Talk:2009 swine flu pandemic/Archive 10

Cochrane review finds Tamiflu of little or no help to prevent flu complications
"Roche Holding AG’s antiviral drug Tamiflu may not prevent complications from influenza in healthy adults, according to a review by an independent research group that reversed its previous findings that the medicine warded off pneumonia and other deadly conditions linked to the disease." http://www.bloomberg.com/apps/news?pid=20601100&sid=a9acc7qIJFdU

Also: http://www.bmj.com/cgi/content/extract/339/dec08_3/b5387

And: http://www.bmj.com/cgi/content/full/339/dec08_3/b5351

How do you think we should add this information? Gandydancer (talk) 14:42, 9 December 2009 (UTC)


 * I would think a sentence or two under Treatment->Antivirals. --Cyber cobra (talk) 14:52, 9 December 2009 (UTC)


 * I'm not so sure that it's quite that simple! First you've got the WHO and the CDC saying use Tamiflu (as we have reported in this article) and suddenly you have the Cochrane people coming out and saying it is practically worthless.  It seems to me that it would need its own heading under antivirals...? Gandydancer (talk) 15:18, 9 December 2009 (UTC)
 * Well, Wikipedia is a wiki and a perpetual work in progress. Be bold and add it however you think would be best, and let the wiki-magic do its thing! --Cyber cobra (talk) 19:19, 9 December 2009 (UTC)


 * Were is the Cochrane paper this is based upon? Should reference directly to Cochrane site?   Doc James  (talk · contribs · email) 19:43, 9 December 2009 (UTC)


 * Here is the conclusion "Conclusion Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed." So it is not nearly as dramatic as the press article.   Doc James  (talk · contribs · email) 19:50, 9 December 2009 (UTC)


 * " .  .  .  found no clear evidence it prevented lower respiratory tract infections  .  .  .  "
 * http://www.bloomberg.com/apps/news?pid=20601100&sid=a9acc7qIJFdU
 * Now, that might be different from treating pneumonia once it already develops.
 * So, we just lay it all on the table. In zen-like fashion, we embrace the messiness!    Cool Nerd (talk) 22:23, 9 December 2009 (UTC)


 * This is an interesting read: http://www.bmj.com/cgi/content/full/339/dec07_2/b5164  Gandydancer (talk) 22:40, 9 December 2009 (UTC)

"If oseltamivir is no better than placebo in its ability to reduce the complications of influenza, and if it is also ineffective against influenza-like illness not caused by influenza, then the drug’s ability to treat the symptoms of influenza may be similar to that of an NSAID such as aspirin." I'd say that's pretty dramatic! Gandydancer (talk) 00:15, 10 December 2009 (UTC)
 * According to one author from the Cochrane research group:


 * Some feedback please. What do you think of this?

On December, 8 the Cochrane Collaboration, which reviews medical evidence, announced in a review published in the British Medical Journal that it had reversed its previous findings that the antiviral drug Tamiflu can ward off pneumonia and other serious conditions linked to influenza. They reported that an analysis of 20 studies showed Tamiflu offered mild benefits for healthy adults if taken within 24 hours of onset of symptoms, but found no clear evidence it prevented lower respiratory tract infections or other complications of influenza. Their published finding relates only to its use in healthy adults with influenza; they say nothing about its use in patients judged to be at high risk of complications—pregnant women, children under 5, and those with underlying medical conditions, and uncertainty over its role in reducing complications in healthy adults may still leave it as a useful drug for reducing the duration of symptoms. Gandydancer (talk) 23:53, 10 December 2009 (UTC)


 * http://www.bmj.com/cgi/content/abstract/339/dec07_2/b5106
 * “ .  .  .  The efficacy of oral oseltamivir against symptomatic laboratory confirmed influenza was 61% (risk ratio 0.39, 95% confidence interval 0.18 to 0.85) at 75 mg daily  .  .  .  ”
 * posted by Cool Nerd (talk) 16:42, 11 December 2009 (UTC)


 * "and 73% (0.27, 0.11 to 0.67) at 150 mg daily."
 * Now, this doesn't really make sense! How can the range be lower than the overall number of 73%??


 * "Inhaled zanamivir 10 mg daily was 62% efficacious (0.38, 0.17 to 0.85)."
 * These numbers are very similar to the first numbers for oseltamivir at 75 mg. Remember, this is a study on neuraminidase inhibitors (with neuraminidase being--of course!--the N in H1N1).
 * . . . :" .  .  .  The remaining evidence suggests oseltamivir did not reduce influenza related lower respiratory tract complications (risk ratio 0.55, 95% confidence interval 0.22 to 1.35).  .  .  "
 * This is really the guts of it. Now, on the face of it, if my risk is only 55% of what it would have been, I'll take it.  Now, it may not be everything I hoped for, but on the theory that Something Beats the Heck Out of Nothing, I will graciously accept it.  The difficult part comes when you look at the range.  1.35?  So, in some cases taking oseltamivir has increased a person's chance of complications?  Probably not.  Probably just the data bouncing all over the place.  Like a slightly below-average poker player having a good run of it for a couple of weeks and thinking he's above-average, ain't necessarily the case!  Or measuring the blood pressure of 20 people, it's not necessarily reflective of the entire population.  So, you use statistics (and I'm guessing a lot of background information) to say that you're 95% sure the entire population is within such-and-such range.   Cool Nerd (talk) 17:59, 12 December 2009 (UTC)

http://www.bmj.com/cgi/content/full/339/dec07_2/b5106?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=neuraminidase&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT [from Introduction] “. . .  This criticism centred on one paper in particular, a meta-analysis of the effects of oseltamivir on complications of influenza.[10]. . "
 * Okay, and following is the article.  Cool Nerd (talk) 18:26, 15 December 2009 (UTC)

Archives of Internal Medicine article, July 2003
Impact of Oseltamivir Treatment on Influenza-Related Lower Respiratory Tract Complications and Hospitalizations, Archives of Internal Medicine, Laurent Kaiser, MD; Cynthia Wat, MBBS, MRCP; et al., July 28, 2003:

“ .  .  .  lower respiratory tract complications (LRTCs). . .  ”

“ .  .  .  In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P = .02). [ . .  . ] In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively."

Origin of flu outbreak
The first sentence of the second paragraph reads, "The outbreak began in Veracruz, Mexico, with evidence that there had been an ongoing epidemic for months before it was officially recognized as such.[5]"

The reference seems to suggest that the outbreak did not actually start in Mexico. Either the sentence needs to be changed, or a new reference found; however, if there is indeed debate as to the flu's origin, this should probably be noted in the article. —Preceding unsigned comment added by 128.138.64.56 (talk) 21:43, 14 December 2009 (UTC)


 * Hmmm, interesting point. From memory it seems that they traced it to an American owned hog farm in La Gloria, Veracruz.  The locals in La Gloria (I remember the town because I felt it was such a pretty name!) said that they had been complaining about getting sick for months and were ignored.  The first (?) person that was identified as H1N1 was from Veracruz but then living in Mexico City.  The American hog factory owner, who also had a hog factory in...South Carolina?, was adamant that NONE of his hogs had the flu and that none of his workers were sick, and furthermore people can NOT catch flu from hogs.  There was a lot of fear in both Mexico and the US that the pork industry would suffer.  This was all big news at one time and I would guess that it was in this article.  I wonder why it has been deleted?  Or has it been moved elsewhere? Gandydancer (talk) 16:18, 15 December 2009 (UTC)


 * is probably the best source for this, the bottom line is that we weren't watching pigs, with only a few studies done in North America, and missed this new virus entirely. Tim Vickers (talk) 17:04, 15 December 2009 (UTC)

Some of the links here in this article go back to that time as well. I would like to see this information in this article, however I will admit to a strong bias against factory farms and NAFTA. It could be argued that factory farms treat the food we eat in a manner that could, at least in the US, land anyone in jail if they treated their pet cat or dog in such a manner. Due to crowding and horrific conditions, factory farms could be called influenza factories as well. Ok, a little rant here...which I know I'm not supposed to do. Gandydancer (talk) 17:46, 15 December 2009 (UTC)
 * I found this as well: http://www.timesonline.co.uk/tol/life_and_style/health/article6182789.ece


 * The role of intensive farming is actually well-established in swine flu transmission, see Swine_influenza. However, since we don't know where this particular strain originated, we can't say those farming methods were definitely involved in this particular case. Tim Vickers (talk) 17:59, 15 December 2009 (UTC)


 * Yes, I know it is well established. That's why it is so pathetic to watch this interview: http://www.msnbc.msn.com/id/21134540/vp/30523283#30523283 in which the spokesperson for Smithfield, Mr. Larry Poop, er, Pope, (sorry, couldn't resist--it was a pretty darn funny slip of the tongue by the interviewer) states flat out that, why he's never heard of such a thing as a pig having the flu! Gandydancer (talk) 15:45, 16 December 2009 (UTC)

Please, assume your readers are slightly smarter than you are.
Non-Safety-Related Voluntary Recall of Certain Lots of Sanofi Pasteur H1N1 Pediatric (0.25 mL, for 6-35 month olds) Vaccine in Pre-Filled Syringes Questions & Answers, CDC, Dec. 15, 2009:

" .  .  .  ongoing stability testing of its influenza A (H1N1) vaccine after the vaccine has been shipped to providers. Stability testing means measuring the strength (also called potency) of a vaccine over time. It is performed because sometimes the strength of a vaccine can go down over time. On December 7, Sanofi Pasteur notified CDC and FDA that the potency in one batch (called a “lot”) of pediatric syringes that had been distributed was later found to have dropped below a pre-specified limit. As a result of this finding  .  .  .  "


 * Notice how it's written at the 8th grade level. If that!  That's being generous to it.  It is a curious mix of stilted, formal language and talking down to the reader, and that's not so cool.  And, yes, even though this is CDC, we should strive to do better.   Cool Nerd (talk) 22:51, 17 December 2009 (UTC)

Signs and symptoms section
The last 2 sentences in this section do not seem related. Do you think they should be moved or deleted? Also, it seems to me the sudden development of ARDS (cytokine storm?) and viral pneumonia which presents as sudden respiratory distress (and other symptoms) is such a medical emergency that perhaps we should give it more weight, perhaps including this CDC info in the signs and symptoms space: http://www.cdc.gov/h1n1flu/homecare/warningsigns.htm  I know it is more or less elsewhere, but I'd like to stress it a little more. Thoughts? Gandydancer (talk) 15:11, 16 December 2009 (UTC)


 * Gandydancer, my gut feeling is that a discussion of cytokine storm would be hype and a distraction. It was part of the horror of 1918, but as far as this go around, I have read a slew of WHO articles and have not seen any extended discussion.


 * Now, as far as pneumonia, yes absolutely! To me, the three most important parts of this article are pneumonia, Tamiflu, and vaccine.  (And by Tamiflu, I also mean similar medicines such as Zanamivir and IV drug whose name temporarily escapes me.)  Okay, at the end of the third paragraph of our introduction, we talk about if someone has the flu and then from day 3-6, they start having troubling breathing.  We should probably move that to its own (short) paragraph because that's different than the situation of people with preexisting conditions.  And the other part of the one-two punch is if a child seems to be recovering and then relapses with a high fever.  That can be bacterial pneumonia.  This is from the Denise Grady Sept. 3 article. http://www.nytimes.com/2009/09/04/health/research/04flu-001.html   I'd like to get additional sources.  Presumably, that's true for adults, too.  But I'd like to how a source directly saying that.


 * So, pneumonia, yes, definitely yes, a very good discussion.  Cool Nerd (talk) 00:38, 18 December 2009 (UTC)


 * ARDS <-->  Acute Respiratory Distress Syndrome


 * Is the following part of acute respiratory distress syndrome, a specific type of it, or a somewhat different phenomenon?


 * When to take a sick child to the ER, Los Angeles Times, By Rong-Gong Lin II, November 21, 2009: "  .  .  .  Lung inflammation is particularly dangerous to infants and young children because their airways are smaller. According to the California Department of Public Health, the flu virus replicates in the airways and lungs, causing them to swell.  .  .  "


 * Even if we can't get a definite answer, and we may not be able to, this is the kind of clear, specific detail that can be very helpful for our readers. Cool Nerd (talk) 01:59, 18 December 2009 (UTC)


 * I did not mean to mention in the article that people seem to be experiencing cytokine storm/ARDS leading to sudden death. But although the CDC has not mentioned it, reading news articles about the deaths does seem to suggest that.  See this article for instance: http://www.washingtonpost.com/wp-dyn/content/article/2009/11/20/AR2009112002734.html  Note that it states that 1/3 of the deaths of children are in previously healthy kids (with strong immune systems).

There has been a lot of discussion about the fact that in some people the H1N1 virus, unlike seasonal flu virus, seems able to attack cells deep in the lungs of some people, though it is not known why it affects only a small number of people in this manner. There is a lot of interesting information here: http://www.flutrackers.com/forum/showthread.php?t=136298&highlight=cytokine+storm Gandydancer (talk) 14:15, 18 December 2009 (UTC)


 * The signs and symptoms for infants no longer is correct - it needs to say that it includes the children section plus the signs for infants. Gandydancer (talk) 13:42, 19 December 2009 (UTC)


 * Fixed it. I had just copied that stuff from the CDC page but upon reading it I realized that the infant section would actually be exactly the same as the children section. Gandydancer (talk) 14:06, 19 December 2009 (UTC)

PANDAS
Can You Catch Obsessive-Compulsive Disorder?, New York Times, Lisa Belkin, May 22, 2005, a seven-page article:

“ .  .  .  They call it Pediatric Autoimmune Neuropsychiatric Disorders Associated With Streptococcal Infection, or, because every disease needs an acronym, Pandas. . .  ” [page 1]

“ .  .  .  So the antibodies mistake the basal ganglia for strep and attack. This, of course, will not happen to every child who has strep throat, or even to most children, in the same way that every child who gets strep does not get rheumatic fever. "It's the wrong germ in the wrong child at the wrong time," says Swedo, who suspects that some children are genetically predisposed toward Pandas. . .  ” [page 2]

“ .  .  .  The bane of all science is coincidence. For example, a notable percentage of children develop their first signs of autism soon after a vaccination, and it is tempting to blame the shot for the symptoms. But autism as a rule tends to show itself during the years when children are also scheduled to receive fairly regular immunizations. So the odds are good that the two events will be temporally linked. . .  ” [page 4]

“ .  .  .  And they cite as an example children with Tourette's syndrome, who frequently have O.C.D. symptoms that ebb and flow with stress. Children with neurological disorders "are sensitive to any number of things," Kurlan says. "If their dog dies. If their parents are fighting. I've seen O.C.D. get worse with a cold, with hay fever, with pneumonia. If there is anything special about strep, I don't think anyone has been able to find it." . .  .  ” [page 5]

PANDAS, National Institute of Mental Health, Pediatrics and Developmental Neuroscience Branch, Susan E. Swedo, MD, Branch Chief, page last updated Feb. 24, 2009: “. . .  researchers at the NIMH are pursuing a theory that the mechanism is similar to that of Rheumatic Fever, an autoimmune disorder triggered by strep. throat infections. In every bacterial infection, the body produces antibodies against the invading bacteria, and the antibodies help eliminate the bacteria from the body. However in Rheumatic Fever, the antibodies mistakenly recognize and "attack" the heart valves, joints, and/or certain parts of the brain. This phenomenon is called "molecular mimicry", which means that proteins on the cell wall of the strep. bacteria are similar in some way to the proteins of the heart valve, joints, or brain. . .  ”


 * posted by Cool Nerd (talk) 04:45, 24 December 2009 (UTC)

Dangerous understatement of the dangers of Swine Flu 2009 Pandemic
1)I tried to add figures to the subjective phrase "a small percentage" of healthy people also died. The actual figures, quoted by the references alongside these phrases, but no figures quoted in wiki are: WHO for the world: 50% of those hospitalised that died were perfectly healthy. CDC for USA: 30% of hospitalised that died were perfectly healthy.

This page is semi-protected so I cannot add the figures in order to explain what "small percentage". Many readers are confused by this understatement of the dangers of Swine Flu.

2) In the symnptoms, someone had maintained the phrase "a small fraction" of the normal flu deaths of 32000 in USA. That may be appropriate in May, when only 3 died, but by December this number is 10,000 estimated deaths for Swine Flu for 7 months versus 32 estimated deaths for Common Flu in 12 months.

Fortunately the figures that I had added survived to this day. But earlier on, some figures that I quoted from the cited references were mysterious deleted. I am not sure how long this current figure will last.

Overall this article is trying to promote that Swine Flu is milder than Common flu quoting the deaths figures of the early months but without the exact figures. They use subjective words such as "a small percentage" and " a fraction", instead of quoting the figures and duration that these figures refer to, and let the readers decide if it were really is a "small percentage".

Swine Flu is not at all dangerous as long as we all take precuations. SARS was much more dangerous but the death toll from SARS(about 800) was much lower because everyone, especially frontline doctors, took excessively high precautions. The death toll from Swine Flu is limited because many parties, even WHO had taken precautions, such as declaring it a Pandemic, but a smaller number still believe that Swine Flu 2009 is milder than common flu and tried to impose their views by denying the facts and figures so far.

With 111 million doses of vaccine available in USA, I would say that the Swine Flu danger has abated in USA but the world at large is still exposed. Part of the reasons for the low fatality of Swine Flu in USA and developed nations, is due to the widely available Tamilflu that are still effective and Vaccine. This is not so for many developing nations. —Preceding unsigned comment added by Othmanskn (talk • contribs) 05:07, 26 December 2009 (UTC)

Tighter Surveillance Of Swine Flu in Pigs Needed Worldwide Says CDC
The end of the 1st paragraph states "it cannot be spread by eating pork products or being around pigs" and gives 2 citations, a page containing public information put out by the CDC and a piece by the LA Times. However, the CDC page cited makes no mention of it being safe to be around pigs. In fact it specifically mentions that the virus contains genes from European pigs (not American mind you). That comes from the LA Times article that discusses the monetary loss incurred by American hog farmers. So this line is ambiguous at best.

Now, in the May 22 edition of Science Magazine ref#1, under the title "Past Pandemics Provide Mixed Clues to H1N1's Next Moves" by Jon Cohen, it is stated that "The new virus is a so-called triple reassortant—a mix of swine, human, and avian genes—that researchers first found in North American pigs in 1998.". Furthermore, in a European Commission Press Release ref#2, Dr Nancy Cox, one of the authors of another paper entitled "Antigenic and Genetic Characteristics of Swine-Origin 2009 A(H1N1) Influenza Viruses Circulating in Humans" ref#3 and Director of the Influenza Division at the Centers for Disease Control and Prevention (CDC) in the US states "This study reinforces the fact that swine are an important reservoir of influenza viruses with the potential to cause significant respiratory outbreaks or even a possible pandemic in humans, and the results of the study show the global need for more systemic surveillance of influenza viruses in pigs."

I am of the opinion that the LA Times opinion on the subject should defer to that of the CDC. As such, I propose that the last sentence of the first paragraph be change from this:

Although the virus, first detected in April 2009, contains a combination of genes from swine, avian (bird), and human influenza viruses, it cannot be spread by eating pork products or being around pigs.[3][4]

To this:

The virus, first detected in April 2009, contains a combination of genes from swine, avian (bird), and human influenza viruses. Although it cannot be spread by eating well cooked pork products, recent findings have restated the well known fact that pigs are a reservoir of influenza viruses and highlighted the need for more systematic surveillance of influenza viruses in pigs.

I believe this is a fair request based on sound argument. Thank you.

Oberon10001 (talk) 05:02, 22 December 2009 (UTC)


 * Interesting observations and certainly food for thought. Pigs do get the flu, and they get it a lot--which is why I was "so surprised" (feel that he is a liar) that Mr. Larry Pope, owner of the hog factory that apparently bred the H1N1 virus, was not aware that they do.  It is well known that pigs are virus mixing factories.  Can  pig virus be transmitted to a humans?  Well, apparently so--see wikipedia http://www.cdc.gov/flu/swine/pdf/brochure.pdf  I would not go so far as to change the article in the way you suggest, but perhaps the words "or being around pigs" should be deleted? Gandydancer (talk) 15:44, 22 December 2009 (UTC)

Simply deleting "or being around pigs" does not impress upon the reader the risk that unmonitored factory farming of hogs presents. At the very least the fact that pigs are virus mixing factories should be clearly stated. This article discusses the facts of the 2009 H1N1 flu pandemic and should present the facts as is without trying to shield hog farmers. The fact that the pandemic is still ongoing and may make a turn for the worse should be reason enough not to accept the status quo wrt to hog farming practices. If Copenhagen teaches us anything it is that pandering to the political sensitivities of vested interests will continue to perpetuate the Tragedy of the Commons. No more please. We need to reform systems that puts us all at great risk.

Oberon10001 (talk) 07:25, 23 December 2009 (UTC)


 * While I agree with you, this article is not the place for all that - it is about the current H1N1 flu. However, have you looked at the flu virus article?  Also, just as I am writing this I wondered if there might be an article "factory farming", and sure enough!  So perhaps you could look at that as well. Hope to hear from you after you look at those articles. Gandydancer (talk) 12:11, 23 December 2009 (UTC)


 * Further thinking on this subject, you may want to review the Epidemiology section of this article.  In my opinion it could use some work.  This topic has evolved so rapidly that it does seem to need to be brought up-to-date from time to time.  Two of the references in that section are not available without payment--which I hate since I like to read sources--and I'm sure you could find something better.  See ref #138, for instance.  Also, if appropriate, you may find it helpful to add   to some of your words, factory farm for example. To my great joy, whole new worlds of information have been opened up for me by clinking some of those words. I have made a few changes in this article and, at least for me, it's a lot of work!  However, unlike some articles, I have found that the people who work on this article are very helpful and very "nice". Gandydancer (talk) 13:23, 23 December 2009 (UTC)
 * Please read WP:GREATWRONGS. That's not what we are here for.LeadSongDog come howl  16:37, 23 December 2009 (UTC)


 * I am not suggesting that we right a great wrong here. If you feel that I have said that, please point out the reasons. Gandydancer (talk) 16:53, 23 December 2009 (UTC)
 * You didn't. Oberon did. LeadSongDog come howl  17:06, 23 December 2009 (UTC)


 * I will delete the "or being around pigs" words as they are not factual. While rare, it has been transferred from people to hogs and from hogs to people.  BTW LeadSongDog, hats off to you for setting Oberon straight with the wikipedia guidelines on "righting great wrongs" thoughts.  While it's true that s/he did not boldly delete and add but rather spoke of his/her thoughts on the talk pages, even thinking such thoughts must be faced head-on if we are to save the world from the misguided thinking of new wikipedia contributors. Gandydancer (talk) 19:34, 27 December 2009 (UTC)

Travel precautions section
I think that this section should be pared down considerably. It was quite an item at one time, but is no longer worth more than a mention, IMO. Thoughts? Gandydancer (talk) 13:42, 30 December 2009 (UTC)


 * I shortened it a little. Gandydancer (talk) 23:17, 31 December 2009 (UTC)

WHO latest confirmed deaths
In the introduction it is stated that there are 12,121 deaths, however the ref provided does not back that up and I have no idea where that number came from. Here is a late news report that says "nearly 12,000". http://www.reuters.com/article/idUSTRE5BS14B20091229 Another report says, "more than 11,5000.  I went to the WHO site and this info is not available.  I would change the number, but perhaps due to my inexperience I do not understand the way it has been added.  Could someone change it or explain to me why it has been entered in the way it is?  Thanks. Gandydancer (talk) 13:55, 30 December 2009 (UTC)


 * I now find a WHO report and will go ahead and change the figure. I am aware that at least one person prefers to not use the date, but it seems better to use that method to me.  If there is disagreement, it can be reverted to "curently". Gandydancer (talk) 16:42, 30 December 2009 (UTC)

Always put the date. Flu and any infectious diseases spread exponentially. Meaning it becomes more rapid as time passes. A week's difference can mean thousands, in the coming months. Othmanskn (talk) 02:27, 31 December 2009 (UTC)


 * Hopefully, it won't. But we need to be prepared if it is (please see below).  Cool Nerd (talk) 19:12, 1 January 2010 (UTC)

concurrent circulation of pandemic and seasonal flu?
Pandemic (H1N1) 2009 - update 79, WHO, Weekly update, 18 December 2009: “. . .  In West Africa, a mixture of pandemic and seasonal influenza viruses have been detected. Seasonal viruses have included both seasonal H1N1 and H3N2, with the later predominating. . .  ”


 * And, as I understand it, Tamiflu works against pandemic H1N1 but not against seasonal (seasonal H1N1 that is). And there's a different antiviral medication that works vice versa.   Cool Nerd (talk) 19:12, 1 January 2010 (UTC)

http://www.cdc.gov/flu/weekly/weeklyarchives2008-2009/weekly39.htm

The adamantanes (amantadine and rimantadine) are used to treat seasonal flu (seasonal H1N1).

2008-2009 Influenza Season Week 39 ending October 3, 2009 "Synopsis: "During week 39 (September 27-October 3, 2009), influenza activity increased in the U.S

•	"2,968 (27.4%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. •	"99% of all subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. . .  "

And per the chart in the “Antiviral Resistance” section:

For Seasonal influenza A (H1N1), only 7 out of the 1,157 samples tested were resistant to Adamantanes.

For Influenza A (H3N2), Zero out of 264 samples were resistant to oseltamivir (Tamiflu).

For Influenza B, zero out of 654 samples were resistant to oseltamivir (Tamiflu).

And for 2009 Influenza A (H1N1), only 10 (12 counting additional labs) out of 2,040 samples tested were resistant to oseltamivir (Tamiflu).


 * And none of the samples tested were resistant to zanamivir. (editorial note:  So far!  There is no such thing as a magic medicine!  Cool Nerd (talk) 20:18, 1 January 2010 (UTC))


 * And please note that West Africa has been relatively lucky so far, with H3N2 as the predominating seasonal strain, both that and 2009 H1N1 can be treated with oseltamivir (Tamiflu).


 * And also note, this concurrent (and different medication being required) would seem to have existed in previous years, for seasonal H1N1 is treatable by amantadine/rimantadine and H3N2 is treated by oseltamivir (Tamiflu).  Cool Nerd (talk) 20:26, 1 January 2010 (UTC)

thimerosal, parents, and knee-jerk reaction of (?) medical establ. to any criticism of vaccines
I am pro-vaccine. I think vaccines are one of the foremost achievements of modern medicine. There's a vaccine against one of the main causitive agents of pneumonia, a lot of people don't know this, but it is recommended for persons over age 60. And when smallpox was wiped off the face of the earth, with WHO doing major, serious coordination, and they felt they had to wait a year and a half to really be sure, and then the formal announcement around 1979, that was perhaps the greatest single achievement in the history of medicine. And I cannot believe there has not been a movie made about it, ever bit as good as Schindler's List (and with a flawed hero, well of course!).

All that said, doctors do not seem to be very open to criticism of vaccines. Canada has a baseline rate of approximately 1 case of anaphylactic shock per 300,000 people receiving the vaccine, and one batch in which 6 people had anaphylactic shock out of approximately 150,000 people receiving it. If we could improve this on both counts, why wouldn't we? And yet doctors seem to take the approach, don't confuse the lay people. That is, they seem to think discussion is a bad thing (I'm speaking in generalities of course.)

So, a person gets a vaccine for their child. And it becomes increasing clear that the child is different, has issues. And then child is diagnosed with autism. Coincidence! Perhaps. Perhaps so. But let's not be so entirely quick. Just like Guillain-Barre is a real phenomenon, maybe there's something else that we just don't know about that's also a real phenonomenon. So, you or I, if we observed this close a relationship between cause and effect, or this close relationship in time, with one following the other, we would also wonder. We would also have our reasonable questions. And if we were then treated disparagingly. . . .   Well, I can say with a fair degree of confidence that stonewalling is not a constructive way to work with either your patients or your fellow citizens

In addition, I think I could bring in William Osler, that the individual case study is of central importance. The patient history and the physical exam. It should not be too readily dismissed. Cool Nerd (talk) 01:15, 18 December 2009 (UTC)


 * You should read this case and look at the many recent reviews on this subject in PubMed eg, , and  The idea has been comprehensively disproven. Tim Vickers (talk) 01:42, 18 December 2009 (UTC)


 * Tim, how can we definitely prove a negative? And the reference currently listed in our article says " . . risk/benefit . . ", that does not exactly sound like slam-dunk proof to me.  Cool Nerd (talk) 02:02, 18 December 2009 (UTC)


 * You can't definitely prove that the phase of the moon does not influence the rate of autism, since you can't prove a negative. However the facts are that thiomersal was eliminated from all childhood vaccines in the US in 2001, and that this has had no effect on the incidence of autism link. This "hypothesis" (prompted mostly in my opinion by legal considerations) has been comprehensively debunked. Tim Vickers (talk) 05:13, 18 December 2009 (UTC)


 * I am not arguing as to whether thimerosal in vaccines is related to autism, however I would argue that the fact that it has continued to increase since thimerosal has been discontinued is not a sound argument. For one thing, the dx is much broader than it used to be, and for another, many substances suspected as possibly being related, including (from wikipedia) heavy metals, solvents, diesel exhaust, PCBs, phthalates and phenols used in plastic products, pesticides, brominated flame retardants... have been increasing. Gandydancer (talk) 06:45, 18 December 2009 (UTC)


 * Yes, autism seems to come from a combination of a genetic predisposition and a child's prenatal environment. However, exactly what the genes are and which aspects of the environment are most important are not clear. The thiomersal scare is now more of an urban myth than a serious scientific hypothesis, since the idea has been examined in detail and has failed every test. Tim Vickers (talk) 18:36, 18 December 2009 (UTC)

Now, first off, I hope we're going to phrase things as confidently in other areas as we do here with thimerosal. For example, it's not that helpful to just laundry-list all the symptoms of influenza. If we can say which of the symptoms are really common, which are medium common, and which are just occasional, that will be a lot more helpful (provided as always that we can find the references).

Okay, I read the whole controversy (and not from direct experience, but rather my world view on how institutions usually work), that it's not for the sake of lawsuits, but rather that doctors have bailed on their patients. The doctor who's suppose to be there through thick and thin, once things start to get a little bit thick, including the parents being hard to work with, refusing to listen to "logic," etc. etc. Well, you don't just bail. You pull a lesson from business. And if necessary, you physically move your chair around so you are literally sitting on the same side of the desk with your patient. And if there's something useful you can show the parent, maybe something in a medical textbook that's the closest you know of, you do so. Or something else. In either case, you acknowledge real human solidarity. And you tell the parent, this is too important not to get a second opinion, but you're going to still be there with them. And maybe you did miss the diagnosis of autism that you could have made early. Or maybe not, since it's a developmental disorder, takes a little time to manifest. You let the parent be a little irrational. You give them space if necessary. And it's not outside the realm of possibility that you made a mistake. It's just like anything else, you try treating an infection with one broad-spectrum antibiotic. And if it doesn't work, you try another. It's all part of the ongoing conversation that so important to have with patients.

Just guessing, as a businessman, not a doctor, I'd say that a more likely cause is an autoimmune reaction to the vaccine. Just like Guillain-Barre syndrome is an automimmune reaction. Or like PANDAS, and that's the really interesting one. Okay, it's been known for 50 years or more that strep throat, in a small percentage of cases, can cause damage to the heart valves (rheumatic fever). This is in children. (In adults, it's more so damage to the joints.) And this is not strep directly attacking the heart valves. This is the antibodies your body produces in response to strep also attacking the heart valves (or the joints), as if they have a similar kind of protein or something. That is, it's an autoimmune response. Now, rheumatic fever has been known about for a long, long time, and just recently it's been discovered that in some cases, the antibodies attack and damage a part of the brain causing a rather sudden onset of OCD or Tourette's. Now, that's way out. Of course, to someone who knows a lot about the human immune system (which usually works beautifully, sometimes goes awry), it might not be all that way out. What I find fascinating is that while some aspects of this autoimmune response have been known for decades, this part has not.

Okay, I plan to make a second, separate section on PANDAS here on the discussion page, and eventually move it off and to the PANDAS article, and if there isn't one, maybe we should make one.

And Gandydancer, the things you list---solvents, PCBs, phthalates, etc, etc---maybe it's someone's body way overreacting, roughly along the lines of an allergic inflammation. Or, something else entirely.

And Tim, your last point is well-taken. Instead of thoroughly, thoroughly looking at thimerosal, and then completely nonlooking at a whole list of other possibilities, maybe we should first skim and see if something absolutely jumps out. And that should also be part of the real conversation with parents and patients. Cool Nerd (talk) 21:14, 23 December 2009 (UTC)

Thimerosal and Vaccines — A Cautionary Tale, New England Journal of Medicine, Paul A. Offit, M.D. (Dr. Offit reports serving on the scientific advisory board of Merck and being the coinventor of the bovine–human reassortant rotavirus vaccine RotaTeq, on which he holds a patent.), Sept. 27, 2007: “. . .  75 µg from three doses of the Haemophilus influenzae type b vaccine, and 37.5 µg from three doses of the hepatitis B vaccine. . .  ”

“ .  .  .  ethylmercury (thimerosal). . .  Ethylmercury is excreted from the body much more quickly. . .  ”

“ .  .  .  Although the precautionary principle assumes that there is no harm in exercising caution, the alarm caused by the removal of thimerosal from vaccines has been quite harmful. For instance, after the July 1999 announcement by the CDC and AAP, about 10 percent of hospitals suspended use of the hepatitis B vaccine for all newborns, regardless of their level of risk. One 3-month-old child born to a Michigan mother infected with hepatitis B virus died of overwhelming infection. . .  ”

“ .  .  .  charlatans offering false hope, partly in the form of mercury-chelating agents. In August 2005, a 5-year-old autistic boy in suburban Pittsburgh died from an arrhythmia caused by the injection of the chelating agent EDTA. Although the notion that thimerosal causes autism has now been disproved by several excellent epidemiologic studies, about 10,000 autistic children in the United States receive mercury-chelating agents every year. Furthermore, this notion has diverted attention and resources away from efforts to determine the real cause or causes of the disorder.

“Meanwhile, some preparations of influenza vaccine still contain thimerosal. . .  By choosing not to vaccinate their children, these parents have elevated a theoretical (and now disproved) risk above the real risk of being hospitalized or killed by influenza. . .  ”


 * posted by Cool Nerd (talk) 20:15, 27 December 2009 (UTC)


 * Since you have now read the sources, do you agree with our summary of their conclusions? Tim Vickers (talk) 18:32, 28 December 2009 (UTC)


 * Not so fast, Tim. Now, first off, please remember that I am a retail manager and businessman, not a doctor  .  .  .   Cool Nerd (talk) 18:24, 2 January 2010 (UTC)

2009 H1N1 may outcompete seasonal strains
Studies in Animals Suggest 2009 H1N1 Virus May Have Biological Advantage Over Seasonal Influenza Viruses, NIH News, National Institutes of Health, August 31, 2009:

“ .  .  .  Tests in animals showed that levels of the 2009 H1N1 virus rose more quickly than levels of the seasonal virus strains, and the new virus caused more severe disease. . .  ”

“ .  .  .  When the investigators inoculated ferrets with 2009 H1N1 virus plus either seasonal H1N1 virus or seasonal H3N2 virus, the animals became co-infected with both viruses. However, only the 2009 H1N1 virus was then transmitted from co-infected ferrets to uninfected ferrets;. . .  ” . . “  .  .  .  The investigators' findings are posted on PLoS Currents: Influenza, a Web site for rapid communication of new scientific data on influenza. Submissions to PLoS Currents: Influenza are screened by a panel of leading influenza experts prior to posting but do not undergo formal peer review. The new research may be submitted later for peer review and eventual publication in scientific journals. . .  ” . . “  .  .  .  Reference: D Perez et al. Fitness of pandemic H1N1 and seasonal influenza A viruses during co-infection. PLoS Currents: Influenza. Posted Aug. 25, 2009. RRN1011. Available at: http://www.ncbi.nlm.nih.gov/rrn/RRN1011. . .  ”

http://knol.google.com/k/plos-currents-influenza#


 * Interesting!  Cool Nerd (talk) 21:07, 2 January 2010 (UTC)

Naming
why is this titled "2009 flu pandemic" and not "2009 influenza pandemic"?24.17.211.150 (talk) 08:52, 4 January 2010 (UTC)
 * For one, Google testing suggests it's more popular (2.15 million results vs. 440K results). But I just don't think the thought happened to occur to anyone until you. --Cyber cobra (talk) 00:55, 5 January 2010 (UTC)


 * so are common names the default rather than scientific names? and "But I just don't think the thought happened to occur to anyone until you" - i can't tell if its flippant or not, please clarify 24.17.211.150 (talk) 01:35, 5 January 2010 (UTC)
 * Indeed, common names are the default; see WP:COMMONNAME. Wasn't to be flippant, was just explaining that the particular naming concern you bring up just so happens to not have been raised before (hence why the current title is what it is). --Cyber cobra (talk) 06:29, 5 January 2010 (UTC)


 * thanks for clarifying, sorry i thought you might have been sarcastic because i just noticed the archives of talk on the name —Preceding unsigned comment added by 24.17.211.150 (talk) 07:16, 5 January 2010 (UTC)

Cochrane review finds Tamiflu of little or no help to prevent flu complications

 * Note: I've pulled this part back from the archives.  For starters, our subject heading in the article states "oseltamivir," but the Cochrane study refers to both oseltamivir(Tamiflu) and zanamivir(Relenza), both of which they seem to classify as "neuraminidase inhibitors."  We might want to more simply phrase it just as antiviral medications.Cool Nerd (talk) 20:47, 4 January 2010 (UTC)

"Roche Holding AG’s antiviral drug Tamiflu may not prevent complications from influenza in healthy adults, according to a review by an independent research group that reversed its previous findings that the medicine warded off pneumonia and other deadly conditions linked to the disease." http://www.bloomberg.com/apps/news?pid=20601100&sid=a9acc7qIJFdU

Also: http://www.bmj.com/cgi/content/extract/339/dec08_3/b5387

And: http://www.bmj.com/cgi/content/full/339/dec08_3/b5351

How do you think we should add this information? Gandydancer (talk) 14:42, 9 December 2009 (UTC)


 * I would think a sentence or two under Treatment->Antivirals. --Cyber cobra (talk) 14:52, 9 December 2009 (UTC)


 * I'm not so sure that it's quite that simple! First you've got the WHO and the CDC saying use Tamiflu (as we have reported in this article) and suddenly you have the Cochrane people coming out and saying it is practically worthless.  It seems to me that it would need its own heading under antivirals...? Gandydancer (talk) 15:18, 9 December 2009 (UTC)
 * Well, Wikipedia is a wiki and a perpetual work in progress. Be bold and add it however you think would be best, and let the wiki-magic do its thing! --Cyber cobra (talk) 19:19, 9 December 2009 (UTC)


 * Were is the Cochrane paper this is based upon? Should reference directly to Cochrane site?   Doc James  (talk • contribs • email) 19:43, 9 December 2009 (UTC)


 * Here is the conclusion "Conclusion Neuraminidase inhibitors have modest effectiveness against the symptoms of influenza in otherwise healthy adults. The drugs are effective postexposure against laboratory confirmed influenza, but this is a small component of influenza-like illness, so for this outcome neuraminidase inhibitors are not effective. Neuraminidase inhibitors might be regarded as optional for reducing the symptoms of seasonal influenza. Paucity of good data has undermined previous findings for oseltamivir’s prevention of complications from influenza. Independent randomised trials to resolve these uncertainties are needed." So it is not nearly as dramatic as the press article.   Doc James  (talk • contribs • email) 19:50, 9 December 2009 (UTC)


 * " .  .  .  found no clear evidence it prevented lower respiratory tract infections  .  .  .  "
 * http://www.bloomberg.com/apps/news?pid=20601100&sid=a9acc7qIJFdU
 * Now, that might be different from treating pneumonia once it already develops.
 * So, we just lay it all on the table. In zen-like fashion, we embrace the messiness!    Cool Nerd (talk) 22:23, 9 December 2009 (UTC)


 * This is an interesting read: http://www.bmj.com/cgi/content/full/339/dec07_2/b5164  Gandydancer (talk) 22:40, 9 December 2009 (UTC)

"If oseltamivir is no better than placebo in its ability to reduce the complications of influenza, and if it is also ineffective against influenza-like illness not caused by influenza, then the drug’s ability to treat the symptoms of influenza may be similar to that of an NSAID such as aspirin." I'd say that's pretty dramatic! Gandydancer (talk) 00:15, 10 December 2009 (UTC)
 * According to one author from the Cochrane research group:


 * Some feedback please. What do you think of this?

On December, 8 the Cochrane Collaboration, which reviews medical evidence, announced in a review published in the British Medical Journal that it had reversed its previous findings that the antiviral drug Tamiflu can ward off pneumonia and other serious conditions linked to influenza. They reported that an analysis of 20 studies showed Tamiflu offered mild benefits for healthy adults if taken within 24 hours of onset of symptoms, but found no clear evidence it prevented lower respiratory tract infections or other complications of influenza. Their published finding relates only to its use in healthy adults with influenza; they say nothing about its use in patients judged to be at high risk of complications—pregnant women, children under 5, and those with underlying medical conditions, and uncertainty over its role in reducing complications in healthy adults may still leave it as a useful drug for reducing the duration of symptoms. Gandydancer (talk) 23:53, 10 December 2009 (UTC)


 * http://www.bmj.com/cgi/content/abstract/339/dec07_2/b5106
 * “ .  .  .  The efficacy of oral oseltamivir against symptomatic laboratory confirmed influenza was 61% (risk ratio 0.39, 95% confidence interval 0.18 to 0.85) at 75 mg daily  .  .  .  ”
 * posted by Cool Nerd (talk) 16:42, 11 December 2009 (UTC)


 * "and 73% (0.27, 0.11 to 0.67) at 150 mg daily."
 * Now, this doesn't really make sense! How can the range be lower than the overall number of 73%??


 * "Inhaled zanamivir 10 mg daily was 62% efficacious (0.38, 0.17 to 0.85)."
 * These numbers are very similar to the first numbers for oseltamivir at 75 mg. Remember, this is a study on neuraminidase inhibitors (with neuraminidase being--of course!--the N in H1N1).
 * . . . :" .  .  .  The remaining evidence suggests oseltamivir did not reduce influenza related lower respiratory tract complications (risk ratio 0.55, 95% confidence interval 0.22 to 1.35).  .  .  "
 * This is really the guts of it. Now, on the face of it, if my risk is only 55% of what it would have been, I'll take it.  Now, it may not be everything I hoped for, but on the theory that Something Beats the Heck Out of Nothing, I will graciously accept it.  The difficult part comes when you look at the range.  1.35?  So, in some cases taking oseltamivir has increased a person's chance of complications?  Probably not.  Probably just the data bouncing all over the place.  Like a slightly below-average poker player having a good run of it for a couple of weeks and thinking he's above-average, ain't necessarily the case!  Or measuring the blood pressure of 20 people, it's not necessarily reflective of the entire population.  So, you use statistics (and I'm guessing a lot of background information) to say that you're 95% sure the entire population is within such-and-such range.   Cool Nerd (talk) 17:59, 12 December 2009 (UTC)

http://www.bmj.com/cgi/content/full/339/dec07_2/b5106?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&fulltext=neuraminidase&searchid=1&FIRSTINDEX=0&sortspec=date&resourcetype=HWCIT [from Introduction] “. . .  This criticism centred on one paper in particular, a meta-analysis of the effects of oseltamivir on complications of influenza.[10]. . "
 * Okay, and following is the article.  Cool Nerd (talk) 18:26, 15 December 2009 (UTC)

Archives of Internal Medicine article, July 2003
Impact of Oseltamivir Treatment on Influenza-Related Lower Respiratory Tract Complications and Hospitalizations, Archives of Internal Medicine, Laurent Kaiser, MD; Cynthia Wat, MBBS, MRCP; et al., July 28, 2003:

“ .  .  .  lower respiratory tract complications (LRTCs). . .  ”

“ .  .  .  In those subjects considered at increased risk of complications, 74 (18.5%) of 401 placebo recipients developed an LRTC leading to antibiotic use compared with 45 (12.2%) of 368 oseltamivir recipients (34.0% reduction; P = .02). [ . .  . ] In contrast, among subjects with an influenzalike illness but without a confirmed influenza infection, the incidence of LRTCs (6.7% vs 5.3%), overall antibiotic use (19.7% vs 19.3%), or hospitalizations (1.7% vs 1.9%) was similar between placebo and oseltamivir recipients, respectively."

formal listing of references
We're throwing two dates at our readers. This makes it easily for us as editors, but harder for our readers.

People read things skimmingly fast. We should accept that. Cool Nerd (talk) 21:08, 4 January 2010 (UTC)
 * Could you explain what you mean exactly? --Cyber cobra (talk) 00:57, 5 January 2010 (UTC)

In a reference like "In New Theory, Swine Flu Started in Asia . . . ", June 23rd

We are throwing two dates at our reader. Cool Nerd (talk) 21:41, 6 January 2010 (UTC)

We arguably miss the point of May 27th New York Times article
From the Signs and symptoms section:
 * ” .  .  .  and those of any age with underlying medical conditions, such as asthma, diabetes, obesity, heart disease, or a weakened immune system (e.g., taking immunosuppressive medications or infected with HIV). ”

--

That is, we use this reference to laundry–list preexisting conditions.

When actually, it is a much more meaty and substantial article, and from what I see, having at least two main points.

“Dr. Frieden intended his warning, which he has applied to all four New York deaths so far linked to the H1N1 virus, to be at once helpful to those who might be more at risk for the disease and reassuring to those who are not.”

And the article rather argues that Dr. Frieden and other health authorities may have overplayed their hand. They may have talked too much about preexisting risk factors,

when in fact. ..

“She [Bonnie Wiener] disputed the city’s assertion that underlying conditions were a factor in his death. “He was overweight and he was taking medicine for high blood pressure,” she said. “How many people 50 and above don’t?” ” [Bonnie is the wife of Mitchell Wiener, who I think may have been the high school principal who died in New York City in that rather famous case.]

and. ..

“Judy Trunnell, 33, a teacher from South Texas, was the first American citizen to die of swine flu, in early May, after delivering a healthy baby girl by Caesarean section. A Texas Health Department spokeswoman said she had “chronic underlying health conditions,” which her husband, Steven, later denied on CNN.” “. . .  and mild asthma, in addition to her pregnancy.”

Okay, so this one, not so much. These are conditions that lead to increased risk, even though pregnancy is entirely normal of course.

The criticism, the debate, is that health authorities are overstating risk factors, perhaps to reassure people without. But, but plenty of people with no risk factors at all have ended up in the hospital.

And the second main point which I take, again it’s meaty and substantial and different people may disagree.

“ .  .  .  statistics suggest that the city’s long list of red flags may encompass as many as one in three people. . .  ”

“About 400,000 New Yorkers have asthma, the city’s most common chronic childhood illness; about 700,000, or 12.5 percent of adults, have diabetes. . .  ”

So, if you worry all the people with risk factors, you may jam emergency rooms, perhaps unnecessarily.

So, both points, is basically a debate that health officials are overstating risk factors. And we use the article for rather the opposite, to compile a list of factors that put a person at increased risk. (From what I see, we cite this New York Times article three times in our article.)  Cool Nerd (talk) 02:41, 6 January 2010 (UTC)

Rename to reflect 2010?
Seeing as it's now 2010 and the pandemic is (apparently) still on, should we move the article to 2009-2010 flu pandemic? --Cyber cobra (talk) 08:52, 6 January 2010 (UTC)


 * I don't think so. The 1918 pandemic lasted longer than a year and we still call it the 1918 pandemic. Gandydancer (talk) 10:00, 6 January 2010 (UTC)

CDC separately lists warning signs for adults, children, infants.
This is where wiki habits of distilling, formalizing, summarizing might work against us. CDC sees fit to separately list the warning signs, and I'm not sure where we should overrule them.

As I understand (again, not a doctor) little babies are really different creatures. A doctor who's an internist and treats adults would have a much better chance treating an eight-year-old child than an infant. That is, if we're going to group and categorize, we should group children and adults together, and then infants as a separate, stand alone category. So, even though CDC's listing is repetitive, it's probably not a percentage move to overrule them.

Remember, we don't give general information for general parent. Or rather, 'general parent' doesn't read wiki. It's specific parent with nice little specific baby Sally who rides wiki. The more specific information we can include, still within the flow of a good overview of the entire swine flu situation, the better.

If we do our very best work, we have the chance to maybe save several dozen lives. That possibility should be taken very seriously. And it trumps formality, easily. Cool Nerd (talk) 22:42, 5 January 2010 (UTC)


 * OK Cool Nerd, let's speak very plainly here. I am the one that combined infants and children.  Exactly what symptoms did you find in babies that were not listed in children?Gandydancer (talk) 23:37, 5 January 2010 (UTC)


 * Zero, absolutely none. But CDC saw fit to list them as separate categories, as if they're saying 'Hey, you parents of infants, these are the three symptoms you should be particularly concerned with.'
 * We at wiki are trying way too hard. It's like we're trying to operate at a skill level appropriate as if we had just completed our medical residencies.  We are trying to quickly read and quickly summarize professional publications.  And, on that count . . . we've got to be kidding!  That is the level we're aspiring to?  That's going to lead us way astray.  Even if we don't make a mistake in particular circumstances, we're taking too much risk.
 * What's the solution? Excerpt!  Just excerpt the piece.  Cool Nerd (talk) 00:02, 6 January 2010 (UTC)

You need to revert the change you have made in the symptoms. Here is what the CDC says:

In children, emergency warning signs that need urgent medical attention include: Fast breathing or working hard to breathe Bluish skin color Not drinking enough fluids Not waking up or not interacting Being so irritable that the child does not want to be held Flu-like symptoms that improve but then return with fever and worse cough Fever with a rash Being unable to eat Having no tears when crying In addition to the signs above, get medical help right away for any infant who has any of these signs: Being unable to eat Has trouble breathing Having no tears when crying

Note that the CDC only repeats 3 of the signs already listed in the infant section. The way you have changed it there are only 3 signs for infants rather than 6. As for doing my edits too quickly and dealing with information that I am not up to dealing with, please point out where I have done that. I am careful with my edits and I usually bring up any change I plan to make on the talk page before I go ahead. In fact, since I've been watching this article, I can't remember one instance of anyone doing differently. I would guess that most of the people that work on this article have some sort of medical training and are well able to edit this article. Gandydancer (talk) 08:17, 6 January 2010 (UTC)


 * Cool Nerd, when I did the changes to this section I WAS thinking about people that may look to Wikipedia for info on a very sick child. That is why I grouped the danger symptoms and got rid of a news report that suggested "a child that will not stop crying" but not some of those that the CDC has listed as a danger sign.  Seriously ill children usually do not cry like that - they just do not have the energy to cry unless they are in severe pain such as a burn. Note that the CDC does NOT say that those 3 symptoms are any more important than the others.  I googled "flu danger emergency signs" and found a different CDC page here:  http://www.cdc.gov/h1n1flu/sick.htm Also note that on this page they do not separate children and infants. Gandydancer (talk) 14:20, 6 January 2010 (UTC)

Gandydancer, you are one of the bright lights of wikipedia. And I thank you for being a bright light.

My argument is with the policies and practices and habits of wikipedia. We seem to elevate formality above all else. It's as if we believe, perhaps like earlier generations believed about Latin, if only we can translate our thoughts into formal language and gain that clarity of thought, that will surmount any problem. And I just don't see it.

From Dr. Nikki Shindo's Nov. 12th virtual press conference:


 * " .  .  .  And regretfully many doctors reported that the treatment has been delayed because the doctors wanted to wait for the test result. They wanted to have the proof that the patients were infected by H1N1 but if the epidemiological information suggests that the virus is circulating then the doctors should not wait for the laboratory confirmation but make diagnosis based on clinical and epidemiological backgrounds and start treatment early. And for severe cases, don't worry about whether within 48 hours but in any stage of severe illness they can start treatment."
 * http://www.who.int/mediacentre/vpc_transcript_12_november_09_nikki_shindo.pdf

Someone rewrites that in more formal language and that's going to improve it? And especially if a second or third person rewrites it again. No, it's not going to improve it.

And from the very first paragraph of our article: "The 2009 flu pandemic is a global outbreak of a new strain of H1N1 influenza virus, often referred to colloquially as "swine flu". .  .  "  I think it was wikiwatcher1 who described "colloquially" as a spelling bee word, and yeah, he pretty much hit the nail right on the head. Either he or someone else changed it to a more common word like "informally." And now, apparently someone has changed it back. And that's what we do. We spend an enormous amount of time debating questions of formality.

And from our second paragraph: "The outbreak began in Veracruz, Mexico, with evidence that there had been an ongoing epidemic for months before it was officially recognized as such. The Mexican government closed most of Mexico City's public and private facilities in an attempt to contain the spread of the virus. However the virus continued to spread globally, clinics were overwhelmed by people infected,  .  .  .  "  I don't think Mexico closed schools and offices in an attempt to completely stop the virus. I think they were just trying to slow it down. That is, we have overly cleaned up the narrative. And the very last part is arguably overstated and alarmist. Clinics is some areas have been overwhelmed, but not clinics globally.

And from our "Symptoms and severity" section before yesterday: "Dr. Thomas R. Frieden, Director of the CDC, suggests that people with "underlying conditions" who come down with flu symptoms should consult their doctors first before visiting an "emergency room full of sick people," since it "may actually put them in more danger." "

But, from the New York Times article: "Such anxiety has been a headache for doctors. They say that people with underlying conditions who have flu symptoms should consult their doctors, but that visiting an emergency room full of sick people may actually put them in more danger." http://www.nytimes.com/2009/05/28/health/policy/28flu.html?_r=1

Quite a difference. Such that Dr. Thomas Frieden didn't say that at all! Plus, these are not direct quotes. They are just part of the narrative of the article.

But, that's what happens. If a second, third, fourth person rewrites a citation, it may drift considerable from the original source. (I made this correction yesterday. But in no way do I have the time, or energy, to check even a tenth of our citations.)

---

But still, our biggest problem is omissions. For example, our "Vaccines" section includes "On December 15, 2009, manufacturer Sanofi-Aventis recalled 800,000 doses of pediatric vaccine in the United States because of slight under-potency.  .  .  "  But we don't talk about a later recall:


 * "Just a week later, MedImmune issued a low-potency recall of 4.7 million doses of intranasal child vaccine. Neither poses a safety risk .  .  .  "
 * Read more: http://www.fiercepharmamanufacturing.com/story/potency-drops-investigated-h1n1-vaccines/2010-01-06#ixzz0brULgZOZ

(Apparently, vaccines on the shelf seem to decline in potency over time. Again, not a safey issue, but an issue of how much protection the vaccine is going to give.)

We need to find other news sources, not just what looks like a company site. And we need to try and find this on the CDC site if at all possible. It's all a fair amount of work.

Okay, back to the CDC warning signs for infants (say that the virus has gone deep enough into the lungs to have caused direct viral pneumonia or acute respiratory distress syndrome)

"In addition to the signs above, get medical help right away for any infant who has any of these signs: "•	Being unable to eat "•	Has trouble breathing "•	Having no tears when crying" http://www.cdc.gov/h1n1flu/homecare/warningsigns.htm

I take it that there are saying---"In addition to the sign above"---be particularly alert if any of these happen to an infant. Cool Nerd (talk) 20:08, 6 January 2010 (UTC)


 * Please remember, I am not a doctor at all (just an ol' country boy with the skill of doggedness).
 * Now, what I would consider to be real experience would be the following:
 * “Dr. [Steven] Davidson has been practicing Emergency Medicine since 1976  .  .  . ”
 * http://www.maimonidesmed.org/clinical.cfm?id=681
 * That is experience! And so if that ol' boy says something about the flu, I'm likely to listen to him.
 * All the same, I don't think he'd attempt to rewrite Dr. Nikki Shindo, because as WHO's Medical Officer for Global Influenza Programme, she's Jane-on-the-Spot. She probably spends a lot more time reading country and region reports than he does.
 * Now, if someone asks me what my threshold is for direct pronouncements on influenza, I'd say two years as a resident. Two years in which a person with their own eyes and their own hands directly evaluates sick babies.


 * And I'd suggest this for moving forward: What if for the three danger signs CDC specifically lists for infants I include . . (especially if an infant).  I ask, let's try that for a while and see how it goes.   Cool Nerd (talk) 22:32, 6 January 2010 (UTC)


 * No, please do not change it again since you are not correct. The CDC has  not said that those 3 signs are any more important than the others.  Did you look at the other CDC site that I offered that listed children which included infants?  If you had medical training you would have known that those three signs are not more important than the others.  It would be very irresponsible of you to change the article just because of your misunderstanding. And BTW, even without medical training it should be obvious that not taking fluids is much more important than not eating. Gandydancer (talk) 23:23, 6 January 2010 (UTC)


 * Since you continue to ignore the information in this discussion I have changed the CDC site. Gandydancer (talk) 11:48, 7 January 2010 (UTC)

late December: 2nd U.S. recall of vaccine, again for potency, not for safety
Second H1N1 vaccine recall announced, The Tampa Tribune, December 27, 2009:

“ .  .  .  MedImmune notified the CDC and FDA that during routine, ongoing stability testing that 13 lots of its nasal spray vaccine's potency decreased below the pre-specified limit, according to a press release. This recall only involves a slight decrease in potency and is not safety-related. . .  ”

“ .  .  .  Highlands County received 1,100 doses from the MedImmune manufacturer and these lots were among the first to be delivered to the counties and therefore have been administered when they were at full potency. Therefore, the CDC and FDA do not recommend revaccination of persons who received the vaccines included in these lots. . .  ”

---

see also: http://www.fiercepharmamanufacturing.com/story/potency-drops-investigated-h1n1-vaccines/2010-01-06#ixzz0brULgZOZ

More swine flu vaccine recalled: FDA, CHICAGO (Reuters), Julie Steenhuysen, Wed Dec 23, 2009: “The U.S. Food and Drug Administration said on Tuesday AstraZeneca's MedImmune unit is voluntarily recalling some of its H1N1 swine flu vaccine because it was not as potent as it should be. . .  ”

" .  .  .  but only about 3,000 of those doses are left in warehouses.

"The rest of the doses were given out in October and November, when the vaccine was still at full potency, Baylor told reporters on a conference call.

"The FDA said people who had already received the vaccine do not need another dose. .  .  "

“ .  .  .  MedImmune is recommending that all lots marked with an expiration date of between January 19 and January 26, 2010 not be used. . .  "

---

and see: http://www.cdc.gov/h1n1flu/vaccination/sprayrecall_qa.htm


 * posted by Cool Nerd (talk) 02:12, 7 January 2010 (UTC)


 * So what exactly is your point? Why are you digging this old stuff up now?  I am starting to feel manipulated by you (since I feel I must read all of your posts) and it's starting to piss me off.  It is starting to seem to me that you are just moving from one complaint to another to express your dissatisfaction with this article.  Perhaps you should spread your interest to other articles since you obviously have no medical background.  Certainly I hesitate to post this, however you seem to have no problem with posting your spur-of-the-moment thoughts. Gandydancer (talk) 03:33, 7 January 2010 (UTC)


 * My general position is that accuracy and completeness of information is more important than the trappings of formality. And apparently, this is enough to make me a radical on wikipedia.  You are not required to read anything I write, nor is anyone else.  I might suggest that you and I try to cool it for a while as far as arguing.  I plan to ask a more experienced member if he'd be willing to referee.  You might want to do the same, or not.  It's entirely your choice.


 * And I think this recall of vaccine is important enough to include in our article.  Cool Nerd (talk) 21:04, 7 January 2010 (UTC)


 * I apologise for my post. I was frustrated and angry about the "warning signs" section but that is no excuse for my personal attack of Cool Nerd. Gandydancer (talk) 12:54, 9 January 2010 (UTC)


 * Thank you. I fully accept the apology.  And Gandydancer, I would like to offer you an apology for including jokes and comedy when it should have been patently obvious to me that you wished to discuss the issue seriously.   Cool Nerd (talk) 17:21, 12 January 2010 (UTC)


 * Thank you! I am glad we can go on in friendship.  Please ignore my post about feeling manipulated, etc.  I did feel that way at the time because of my concern about the S & S entry, but I do not generally feel thay way.  I do read your input and feel it is valuable.  As for jokes, etc., I do love to laugh! (I LOVED that joke that Tim wrote on his page!)Gandydancer (talk) 22:39, 12 January 2010 (UTC)

Some interesting flu facts
"In the federal government's explanations of swine flu, through its Web site and public-service announcements, one message has come through loud and clear: seniors can rest easy. Children face a much greater risk from this disease, and they are dying from it in numbers never seen with regular, seasonal flu. Maybe seniors even have some special immunity to H1N1."

Article here: http://www.newsweek.com/id/229947  —Preceding unsigned comment added by Gandydancer (talk • contribs) 13:02, 9 January 2010 (UTC)

False pandemic
Several news articles have been published by reliable sources questioning the authenticity of this "pandemic" manufactured by drug companies, why is there no mention of it here? JBsupreme (talk) 20:08, 12 January 2010 (UTC)
 * Please list any such sources, so we can read them too. Tim Vickers (talk) 20:42, 12 January 2010 (UTC)


 * This talk has been going on for some time now. What's her name, Chan?, spoke of it at a recent WHO meeting.  She spoke very well, and certainly I was convinced that if anything dishonest went on, she was not aware of it.  It is too soon to know for sure exactly what is going on.  But there are plenty of rumors that the members of the WHO are "secret members" (I believe that that is factual) and that at least some of them do have connections to the very same corporations that made massive amounts of money from the vaccine (I tend to believe that as well).  Also, for a fact, the meeting in which they decided to change the definition of pandemic so as to include the H1N1 pandemic was done in secrecy and no minutes of the meeting were taken.


 * As we all know, many countries now have a lot of vaccines that they'd like to get rid of. Several European countries are beginning to suggest that they were conned into stocking up to such a degree, that the WHO hyped the H1N1 to make it seem like a real killer virus.  There may be some truth to that, who knows for sure?, however we all remember very well that at its start in Mexico we were getting figures that DID make it seem that it was more of a killer than it turned out to be, most likely because they had many more cases of mild flu that had not been reported.  I have to go for now, but after dinner I will continue this post with what is going on in the UK and hope to find some links. Gandydancer (talk) 23:08, 12 January 2010 (UTC)


 * More...and please remember that I am not saying that I support any of this, I am only posting what I have found.

Scandal prompts WHO to assert consistency in pandemic definition

The World Health Organization has said they have not changed the definition of pandemic during the course of the influenza A (H1N1) outbreak.

http://www.thanhniennews.com/healthy/?catid=8&newsid=54637

(copyvio from above address redacted, just the link please)

Some links: http://news.bbc.co.uk/2/hi/health/8455035.stm http://www.abs-cbnnews.com/world/01/12/10/under-fire-who-ready-review-handling-flu-pandemic http://www.reputationmanagementfor.com/blog/2010/01/12/pharmaceutical-companies-and-bird-flu/ Gandydancer (talk) 23:46, 12 January 2010 (UTC)


 * recently from the CDC (that is used in the recent addition to the article) http://www.cdc.gov/flu/weekly/?s_cid=ccu082109_SeasonalInfluenzaWeekly_e Gandydancer (talk) 16:05, 13 January 2010 (UTC)


 * Sounds like one politician making a fuss on the basis of some highly questionable assertions, too early to judge if this story will have any long-term significance. Tim Vickers (talk) 21:05, 13 January 2010 (UTC)


 * For-profit organizations wish to make a profit, people who seek powerful public offices seek power, scientists faced with too little data make ambiguous statements, and organizations responsible for public safety choose choices that are "better safe than sorry". This is obviously breaking news. Right.  WAS 4.250 (talk) 21:28, 13 January 2010 (UTC)


 * Reading my above post I said " that the members of the WHO are "secret members". What I meant to say was that their vote is done in secret. Gandydancer (talk) 22:14, 13 January 2010 (UTC)


 * So is my vote when I vote in elections. Water is wet. Do you have a point here??? WAS 4.250 (talk) 22:38, 13 January 2010 (UTC)


 * And do your local representatives and your state representatives vote in secret as well? Or is their vote public information, so as to judge them on whether or not your tax money is being well-spent.Gandydancer (talk) 10:19, 14 January 2010 (UTC)


 * Very good point. We do vote in secret to elect our representatives, and once elected, our representatives cast their votes publicly.  Cool Nerd (talk) 21:01, 21 January 2010 (UTC)

Probably should include claims of conflict of interest and WHO's response
Himalayan Blunder, Comment, Times of India, 20 January 2010, 12:00am IST: “ .  .  .  The ties between the members of the board and pharma majors have prompted speculation that the WHO colluded with drug manufacturers to panic governments into buying vaccines. While that may not necessarily be true, at the very least such ties do amount to a significant conflict of interest. . .  ”

Pandemic Flu Scare Fades, Vaccine Glut Seen for Glaxo (Update1), Bloomberg, by Andrea Gerlin, Jan. 15, 2010: ‘ .  .  .  The Strasbourg-based council [Council of Europe], set up in 1949 to promote democracy and human rights, will debate Wodarg’s proposed resolution on Jan. 28 that governments made unnecessary vaccine purchases after drugmakers, seeking to boost sales, influenced them. . .  ’ . . ‘  .  .  .  “The orders were decided in May and June, a moment of real uncertainty,” Didier Houssin, director general of health in France, said at a Paris news conference last month. “We were working under the possibility it could require two shots a person.”. . .  ’


 * posted by Cool Nerd (talk) 18:54, 19 January 2010 (UTC)


 * That's in the article already, see 2009_flu_pandemic, 7th paragraph. This is already a bit long for balance, so if you wish to add something else on the subject you'll need to cut some of the existing discussion. Tim Vickers (talk) 19:28, 19 January 2010 (UTC)


 * I will see what I can do.  Cool Nerd (talk) 01:04, 21 January 2010 (UTC)

Other sections deleted from article
Regarding the probable or possible history of novel H1N1, a July 9, 2009, New England Journal of Medicine article states: "H1N2 and other subtypes are descendants of the triple-reassortant swine H3N2 viruses isolated in North America. They have spread in swine hosts around the globe and have been found to infect humans. The segments coding for the neuraminidase and the matrix proteins of the new human H1N1 virus are, however, distantly related to swine viruses isolated in Europe in the early 1990s."

--

The basic reproduction number (the average number of other individuals that each infected individual will infect, in a population that has no immunity to the disease) for the 2009 novel H1N1 is estimated to be 1.75.

---

The pandemic is expected to peak by mid-winter in the Northern hemisphere. The CDC recommended that initial vaccine doses should go to priority groups such as pregnant women, people who live with or care for babies under six months old, children six months to four years old and health-care workers. In the UK, the NHS recommended vaccine priority go to people over six months old who were clinically at risk for seasonal flu, pregnant women, and households of people with compromised immunity.


 * Note: In a Jan. 14th press conference, WHO's Dr. Keiji Fukuda said "  .  .  . and it is has not gone back to baseline. Based on the situation, our current assessment is that it remains too early to say that the pandemic is over. This is because we continue to see continued activity at elevated levels in a number of countries. And because it is unclear whether we will see in the northern hemisphere over the next few months during the winter and spring period another significant wave of activity and also because we do not know yet what will happen in the southern hemisphere during its winter months.  .  .  "
 * http://www.who.int/mediacentre/vpc_transcript_14_january_10_fukuda.pdf

To combat the virus, the WHO and the US government geared up for a massive vaccination campaign in late 2009, one not seen since Jonas Salk discovered the polio vaccine in 1955.

The Mayo Clinic suggested personal measures to avoid seasonal flu infection were applicable to the 2009 pandemic: vaccination when available, thorough and frequent hand-washing, a balanced diet with fresh fruits and vegetables, whole grains, and lean protein, sufficient sleep, regular exercise, and avoiding crowds. Smoking raises the risk of contracting influenza, as well as producing more severe disease symptoms. In Melbourne, Astralia, Fifty percent of hospitalized 2009 influenza patients without identified risk factors were smokers.

Leading health agencies have stressed that eating properly cooked pork or other food products derived from pigs would not cause flu.

-


 * I'm just using my best judgment calls of what might be less helpful, less relevant, and esp. less timely. Please jump in and help.   Cool Nerd (talk) 19:03, 21 January 2010 (UTC)


 * Is this meant to suggest that the pandemic is (somewhat) over? We could still get a third wave, at least that's my understanding. Gandydancer (talk) 19:46, 21 January 2010 (UTC)

Preparing to demote our Diagnosis section

 * So, we can demote this section to here the Discussion, and in good time, let it demote to the Archives.  Cool Nerd (talk) 18:34, 21 January 2010 (UTC)
 * How about no, let's not butcher the article by randomly removing major sections. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 00:21, 22 January 2010 (UTC)
 * Yes. This section should never have been added to a general disease topic. Average readers can be told about symptoms to watch for, but only doctors are allowed to give a true "diagnosis." --Wikiwatcher1 (talk) 03:32, 22 January 2010 (UTC)


 * Explanation. The article Medical diagnosis includes this in its "Overview" section:
 * ==Overview==
 * Typically, a person with abnormal symptoms will consult a health care provider such as a physician, podiatrist, nurse practitioner, or physicians assistant, who will then obtain a medical history of the patient's illness and perform a physical examination for signs of disease. The provider will formulate a hypothesis of likely diagnoses and in many cases will obtain further testing to confirm or clarify the diagnosis before providing treatment.


 * Medical tests commonly performed are measuring blood pressure, checking the pulse rate, listening to the heart with a stethoscope, urine tests, fecal tests, saliva tests, blood tests, medical imaging, electrocardiogram,hydrogen breath test and occasionally biopsy.


 * BTW, even the Common cold doesn't include a diagnosis section. --Wikiwatcher1 (talk) 04:25, 22 January 2010 (UTC)


 * This issue was settled (several times) already. Wikipedia is not a resource for "patients", or for "non-experts", but for everyone.  The articles should not be dumbed down arbitrarily.  And outside of the neverland where legal disclaimers are written, ordinary people do diagnose and treat themselves for flu - in this case they were often advised to avoid professional consultation except for "severe" cases (also a self-diagnosed criterion). Mike Serfas (talk) 22:14, 23 January 2010 (UTC)


 * The fat lady has not yet sung on this one. It is too soon to start scraping stuff.  There could be a third wave.  Let's just leave well enough alone for now...Gandydancer (talk) 22:38, 23 January 2010 (UTC)


 * I agree---too early to call. My goal was to save space so that we can freely and easily add new information (preferably within a week).  And regarding the diagnosis section, I would respond this way.  We are presenting an idealized version as if it’s factual, and it just isn’t.  It’s not even recommended.   Cool Nerd (talk) 04:50, 28 January 2010 (UTC)


 * For example, Dr. Nikki Shindo from her Nov. 12th virtual press conference: “  .  .  .  And regretfully many doctors reported that the treatment has been delayed because the doctors wanted to wait for the test result. They wanted to have the proof that the patients were infected by H1N1 but if the epidemiological information suggests that the virus is circulating then the doctors should not wait for the laboratory confirmation but make diagnosis based on clinical and epidemiological backgrounds and start treatment early.  .  .  ”  [in response to question from Helen Branswell, Canadian Press]
 * http://www.who.int/mediacentre/vpc_transcript_12_november_09_nikki_shindo.pdf


 * Diagnosis generally is not ideal for any disease. That's why it can be so difficult and the reason that misdiagnosis is so often made.  If someone presented with an apparent stroke or heart attack you would not wait for the lab tests, etc., to come back.  You'd treat on your best educated guess because the first minutes and hours are so important.  But you'd still do all the testing.  If you turn out to be wrong, it was still better to err on the safe side. Gandydancer (talk) 13:49, 28 January 2010 (UTC)


 * I like the example of heart attack, go ahead and treat based on clinical diagnosis, deal with the immediate here and now. And lab tests---I think often of enzymes in the blood (again, I am not a doctor)---can provide later confirmation.  But with less serious cases, whether they should or whether they shouldn't, it seems like doctors often do not follow this approach.  For example, in the case of a routine infection, once a doctor makes an initial determination viral vs. bacteria, hit the patient with one broad-spectrum antibiotic, and if that doesn't work, hit 'em with another.   Cool Nerd (talk) 20:07, 29 January 2010 (UTC)


 * Sometime there is no choice because it takes time to culture the organism to see what it is. However, you are correct, antibiotics are often not used appropriately.  See the wiki "antibiotic misuse" article.  Gandydancer (talk) 20:35, 29 January 2010 (UTC)


 * Now, I think this is where I can play to strength as a nondoctor, for I am not chomping at the bits to say how medicine should be practiced. Instead, I'm just struggling to learn and catch up with how medicine currently is practiced.  And that should be our starting point in any case.   Cool Nerd (talk) 02:02, 1 February 2010 (UTC)


 * And following is a New England Journal of Medicine article, that for patients with clinical symptoms of flu and if a chest X-ray indicates pneumonia, it is recommended that the patient receive BOTH antivirals AND antibiotics.


 * Hospitalized Patients with 2009 H1N1 Influenza in the United States, April–June 2009, New England Journal of Medicine, Jain, Kamimoto, et al., Discussion section (8th paragraph), Nov. 12, 2009: "  .  .  .  In our study, only 73% of patients with radiographic evidence of pneumonia received antiviral drugs, whereas 97% received antibiotics. In the absence of accurate diagnostic methods, patients who are hospitalized with suspected influenza and lung infiltrates on chest radiography should be considered for treatment with both antibiotics and antiviral drugs.[10]  .  .  .  "  (I seem to remember this article being before Nov. 12th.  Perhaps this is an updated version.  Cool Nerd (talk) 17:17, 1 February 2010 (UTC))


 * And from earlier in this same paragraph: “  .  .  .  Although it is difficult to precisely determine the cause of pneumonia from radiographs, during the 1957–1958 influenza pandemic, Louria et al.[18] reported findings of diffuse bilateral infiltrates in patients with primary influenza viral pneumonia, whereas lobar infiltrates were seen in patients with secondary bacterial infections.  .  .  ”
 * http://content.nejm.org/cgi/content/full/361/20/1935

Trimming ideas
There's a lot of dated material, much of it written as news reports, that can be removed without any harm to the article. There are also numerous minor facts with multiple cites, so removing one of the cites should mostly be OK. Any support for a citosuction?

Also, have there been any discussions about the article title, now that it's 2010? --Wikiwatcher1 (talk) 04:01, 22 January 2010 (UTC)
 * Re: the title: Yes, it's apparently been archived now; I broached the subject (having observed via an interwiki bot edit that French Wikipedia changed their article to be "2009-2010"), someone else brought up the precedents of the previous pandemics, which are named for their first year despite their multi-year length in some cases. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 04:43, 22 January 2010 (UTC)


 * While I agree that there is some stuff, the vaccines that were found to be low-potency- information could be trimmed for instance, overall I am against removal of most information. The pandemic  is not yet over and the virus is mutating as you read this.  Those little guys are Survival of the Fittest on steroids.  Several mutations are being closely watched and a few "low reactors" (strains that have outsmarted the vaccine), are being watched as well.  Gandydancer (talk) 12:39, 25 January 2010 (UTC)


 * Furthermore :-), there is no reason to not continue to be concerned that the H1N1's could mate with their H5N1 cousins and produce horrible demon children as happened in 1918. It would be the worst scenario imaginable and the death might not stop till they ran out of hosts. Gandydancer (talk) 09:31, 26 January 2010 (UTC)

Does WHO criticism need its own section?
I feel that the WHO criticism does not really fit in the vaccine section. Does anyone else have any thoughts on this? Gandydancer (talk) 12:47, 25 January 2010 (UTC)


 * Certainly not, since the initial scattered reports of that German politician's comments the story has attracted little interest. I'm therefore doubtful as to if we should even continue to cover this in the article, since it seems to have been a passing story of no long-term importance. Promoting this to its own section would be an even worse violation of WP:UNDUE than it may be at present. Tim Vickers (talk) 17:28, 25 January 2010 (UTC)


 * As you like, however it was not my intention to "promote" this. But it is in the news, India has come out with a statement and the European group will discuss it next week. WHO has come out with a second statement.  And of course the rumor mills are busy with it.  My intention was to offer another point of view since the rumors may make more news than what the WHO has to say. Gandydancer (talk) 19:03, 25 January 2010 (UTC)


 * I also am of the impression that this is not a marginal, "dying" story. This week one of Norway's largest circulation publications, A-Magasinet feature this story in a 7-page spread titled "Were we fooled?" going into extensive detail over the issues which Wolfgang Wodarg has brought up. And for a mainstream Norwegian publication to do this is of added interest because Norway is the third largest national contributor to the WHO. Also, Wodarg's initiative has been covered fully by a high number of mainstream international news media. __meco (talk) 19:06, 26 January 2010 (UTC)


 * The "scattered reports" have led to the WHO refuting the accusations being covered on a scale which suggests that the requested criticism/controversy section of the currect article is far from UNDUE or FRINGE. __meco (talk) 19:19, 26 January 2010 (UTC)


 * We have an accusation and a denial, this article currently notes both events. There is not much more we can say about the story until the WHO investigation is completed. At the end of last year the "controversy story" in flu vaccines was safety (remember the squalene scare stories?) Now that has faded off to nothing and a new "controversy story" has replaced it. We cover this as a small part of the overall political and governmental response to the pandemic over the past year, but imagining that this is particularly important is giving undue weight to a minor European political event. Tim Vickers (talk) 19:43, 26 January 2010 (UTC)


 * I think the problem with the article is that the coverage of the controversy is too hard to find. As we have to option of recursive header levels perhaps the Wodarg-fronted controversy could be presented with a sub-level header within the vaccines section. __meco (talk) 21:36, 26 January 2010 (UTC)


 * If you're advocating having a sub-section in the Vaccines section on Wodarg's comments and not a sub-section on vaccine safety or effectiveness, then I suppose you must believe that his comments are a more important news story than the other topics covered in the vaccine section. Wodarg results, flu vaccine safety results flu vaccine effectiveness results. If not, why would you want to highlight one of the several topics covered in this section for the readers (ie "make it easier for readers to find") but not the others? Tim Vickers (talk) 21:48, 26 January 2010 (UTC)

Shouldn't "Swine Flu" redirect to the article on swine influenza?
The redirection to this article gives the impression that the term "swine flu" didn't exist prior to 2009. —Preceding unsigned comment added by 122.107.81.33 (talk) 00:17, 6 February 2010 (UTC)

WHO Weekly Update, Feb. 5, 2010.
Pandemic (H1N1) 2009 - update 86, Weekly update, 5 February 2010:

"As of 31 January 2010, worldwide more than 209 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including at least 15174 deaths. .  .  "

" .  .  .  In North Africa, pandemic influenza transmission remains active and geographically widespread but overall activity has been declining since peaking during late December 2009 and early January 2010.  .  .  "

" .  .  .  In northern and southern China, rates of ILI have returned to levels seen during recent seasons; however, approximately 30% of respiratory specimens tested were positive for influenza suggesting that active transmission of influenza viruses persists. Of note in China, in recent weeks the circulation of pandemic influenza H1N1 continued to decline with a concomitant increase in the circulation of seasonal influenza type B viruses (pandemic H1N1 and seasonal Type B viruses accounted for 34% and 66% of all influenza viruses detected, respectively).  .  .  "

" .  .  .  In addition to the increasing proportion of seasonal influenza type B viruses recently detected in China, low levels of seasonal H3N2 and type B viruses are circulating in parts of Africa, East and Southeast Asia and are being detected only sporadically on other continents.  .  .  "


 * posted by Cool Nerd (talk) 01:31, 9 February 2010 (UTC)


 * Now, as far as co-circulation of different flu viruses: Okay, first off, the good news, oseltamivir (Tamiflu) treats both 2009 influenza A (H1N1) as well as both seasonal influenza B and seasonal A (H3N2).  What oseltamivir does not effectively treat is seasonal A (H1N1).  And thus for China, it would appear that the situation so far is manageable.  Cool Nerd (talk) 20:06, 9 February 2010 (UTC)


 * For more information see Fluview, A Weekly Influenza Surveillance Report Prepared by the Influenza Division, CDC, 2008-2009 Influenza Season Week 39 ending October 3, 2009, especially the section in the middle on “Antiviral Resistance.”

in favor of a “Current Situation” section
Many readers understandably want to know what’s going on right now, and on a deeper level, that’s half the story. And perhaps more than half the story since 2009 influenza A (H1N1) first became known in April ’09 (and maybe existing on a smaller scale for several months prior), but will go on, for who knows how long? Now, we could quote various scientists and public health officials regarding their predictions for the future. But many of the best ones are cautious, saying we don’t really know how things will develop. And so, a better way may be to simply include somewhat more material about the present, all the while acknowledging that we do not know which of these trends or aspects will prove to be most significant, but this is what’s going on right now. And for you, our reader, we are laying it on the table the best we can. encyclopedia --> completeness

Yes, I would say the defining characteristic of an encyclopedia is completeness. (it sure isn’t formality which is window dressing at best.) Whether the topic is Etruscan Art, the life of Gautama Buddha, the Magna Carta, etc, does our article cover the main aspects with reasonable completeness? And I encourage us to think through what this might mean for ongoing situations. Cool Nerd (talk) 15:23, 10 February 2010 (UTC)


 * Cool Nerd, I'd agree with you and also add that the beauty of Wikipedia is wikipedia --> currentness. As any student knows, text books change so rapidly that new rather than used books are frequently bought, and they are not cheap, either!  Not that it would have to be this way, but in our throw-away-and-buy-new society, that's how we do it.  Small wonder that so many students look to wikipedia for information.


 * Yes, it would seem that we are at a "looking back and looking forward" stage. I have a few thoughts and references that I was going to post under existing sections, but I will post them here.  Mostly my thoughts center around what can happen when agencies that we pay for feel the need to do things behind closed doors and release information in a less than honest way.  I don't think that one can deny that the 1009 flu did not turn out to be the killer that some predicted that it would be.  And, it would not surprise me one bit to find that multinational drug companies had a hand in pushing this scenario.  Why?  Because it is true that every other governmental agency that I know of is more in the business of protecting business, than protecting people.


 * That said, I do feel that this pandemic DID have the potential of being a real killer that would have had even worse repercussions than the deadly 1918 pandemic. I do NOT feel that it was a mistake to react very strongly and proactively.  My fear is that when a mutant comes along, and it will, that really does turn out to be deadly, people will be slow to accept recommendations, and this will be, at least in part, because the CDC and the WHO have been secretive in their dealings with governments and people.  See this discussion:  http://www.recombinomics.com/News/02091001/H1N1_Fake.html  And see this old article re the CDC:  http://www.cbsnews.com/stories/2009/10/21/cbsnews_investigates/main5404829.shtml?tag=cbsnewsLeadStoriesArea  —Preceding unsigned comment added by Gandydancer (talk • contribs) 16:10, 10 February 2010 (UTC)


 * Gandydancer, I think it’s worse than it used to be. Medical schools, and large universities with research programs, used to be far more independent.  Now, so much of the research is done in “partnership” with industry, who is genuinely independent any more?  That said, Tim in his comments above, does bring up good points, including how much of the current controversy is primarily on the basis of what one guy, Dr. Wolfgang Wodarg, is saying?


 * I suggest (in Zen turnaround!) that we look at it as a gift. We look at the very fact of the uncertainly as a gift.  It is not our job to strive for definite conclusions.  As always, we just want to present good information and let the reader decide for himself or herself.  Even if we try to find and provide the “best” information, that is a perfectionist trap.  Instead, let’s just present information that is merely good, and present it as we find it.  And as our merely good information is supplanted by better and/or more recent information, we roll with that (perhaps demoting the older information to here the Talk page and then the archives).  Now, I prefer direct quotes, but so many of our fellow participants object, for the sake of moving forward, we can use summaries.  And perhaps save the occasional direct quote for a particularly juicy quote from a doctor or public health official that really gets a point across.


 * There was a report by the President’s Council of Advisors on Science and Technology (United States) back around August that estimated fatalities from the swine flu at between 30,000 and 90,000, compared to a baseline of approximately 36,000 people dying from the flu each year in the United States. So, it needn’t only be a super flu to be taken seriously.  If it’s, say, 40,000 over baseline, that’s serious enough.  In addition, I think more children have already died from influenza for the 2009-2010 flu season than is typical for a season, a real tragedy.  So, it certainly has not been all hype.  There has been real tragedy.


 * I would draw an analogy between preparing for a flu pandemic and Hurricane Katrina/evacuating New Orleans. Since we don’t have complete information and are always operating with uncertainty, we might adapt a strategy of 3 for 1.  We try and target it so that we evacuate the city three times for each one time it’s hit, and we spend the money to evacuate it these three times (putting aside the fact whether it’s going to be a mandatory or a voluntary evacuation, it’s still going to cost some money).  Now, each time we evacuate the city and it doesn’t get hit by the hurricane looming in the gulf, there will be major, major complaints.  I don’t see how we can avoid that.  In fact, 3 for 1 is a pretty passive strategy.  I think a case could be made to run a 5 for 1 strategy.


 * And for a possible flu pandemic, manufacturing and administering a vaccine seems so much cheaper than evacuating a city, maybe we should run a 10 for 1 strategy. And I’m still amazed that it takes five months to manufacture (and test) a vaccine once we’ve both already isolated the virus and have decided what vaccine we want to make.  Since we’re using a killed vaccine, since we’ve done this so many times---and if there’s a wide range between an effective dose and an unsafe dose, which I don’t know at all (again, I’m not a doctor, just an averagely smart country boy)---maybe we can skip some of the testing, or test as we go along, knowing that we’ve done something very similar many times.


 * In any case, a lot of work to do. A lot of good issues to include, with authoritative references (this country boy has quickly scanned New England Journal of Medicine and let it washed over him like water, then gone back and read and quit a second time, then gone back and read and took notes the third time).  We can make a good article even better!   Cool Nerd (talk) 17:23, 11 February 2010 (UTC)


 * the Recombinomics Commentary, February 09, 2010, I summarize as follows:
 * http://www.recombinomics.com/News/02091001/H1N1_Fake.html
 * The situation at Duke University Hospital back in mid-Oct., early Nov., in which there was transmission among severely immunocompromised patients of an oseltamivir-resistant strain was potentially way serious, was understated by WHO, and this made it easier for some politicians to claim that the whole H1N1 situation was overhyped. Four severely immunocompromised patients got this strain, and three of them died.---summary by Cool Nerd (talk) 23:33, 12 February 2010 (UTC)

New Eng J Med study for April 15 to May 5, '09---fever and cough as the signature symptoms?
Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans, New England Journal of Medicine, Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team*, June 18, 2009 (published on May 7, 2009, and was last updated on June 3, 2009, at NEJM.org):

“ .  .  .  The most common presenting symptoms were fever (94% of patients), cough (92%), and sore throat (66%);. . .  ”


 * posted by Cool Nerd (talk) 01:58, 15 February 2010 (UTC)

POV issue? Headline of table, "2009 flu pandemic data " gives false impression -- specific would avoid creating misimpression; i.e., "2009 flu pandemic, 'laboratory confirmed deaths"
The accurate information is that there were hundreds of millions of cases and many tens of thousands of deaths. This is the lead, and it has been buried. —Preceding unsigned comment added by Ocdcntx (talk • contribs) 17:04, 21 February 2010 (UTC)

Child mortality in the United States
2009-2010 Influenza Season Week 6 ending February 13, 2010, CDC, Fluview: A Weekly Influenza Surveillance Report Prepared by the Influenza Division.

“ Influenza-Associated Pediatric Mortality. . .  Two hundred seventeen (83%) of the 262 deaths were due to 2009 influenza A (H1N1) virus infections, 44 were associated with an influenza A virus for which the subtype is undetermined, and one was associated with an influenza B virus infection. . .  ”

The chart in this section shows that 217 pediatric deaths from lab-confirmed 2009 H1N1 have occurred since Aug. 30, 2009, and 277 have occurred since April 26, 2009.


 * posted by Cool Nerd (talk) 01:11, 22 February 2010 (UTC)

Mutations
There is no mention of them NineNineTwoThreeSix (talk) 04:12, 1 March 2010 (UTC)


 * The threat of a mutation remains.   See this article:


 * Virus hybridization could create pandemic bird flu
 * February 22, 2010 Genetic interactions between avian H5N1 influenza and human seasonal influenza viruses have the potential to create hybrid strains combining the virulence of bird flu with the pandemic ability of H1N1, according to a new study.
 * http://www.physorg.com/news186071749.html Gandydancer (talk) 23:12, 12 March 2010 (UTC)

notable people who got H1N1
I think there should be an article for that don't you think? —Preceding unsigned comment added by User2010II (talk • contribs) 01:22, 24 March 2010 (UTC)

maybe if this was a serious disease that took out half the population and notable people died or were maimed by it, then maybe.. it should be in the article. Otherwise we can't really start a list of people who caught the flu now, can we? I mean by the next year or two its likely just about everyone will have caught it at some point... and this flu (up to this point) actually has caused less death then the regular flu usually does every year.. so Id go with no. -Tracer9999 (talk) 04:21, 24 March 2010 (UTC)

20th century flu pandemics table
This is actually kinda deceptive. We list estimated deaths for all the other flu's and labatory confirmed cases for pandemic h1n1. Im sure there was more then 14k deaths when reg flu does approx 250k yearly. It might be best to leave h1n1 out of the graph all together or find an estimate. otherwise.. the numbers are just misleading in the big scheme of things and is like comparing apples to oranges. -Tracer9999 (talk) 04:48, 24 March 2010 (UTC)
 * The chart clearly notes that caveat. "lab-confirmed" and "^† Note: The ratio of confirmed deaths to total deaths due to pandemic H1N1/09 flu is unknown. For more information, see "Data reporting and accuracy"." --<b style="color:#3773A5;">Cyber</b> cobra  (talk) 05:35, 24 March 2010 (UTC)

Two cases of antiviral-resistant H1N1 among immunocompromised patients, March 2010 news report
Resistance can develop fast with swine flu: report, Reuters, Mar 26, 2010:

“ .  .  .  Dr. Jeffery Taubenberger and colleagues studied two flu patients who had immune limitations due to past blood stem cell transplants. They were treated with Tamiflu.

“Writing in the journal Clinical Infectious Diseases, Taubenberger and colleague Dr. Matthew Memoli said the virus infecting one patient developed a drug-resistant mutation after nine days and the other after 14 days of treatment.

“And one of the patients also developed resistance against a second antiviral, Biocryst's peramivir, which is an experimental drug approved for emergency intravenous use in patients who cannot take Tamiflu. . .  ”


 * There were also maybe about a half dozen cases of this back around November.  Cool Nerd (talk) 20:15, 27 March 2010 (UTC)

WHO: As of March 19th, 267 cumulative cases of oseltamivir (Tamiflu) resistance reported
Pandemic (H1N1) 2009 - update 90, WEEKLY VIROLOGICAL SURVEILLANCE UPDATE, WHO, 5 March 2010:

“ .  .  .  264 cases of oseltamivir resistance have been reported by GISN and other partners. . .  ”


 * this reference is already in our article, currently at # 124   Cool Nerd (talk) 00:28, 29 March 2010 (UTC)

---

Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses:

“5 March 2010 -- For this reporting week (25 February - 3 March 2010), 11 new sporadic cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 264 so far. . .  ”

-

Weekly update on oseltamivir resistance to pandemic influenza A (H1N1) 2009 viruses

19 March 2010 -- For this reporting week (11 - 17 March 2010), 3 new sporadic cases of oseltamivir resistant pandemic influenza A (H1N1) 2009 viruses have been reported. It brings the cumulative total to 267 so far. All have the H275Y substitution and are assumed to remain sensitive to zanamivir. . .  ”


 * and added to article as reference  Cool Nerd (talk) 16:38, 1 April 2010 (UTC)

---

see also. . .  http://www.cdc.gov/eid/content/16/4/723.htm

not sure where we were getting “264 out of over 15,000” in Resistance section. Might be 264 out of over 24,000
from the beginning of the Resistance section:

“, the World Health Organization (WHO) reported 264 out of over 15,000 samples of the prevalent 2009 pandemic H1N1 (swine) flu tested worldwide have shown resistance to oseltamivir (Tamiflu). . .  .  ”

whereas the WHO briefing note states:

“ .  .  .  Since the beginning of the pandemic in 19 April 2009 to 27thFebruary, 2010, cumulatively 153 countries [emphasis added] shared a total of 24,304 specimens (18,748 clinical samples and 5,556 virus isolates) with WHO CCs for further characterization. The majority of pandemic A (H1N1) 2009 influenza viruses analysed to date are antigenically and genetically closely related to the vaccine virus A/California/7/2009. “Antiviral susceptibility surveillance has been conducted by the WHO Global Influenza Surveillance Network (GISN) including WHO CCs. So far, pandemic A (H1N1) specimens and isolates from at least 91 countries [emphasis added] have been tested, showing that oseltamivir resistant pandemic A (H1N1) viruses are sporadic with rare onward transmission. So far, 264 cases of oseltamivir resistance have been reported by GISN and other partners. All of these viruses showed the H275Y substitution and all remain sensitive to zanamivir. . .  ” Pandemic (H1N1) 2009 - update 90


 * So, a case could be made "264 out of more than 24,000"   Cool Nerd (talk) 01:27, 29 March 2010 (UTC)


 * However, it gets tricky. I'm not at all sure that these 24,304 specimens which have been further studied, are the pool from which we're saying 264 cases of oseltamivir resistance.  Because in one case you're talking about 153 countries and in the other, 91 countries, and they're in separate paragraphs.


 * So, long-term, we probably need to find clearer references (and on this one, WHO is not up to their usual high standards because usually they are very clear).


 * And in the meantime, I have changed this part to " .  .  .  the World Health Organization (WHO) reported 264 out of more than 24,000 samples of the prevalent 2009 pandemic H1N1  .  .  .  "    Cool Nerd (talk) 23:23, 29 March 2010 (UTC)


 * And, as above it's now 267 cases (added to article). But still, almost the most important question is the baseline.  Okay, so it's 267, but out of how many . . .    Cool Nerd (talk) 16:33, 1 April 2010 (UTC)

CDC, week ending ending April 3, 2010, testing for antiviral resistance
Antiviral Resistance: “ .  .  .  and 1,688 2009 influenza A (H1N1) virus isolates have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir), and 2,735 2009 influenza A (H1N1) original clinical samples were tested for a single known mutation in the virus that confers oseltamivir resistance. . .  ”

And from the chart Antiviral Resistance Testing Results on Samples Collected Since September 1, 2009, for 2009 Influenza A (H1N1): 4,423 samples have been tested and 52 have been found to be resistant to oseltamivir. (For zanamivir, 1,617 have been tested and zero have been found to be resistant.) http://www.cdc.gov/flu/weekly/   week ending April 3, 2010


 * So, I think we’ve got our baseline. I’m going to look at this a couple more times, but I think this is it.   Cool Nerd (talk) 19:20, 10 April 2010 (UTC)

"1,688 . . . tested . . . (oseltamivir and zanamivir)" Yet, the chart shows 1,617 tested for resistance to zanamivir. Wow. Well, like with system accidents, it is extremely difficult to get both big picture and details. And between the two of them, I'll take big picture. (And I'm sure there are things I'm not seeing, but multiple quick passes, and multiple sets of eyes, that helps.)

" .  .  .  The proportion of oseltamivir-resistant 2009 H1N1 viruses does not represent the prevalence of oseltamivir-resistant 2009 H1N1 in the United States. Most cases were tested because drug resistance was suspected.  .  .  "

" .  .  .  To prevent the spread of antiviral resistant virus strains, CDC reminds clinicians and the public of the need to continue hand and cough hygiene measures for the duration of any symptoms of influenza, even while taking antiviral medications  .  .  .  "


 * posted by Cool Nerd (talk) 18:10, 12 April 2010 (UTC)

NEJM: pandemic H1N1 is probably a reassortment of previous triple reassortment along with Eurasian pig
Geographic Dependence, Surveillance, and Origins of the 2009 Influenza A (H1N1) Virus, New England Journal of Medicine, Vladimir Trifonov, Ph.D., Hossein Khiabanian, Ph.D., and Raul Rabadan, Ph.D., July 9, 2009.

“Genomic analysis of the 2009 influenza A (H1N1) virus in humans indicates that it is closely related to common reassortant swine influenza A viruses isolated in North America, Europe, and Asia (Figure 1). . .  ”  And to see Figure 1. http://content.nejm.org/cgi/content-nw/full/361/2/115/F1


 * posted by Cool Nerd (talk) 22:00, 21 April 2010 (UTC)

treatment options for Acute Respiratory Distress Syndrome (ARDS)
Blood Oxygenation Key To Survival Of H1N1 Respiratory Failure Patients, New Zealand, Voxy, 13 October 2009:

" .  .  .  During 01 June to 31 August this year [2009], 68 patients with severe influenza A H1N1 associated acute respiratory distress, received Extracorporeal Membrane Oxygenation (ECMO) in 15 intensive care units across New Zealand and Australia," says Dr Shay McGuinness, Specialist in Cardiothoracic Intensive Care, at Auckland City Hospital. . .  ”

“ At the time of reporting, 54 of the 68 patients had survived and 14 (21 percent) had died. Six patients remained in ICU, including two who were still receiving ECMO. The 68 patients who received ECMO had a median (midpoint) age of 34.4 years and half were men.

“Acute Respiratory Distress Syndrome is a lung condition that leads to respiratory failure due to the rapid accumulation of fluid in the lungs. . .  ”


 * posted Cool Nerd (talk) 17:41, 30 April 2010 (UTC)

That's odd...there seems to be a ECMO page... http://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation Gandydancer (talk) 22:05, 30 April 2010 (UTC)


 * And it seems like an alright article. My question is, should we also have a couple of informative sentences about ARDS in our article here (with maybe one sentence on ECMO, or perhaps merely mentioning it)?   Cool Nerd (talk) 22:25, 4 May 2010 (UTC)

Removed
Removed inaccurate info about mortality rate in Japan because the figure quoted did not appear to be from the article which was referenced: http://knol.google.com/k/epidemiological-characteristics-and-low-case-fatality-rate-of-pandemic-h1n1# Nameless123456 (talk) 16:25, 16 April 2010 (UTC)


 * Thank you for checking the reference. It's something that needs to be done more often.   Cool Nerd (talk) 22:06, 21 April 2010 (UTC)

Use of positive end-expiratory pressure in SOME patients with ARDS
Lung Recruitment in Patients with the Acute Respiratory Distress Syndrome, New England Journal of Medicine, Luciano Gattinoni, M.D., F.R.C.P., Pietro Caironi, M.D., Massimo Cressoni, M.D., et al., April 27, 2006.

“ .  .  .  The lung-protection strategy combines the use of higher levels of positive end-expiratory pressure (PEEP) (greater than 12 to 15 cm of water) and low tidal volumes to prevent regional and global stress and strain on the lung parenchyma. Ventilation at low tidal volumes alone has been shown to increase survival among patients with acute lung injury or ARDS, and the addition of higher PEEP to low tidal volumes did not further increase survival. In patients with low levels of recruitable lung (i.e., lung tissue in which aeration can be restored) however, the application of higher levels of PEEP may be more harmful than beneficial, since it will serve only to increase inflation of lung regions that are already open, increasing the stress and strain on these regions. . .  ”


 * posted by Cool Nerd (talk) 22:40, 4 May 2010 (UTC)

Years of potential life lost
Should we mention the preliminary estimates of a high level of years of potential life lost due the pandemic? ? Nil Einne (talk) 09:28, 5 May 2010 (UTC)


 * Okay, while seasonal flu (and the serious cases and the fatalities) affects mainly young children and senior citizens, new strains of flu also have serious cases among older children and young adults. I'd first want to check if we already have a couple of sentences describing this in our article.   Cool Nerd (talk) 20:30, 7 May 2010 (UTC)

Possibility of universal flu vaccine in years to come?
Researchers take step to 'universal' flu vaccine, Reuters, Washington, Maggie Fox, Health and Science Editor, (Editing by Eric Walsh), May 25, 2010:

‘ .  .  .  The "neck" of hemagglutinin does not mutate the way more visible bits of the virus do, and if there was an easy way to help the immune system to see it, this provides a good antigen -- a target for a vaccine.

‘But the top, umbrella-shaped part of the hemagglutinin protein hides this vulnerable neck from the immune system. Palese's team found a way to get to the neck, cut it out and make a vaccine out of it

‘"A headless hemagglutinin molecule could form the basis for a broadly protective influenza virus vaccine," the researchers wrote.

‘"This paper is more proof of concept," Garcia-Sastre said in a telephone interview. "We don't think we have yet the most optimal way to display the antigen." . .  .  ’


 * posted by Cool Nerd (talk) 16:13, 28 May 2010 (UTC)

External Review Comments
The following comments are from an external reviewer BSW-RMH as part of the new joint Wikipedia talk:WikiProject Medicine/Google Project.

Hello 2009 Flu Pandemic article writers and editors, This article currently has GA status and is a priority article for the Wikipedia talk:WikiProject Medicine/Google Project. I hope that I can offer some useful suggestions to enhance it further. Specific suggestions are as follows:

Introduction
This topic is of great interest to communities worldwide, and it is critical that the information be factually correct and well-referenced. I am going to make some direct edits to sources that are more relevant or reliable than the current sources used in this section. The references to the 'number of incidences being in steep decline' have been replaced with WHO references because the Google.org Flu Trends shows total seasonal flu incidences, rather than just H1N1 incidences, and the AP article is not a reliable or up-to-date source for scientifc or medical statistics. In addition, this statement has been altered to reflect that the incidences are only in decline in most of the world. Some parts of the world are in their winter flu seasons and are still experiencing increases in the incidences of H1N1. Please see the noted resources for more information. These sources were replaced with:
 * WHO Pandemic (H1N1) 2009 - update 100, May 14, 2010
 * WHO Global Update on 2009 H1N1, Week 17(April 26, 2010-May 2, 2010)
 * WHO Map of influenza activity and virus subtypes, Week 17(April 25, 2010-May 1, 2010)
 * CDC 2009 H1N1 flu: International situation update Accessed May 14, 2010

In general, I highly recommend replacing newspaper articles with primary scientific or medical resource articles for this article. For example, I replaced: McNeil Jr., Donald G. In New Theory, Swine Flu Started in Asia, Not Mexico The New York Times 2009-06-23with:
 * Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection. N Engl J Med (2010);362:1708-19.
 * CDC. Outbreak of Swine-Origin Influenza A (H1N1) Virus Infection --- Mexico, March--April 2009. MMWR April 30, 2009/58(Dispatch);1-3 Accessed May 14, 2010


 * Comment: It is very difficult for people like me (like most of us) who are not able to access journal articles.  It is my nature to check out what I read for accuracy, and that's certainly true for Wikipedia.  But when news articles have been removed I am left with nothing other than some editor's word that it is correct.  That's not enough for me.  A NYT's article is better than nothing.  To add a journal ref is fine, but I wish it would be in addition to the news article and not a replacement. Gandydancer (talk) 19:43, 19 June 2010 (UTC)
 * You might want to read WP:SOURCEACCESS. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 20:03, 19 June 2010 (UTC)

In the paragraph mentioning susceptibility, I recommend noting that unlike most strains of influenza such those that cause seasonal flu, H1N1 does not disproportionately infect adults older than 60 years. This is an unusual and characteristic feature of the H1N1 pandemic. See: Writing Committee of the WHO Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza. Clinical Aspects of Pandemic 2009 Influenza A (H1N1) Virus Infection. N Engl J Med (2010);362:1708-19.
 * Done. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 22:09, 14 May 2010 (UTC)
 * Cybercobra, I can't find the info re H1N1 tended to not infect those over 60. Perhaps it has been removed? Gandydancer (talk) 19:33, 19 June 2010 (UTC)
 * It's under "Signs and symptoms". Try searching for "60" in the browser window next time. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 19:57, 19 June 2010 (UTC)
 * I saw that but I think the reviewer means that it should be in the lede. What do you think? Gandydancer (talk) 23:15, 19 June 2010 (UTC)


 * I agree with the review and I added it to the lede. Gandydancer (talk) 19:00, 22 June 2010 (UTC)

Total worldwide death figure was updated from 14,286 to the current figure of 18,036, and clarified to show this figure is for deaths confirmed to be due to H1N1 with laboratory testing. I also removed this statement "The WHO states that total mortality (including deaths unconfirmed or unreported) from the new H1N1 strain is "unquestionably higher" but this conclusion has been criticized." The total number of deaths that are reported by the WHO are only for laboratory confirmed cases and it is unequivocal that the number of unconfirmed cases far excedes the number of laboratory-confirmed cases and thus laboratory-confirmed deaths due to H1N1. *WHO Pandemic (H1N1) 2009 - update 100, May 14, 2010
 * Err, you didn't remove it. I've taken the liberty of amending it however. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 22:16, 14 May 2010 (UTC)
 * Thanks. BSW-RMH (talk) 15:19, 17 May 2010 (UTC)

In regards to the last paragraph: "The pandemic began to taper off in November and critics claimed the WHO had exaggerated the danger, spreading "fear and confusion" rather than "immediate information". The WHO began an investigation to determine whether it had "frightened people unnecessarily." This does not seem like a balance presentation of the WHO investigation and the recent reports. It relies heavily on articles on newspapers that chose to give voice to a "A small but vocal minority of scientists and government officials around the world"-a quote taken directly from the MSNBC source cited as support for this paragraph (WHO admits errors in handling flu pandemic: Agency accused of overplaying danger of the virus as it swept the globe, MSNBC.com news services, updated 11:15 a.m. CT, Mon., April 12, 2010). This type of questioning always occurs after a major worldwide health event, whether the agency errs on the side of caution or the side of risk. I strongly suggest rewriting this paragraph from a more balanced majority POV and taking into account the recent updates on the investigation.
 * Report of the First Meeting of the Review Committee on the Functioning of the International Health Regulations (2005) in Relation to Pandemic (H1N1) 2009, April 14, 2010

BSW-RMH (talk) 20:49, 14 May 2010 (UTC)


 * Comment: In my opinion the entry is an accurate representation of the current situation, and I feel that the MSNBC report does an excellent job of summing it up.  I always was in favor of covering it and even felt it could have used its own section, but there was resistance to that.  I think its important to consider that this information had gone viral in the blogs, forums, and emails. Then the Cochrane review of Tamiflu came out, and the blogs got hold of that...


 * There was and still is a large amount of mistrust of government in the US right now (and perhaps even the world).  If Wikipedia is to be trusted it must be careful to represent information from every point of view, and right now I'd bet that if you did a poll 50% of people would hold doubts as to whether or not the pandemic was orchestrated to sell the vaccine, and a pretty large percent would be convinced that it was.  Those of us who followed the progression are aware of why the WHO's decisions were so difficult, but the general public is not.


 * As for myself, I believe Margaret Chan to be an honest and honorable person and I do not believe that the WHO manufactured a pandemic to sell a vaccine, but I am far from ready to say that elements within the WHO did not set about to sway their actions for monetary gain. I think it would be very naive to not be aware of that possibility.


 * My fear has been, and remains, that when (or if) this strain mutates and does become deadly, people are going to resist the warnings. The blogs will  pounce on the new governmental reccomendations and people will not take them as seriously as they should. Gandydancer (talk) 11:34, 19 June 2010 (UTC)

Infobox and Figures
The Pandemic mortality data figure needs updating. See the previousy cited WHO website.

I find the Template:Flu extremely confusing. Parts of it seem to refer to influenze in general, others to multiple strains, others specifically to the 2009 H1N1 strain. Could someone please define the purpose of this figure, make that clear (especially in the title), and also make sure it refers in entirely to 2009 pandemic H1N1?
 * Template:Flu is about influenza generally, not H1N1 specifically, hence why it has a generic name. It happens to use a picture of H1N1. --<b style="color:#3773A5;">Cyber</b> cobra (talk) 21:36, 14 May 2010 (UTC)
 * OK. But the article is about H1N1 specifically so shouldn't this template be modified to be more specifically about the H1N1 subtype, the 2009 pandemic strain of H1N1, or least the genus/species Influenza A? Seems like it should be, unless the the idea of these boxes is to be for the whole viral subfamily of influenza viruses...? BSW-RMH (talk) 15:34, 17 May 2010 (UTC)

The world map of deaths and confirmed cases is also confusing. What is this showing? Please add a title or caption as the legend is inadequate. Is it showing any country that has a confirmed death in black and any that has not had confirmed deaths but does have confirmed cases in red? I would expect this would be similar, if not identical, for influenza in general in any flu season. Wouldn't heat maps showing percents of influenza that are H1N1 at the peaks of nothern and southern flu seasons be more informative? This would give an idea of the extent of the pandemic of this particular strain in 2009, which is the focus of this article. The layout within the article is also awkward.
 * Your reading of the legend is correct. There are some heat maps: File:H1N1 map by confirmed cases.svg and File:H1N1 map by confirmed deaths.svg. Do you have a recommendation on one vs. the other? --<b style="color:#3773A5;">Cyber</b> cobra (talk) 21:59, 14 May 2010 (UTC)
 * I think the cases heatmap is more useful. Overall the seasonal flu death rates during the pandemic were similar to rates due to seasonal flu in other years-the 2009 pandemic was just more skewed toward children. BSW-RMH (talk) 04:26, 16 May 2010 (UTC)

Why is this statement tagged onto the description of the image of Obama being vaccinated? "well after the number of reported cases of the flu had decreased." Is this to emphasize that he is being vaccinated in preparation for the usual second wave of flu season expected in Jan-March of 2010 (which was the case)? Please clarify that because it might seem odd most readers, who would not necessarily know there are usually two peaks of cases during every flu season, that he is being vaccinated "after the cases of the flu had decreased".

BSW-RMH (talk) 21:18, 14 May 2010 (UTC)


 * Re the Obama photo - it seems that that has been fixed. Gandydancer (talk) 19:03, 22 June 2010 (UTC)

Classification
The classification section as written discusses common names of the viral strain and the disease it causes. This section should begin with a paragraph giving the official taxonomic classification of the pandemic H1N1 virus. Example: Order:Mononegavirales, Family:Orthomyxoviridae, Genus:Influenzavirus A, Species: Influenza A virus, Subtype:H1N1, Strain: Influenza A/California/07/2009 (H1N1), (commonly informally shortened to pandemic H1N1/09). See: BSW-RMH (talk) 16:25, 17 May 2010 (UTC)
 * CDC style guide for viral nomenclature with Influenza-specific section (http://www.cdc.gov/ncidod/eid/StyleGuide/scientific_nomenclature.htm#vir)
 * Zhang H, Chen L. Possible origin of current infl uenza A H1N1 viruses. Lancet. (2009);9:456-7.(http://download.thelancet.com/flatcontentassets/H1N1-flu/virology/virology-39.pdf)


 * Thinking that this information would be available at the virus site, I thought I'd just copy and paste it here, but no luck! If the reviewer feels it to be important, perhaps s/he should do it. Gandydancer (talk) 19:15, 22 June 2010 (UTC)

Complications
This section needs to be expanded to discuss pulmonary complications (like pneumonia and exacerbation of chronic lung diseases), which are the most common types of complications, and cardiac complication in more detail. In addition, kidney and neurological complications have been noted. See: BSW-RMH (talk) 16:51, 17 May 2010 (UTC)
 * Rothberg MB, Haessler SD. Complications of seasonal and pandemic influenza. Crit Care Med. (2010);38(4 Suppl):e91-7.


 * I added a little... Gandydancer (talk) 13:59, 19 June 2010 (UTC)

Diagnosis
This section could benefit from more detailed information on the available tests, including the recent IQuum Liat assay, and their emergency use approval by the FDA. (http://www.fda.gov/MedicalDevices/Safety/EmergencySituations/ucm161496.htm) This information guides CDC and WHO testing policies. BSW-RMH (talk) 16:51, 17 May 2010 (UTC)


 * The information at that site is too complicated for me without spending a lot of time trying to figure it out. Perhaps the reviewer could add a line or two to the article and include the link if s/he feels it is important.  I did add one new flu test to the article. Gandydancer (talk) 11:10, 27 June 2010 (UTC)

Prevention
It might be good to rewrite the intro overview paragraph from the current perspective, rather when starting with the early Fall 2009 perdpective when the vaccine supply was limited and therefore recommended for priority groups only. For example, the CDC is now recommending that everyone over the age of 6 months ve vaccinated for seasonal flu, which will include protection against H1N1/09.
 * http://www.cdc.gov/flu/
 * I added that information. Gandydancer (talk) 20:04, 19 June 2010 (UTC)

Also, many parts of this section are written as if certain situations are currently happening-which they probably were when this was written, but this should be updated. ex. "In California, school districts and universities are on alert and working with health officials to launch education campaigns." in the Schools section.
 * I updated the wording. Gandydancer (talk) 20:04, 19 June 2010 (UTC)

The section on Pigs and Food Safety contains an inaccurate statement, "However, despite its origin in pigs, this strain is transmitted between people and not from swine to people", which I have deleted. While the virus cannot be contracted from pork, it can spread from live pigs to humans.
 * http://www.cdc.gov/h1n1flu/guidelines_commerical_settings_with_pigs.htm#c

I added some details about the firstlab-confirmed H1N1/09 related death-occurred in Houston but was of a child from Mexico city. I happen to work in the Texas Medical Center, one block from where this happened. Very sad.

BSW-RMH (talk) 17:19, 17 May 2010 (UTC)

One final note: Throughout the article, the H1N1/09 pandemic flu is sometimes referred to as swine flu. This an inaccurate term, and although it may be in common use, it probably should not be used in this article for the sake of accuracy.
 * I think I have fixed that. Gandydancer (talk) 20:04, 19 June 2010 (UTC)

Good luck with the updates!

BSW-RMH (talk) 17:23, 17 May 2010 (UTC)


 * I updated the Schools, Workplace, and Masks sections. Gandydancer (talk) 14:00, 19 June 2010 (UTC)

Criticisms
With new information about scientists being paid by profiting drug companies, there needs to be a criticisms section with links to that information if this article is to be considered neutral. guardian.co.uk/..swine-flu-experts-big-pharmaceutical 88.0.226.31 (talk) 04:33, 4 June 2010 (UTC)

188.2.24.42 (talk) 10:04, 17 June 2010 (UTC)

H1N1 swaps genes with other pig viruses
((copyvio redacted, see the link- LeadSongDog come howl!  18:47, 19 June 2010 (UTC)) http://www.winnipegfreepress.com/special/flu/h1n1-swaps-genes-with-other-pig-viruses-proves-surveillance-need-scientists---96582079.html  Gandydancer (talk) 14:56, 19 June 2010 (UTC)

Febrile fits???
It is hard to make heads or tails of this article, so for now I am just going to park it here. Sounds like the flu vaccine is on hold because it has caused high fevers with seizures in 1% (that's a lot!) of children under 5 in Australia. Sounds like a very dirty lab, but it's hard to tell for now... http://www.foxnews.com/story/0,2933,596767,00.html Gandydancer (talk) 23:38, 15 July 2010 (UTC)


 * Here's one more reliable Aus MoH source, but rather older (1 June 2010)
 * Here's the Aus Theraputic Goods Administration report as of 2 July 2010. The key result "At this stage, based on findings from the two TGA audits and information from the US FDA audit, it has not been possible to identify a manufacturing deficiency that is causally linked to the occurrence of a higher than expected rate of febrile convulsions."
 * Here's the FDA "Untitled letter" to CSL
 * Here's the FDA FAQ on its letter
 * All of which suggests they haven't found the cause yet, but they're fairly sure there is a specific problem with the new trivalent vaccine, particularly in children never before exposed to H1N1 or H1N1 vaccines. No indication of a linkage to a specific vaccine component, but the recent addition is for an H3N2 virus.
 * Fox' coverage predictably jumped on the word Thimerosal in the FDA letter, failing to observe that it is not used in the single-dose syringe products that are the subject of concern. That's Fox for you.LeadSongDog come howl!  15:23, 16 July 2010 (UTC)

I have not yet heard the fat lady sing...
The pandemic is not yet over. I shall change "was a global outbreak" to "is a global outbreak". Gandydancer (talk) 14:41, 19 June 2010 (UTC)


 * I will park this here to be added later.

http://www.ncbi.nlm.nih.gov/pubmed/20644650 Gandydancer (talk) 23:12, 21 July 2010 (UTC)


 * She's warming up! http://www.thestar.com/article/845312--who-hints-h1n1-pandemic-could-be-done Gandydancer (talk) 03:08, 9 August 2010 (UTC)


 * http://www.speedysigns.com/images/decals/jpg/H/62/282.jpg


 * http://www.who.int/csr/disease/swineflu/frequently_asked_questions/post_pandemic/en/index.html Gandydancer (talk) 17:03, 10 August 2010 (UTC)

20th century flu pandemics
The title of the chart "20th century flu pandemics" should be changed to reflect that it also lists a 21st century flu pandemic. I would do it, but I am not an "autoconfirmed" user. Hurtsmyears (talk) 00:14, 11 August 2010 (UTC)

"Swine flu pandemic"
"From August 30, 2009 to  April 3, 2010, there were 2,125 laboratory-confirmed influenza-associated deaths were reported to CDC." AND "Since August 30, 2009, A total of 282 deaths in children associated with 2009 influenza A (H1N1) virus infection have been reported to CDC."

w w w .c d c.g o v / f l u /w e e k l y May 21, 2010 —Preceding unsigned comment added by 207.144.182.4 (talk) 20:20, 22 July 2010 (UTC)


 * I will park this here for now till someone has time to get to it: http://www.bloomberg.com/news/2010-09-07/swine-flu-in-children-is-no-more-severe-than-seasonal-virus-study-finds.html Gandydancer (talk) 00:29, 8 September 2010 (UTC)

Recent edits about vaccine bans
Regarding this edit:


 * 1)  TopNews.ae is not a reliable source for medical developments in Finland.
 * 2)  The BusinessWeek article said that one type of vaccine from one manufactures was temporarily suspended for children 5 and under.  This is trivia, most likely.  If we include this fact, it should be included accurately, without overstating the scope of the suspension.

Please don't repeat these edits without discussion and consensus. Jehochman Talk 20:55, 1 September 2010 (UTC)


 * This source is not about H1N1 but a single seasonal flu vaccine.
 * This ref might be worth following up.  Only the "stand-alone version with adjuvants" use has been halted while the combination flu / swine flu is still be ing used.
 * Have reverted. Doc James (talk · contribs · email) 21:08, 1 September 2010 (UTC)

Major problem with statistics
This article fails to give the estimated numbers of those infected with swine flu and those who died from it. It only gives the number confirmed by labs, this would be a tiny proportion of the total number of people effected globally as in most cases only the richest people will get lab confirmation. Even in countries like the UK, most swine flu suffers before and after the pandemic was identified were not tested, in developing countries the number would be almost zero.

Worse still, the lab confirmed numbers are placed in tables against estimated number from other pandemics and comparison, this is terribly misleading. It needs sorting out.--Hontogaichiban (talk) 04:21, 6 February 2011 (UTC)

The CDC estimated that cases in the US alone might have been as high as 88 Million! With maybe 18,000+ deaths.

http://www.cdc.gov/h1n1flu/estimates_2009_h1n1.htm

--Hontogaichiban (talk) 04:30, 6 February 2011 (UTC)

Im confused. it says in the lead of the article "According to the latest WHO statistics, the virus has killed more than 18,000 people since it appeared in April 2009,[22] approximately 4% of the 250,000 to 500,000 annual influenza deaths.[23] ".. Thats basically what your saying right. As for the total amount of people infected.. thats a bit more difficult has most wont even end up in the hospital.. its basically a guess. Its a bit easier to count bodies and hospitalizations but not so much total people that caught the flu. If you can source better number from a reliable source then feel free to include them in the article. -Tracer9999 (talk) 06:14, 6 February 2011 (UTC)

I don't think there is an estimate of the real number of infections and deaths yet, I think the WHO has still to calculate it. My main immediate issue is that there is a table in this article which is comparing apples and pears, i.e. estimates of total deaths with lab confirmed cases which will be a tiny proportion of the true total worldwide. I know it kind of points this out in the table, but for most people it will still be dangerously misleading.--Hontogaichiban (talk) 11:34, 22 February 2011 (UTC)

I totally agree. The sentence "the virus has killed more than 18,000 people since it appeared in April 2009,[22] approximately 4% of the 250,000 to 500,000 annual influenza deaths.[23" is seriously misleading, as it compares rare lab-confirmed cases with a rough estimate (probably an overestimate anyway) of total flu mortality. To put the relations in perspective: In Germany, for example, rough estimates of annual seasonal flu deaths are 5000 to 20 000. But there are fewer than 100 lab-confirmed cases in normal flu years because doctors simply don't test. The text above suggests that even in 2009, far more people died of seasonal flu than from the epidemic. This is utter nonsense. In 2009/2010, lab-confirmed deaths from seasonal flu were a tiny minority compared with lab-confirmed h1n1(2009)flu fatalities. Lab confirmed deaths were higher than in normal flu years in the US during the pandemic conpared to normal years, because of the pandemic. Even in the current 10/11 season, when both seaonal and pandemic strains are circulating in Germany, the number of lab-confirmed deaths from pandemic flu are higher than those from seasonal flu (124 of a total of 137 flu deaths had pandemic flu).(http://influenza.rki.de/Wochenberichte/2010_2011/2011-14.pdf, page 4) This really needs to be changed. Either no comparison at all (with the hint that real numbers are far higher, as most patients don't get tested), or the comparison needs to be with lab confirmed deaths from seasonal flu.)Hezarfen67 (talk) 09:25, 16 April 2011 (UTC)


 * Thanks for pointing out some major problems. OK, so where are we at now that I deleted some stuff.  Gandydancer (talk) 12:49, 16 April 2011 (UTC)


 * I see that CyberCobra has restored the chart - perhaps I was hasty to delete it. I trust his judgment.  But there is something in that section that has bothered me from the start.  We have used the 41,000 annual deaths figure for seasonal flu in the U.S. while the CDC used a figure of 36,000.  Do you think we should do anything about that? Gandydancer (talk) 21:56, 17 April 2011 (UTC)

Notable victims
For sure a pandemic this big would've gotten to famous actors, politicans, and athletes. Is there a list for notable cases for this pandemic? And is someone working on it? C'mon the whole thing happened last year. —Preceding unsigned comment added by 68.88.14.124 (talk) 13:48, 20 September 2010 (UTC)

Sorry but I don't think that a list of famous victims of Swine flu would be very important in the general scheme of things.--Hontogaichiban (talk) 11:37, 22 February 2011 (UTC)


 * As it turned out, there was no pandemic - just an ordinary yearly flu. Gandydancer (talk) 18:16, 16 April 2011 (UTC)


 * That assertion would need very strong sourcing. LeadSongDog come howl!  13:38, 9 May 2011 (UTC)


 * As would your apparent position that it was not if this were the article and not just the talk page. Gandydancer (talk) 13:21, 11 May 2011 (UTC)

This article is well-named the 2009 flu pandemic
After extended discussion of possible alternates, the Wikipedia community arrived at a good choice for article title. "2009 flu pandemic"

"Swine flu" was wisely avoided as a title. It is disapproved by pork producers and some Muslims.

"H1N1" or "AH1N1" was likely wisely avoided. It is triple-ambiguous -- could equally as easily refer to:

1. The original deadly Spanish Flu H1N1;

2. Seasonal, relatively mild, H1N1; OR

3. The 2009 pandemic H1N1.

Better a specific title, non-offensive to pork producers -- as we have. —Preceding unsigned comment added by 66.167.61.75 (talk) 00:15, 29 December 2010 (UTC)


 * Personally I think the name is a horrible joke. The fact that this article is linked (and mentioned in the first sentence) to the 1918 flu pandemic is ridiculous. This "pandemic" was media nonsense. It barely killed anyone compared to a typical seasonal flu, let alone when compared to the 1918 pandemic which killed MILLIONS.     Richjenkins (talk) 04:08, 14 August 2011 (UTC)

Actually there were more than 2 H1N1 pandemics. Harrison's says that H1N1 had pandemics or epidemics in the following years: 1918-19 Severe pandemic 1933-35 Mild epidemic 1946-47 Mild epidemic 1977-78 Mild pandemic --Nbauman (talk) 03:27, 21 September 2011 (UTC)

Followup edit
I understand what the editor is getting at, but I believe there are some problems with the edit. First, what does this mean: "and this is frequently misunderstood as an indication that the H1N1 strain was not as severe as seasonal influenza. The misunderstanding arises from the fact that this figure is an average of "influenza-related" deaths: deaths in which influenza is at least partially involved, but which may have another direct cause" I don't see anything about "at least partially involved, but which may have another direct cause" in the ref, did I miss it? Here's a good ref that explains why the CDC changed their estimate. Also, we do know that this strain actually was less severe (less deaths) than the other strains that have been going around. Thoughts? Gandydancer (talk) 18:00, 14 September 2011 (UTC)

UK data show almost fourfold increase in H1N1 deaths in 2nd pandemic wave
Deaths in the United Kingdom attributed to pandemic 2009 H1N1 flu were almost four times as high during the second wave as during the first, according to data from Department of Health researchers published today. They investigated deaths reported through the country's mandatory reporting system and found a rate of 5.4 per million during the second wave in the fall of 2009, compared with a rate of 1.6 per million in the first wave in the preceding summer (P < 0.001). They found per-million mortality rates during both waves particularly high in those with chronic neurologic disease (450), chronic heart disease (100), immune suppression (94), and chronic respiratory disease (39), compared with a rate of 2.4 in those with no risk factors. The difference between the two waves, they suggest, may have been based largely on people's behavior, such as actions reflecting a decreased perception of risk. They conclude that the data emphasize "the importance of maintaining preventative and treatment-seeking behaviours in the population beyond the period of initial high profile that the pandemic phenomenon attracts." Nov 1 Epidemiol Infect

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/nov0111newsscan.html — Preceding unsigned comment added by 99.190.133.143 (talk) 01:36, 2 November 2011 (UTC)

Proposed merger
This is a notice that I have proposed merging the content of 2009 flu pandemic summary with this article. Andrew (talk) 03:51, 26 December 2012 (UTC)
 * Note that I just changed the content of that article into a redirect. The page has useful information, however, so feel free to use this dif of the old article to incorporate its content. Andrew (talk) 01:04, 31 December 2012 (UTC)

it have returned in norway
more than a 100 people have been infected and one is already dead. — Preceding unsigned comment added by 84.208.59.120 (talk) 23:39, 29 December 2012 (UTC)

Stay tuned
"H1N1 Virus Outbreak Kills 17 in Venezuela", May 27, 2013. --Wikiwatcher1 (talk) 05:57, 28 May 2013 (UTC)

Mortality Estimates - Why aren't the total world estimates used except in the introduction?
The WHO estimates for total deaths is used once at the beggining of the article, then pretty much ignored after that. The figures of fourteen and eighteen thousand deaths are quoted multiple times as being fact. Which it is. Some tens of thousands of people definitely died of the H1N1 strain. But those are only the people in the developed world who died close enough to labs and doctors to be recorded, and we are essentially misrepresenting the deaths of around two hundred and fifty thousand people mostly in africa and southern asia. That's wrong. We can't just be citing the figures of deaths from the developed world and saying that those are the only ones that count.

The WHO is a reliable enough source to be trusted to tell us how many lab tested cases there were of the H1N1 strain, but not to estimate the total number of people who died? That's madness.

We need to be honest and open in this regard, and report what sources we trust are telling us. They are telling us that outside the developed world the 2009 flu killed fourteen times as many people as are being reported on this page. The people reading the page can understand that estimates aren't perfect, and as long as it it's clear that they are estimates but from reliable sources they can better understand exactly why the 2009 pandemic was an event worthy of note.

As it stands if you don't see the estimate quoted in the opening section then you are lead to believe that less than twenty thousand people died the world over and that as a result 2009 outbreak is scarecly worthy of note; barely contributing to the world wide flu season and that is absolutely not the case. While reports in the press at the time were overblown, there certainly were a lot of people getting sick and a significant number dying. How can we justify just ignoring them because they didn't have the good manners to live in countries with a good enough health care system to run the tests? — Preceding unsigned comment added by 86.162.189.172 (talk) 06:12, 23 June 2013 (UTC)

WHO is not a reliable source. WPcorrector (talk) 01:17, 5 July 2013 (UTC)

Vaccine section
This article was already quite long and the vaccine section has recently been increased by a third. If there are no objections, I'm going to cut it back--a reader that has interest may read further information in the vaccine article. Gandydancer (talk) 23:05, 28 April 2014 (UTC)


 * This article is more than twice as long as a suggested article length and the vaccine section has been almost doubled in size the last few days. I suggested above that it be pared down but instead even more copy was added.  I have pared it back and I assume that the information is included in the main article.  Gandydancer (talk) 00:17, 30 April 2014 (UTC)

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Outdated map removal : wrongly suggest Africa not impacted
I removed this misleading map. The removal is based on academic source https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(12)70121-4/fulltext Maybe ask the Graphic Lab to update it. Yug (talk)  16:45, 8 March 2020 (UTC)
 * Figure 1: Global distribution of deaths associated with 2009 pandemic influenza A H1N1 during the first year of virus circulation by country
 * Figure 2: Estimated age-adjusted respiratory and cardiovascular mortality rate associated with 2009 pandemic influenza A H1N1 per 100 000 individuals by country.

Global encyclopedia - or not?
This statement from the text: "The 1918 flu epidemic began with a wave of mild cases in the spring, followed by more deadly waves in the autumn, eventually killing hundreds of thousands in the United States and 50–100 million worldwide". Why the reference to the US? 5.81.164.49 (talk) 20:00, 8 March 2020 (UTC)

Moderator - please look at row in comparison chart labeled Coronavirus
First, coronavirus is not an influenza virus so it technically doesn’t belong in a chart labeled Influenza Pandemic, but I previously found having this in the chart was helpful and informative.

More importantly most of the key info in this row at 4:25am ET is wrong.

The subtype column says H1N1 and H3N2 but these are are types of influenza viruses and to repeat, a coronavirus is a different type of virus from influenza virus. H1N1 specifically is the swine flu virus and apparently H3N2 is the type of flu virus by that caused the 1968 Hong Kong flu. Coronavirus is not a flu or influenza virus.

Even more importantly the coronavirus Estimated Infected column indicates 11% and 800 million globally and 33-42 million in the US. That might be a very speculative projection of what could happen but the actual current numbers for the ongoing pandemic are much much less than that - less than 1/300th of 1% and about 246,000 globally and about 14,000 in the US.

For deaths the chart indicates (very speculative projections?) 0.45 to 1.2 million worldwide and 20-52,000 in the US. Those numbers are not even consistent with the above projections of Estimated Infected. The actual current numbers for deaths for the ongoing pandemic are much much less than what the chart indicates - about 10,000 globally and about 200 in the US.

This needs to be corrected!

A good source for the correct current coronavirus numbers would be https://www.worldometers.info/coronavirus or the Johns Hopkins dashboard at https://coronavirus.jhu.edu/map.html Rschwalb (talk) 08:45, 20 March 2020 (UTC)

COVID-19 case number
Why does this article claim 800 million; USA, 34-49 million infected with COVID-19, and 1.2 million deaths? The source says nothing about that virus, and current confirmed case numbers are a lot lower than that. Besides, COVID-19 is not a kind of flu so it certainly doesn't belong in a table of influenza pandemics... The coronavirus pandemic is relevant to that section, but the addition to the table seems questionable. Renerpho (talk) 05:47, 20 March 2020 (UTC)

I posted a similar concern in discussion. I like having coronavirus in the comparison table even though it is not an influenza virus, but

1. The (influenza) subtype should be blank or N/A or “Not Influenza”

2. The Ongoing Est. Infected should be 244,523 globally and 14,250 in the US as of 3/19 and would need to be updated at least daily.

3. The Deaths should be 10,049 globally and 217 in the US as of 3/19 and would need to be updated at least daily. Rschwalb (talk) 09:00, 20 March 2020 (UTC)
 * I've removed the help me as this is a content issue and needs discussion.Praxidicae (talk) 13:38, 20 March 2020 (UTC)
 * Actually, it appears it's been removed. Praxidicae (talk) 13:39, 20 March 2020 (UTC)

What happened to the reference to Covid-19/Coronavirus in the comparison table? It looks like that reference was changed to 2019-2020 seasonal flu, which makes sense, but why isn’t that update reflected in the page history? Rschwalb (talk) 15:20, 20 March 2020 (UTC)

"America flu" listed at Redirects for discussion
An editor has asked for a discussion to address the redirect America flu. Please participate in the redirect discussion if you wish to do so. Praxidicae (talk) 20:10, 20 March 2020 (UTC)

Requested move 16 March 2020
<div class="boilerplate" style="background-color: #efe; margin: 2em 0 0 0; padding: 0 10px 0 10px; border: 1px dotted #aaa;">
 * The following is a closed discussion of a requested move. Please do not modify it. Subsequent comments should be made in a new section on the talk page. Editors desiring to contest the closing decision should consider a move review after discussing it on the closer's talk page. No further edits should be made to this section. 

– I recently proposed Talk:Spanish_flu where I proposed the title to be 1918 influenza pandemic, but I'm not sure whether it should be that title or 1918 flu pandemic so I am currently seeking a consensus to whether pandemics like this should be called Flu pandemics or Influenza pandemics. Interstellarity (talk) 16:21, 16 March 2020 (UTC)
 * 2009 flu pandemic → 2009 influenza pandemic
 * 1889–90 flu pandemic → 1889–90 influenza pandemic
 * 1968 flu pandemic → 1968 influenza pandemic


 * Support only for move from flu>influenza to match influenza. In reality, some need further consideration, for example moving first one to 2009 H1N1 influenza pandemic or just H1N1 influenza pandemic. -- Netoholic @ 11:07, 17 March 2020 (UTC)
 * Oppose and move to 2009 swine flu pandemic per WP:COMMONNAME - the common title which sources use and which the public would recognise. See for example And just as we don't use "COVID-19" for the current pandemic, because people recognise it as "coronavirus disease", so we should steer clear using technical names like "H1N1".  &mdash; Amakuru (talk) 23:07, 17 March 2020 (UTC)
 * Oppose. Everyone knows that "flu" is short for "influenza", and no one says "influenza" when talking about "flu". WCCasey (talk) 18:46, 18 March 2020 (UTC)
 * Oppose - but support move to 2009 swine flu pandemic per COMMONNAME. Blueboar (talk) 18:20, 19 March 2020 (UTC)
 * Oppose move, Support 2009 swine flu pandemic since it's a much more recognizable name. ◢ <i style="background-color:#fdcdd1; color:#f63646">   Ganbaruby!  </i>  (remember to ping!) 18:26, 19 March 2020 (UTC)
 * Support all for consistency with WP:DISASTER. As for flu vs. influenza, enWP is read by many non-native speakers who may not know that "flu" is short for "influenza" and might think they're separate diseases.  Mini  apolis  19:54, 19 March 2020 (UTC)
 * Support for consistency with influenza, Influenza A virus, etc. — UnladenSwallow (talk) 00:37, 20 March 2020 (UTC)
 * Oppose, because such pandemics are commonly called "the flu" and ample reference has already been made to them being caused by the influenza virus. Furthermore, Support moving the article to 2009 swine flu pandemic, as per WP:COMMONNAME. The 1889 pandemic could likewise be renamed to Russian flu, although this is debatable as both variants are in use nowadays. But the 1918 and 1968 pandemics should unequivocally be titled Spanish flu and Hong Kong flu, because a vast majority of sources use that name. See Talk:Spanish flu and Talk:1968 flu pandemic for more arguments and evidence. —General534 (talk) 21:56, 21 March 2020 (UTC)
 * Oppose - but support move to 2009 swine flu pandemic for the very simple reason that I remember seeing news about the swine flu, but if someone just asked about the 2009 flu, I would draw a blank until someone reminded me that was the year with the swine flu. We shouldn't have to look up a topic just to know whether an article is the topic we want. Ock Raz   talk  00:33, 22 March 2020 (UTC)
 * Oppose - Massive revisionism instigated by Interstellarity in a number of pages, as he himself confesses. Already failed for the Spanish Flu.  Utterly unjustified.  Does not meet WP:UCRN.  Please cease and desist. XavierItzm (talk) 16:55, 22 March 2020 (UTC)
 * Oppose move suggested; support move to 2009 swine flu pandemic per WP:COMMONNAME. Most sources intended for a lay audience appear to call it "swine flu". userdude 08:04, 23 March 2020 (UTC)
 * Oppose but support moving 2009 to "swine flu" for reasons given above. jamacfarlane (talk) 03:14, 25 March 2020 (UTC)
 * Comment - Anyone else think invoking WP:COMMONNAME for this and 1918 Spanish flu may set a bad precedent? I'm definitely jumping the gun here but let's say the 2019 coronavirus becomes more commonly known as the Chinese flu... do we change it to that name, too? --112.206.67.75 (talk) 15:07, 26 March 2020 (UTC)
 * Comment: to be frank, yes. I don't think this disease has a chance of being commonly know as the "Chinese flu", but if it did then Wikipedia is not there to WP:right wrongs. jamacfarlane (talk) 17:02, 26 March 2020 (UTC)
 * Oppose but I would be in support of moving to 2009 swine flu pandemic. Iamreallygoodatcheckers (talk) 03:59, 28 March 2020 (UTC)
 * Oppose but I would be in support of moving to 2009 swine flu pandemic. Unibond (talk) 19:15, 28 March 2020 (UTC)


 * The discussion above is closed. <b style="color: #FF0000;">Please do not modify it.</b> Subsequent comments should be made on the appropriate discussion page. No further edits should be made to this discussion.

Correct number of deaths
Hi, could someone explain me which is the correct number of victims of the 2009 flu pandemic? Because in these template we have "only" 19,654 victims, but in the infobox someone wrote 150,000–575,000. Thanks. -- Nick.mon (talk) 22:43, 20 March 2020 (UTC)

Hey, anybody could find exact information about deaths? I think 150-575 thousands is really exaggerated. This is information of late period of pandemic (1 months before post-pandemic period) and it states 18449 deaths. https://www.who.int/csr/don/2010_08_06/en/  Couldn't found death statistic after official end of pandemic. — Preceding unsigned comment added by Gota (talk • contribs) 16:37, 23 March 2020 (UTC)
 * The so-called "confirmed" deaths listed in this article is incorrect. That is the number of lab-confirmed deaths reported to the WHO by member countries. Lab-testing of suspected influenza stopped early in the pandemic because confirmation didn't change treatment; per the CDC's page on Influenza Diagnostic Testing During the 2009-2010 Flu Season, "most people with flu symptoms do not need a test for 2009 H1N1 flu because the test results usually does not change how you are treated." The correct number of deaths is estimated to be 151,700-575,400; this estimate is based on a collaboration between the WHO, CDC, and NIVEL. WHO had this to say about the smaller ~18,000 number: "The number of pandemic deaths reported to WHO by its member states during the influenza A(H1N1) pandemic of 2009/10 is based on laboratory confirmation and is widely considered a gross underestimate for a number of reasons... WHO is currently working with two teams, one from the US Centers for Disease Control and Prevention (USCDC) and a second from the Netherlands Institute for Health Services Research (NIVEL), to produce independent estimates of the influenza deaths that occurred during the global pandemic using two distinct methodologies. The process has been overseen by a committee of technical experts from around the world which has periodically reviewed the progress of the groups and provided critical advice for improvement..." The CDC's global estimate is WHO's estimate. This is the official global death toll recognized by the WHO. The CDC estimates that the number of deaths in the US alone was as high as ~18,000. Global Cerebral Ischemia (talk) 13:50, 4 April 2020 (UTC)

Overall numbers? 18,000 or 550,000???
I am very confused by the statements that the swine flu killed 18,000 people and other articles says perhaps over 500,000. Why this difference? What was the more reliable extimate? — Preceding unsigned comment added by 62.11.3.98 (talk) 15:06, 15 March 2020 (UTC)
 * Yes, you’re right. In Italian Wiki, the death toll is 18,000, here more than 550,000. I’m a bit confused... -- Nick.mon (talk) 12:24, 19 March 2020 (UTC)


 * I read the link from the CDC, and the 550,000 number is the estimated number from models, but the 18,000 number is from laboratory confirmed numbers. There's such a big difference because many who died weren't tested after they died and the virus may not have been detectable at the time of their death. This article could be much clearer about these different numbers.James (talk) 19:36, 5 April 2020 (UTC)

Confirmed cases and deaths severely edited
Take note in the first table of the article, the number of cases and deaths has changed severely, it seems very inaccurate

In addition, I think the previous title ("2009 flu pandemic") was better — Preceding unsigned comment added by 179.113.172.58 (talk) 00:33, 1 April 2020 (UTC)

I have been looking at this since Jan. 2020 and the number of fatalities has dropped significantly. It was 1.5 million in January. Apreinesberger (talk) 13:46, 29 July 2020 (UTC)
 * Regarding deaths, please see the section at the bottom of this page (new sections should be added to the bottom, but the IP user who made this section didn't do so, and thus didn't notice that section). And for the record, the number of fatalities listed in this article was *never* as high as 1.5 million (because no reliable source makes that claim). We don't have to rely on memories, anyone is free to look at old revisions of this article to see that this is the case. Global Cerebral Ischemia (talk) 13:59, 29 July 2020 (UTC)

Shouldn't the title be capatilized?
Shouldn't the title be "2009 Swine Flu pandemic" since the Swine Flu is a proper noun? — Preceding unsigned comment added by 76.102.2.73 (talk) 21:18, 25 January 2021 (UTC)

"Recent swine flu outbreak" listed at Redirects for discussion
A discussion is taking place to address the redirect Recent swine flu outbreak. The discussion will occur at Redirects for discussion/Log/2021 June 21 until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Hog Farm Talk 01:15, 21 June 2021 (UTC)

"The recent swine flu outbreak" listed at Redirects for discussion
A discussion is taking place to address the redirect The recent swine flu outbreak. The discussion will occur at Redirects for discussion/Log/2021 June 21 until a consensus is reached, and readers of this page are welcome to contribute to the discussion. Hog Farm Talk 01:16, 21 June 2021 (UTC)