One year ago this weekend, the World Health Organisation issued its first Disease Outbreak Notice on swine flu, confirming the infection of a number of people in Mexico and the US. A few weeks later the previously unknown virus had Australia holding its breath when the first cases hit our shores.

The Australian's Peter Nicholson, a year ago

The World Health Organisation went on to declare their first pandemic in more than 40 years and the media went into overdrive. A year on you could argue the hype was all a bit excessive and that experts keen to get their names up in lights were crying wolf and playing into the hands of news editors who think the biggest numbers make the best headlines.

But ultimately if a new virus was to emerge again this flu season, should we react differently? Probably not. The reality is most viruses don’t mutate into deadly killers; but it has happened before and it will happen again.

The worst case predictions are not plucked out of thin air, they are made on the best influenza research available – but we can’t predict exactly what will happen and looking back, what struck me most about what the experts said at this time last year is how often they said “we don’t know”.

Science moves in small steps and each time a new threat comes along we are better prepared to characterise the next one.  And when it comes to infectious diseases, if we “don’t know”, then I am a big believer in preparing for the worst.

The H1N1 swine flu virus is potentially still evolving but how it will evolve and change is something we can’t easily predict. Remember that out there somewhere, still circulating, is the H5N1 avian influenza, otherwise known as bird flu.

This virus is still infecting people and still killing between 50-60% of people it infects. If that virus or another were to become readily transmissible from human to human and keep its nasty ability to kill very large numbers of people we would have a disaster on our hands, far from crying wolf we would have on our hands a wolf with savage fangs that would tear us to shreds. So are we getting any better at identifying aggressive flu strains?

According to Alan Hampson the Chair of the Australian Influenza Specialist Group: “We are far from being able to read influenza viruses like an open book. While we do have some clues as to the factors that make that such a nasty virus, I don’t think we will have that completely defined in a way that would allow us to take a new virus and immediately say that this is going to be a mild virus or a terribly severe virus except for watching what is happening in the population.”

Alan also suggests we are a long way from being able to just look at the virus itself and predict how severe it is going to be. “There are a number of factors that are involved in how severe a virus is likely to be in a population. This H1N1 was a little unusual in that it had a degree of relatedness to viruses that older members of the population may have experienced way back in the past. It might have been the thing that saved it from becoming a more widespread infection,” he said.

The other big challenge is identifying everyone who contracts the virus so that the number of people who die can be put into some perspective to work out how deadly the new strain really is.

Unfortunately this is an area of huge uncertainty. I’m pretty sure I had swine flu last year, was it reported?  No.

I just felt rotten and stayed at home for a few days.

The other big area of uncertainty is who’s most at risk. Dr Ian Seppelt, an intensive care physician who was at the front line of swine flu says one-third of all the people who ended up in intensive care with swine flu last year were apparently healthy people with no underlying illness.

Far from being mild, he saw large numbers of people with influenza passing through intensive care and warns that “if we had twice the case load, or even probably 1.5 times the case load the system could not have coped and it would have led to more difficult triage decisions, including refusing intensive care admission to people who were less likely to do well and that’s the sort of decision we’re not so used to making, but would have to make if there is a future epidemic that is more severe.”

So just because we cried wolf, and the wolf did not savage us all to death, does not mean there wasn’t a wolf or that wolves don’t exist and that we shouldn’t be ready for the next one.

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    • T.Chong says:

      07:54am | 24/04/10

      Well Lyndal it was all a big hoax, perpetrated by Obama and Rudd, as a first step in a world communist take over plot, the same as concern about global warming.
      Just ask Lord Bottomley (or whatever his name was) who holidayed here just recently , to the delight of climate sceptics, flat earthers, and other members of the collective known as conservatives.
      With this type of deception being placed upon us, (global warming, swine flu, etc) its no wonder that so many here wear their tin foil hats with pride.

    • Eric says:

      03:22pm | 24/04/10

      It isn’t April Fools Day any more, TC.

      Just sayin’.

    • BigBob says:

      11:12am | 25/04/10

      Yes it was all a conspiracy, they just want to see Australians suffer as they get that flu shot, they had a hard time convincing all those people to die, but they managed it anyway. And to add insult to injury when the Tooth Fairy invented Global Warming, it was in the hope that you would stop putting out your teeth for cash, after all Tooth Fairies suffered in the Global Crisis too!!!
      On a more serious note, I feel its better to be immunised rather than take a risk of a child dying.

    • Brett L says:

      09:36pm | 24/04/10

      I’m no medical person, but I know this: A vaccine is the introduction of a sub clinical infection that stimulates the immune response to remember and thus fight it in future.The problem is it relies on a mature immune system. Children don’t have this. But then there is this too. Breast feeding stimulates the early immune system. Has there been any studies about bottle fed babies and the reaction to this flue vaccine? Of course I would never doubt there has been financial interest as well.

    • marley says:

      08:46am | 25/04/10

      I’m not entirely clear what your point is.  Surely it’s better for a small child to get the vaccine than the disease itself, regardless of whether they’ve been breast fed or not.  Immunity from the mother only lasts a few months, after all.

    • Brett L says:

      10:20am | 25/04/10

      Marley my point is this: Breast milk helps a baby’s own immune system mature faster. Now there is evidence for a lasting effect of breastfeeding on the immune system, resulting in enhanced protection against infection for many years and not just a few months like you say. This goes to say that maybe babies who are not breast feed are more likely to have adverse reactions to an artificially introduced pathogen. Vaccines with the exception of Hep B are given at least 2 months after birth, and usually after some good breast feeding. Of course I think all children should be vaccinated, but maybe some research here may show some clues as to the recent tragedies.

    • fii says:

      03:59pm | 25/04/10

      Google Jane Bürgermeister. who is an Austrian Medical journalist.
      She has done extensive research on the complicity of the WHO and certain vaccine makers ... *surprise surprise*

    • Daniel says:

      09:52pm | 25/04/10

      What happened to the bird flu?

    • Alex says:

      03:12pm | 26/04/10

      Guess it flew off along with the birds

    • PKelly says:

      08:46am | 26/04/10

      It was just a scare campaign cum marketing campaign for flu companies flu vaccine wasn’t it?

      Wish I had bought shares now!

    • Brett L says:

      10:32pm | 26/04/10

      Isn’t there anyone who can add some constructive comment? Are there any MD out there? Please give some rational informed debate.

    • CS says:

      04:00pm | 27/04/10

      Well - I’m not an MD, but I am a qualified immunologist in the field of newborn immunity.  From my point of view, this is an excellent article that sums up the sensible approach of the authorities to last year’s outbreak.  It isn’t controversial, hence the lack of comments.

      The bottom line is that the response to the outbreak last year was appropriate.  Had the virus been a nasty one, even this level of response would have been criticised in retrospect.  Authorities can’t win on these issues.

      Regarding the comments here on maternal influence of newborn immunity: antibodies passed on from the mother help the newborn immune system, but these are not very effective against viruses - more for bacteria.  Immune cells (NOT passed on from the mother) need to be educated against viral infection, hence the value of inoculation.  For this reason, vaccination for children is MORE important that for older groups.  There aren’t enough immune cells to be educated in the first few months of life, so vaccinations tend to be given after this period.

      Regarding better responses to artificially introduced pathogens - it is important to note that flu vaccinations do not introduce pathogens, only particles of pathogens.  Such research can’t really be applied to adverse reactions to vaccination.  It is also important to understand that vaccines are rarely undertaken by stimulating a subclinical infection - these days it is usually accomplished by the giving the aforementioned particles, or particles with an immune stimulant (called adjuvants).

      Research indicating better newborn responses from breastfeeding (beyond simple antibody protection) is in it’s early days, and may yet prove to be important, but it is premature to suggest breastfeeding would counteract adverse reactions to vaccinations that are constructed from dead viruses.  Due to the rare adverse reaction incidence to vaccines, any study into breastfeeding vs adverse reactions would be extrememly difficult. 

      Forensic research into the recent reactions to a flu vaccine is still underway, but is likely to be due to inert contaminants or adjuvants that over-stimulate some immune systems.  That’s my best guess.

    • Glad to be a Grandma says:

      02:25pm | 19/01/11

      There has to be some public registry of un vaccinated children, so we know which kids are at risk for diseases. The information would be useful for expectant mothers who have to keep their newborns safe. Personally I wouldnt want to be a pregnant teacher looking after a roomful of kids with the potential to catch rubella and pertussis…


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