For those interested in the latest updates on H1N1 spread, for the US see CDC, for the world see WHO and for the latest news round-up see Flu Wiki Forum. These updates come from news reports and lab surveillance.
Whether it's this H1N1 or virus or something else, having strong laboratory capacity around the world is very important. - Anne Schuchat, M.D., Interim Deputy Director for Science and Public Health Program, CDC 5/9/08
The above statement by Anne Schuchat, M.D was a comment in the the CDC media conference held yesterday. In that regard, let me point you to part II of this series, in which we discussed lab capacity and interviewed Dr. Scott Layne from UCLA's School of Public Health, who is in the process of building a high capacity high throughput lab that could handle analyzing thousands of flu samples a day. That would certainly come in handy right about now, and would help improve turnaround time on pending samples. One can also anticipate the need for rapid identification and turnaround of viral specimens this fall.
In a Huffington Post article this week, Scott wrote:
The current predicament: Swine flu has already fulfilled two criteria -- efficient transmissibility and limited prior immunity worldwide -- to sustain global spread. The often used definition of a pandemic is that 25% of the world's population becomes infected by the same influenza strain. The new Swine flu certainly has that potential.
The situation at present is fluid. Swine flu has not yet fully revealed its propensity for virulence, including the ability to cause health care visits, hospitalizations, pneumonias, respiratory failure, cytokine storm, and death. If virulence remains low, the pandemic could be mild. If virulence increases significantly, the pandemic could be severe...
This is no time for complacency. We must remain vigilant. The new H1N1 Swine flu remains a real, unpredictable and worldwide threat.
I had the opportunity to ask Scott some further questions about where we stand right now with H1N1:
Daily Kos: We interviewed you about the UCLA high throughput lab. When will that be up and running?
Finished with BSL3 facility construction and commissioning Summer 2009. Begin high-throughput operations Fall 2009. Aim to be fully operational by end of 2009. Because of the Swine flu outbreak and potential pandemic, seeking additional FY2010 funding to speed progress. Would that help with testing bottlenecks? Yes. Many key federal and state laboratories have capacities of several hundred samples (max) per day. The new high-throughput laboratory facility will approach 10,000 samples per day.
Daily Kos: Other flu experts such as Richard Besser (CDC) and Keiji Fukada (WHO) expressed concern about the possibilities of a resurgence of H1N1 this fall. Are you worried about the fall as well?
Yes, as I explained in The Huffington Post blog/05.06.09, Swine flu has demonstrated that: 1) it is transmisible from person to person; and 2) it is a new (novel strain) and not blocked by most peoples' immune systems worldwide. Swine flu is now out in the world, undergoing incessant cycles of reproduction, mutation, and (still unpredictable) selection. This process could lead to changes in virulence (down or up). Increases in virulence set us up for a severe pandemic. What should we be watching for this summer? Influenza is a seasonal disease. Summer in the Earth's northern Hemisphere is winter in its southern hemisphere and vice versa. In the United States, we are moving into summer. But below the equator, they are moving into winter. I would keep a very careful watch on the southern hemisphere. Its the making of the perfect storm: new Swine flu in circulation and winter conditions promoting its circulation.
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Daily Kos: Do you think the pandemic phases need to be altered to reflect severity as well as geographic spread?
Yes, we need to better integrate the notions of transmissibility and novelty (the determinant of pandemic spread) with virulence (the determinant of outcome).
Daily Kos: A recent NY Times article and a comment by Dr. Besser addressed "flu parties" akin to the old practice of holding chicken pox parties to get the illness, and get it over with (in this case, to build immunity.) Do you think getting the virus deliberately is reasonable?
No. It's a really bad idea to get infected deliberately! It's better to stay well.
Daily Kos: What have I not asked you?
I perceive that either people are confused about Swine flu or that they are thinking about other things. The media has handled the Swine flu story in a very up (let's get worried ) and down (let's forget about it -- all hype) way. Whatever happens with Swine flu should not distract us from realizing that the world is facing unprecedented challenges from emerging infectious diseases. I'm concerned that the "infectious disease tsumani" is coming and that we must remain vigilant! We must maintain a bigger, consistent and long term view of the challenges. As explained in a recent Science perspective [Pandemic Influenza: An Inconvenient Mutation], we need new and faster ways to manufacture influenza vaccines for more people on the planet. We need more antiviral drugs against influenza. The two classes of antiviral drugs against influenza, Tamiflu/Relenza and Amantidine/Rimantadine, are losing their effectiveness to resistance.
Daily Kos: Thank you, Dr. Layne.
For previous parts of this series on pandemic flu and public health infrastructure, see Flu and You.
