications were being suggested (Sept. 8, 2009) to the interim guidelines for use of Tamiflu and Relenza:

1. Patients with high-risk factors should discuss flu symptoms and when to use antiviral medications; doctors should provide a prescription for the antiviral drug for the patient to use if the patient is exposed to flu or develops flu-like symptoms without having to go in to see the doctor. 2. "Watchful waiting" was added as a response to taking antiviral medications, with the emphasis on the fact that those people who develop fever and have a preexisting health condition should then begin the antiviral medication. 3. The antiviral medications are the first-line medicines for treatment of novel H1N1 swine flu, and most current cases of flu are novel H1N1 and are, to date, susceptible to Tamiflu and Relenza.

Your doctor should be consulted before these drugs are prescribed.
In general, preventive measures to prevent the spread of flu are often undertaken by those people who have symptoms. Symptomatic people should stay at home, avoid crowds, and take off from work or school until the disease is no longer transmittable (about two to three weeks) or until medical help and advice is sought. Sneezing, coughing, and nasal secretions need to be kept away from other people; simply using tissues and disposing of them will help others. Quarantining patients is usually not warranted, but such measures depend on the severity of the disease. The CDC recommends that people who appear to have an influenza-like illness upon arrival at work or school or become ill during the day be promptly separated from other people and be advised to go home until at least 24 hours after they are free of fever (100 F [37.8 C] or greater), or signs of a fever, without the use of fever-reducing medications. The novel H1N1 swine flu disease takes about seven to 10 days before fevers stop, but new research data (Sept. 14, 2009) suggests waiting until the cough is gone since many people are still infectious about one week after fever is gone. The CDC has not yet extended their recommendations to stay home for that extra week.

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What is the history of swine flu (H1N1) in humans?

In 1976, there was an outbreak of swine flu at Fort Dix. This virus is not the same as the 2009 outbreak, but it was similar insofar as it was an influenza A virus that had similarities to the swine flu virus. There was one death at Fort Dix. The government decided to produce a vaccine against this virus, but the vaccine was associated with neurological complications (Guillain-Barré syndrome) and was discontinued. Some individuals speculate that formalin, used to inactivate the virus, may have played a role in the development of this complication in 1976. There is no evidence that anyone who obtained this vaccine would be protected against the 2009 swine flu. One of the reasons it takes a few months to develop a new vaccine is to test the vaccine for safety to avoid the complications seen in the 1976 vaccine. New vaccines against any flu virus type are usually made by growing virus particles in eggs. A serious side effect (allergic reaction such as swelling of the airway) to vaccines can occur in people who are allergic to eggs; these people should not get flu vaccines. Individuals with active infections or diseases of the nervous system are also not recommended to get flu vaccines.

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Can H1N1 be prevented if the H1N1 flu vaccine is not readily available?

Although vaccination is the best way to "prevent" H1N1, currently (November 2009), there is not enough available for everyone who wants or needs H1N1 vaccination. Until H1N1 vaccine supplies meet demand, there are some things people can do to try and prevent infection. Without vaccination, the best strategy is to not allow H1N1 virus to contact a person's mucus membranes because if the virus does not reach cells in which it can grow, it cannot cause infection. Quarantining H1N1-infected people is an extreme measure that may work in some instances (for example, China uses this method), but even with quarantining, the virus may still spread by people who have minimal or no symptoms.
The next step that is easier to be implemented by individuals is for people with the disease to self-quarantine until they become noninfectious (about seven to 10 days after flu symptoms abate). Infected people can wear surgical masks to reduce the amount of droplet spray from coughs and sneezes and throw away contaminated tissues. Unfortunately, these approaches depend on the compliance of many other people, and the likelihood that such methods will be highly successful in preventing H1N1 infections, at best, is only fair. Such methods have not stopped the current pandemic. Yet there are still some other methods available to individuals. Perhaps the best way for individuals to try to prevent H1N1 infection is a combination of methods that are aimed at fulfilling the very basic principle that if H1N1 doesn't reach an individual's mucus membrane cells, infection will be prevented. The methods are as follows:

1. Kill or inactivate the virus before it reaches a human cell by using soap and water to clean your hands; washing clothing and taking a shower will do the same for the rest of your body. 2. Use an alcohol-based hand sanitizer if soap and water are not readily available. 3. Use sanitizers on objects that many people may touch (for example, doorknobs, computer keyboards, handrails, phones). 4. Do not touch your mouth, eyes, nose, unless you first do items 1 or 2 above. 5. Avoid crowds, parties, and especially people who are coughing and sneezing (most virus-containing droplets do not travel more than 4 feet, so experts suggest 6 feet away is a good distance to stay). If you cannot avoid crowds (or parties), try to remain aware of people around you and use the 6-foot rule with anyone coughing or sneezing. Do not reach for or eat snacks out of canisters or other containers at parties. 6. Avoid touching anything within about 6 feet of an uncovered cough/sneeze, because the droplets that contain virus fall and land on anything usually within that range. 7. Studies show that individuals who wear surgical or N95 particle masks may prevent inhalation of some H1N1 virus, but the masks may prevent only about 50% of airborne exposures and offer no protection against surface droplets. However, masks on H1N1 infected people can markedly reduce the spread of infected droplets.

These seven steps can help prevent individuals from getting H1N1 infection, but for many people, adherence to them may be difficult at best. However, there are some additional strategies that may also help prevent H1N1 infections in unvaccinated people according to some investigators. Saline nasal washes and gargling with saline (or a commercial product) as a way to reduce or eliminate H1N1 virus from mucus membranes has been suggested. Proponents of these methods base their rationale on the fact that flu viruses usually take about two to three days to proliferate in nasal/throat cells. While nasal washes and gargling may be soothing to some people, there are no studies that indicate H1N1 is killed, inactivated, or completely removed by these methods; conversely, there are no data suggesting these methods cannot have any effect on H1N1. However, with long-term nasal washes using Neti pots, sinus infection with other pathogens may be encouraged.
Other investigators and physicians have offered additional methods that may help reduce exposure to H1N1 virus. For example, Dr. Gerberding, a former CDC director, had several suggestions about how to avoid H1N1 infection on an airplane. She suggested the following:

1. If a person is next to you or near (within 6 feet) and is coughing/sneezing, ask the flight attendant to offer the person a mask. 2. If there are available seats 6 feet or more away from the coughing/sneezing person, ask to change your seat (planes are good means of travel because the air is recirculated through HEPA filters that can capture viruses, but even the filters will not help if people touch areas where droplets have landed; HEPA filters are usually not available in buses, cars, ships, or trains). 3. Turn away from the coughing/sneezing person and turn the air vent toward the person to blow the droplets away from yourself.

Variations of her suggestions may be applicable in many different social, work, or travel situations, but there are no data to prove these methods are effective. In addition, common-sense precautions such as not drinking or eating things touched by others, avoiding casual physical contacts (for example, handshakes, social hugs or kisses, public water fountains [these are OK if you touch nothing and lips only touch flowing water], banisters on stairways, and restroom door handles) will limit exposure to H1N1. Again, these common sense suggestions lack data substantiation.
Many investigators suggest that people stay well hydrated, take vitamins, and get plenty of rest, but these precautions will not prevent H1N1 infections although they may help reduce the effects of infection by strengthening the person's immune system to fight infection. Similarly, current antiviral medications (described in the preceding section) act on H1N1 viruses that have already infected cells; they work by preventing or reducing viral particles from aggregating and being released from infected cells. Timing is important; if only a few cells are infected and the antiviral medications are administered quickly (usually before flu symptoms develop or within 48 hours), the viruses are reduced in number (they cannot easily bud out from the cell surface), so few, if any, other respiratory or mucus membrane cells become infected. This can result in either no flu symptoms or, if a larger number of cells were initially infected, less severe symptoms. The overall effect for the person is that the H1N1 infection was prevented (it was not; the symptoms were prevented from developing) or that symptoms were reduced.
In the strictest sense of the word prevention, even effective vaccines do not "prevent" infections. What they do accomplish is to alert the immune system to be on guard for certain antigens that are associated with a pathogen (for example, H1N1 virus, pneumococcal bacteria). When the pathogen first infects the host, its antigens are recognized, and these cause a rapid immunoprotective response to occur that prevents the pathogen from proliferating and developing symptoms in the host. People, including physicians and researchers, often term this complex response to vaccination as "prevention of infection" but what actually occurs is the prevention of further infection so well that symptoms do not develop or are minimal in the host.
In summary, if H1N1 viruses fail to contact cells they can infect, the disease will be prevented. As stated above, this is difficult, but not impossible, to do in almost all societies. Prevention of H1N1 symptoms of infection is possible with antiviral medications if these are given very early in the infection. There are many other methods that may reduce the chance of getting the virus on a person's mucosal surface, but most methods have not been backed up with objective data. Most doctors and investigators suggest that items that help boost or allow the immune response to function well will help people resist H1N1 infections and reduce symptoms, but these also do not prevent infections. Consequently, while waiting for H1N1 vaccine, these are some ways individuals can improve their chances of preventing or reducing the symptoms of H1N1 infections.

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Is swine flu (H1N1) a cause of an epidemic or pandemic in 2009?

An epidemic is defined as an outbreak of a contagious disease that is rapid and widespread, affecting many individuals at the same time. The swine flu outbreak in Mexico fit this definition. A pandemic is an epidemic that becomes so widespread that it affects a region, continent, or the world. As of April 2009, the H1N1 swine flu outbreak did not meet this definition. However, as of June 11, 2009, WHO officials determined that H1N1 2009 influenza A swine flu reached WHO level 6 criteria (person-to-person transmission in two separate WHO-determined world regions) and declared the first flu pandemic in 41 years. To date, the flu has reached over 74 different countries on every continent except Antarctica in about three month's time; fortunately, the severity of the disease has not increased.

What is the prognosis (outlook) for patients who get swine flu (H1N1)?

The following is speculation on the prognosis for swine flu (H1N1) because this disease has only been recently diagnosed and the data is changing daily. This section is based on currently available information.
In general, the majority (about 90%-95%) of people who get the disease feel terrible (see symptoms) but recover with no problems, as seen in patients in both Mexico and the U.S. Caution must be taken as the swine flu (H1N1) is still spreading and has become a pandemic. So far, young adults have not done well, and in Mexico, this group currently has the highest mortality rate, but this data could quickly change.
People with depressed immune systems historically have worse outcomes than uncompromised individuals; investigators suspect that as swine flu (H1N1) spreads, the mortality rates may rise and be high in this population. Current data suggest that pregnant individuals, children under 2 years of age, young adults, and individuals with any immune compromise or debilitation are likely to have a worse prognosis. Unfortunately, the problem with the prognosis is still unclear. If the mortality is like the conventional flu that causes mortality rates of about 0.1%, the result would be about 36,000 deaths per year because of the huge number of people who get infected. If the Mexico swine flu (H1N1) ends up with a mortality rate of about 6% and infects the same number of millions of people as conventional flu viruses, the projected numbers could be as high as 2 million deaths in the U.S. alone. This is a bad prognosis for about 2 million people and their families; these potential deaths are major reasons that health officials are so concerned about the spread of this new virus. As of September 2009, the current estimates are that about 90,000 deaths will occur in the U.S. from novel H1N1 swine flu (estimated by the president's advisory committee). As of October, these estimates have not been revised by the advisory committee or the CDC.
Another confounding problem with the prognosis of swine flu (H1N1) is that the disease is occurring and spreading in high numbers at the usual end of the flu season. Most flu outbreaks happen between November to the following April, with peak activity between late December to March. This outbreak is not following the usual flu pattern since novel H1N1 began its outbreak in April and had spread throughout the world by September. Some scientists think that swine flu (H1N1) will die down but return with many more cases in the fall, and still others speculate the current pandemic will eventually resemble the outcomes similar to the 1918 influenza pandemic. Some suggest it may resemble the SARS (severe acute respiratory syndrome caused by a coronavirus strain) outbreak in 2002-2003 in which the disease spread to about 10 countries with over 7,000 cases, over 700 deaths, and had a 10% mortality rate. Effective isolation of patients was done in this case, and many investigators think the outbreak was stopped due to this measure. Because swine flu (H1N1) is a new virus and does not seem to be following the usual flu disease pattern, any prognosis is speculative, although as of October 2009, the numbers of people with flu-like illness are higher than usual and the illness is affecting a much younger population than the conventional flu. As the pandemic progresses, this article will be updated. The best news about this novel H1N1 swine flu is that the majority of people, as of October 2009, who have caught the flu recover without medical treatment and have an excellent prognosis.

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