Talk:2009 swine flu pandemic/Archive 8

Argentina
Are the 100,000+ cases in Argentina real? Yes, it´s an estimate given by health minister Juan Manzur on July 3rd 2009!--86.25.11.99 (talk) 15:28, 22 July 2009 (UTC)


 * Estimates don't do us much good, as you can estimate however many cases you'd care to. But the fatality figures from Argentina show that they have a very serious problem, which their extended holiday may or may not have helped dampen. So, yes, it's reasonable to assume they probably have at least a hundred thousand infected. And were I to join in the fun and guestimate, I'd guess they've got at least a million infected. As an side, so far, looking at Mexico and Argentina's experiences, I'm thinking we can look forward to some lovely national holidays come the fall, if there isn't enough vaccine to go around. It'll also be interesting to see if health officials do the stupid thing, and give the same preferential distribution for pandemic vaccine as they give normal vaccine (the very old, and the very young) given that this strain doesn't seem to be killing the elderly at all, relatively speaking.68.111.62.56 (talk) 09:21, 24 July 2009 (UTC)

"Meaningless numbers" "can be worse than no measures at all" dangerously confusing journalists
http://www.nytimes.com/2009/07/17/world/17flu.html

'''W.H.O. Says It Plans to Stop Tracking Swine Flu Cases

By DONALD G. McNEIL Jr. Published: July 16, 2009

...

Many epidemiologists have pointed out that, in reality, millions of people have had swine flu, usually in mild form, so the numbers of laboratory-confirmed cases were actually meaningless. And performing the tests has overwhelmed many national laboratories.

...

Dr. Joseph S. Bresee, chief of epidemiology for the C.D.C.’s flu division, said he agreed with the W.H.O. premise that case counts were just too inaccurate to keep using.

...

Dr. Michael T. Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said confused journalists in many countries had misread the low W.H.O. numbers of confirmed deaths to report that the new flu is not a threat. And testing is so hit-or-miss that even apparent differences in death rates like those between Chile and Argentina “may not be based in science,” he said.

“Bad measures can be worse than no measures at all,” he added. “But I hope this will force the public health community to come up with better ones.”

Hence, this 2009 flu pandemic article should begin with a trenchant summary of the situation, followed by a table of links to the sub-sections in the article which follow -- rather than with meaningless and dangerously confusing numbers. —Preceding unsigned comment added by 66.167.95.248 (talk) 14:02, 23 July 2009 (UTC)


 * Agree it probably outlived its use at this point. It almost seems silly to list counts for Tonga, with a population of 120,000, and totally ignore China and India which aren't even shown. May be best to just give WHO's overall estimates by continent or hemisphere periodically which would give the "big" picture, which also makes sense during a pandemic. --Wikiwatcher1 (talk) 19:54, 23 July 2009 (UTC)


 * The reason those fatality numbers are "meaningless" is because WHO and other medical experts have been guilty of spouting made-up flu fatality figures for decades. To throw away good data because it has been preceded by decades of bad data is absurd. We need to emphasize how baseless the "estimated" flu deaths are so that journalists can make sense of the fatality numbers from swine flu. What we really need are some properly referenced, attributable numbers on "real" flu deaths from the past few flu seasons, so journalists have some meaningful benchmark to compare. They need to understand that the flu doesn't kill a documented half million people a year. It kills a handful, mostly because it only kills the very old and the very young, and usually kills them as one contributing factor among many. Even with the Spanish flu pandemic, a great number of patients died from secondary infections, not influenza itself. Journalists need to understand that a thousand confirmed, attributable fatalities is a *lot*, and the only way they'll understand that is if we find more good data. Which is what Wikipedia is for: Finding good data. Throwing away good data is the polar opposite to what we should be trying to do. 68.111.62.56 (talk) 09:09, 24 July 2009 (UTC)

Swine flu (H1N1) in England
I have found a BBC source that could be useful, anyone?

http://news.bbc.co.uk/1/hi/health/8163930.stm

(86.170.160.255 (talk) 14:44, 23 July 2009 (UTC))


 * "There were an estimated 100,000 new cases with the under 14s the worst hit." —Preceding unsigned comment added by 92.13.159.252 (talk) 17:30, 23 July 2009 (UTC)

It is now at only 12,000 or 55,000 acording to diferent sources.--86.25.14.95 (talk) 14:27, 24 July 2009 (UTC)

The new, pro-'confirmed cases' table
I have rescued the old archived version of the history page, to make it different I used ‘lab’ instead of ‘Laboratory’. --86.25.14.95 (talk) 13:54, 24 July 2009 (UTC) The Ill are as important as the dead!--86.25.14.95 (talk) 15:29, 24 July 2009 (UTC)

World's first 2009 H1N1 swine flu immunisation
The race by companies around the world to develop the first swine flu vaccine for delivery to the clinic officially ended on Monday 20 July 2009 when the world's first swine flu vaccine immunisation of a human subject was performed by Dr Dimitar Sajkov, Respiratory Physician, Flinders Medical Centre using a swine flu vaccine developed by the Australian biotechnology company Vaxine Pty Ltd in partnership with the US biotechnology company Protein Sciences Corporation. This vaccine was composed of a recombinant haemagglutinin derived from the sequence of the 2009 H1N1 swine flu virus produced by Protein Science Corporation together with the polysaccharide (sugar)-based Advax(TM) vaccine adjuvant produced by Vaxine Pty Ltd. This vaccine is currently being tested in an Australian trial in 300 healthy adults aged 18-70 years. Nikolai Petrovsky
 * Red information icon with gradient background.svg Not done: The provided sources do not seem to backup the claims made in the above paragraph. For example, no mention is made of Dr. Sajkov, nor of the composition of the vaccine. Additionally, the www.vaxine.com.au source really should be replaced with a non-self-published source.
 * When you make another request, please include instructions for the reviewing editor, like "Please add the paragraph below to the article, after the paragraph that begins..."
 * This page is only semi-protected, so you should use the tag instead of the  tag: non-administrators can edit this page, so long as they have been around for "a while." Thank you.&mdash;C45207 &#124; Talk 06:52, 25 July 2009 (UTC)

The US CDC has also stopped counting cases
The nation's number of lab-confirmed novel flu cases rose to 43,771, including 302 deaths, the CDC said. Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, said at a press conference today that this would be the last national case count update, though the CDC will still provide regular updates on hospitalizations and deaths.

http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/jul2409updateflu-jw.html —Preceding unsigned comment added by 68.165.11.165 (talk) 16:50, 25 July 2009 (UTC)


 * It's kind of sad, but at this point, it seems like the folks who want to keep confirmed cases on the table are just as entrenched as the folks who wanted to do away with the table altogether were a week or two ago. While deaths remain a useful data set, confirmed cases are pointless and shouldn't be there, but I think we have to accept their presence due to the inflammatory nature of the response if you try to remove them. Is there some way we could make the confirmed cases column default to being hidden, where folks have to click to show it, to emphasize that it's obsolete data inconsistently harvested in the first place?68.111.62.56 (talk) 00:37, 27 July 2009 (UTC)

Controversy
Why isn't there a section about the controversy surrounding the whole thing? I mean, wouldn't it be relevant to include references to some of the so-called conspiracy theorists who claim it's all a hoax designed to trick people into taking vaccines that would supposedly make them more vulnerable to the flu? I don't want to be a doomsayer, but I have to admit that a lot of it kind of fits the sayings and writings of people like David Icke, Alex Jones, et al. —Preceding unsigned comment added by 78.83.75.149 (talk) 16:42, 22 July 2009 (UTC)


 * See the neutral point of view policy, especially the piece about undue weight. Tim Vickers (talk) 16:58, 22 July 2009 (UTC)


 * See [] —Preceding unsigned comment added by 129.186.253.6 (talk) 03:37, 25 July 2009 (UTC)

I cannot believe a Controversy section doesn't exist in this article. There are growing concerns among many people out there that Swine Flu is an agent of bioterrorism. It was made in a lab, with the intention of global human depopulation. Look up NWO and Illuminati. This shit is for real and the word needs to get out...FAST.Orbzon (talk) 05:17, 27 July 2009 (UTC)

The Argentina number
The number for Argentina cases is wrong and many of the information. http://flutracker.rhizalabs.com/ Seems like more of a reliable source. —Preceding unsigned comment added by 201.230.4.13 (talk) 21:29, 24 July 2009 (UTC)


 * That's great -- except that we have to have attributable, individual sources, and the data used in compiling this wiki is all based from official reports from national medical bureaus, and news reports. Niman can and does include more apocryphal reports. Something which may give you better moment-by-moment data, but something which is not reliable enough to meet the standards of Wikipedia. What's more, if you're going to critique a figure used here, the very least you have to do is provide some data breaking down precisely which numbers we use are wrong, why, and how your source is more accurate and reliable. Simply denigrating our totals because they're not the same as what you've found on another site is both rude and pointless.68.111.62.56 (talk) 00:52, 27 July 2009 (UTC)

How to provide responsible estimates when official figures are so far below as to be misleading?
One quick answer is this CDC page:

http://www.cdc.gov/flu/weekly/

The graphs provided by the CDC on this page show that ER visit percentage that is URI is double the typical; that while summer URIs are almost never influenza, 10% of these still are, even in late July. And it shows that the serious complications have broken above the seasonal sine-wave fluctuation into epidemic proportions.

It is from information like that presented by the CDC that responsible information can be provided. The CDC's decision to cease testing except rarely recognizes the enormous distortion in both incidence and lethality that results when such figures are reported and invariable taken to represent the actual numbers of cases and fatalities. —Preceding unsigned comment added by 64.105.0.247 (talk) 14:36, 27 July 2009 (UTC)

The WHO expects multiple waves
A short article on the WHO's planning assumptions is presented at

http://www.reuters.com/article/GCA-SwineFlu/idUSTRE53T4QV20090430

This article links the WHO official PDF that it summarizes,

http://www.who.int/csr/disease/influenza/PIPGuidance09.pdfhttp://www.who.int/csr/disease/influenza/PIPGuidance09.pdf —Preceding unsigned comment added by 64.105.0.247 (talk) 15:28, 27 July 2009 (UTC)

Error,Error
The numbers in the United States are actually increasing,not decreasing. It's been all over the news these past days. —Preceding unsigned comment added by 71.133.138.180 (talk) 03:33, 26 July 2009 (UTC)

I heard it was 1,000,000! --86.25.15.151 (talk) 16:49, 28 July 2009 (UTC)

Potential land mine column
Here's an article that discusses the total cases issue and brings up some good points: "Swine flu death rate estimates 'flawed'". But it also brings up a question: isn't it OK to add a column for fatality rates based on the "confirmed" figures? It wouldn't seem to be OR since it's simple math using "confirmed" numbers. Is there a problem? Wouldn't that number be more meaningful than raw numbers and give a simple relative comparison column with important information?

While you're thinking about it, consider what some of the fatality rates would be as of today:
 * US .76%
 * Argentina 6.28%
 * Mexico .91%
 * U.K. .28%
 * Uraguay 3.82%
 * Costa Rica 2.80%
 * Columbia 3.68%
 * Japan, Germany, China, Taiwan, S. Korea, and India, all of which have had many cases for quite a while, would show a 0% fatality rate.

Based on the rates, medical journalists might question whether antivirals and vaccines should go to Argentina before the U.K. The CDC estimates a .1% to .35% rate. Each country's medical system and reporting criteria are probably not easily comparable. Also keep in mind that Mexico apparently had a "silent epidemic" and got inundated with serious cases off the mark, giving super high fatality rates, which led to some panic around the world. IMO, erroneous raw data can lead to wrong conclusions and dangerous decisions - a potential land mine that Wiki should avoid if possible. --Wikiwatcher1 (talk) 01:48, 27 July 2009 (UTC)


 * There are three major problems with calculating this figure:


 * Notability: As far as I know, no credible source regards figures from this type of calculation to be meaningful (in anything other than hypothesis generation).


 * Misleading: Countries do not have the same policies regarding reporting of infections. In the US for example only severely ill patients are even tested.  This will inflate the death figures in this country as compared with other countries.  Also the definition of a confirmed swine flu death is very restrictive in that it requires a positive test for variant H1N1 (and in some places a conclusive post mortem).  Although this means almost every confirmed death will have been from swine flu it will miss many deaths from complications and secondary infections (which are a substantial portion of deaths from seasonal flu) as well as some deaths where the swine flu was never suspected.  As such the confirmed death rates cannot be assumed to estimate total deaths.  Given that neither figure is an estimate of infections or of deaths it really begs the question "What are you calculating here?"


 * Original research: If this figure is calculated in the manner described it is a non-notable arbitrary figure which has no place in an encyclopedia article. If the methodology is changed to address the issues I raise then that would be orginal research.  If an argument is made that this figure does represent something meaningful then that too would be original research.  The only way to get around this is to source the calculated figures from a third party (together with any caveats they present).


 * As such this column should not be added to the table.


 * The numbers we have are not ideal but they are sourced. We will just have to wait for the scientific establishment to come up with better ways of tracking this disease.  We aren't in a position to do this ourselves.  We are likely to make grave errors if we try. Barnaby dawson (talk) 11:21, 28 July 2009 (UTC)

Confusing sentance needs correcting or a 7% mortality rate is not mild
"Most cases mild Evidence mounted through May 2009 that the symptoms were milder than health officials initially feared. As of May 27, 2009, most of the 342 confirmed cases in New York City had been mild and there had been only 23 confirmed deaths from the virus.[190]" 23/342 is a nearly 7% mortality rate. Does the 23 deaths refer to deaths in New York City, or total deaths in the USA at that time? If the former then they cannot be described as mild, if the later then the sentence needs to be made clearer in meaning. I thought I made this remark before but it seems to have disapeared. 78.147.11.227 (talk) 13:41, 28 July 2009 (UTC)


 * Judging by the date, 23 confirmed deaths is total deaths in the USA (or the whole world?). Anyway, this is a very good example of comparing apples and oranges. Samulili (talk) 20:26, 28 July 2009 (UTC)

New column estimated cases
I believe it should be deleted, no sources...201.252.112.200 (talk) 18:56, 28 July 2009 (UTC)
 * I agree.. where does this information come from? or has it just been made up? Mirrorme22 (talk) 20:07, 28 July 2009 (UTC)

Requesting for the Return of the "Confirmed Cases" column and Update some Mistakes
Good afternoon!!

I just noticed this afternoon that the confirmed cases column is not showed up, instead, they remained the confirmed deaths column. I'm just requesting to return it back just like the way before because I'm always watching the updates on how was the virus spreading is going on right now on the world. I even bookmarked this page last month to watch the events or updates happening. But I'm giving so much attention to the "Confirmed Cases" column every day or every time that I go to this page. But this afternoon, it's gone.

I also visited and observed the "2009 Flu Pandemic in the Philippines" and "by region". I would like to recommend that you merge the said pages. I also noticed that many parts of the pages are not updated as needed. Also, the columns there are not updated. Also, in the "2009 Flu Pandemic - table" page, there are mistakes like in the number of deaths of the countries Uruguay and United States. I think you interchanged them with some other countries. I'm hoping for your updates for the benefit of everyone.

Please consider my requests as your loyal viewer and visitor of this website.

Thank you and I'm hoping for your positive answer and consideration.

My loyalty is yours,

Anonymous(Philippines) —Preceding unsigned comment added by 122.2.95.46 (talk) 07:07, 24 July 2009 (UTC)


 * Unfortunately this article and its table have been hijacked by a small group chasing an ideology. The table and the information that it contains is under constant deliberate attack by those that want us all to enter the magical world of multiplier estimates.  This article, because of the constant ideological vandalism, might as well be tombstoned.  However, good numbers and information can still be had from http://ecdc.europa.eu/ --Dion Liddell (talk) 08:04, 24 July 2009 (UTC)


 * Once WHO and others officially announced they were no longer going to try to track or test confirmed cases, it meant that the confirmed case data was officially useless (as it had unofficially been for a while). It could be replaced with a column tracking how many people had been tested, but since many countries aren't testing at all, and we have no good way of indicating which are, and which aren't, the data is a poor means of tracking spread. Fatalities are a much better means, because folks who are actually dying from flu symptoms will continue to be tested. A hospital would be negligent *not* to test, if for no other reason than that they need to make sure there isn't some other malady responsible for the individual patient's condition. There is no tracking data in the confirmed case counts, because there is no mechanism to compel countries to test folks with flu-like symptoms. Deaths, on the other hand, are a stark and very current measure of spread. So, again, it's deaths you should look to if you want to track this thing. Cadavers are much harder to ignore than the sniffles.68.111.62.56 (talk) 09:15, 24 July 2009 (UTC)


 * You would have us use Influenza surveillance information for estimating deaths. This is not good data for that purpose.


 * "...influenza is infrequently listed on death certificates of people who die from flu-related complications.", "Only counting deaths where influenza was included on a death certificate would be a gross underestimation of influenza’s true impact." -CDC


 * The 'made up' numbers you deride (re seasonal flu) are our best estimates of these hard to estimate figures. Yes they have wide error bars but the order of magnitudes of these figures is in little doubt.  These numbers have been estimated using multiple independent methods.  The fact that these methods agree on the order of magnitude (and are close regarding the first significant digit) makes your contention suspect.


 * For the record I don't agree with an unsourced table of estimates (for swine flu) either (but for OR reasons).Barnaby dawson (talk) 07:17, 26 July 2009 (UTC)


 * Unfortunately, you're using flawed logic here. The fact that there is so much agreement on these entirely arbitrary estimates is evidence that nobody wants to be the outlier -- and that individual estimates get tweaked until they fall somewhere in the vicinity of the commonly accepted figures. Not, as you've concluded, evidence that they were right to begin with. The fact that U.S. fatalities sat at 20k for years until, magically, they got updated to our current 36k figure shows that these aren't some scientifically rigorous statistical extrapolation. They're a guess. Frankly, since we see such wide variance from season-to-season in flu-related hospitalization rates, the fact that we *don't* see a wider variance in the estimated numbers from different sources is a reason to *doubt* those numbers. Not a reason to believe them confirmed. —Preceding unsigned comment added by 68.111.62.56 (talk) 15:08, 29 July 2009 (UTC)

Calculation vs speculation
For the ongoing discussion about estimation numbers I recommend the very good article in Times Online on | Swine Flu: knowns, unknowns, calculation and speculation.

Another good article on fatality rates is Swine flu death rate estimates 'flawed'.

FHessel (talk) 09:27, 27 July 2009 (UTC)
 * This article has the same fuzzy reasoning that has gotten us into a bind in the first place, when it comes to fatality numbers. To suggest, in the middle of a pandemic, that doctors would mistakenly attribute swine flu fatalities to pneumonia is a baseless supposition. Without some systematic effort to spot-check (by, say, randomly testing every fatality in a representative geographic region for two weeks for swine flu) the only "data" we have to base this flawed notion upon is that during regular years, a large number of flu fatalities are *presumed* to go unnoticed, blamed on other causes. Are we to supposed to assume that doctors have somehow failed to hear that there's a pandemic going? Or are we, instead, somehow to suppose that in the middle of a pandemic, a doctor would ignore the possibility that a deceased patient might, just possibly, have died from the flu? Yes, it's correct that estimating case fatality is an exercise in futility, and one which can (depending on how it is done) either provide a false sense of security, or an equally false sense of doom. However, until we have some statistically significant source of data to show how our flu fatality numbers are under-reporting we need to quit treating them as if they're wildly off. It is just as likely, if not more, that seasonal flu is grossly over-estimated in its lethality than it is that swine flu is being missed by a failure to recognize when it kills. But, yes, I absolutely agree that we should steer clear of metrics like case fatality. They are based on incomplete data, and as such, provide no valid information.68.111.62.56 (talk) 14:13, 29 July 2009 (UTC)

When I enter the 2009 flu pandemic article, my entire screen is consumed by an enormous table
... from side to side, and all the way down for screens and screens of depth. And this entire table is a reprinting at length of a table that exists elsewhere in Wikipedia (Pandemic H1N1/09 by country).

It should be referenced here, not re-printed at length. As it is, the contents of this article, different from the "Pandemic H1N1/09 by country" article, are shoved down and down to where many may never arrive. The only "non table" article words that can be seen before the bottom of the huge table are these:

2009 flu pandemic From Wikipedia, the free encyclopedia (Redirected from 2009 swine flu outbreak) "The 2009 flu".

That's it; for many, that will be their entire impression of this article, because they will stop after a couple of screens. If they make it to the bottom, their time was still consumed by a complete, redundant reprint.


 * Yeah, that's great, if for some reason most visitors to the article were getting to it after carefully and painstakingly typing out a Wiki search entry to bring them, somehow, miraculously, first to the Pandemic H1N1/09 by country article. What's the ratio of page views for that article to this one? Ten to one in favor of this one? One hundred to one? Of the views that article gets, how many are from anything *other* than clicking the link to it from *this* article? Any? The table presents the most pertinent data available on the flu, as well as some useless figures on lab-confirmed infections. There has been a running debate on the size, content and placement of the table for much of the time that there has been a swine flu pandemic wiki, and if you'd like to weigh in, perhaps you should find, follow, and contribute to that debate, rather than assuming that by noting that the table is, indeed, large, you've stumbled across a fresh piece of data we hadn't considered before.68.111.62.56 (talk) 13:55, 29 July 2009 (UTC)

Current official (and still updated weekly) CDC graphs indicate sharp rise in influenza-like illnesses in US emergency rooms year-over-year
Though the CDC no longer updates confirmed case numbers, it continues to provide a number of revealing charts that give a feeling for actual incidence. The CDC's weekly web-page report providing these and other very interesting information is at:

http://www.cdc.gov/flu/weekly/

This is a full-page version of the first chart, current to July 28:

http://www.cdc.gov/flu/weekly/weeklyarchives2008-2009/images/picILI28.GIF

This page shows that the national percentage of ER admissions in the US this week in July with Influenza Like Illness (ILI) is typically somewhat below 1%, but in 2009, following the spike in swine flu cases, remains much higher (red line). It's about double the usual, somewhat over 1.5%, as shown by the graph for earlier years' rates (blue & green lines).

Information in this chart is coupled with an even more interesting finding, shown in the tests and percent-positive results in the chart provided (full page) at http://www.cdc.gov/flu/weekly/weeklyarchives2008-2009/WhoLab28.htm (current when writing) and updated weekly on the main http://www.cdc.gov/flu/weekly/ page. The bars in this second CDC chart show that in the most recent week, about 1000 of the specimens tested were positive. The black line shows that the percentage positive was about 10% of all tested specimens. And the bar color coding shows that almost all of those that were flu were swine flu, or were not subtyped for whatever reason (current estimates is that 99% of circulating flu is swine -- including 99% of the non-subtyped). Comparison with the earliest weeks shown (about September of 2008) shows that the number of positive specimens, and the percent positive, in a non-pandemic situation are both near zero -- well under 1%.

By these charts, the CDC shows us that we have twice the ILI cases in US emergency rooms, and of those high ILI numbers 10%, rather than the usual (1/2 of 1% or so) cases test positive for influenza. Double the ER cases, 20 times the positives. Maybe 40 times the cases overall of a non-pandemic year.

The second chart mentioned also shows that the incidence has plummeted to current high levels from even higher levels.

This information is of use in estimating the current number of cases, something the CDC and other governmental planning units and the WHO are now doing. Unfortunately for estimating (but good for health of the public) ER cases tend to be more severe than the (probably much more common) cases who recover at home or just visit their family physician.

—Preceding unsigned comment added by 66.167.95.186 (talk) 19:53, 29 July 2009 (UTC)

Is the UK being ignored?
Over the past 3 days, I have noticed the UK section for 'confirmed cases/deaths' is being ignored. PLEASE update it, thank you.

(86.170.160.255 (talk) 20:51, 28 July 2009 (UTC))

UK update
55,000 more Brits are ill [], but The CDC say it's only 12,000!--86.25.10.101 (talk) 02:09, 30 July 2009 (UTC)

Brazil numbers aren't being updated
The brazilian flu pandemic page have 4,246 confirmed cases and I've noticed the total numbers have been ignored for a long time now. Only the death numbers keep being updated. **** —Preceding unsigned comment added by 189.26.78.43 (talk) 16:26, 30 July 2009 (UTC)

Canada's death toll is 58, not 57
Please see the official Canadian public health website: http://www.phac-aspc.gc.ca/alert-alerte/swine-porcine/surveillance-eng.php

It was been 58 since July 23rd!!! —Preceding unsigned comment added by Batman Canada (talk • contribs) 18:07, 30 July 2009 (UTC)

Edit request
Please update the world map in the "Response"-section: The small Western-European country Belgium is indicated in red, and it should be black, because there has been confirmed one dead by the H1N1-virus. (the column with death cases is correct however, and it has the link to the source) —Preceding unsigned comment added by The Fatal Turtle (talk • contribs) 15:07, 30 July 2009

Already done Welcome and thanks for improving the article. Fonadier updated this today. Celestra (talk) 14:42, 31 July 2009 (UTC)

Almost undecipherable table column
The column in the outbreak table is ridiculous and almost impossible to read. This kind of information is much better explained in the text and is only distracting given the non-standard shortenings used. I suggest it is removed completely. 220.225.126.138 (talk) 09:28, 31 July 2009 (UTC)


 * Replace with a pointer. The entire table is its own article on WP. Hence its placement here in full is not only "ridiculous" (I agree) but also redundant.  —Preceding unsigned comment added by 68.165.11.149 (talk) 16:51, 31 July 2009 (UTC)
 * It doesn't have its own article; it's a template. Templates are created to be transcluded.  hmwith  τ   18:27, 31 July 2009 (UTC)

New name, per World Health Organization (WHO) is “Pandemic (H1N1) 2009”
The main article states that recently,


 * "...[I] recognition of those issues, what WHO, FAO and OIE did, actually some weeks ago, was to get together several of the experts who work in these organizations and with many of the laboratory experts who work with these organizations, and then we had a meeting – a virtual meeting – in which these issues were discussed and one of the things that we wanted to do was make sure that any naming of the virus was scientifically accurate but also would avoid any kind of adverse reactions to the name or to minimize those as much as possible. Based on those discussions, what the experts decided – calling this a pandemic H1N1/09 virus – was a good way to distinguish it from the current seasonal H1N1 viruses and to do so, in a way which was scientifically sound, but also would avoid some of the stigma associated with other options."[152]"

FROM: the NZ gov site:

Change in name of infection The World Health Organization (WHO) is now referring to the current pandemic as “Pandemic (H1N1) 2009”.

FROM: http://blogs.sciencemag.org/scienceinsider/2009/07/international-a.html July 7, 2009 International Agencies Try to End Flu Naming Wars


 * "Repeat after me: "Pandemic H1N1 2009." That's the new name three international agencies, including the World Health Organization, have picked to end the chronic confusion about what to call the influenza pandemic and the virus that causes it. But some scientists are only half-happy with the solution." ...

...
 * "Now, WHO, the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (OIE) have chosen to use "pandemic (H1N1) 2009" for the disease. For example: "Hundreds of new cases of pandemic (H1N1) 2009 were reported." And: "pandemic (H1N1) 2009 virus" for the agent. In scientific papers, genome databases, et cetera, researchers can use the existing, complex naming scheme for individual viral isolates, but add a "v" to indicate that it's the pandemic strain, as in "A/California/7/2009(H1N1)v." "


 * "The new nomenclature was first reported yesterday on ProMED, an online outbreak reporting system, where it had arrived through a "personal communication" from someone within WHO, says ProMED Viral Diseases Moderator Craig Pringle. At a telephone press conference today, WHO flu chief Keiji Fukuda said the three agencies picked the new name after a virtual consultation with virus experts several weeks ago. They didn't issue an official statement to introduce the name, however; WHO simply started using it in its Situation updates on the web on 1 July. OIE and FAO have yet to introduce it on their Web sites, where various other names are in use."

—Preceding unsigned comment added by 68.165.11.149 (talk) 16:49, 31 July 2009 (UTC)

New name poll?
I think the current name may be doing a large number of information seekers a disservice so would suggest a new poll. The goal is to simply get people wanting Wiki's Swine flu article to where they were intending to go - namely, to this article. There's reason to suspect that a large percentage don't, based on what I see in search information.

For example, a Google search for "swine flu" will direct them, after the CDC sites, to "Swine influenza" as the key article, with this one as a sub-category. A quick reading of the lead for that article will show it will not help most "swine flu" searchers with its heavy focus on pigs. While there is a "main" article link at top, I suspect that a large percentage don't use it. The Wikipedia stats for July show that the "Swine influenza" article got about 31,000 readers per day, while this one averaged 20,000, implying that up to 33% didn't bother to go any further. A Wiki search for "Swine flu" also goes to "Swine influenza."

Using a seo tool like Wordtracker shows that of the searches over the last month that included the word "flu," over 75% were within a search for "swine flu" and its related symptoms, while only 0.16% were part of "flu pandemic." A Google search within either News or Web shows that "Swine flu" is used by far most of the time within article titles.

So the point in all this is that a large percentage of people hoping to learn about "swine flu" by using this article, are never getting here. It's not just a matter of what's "correct" or preferred by the CDC, but of giving readers the information they want and probably need. My thinking is that the best way right now to do that would be to have this article include the term "Swine flu" in its title. Thoughts? --Wikiwatcher1 (talk) 23:15, 25 July 2009 (UTC)


 * Strongly agree. I've ended up more than once on the animal swine flu page.  That page should be re-named "Animal swine flu." or "Swine flu in animals."  This page should be named Swine Flu Pandemic, 2009.  It will likely end up "Swine Flu Pandemic, 2009-2011.  —Preceding unsigned comment added by 64.105.0.247 (talk) 14:39, 27 July 2009 (UTC)


 * Mildly disagree. Although I discover myself again and again, that media (and partly official sources too) still use the term 'swine flu', often in phrases like "A/H1N1, also named 'swine flu'", I found, that many switched to H1N1, or just 'el gripe' or 'el virus' in the spanish sources. Consequently I have changed my news searches, which had originally included the term 'swine flu', because I began missing articles. Furthermore it regularly strikes me, that the usage of 'swine flue' or 'Schweinegrippe' appears to be somehow archaic or old fashioned (s.o., who took part in the discussion in April/early May and is back now, using the same vocabulary he did once).


 * My quick google news search resulted to: 12% using swine flu (or similiar) but not the term H1N1, whereas 69% using H1N1 but not swine flu (or similiar). I only searched news, because the google search itself includes all old publications and usage has changed over time. The detailed results were: H1N1=208451, swine flu=48819, swine flu-H1N1=18572, Schweinegrippe=11667, Schweinegrippe-H1N1=6844, gripe porcina=8293, gripe porcina-H1N1=3015, grippe porcine=3754, grippe porcine-H1N1=364.


 * Looking at the wikipedia pages, I find, that the links are prominent enough. There is one link right in the beginning of 'Swine influenza' plus a second one, when you go to "3. History / 3.6 2009 outbreak in humans". That should be enough to give every interested reader the chance to go right where he wants.


 * But I think, that the redirect of 'Swine flu' in WP should link to the page '2009 flu pandemic' instead of 'Swine influenza', because I guess(!), that for 99% of humans the term 'swine flu' has got its meaning only in connection with the current pandemic and not with other (earlier) outbreaks of swine influenza.


 * Summary: Change name: NO - Change redirect: YES


 * FHessel (talk) 06:54, 28 July 2009 (UTC)

Interesting survey: "More than half of U.S. adults turn to the Internet when they have health or medical questions, according to a survey from the Pew Research Center. More alarmingly, a survey in April found that 50 percent of doctors turn to Wikipedia for medical info."

Unless there is disagreement, we should have the term "Swine flu" redirected to this article instead of "Swine influenza" for all the reasons given. It apparently needs an admin to make the change. Any volunteers? --Wikiwatcher1 (talk) 17:48, 31 July 2009 (UTC)

Perhaps people were curious about the swine flu in general when they stopped at that page. Swine flu should redirect to the article about swine flu. We can make a notice at the top of that page bigger, but swine flu should not redirect to this page.  hmwith  τ   18:35, 31 July 2009 (UTC)


 * Don't agree. Before the "swine flu" epidemic started, the Swine influenza article was averaging less than 10 readers per day.  Afterwards, including this month, it's averaging over 25,000 readers each day.  That means that only .04% of the readers of that article were intending to read it, as opposed to this article. I'm personally amazed that a search for "Swine flu" is still redirecting readers to where they clearly don't want to go. --Wikiwatcher1 (talk) 18:51, 31 July 2009 (UTC)

Am hoping that User_talk:Jauerback, who created the redirect, can respond to my question of why he chose the target. As the figures above imply, it's likely that many thousands of readers each day are being "mis-directed." --Wikiwatcher1 (talk) 18:58, 1 August 2009 (UTC)
 * There was a consensus of one on my creation of the redirect. :)  Okay, that's only the partial truth.  The real reason (which is only available in the deletion history) is because of this:

(diff) 08:55, July 20, 2009. . Oxicleanfanatic (talk | contribs | block) (54 bytes)  (moved Swine flu to Swine flu is nothing to be worried about: unless you're really old or really young or very ill)
 * I assumed that this was probably not correct and further assumed that it was supposed to be redirected to Swine influenza (incorrectly, it seems). If this is a discussion to redirect it back to Swine flu is nothing to be worried about: unless you're really old or really young or very ill, then I disagree, otherwise I honestly have no opinion.  Do as you will.  Jauerbackdude?/dude. 01:40, 2 August 2009 (UTC)

Straw poll to redirect "Swine flu" to this article
The original redirector (new word?) has unlocked the redirect allowing it to be edited.
 * For
 * Per above comments. --Wikiwatcher1 (talk) 02:38, 2 August 2009 (UTC)
 * Have taken the liberty of redirecting "Swine flu" to this article in meantime. --Wikiwatcher1 (talk) 17:18, 2 August 2009 (UTC)


 * Against

Rename this article “Pandemic (H1N1) 2009”?
Why fight the WHO. Its new name, “Pandemic (H1N1) 2009”, is unambiguous enough.

—Preceding unsigned comment added by 68.165.11.149 (talk) 23:48, 31 July 2009 (UTC)


 * Well for one that is the name of the virus not the outbreak, for two the current name is correct per WP:COMMON, and for three the current name is the consensus name after massive debate (see the archives). So, no I don't think we should change. --ThaddeusB (talk) 00:31, 1 August 2009 (UTC)


 * New information should never be used as an excuse to re-consider a consensus if it was reached after massive earlier debate.


 * Regarding disease vs. virus, the above (and below) information suggests that perhaps the disease might be intended after all.


 * "Now, WHO, the Food and Agriculture Organization of the United Nations (FAO), and the World Organisation for Animal Health (OIE) have chosen to use "pandemic (H1N1) 2009" for the disease. For example: "Hundreds of new cases of pandemic (H1N1) 2009 were reported." And: "pandemic (H1N1) 2009 virus" for the agent.


 * I prefer common usage, but for this flu I think the common usage ("swine flu" -- 9,790,000 hits on Google) has been set aside. "2009 flu pandemic" draws 27,300 hits.  "pandemic (H1N1) 2009" draws more -- 93,200. Go figure.

—Preceding unsigned comment added by 66.167.61.252 (talk) 01:10, 1 August 2009 (UTC)
 * Don't change the name again, but a redirect can be created for Pandemic (H1N1) 2009. Graeme Bartlett (talk) 01:39, 1 August 2009 (UTC)
 * I think the WP:COMMON name would be 2009 swine flu pandemic. -Pecoc (talk) 17:28, 1 August 2009 (UTC)


 * Lots of redirects definitely needed. This thing has been called a lot of names, and every one of them will be used to search in wikipedia for this article.  —Preceding unsigned comment added by 64.105.0.186 (talk) 20:33, 2 August 2009 (UTC)

Symptoms
The symptoms are listed here [] on an N.H.S. site.


 * a sudden fever (a high body temperature of 38°C/100.4°F or above), and
 * a sudden cough.
 * headache,
 * tiredness,
 * chills,
 * aching muscles,
 * limb or joint pain,
 * diarrhoea or stomach upset,
 * sore throat,
 * runny nose,
 * sneezing, or
 * loss of appetite.

--86.25.4.98 (talk) 19:18, 1 August 2009 (UTC)

The table of contents for the article is submerged. It should be moved to the top.
The table of contents for the article is submerged. It should be moved to the top. —Preceding unsigned comment added by 64.105.0.186 (talk) 20:35, 2 August 2009 (UTC)

No one dies from a car accident.
No one dies from a car accident. Some die from bleeding too much or a heart attack or from their brain being crushed. In the same way, no one dies from flu. The death numbers do not reflect accurate medical knowledge because "confirmed deaths" does not mean what some of you think it means. WAS 4.250 (talk) 00:22, 25 July 2009 (UTC)
 * Are you suggesting something? I know that some people who die from this flu die from a bacterial pneumonia caused by a weakened immune system.  I read the pneumonia bacteria can be a staff infection, same type of bacteria that is found on your skin.   Daniel.Cardenas (talk) 00:50, 25 July 2009 (UTC)
 * Except that you're mistaken. During a pandemic, doctors are absolutely cognizant of flu as a potential cause of death -- and will list & name it as such, even if the proximate cause is pneumonia, or renal failure, etc. What's more, the "hidden" nature of flu is usually due to the fact that regular flu only kills people who don't take much to die. Most elderly have partial or full resistance to this strain, so it's killing people where it's a much more obvious cause. If you can find any attributable data proving that we're allowing swine flu fatalities to go unreported the same way regular flu does, then you've got a valid argument. Otherwise, you don't. If anything, I hope our more accurate fatality figures from swine flu might influence more reasonable estimates for seasonal flu fatalities -- as the arbitrary 36k/500k rate is of dubious value, at best. —Preceding unsigned comment added by 68.111.62.56 (talk) 00:45, 27 July 2009 (UTC)


 * Not true. To diagnose a death as being primarily as a result of swine flu the doctor must first notice it amongst the thousands of deaths that otherwise appear very similar that are not a result of the flu.  Secondly they must have a positive result back from testing.  Which is often impossible given the nature of the secondary infections and when they tend to present (also don't forget the very high false negative rate with the standard tests).  In any case it is not our viewpoints that matter in this article but credible peer reviewed research.  People may be looking harder for flu deaths but the criterion (implicit or explicit) for reporting swine flu deaths are also much stricter than those used for seasonal flu.  91.125.50.226 (talk) 11:47, 3 August 2009 (UTC)


 * People can be and are killed by viral pneumonia caused by an influenza virus capable of invading the lungs, such as H5N1 or (far less often) swine flu. But yes, bacterial pneumonia is the most likely candidate for finishing off most who died during the Spanish Flu, after it had knocked out their pulmonary immune system.  —Preceding unsigned comment added by 68.165.11.149 (talk) 00:37, 1 August 2009 (UTC)

Church liturgy
Certain Church leaders have reacted to the swine flu by modifying certain liturgical norms. This could perhaps be noted in the article.  ADM (talk) 08:50, 3 August 2009 (UTC)

Vietnam first death.
This is broadcast at 12:05 (UTC+7) in the News Program on VTV1, the News Channel of Vietnam. The name of the case is Bùi Thị Xuân. Found positive to flu on July 30, with her son positive too. Reason of death is to be investiaged. —Preceding unsigned comment added by 123.16.255.160 (talk) 05:09, 4 August 2009 (UTC)

General comments in lead?
It's usually silly to get into edit wars so want to clarify why the following text was removed twice, but is again being reinserted:


 * "Then again, Dr Anne Schuchat from CDC thinks, "this is a virus that's capable of causing a spectrum of illness that includes severe complications and death". "It's very important we take this virus seriously".

It was removed, along other pruning edits, because it seems to add nothing that the lead doesn't already imply. For instance, one would assume that after a pandemic is declared, that our CDC would "take this virus seriously." And to add a citation as proof seems doubly unnecessary. The lead should be kept lean and not fluffed up with general statements, IMO. I've removed this twice and it's been put back twice, so unless anyone agrees with why it seems to be unnecessary and edits it, it can stay. --Wikiwatcher1 (talk) 18:53, 3 August 2009 (UTC)


 * I have reinserted that citation again, because it gives a quite different view of the pandemic, compared with all the rest of the lead. It is pointed out that the pandemic is of 'moderate severity', 'most cases mild' and so on. Being a reader without background, I would get the impression, that there is no real reason to care about an infection. Actually all actors (Dr Fukuda, Dr Schuchat, and many more) have tried to communicate, that the virus on one hand causes mild symptoms, BUT ON THE OTHER HAND there are those people, who are experiencing an life endangering or even fatal illness. This has not been communicated clearly enough in the lead. And it belongs in the lead. The declaration of a pandemic is telling us something about the geographical spread and nothing about the severity. And leaving such an important statement to the right (in this case wrong, see before) conclusions of the reader, is dangerous IMO.


 * By the way, it should also be corrected, that an appreciable proportion of fatal cases has not had any underlying medical conditions, but occurred in previous healthy young people. FHessel (talk) 08:22, 4 August 2009 (UTC)


 * Your last comment, "an appreciable proportion of fatal cases has not had any underlying medical conditions, but occurred in previous healthy young people" is true and factual, and if there's first some cited material about that fact added to the article, it would be a good balancing statement in the lead. We can't include mortality rates of this flu compared to "seasonal" since there seems to be no accurate data, just the raw numbers. But even those are questionable now that WHO and the CDC have stopped counting or even testing cases. --Wikiwatcher1 (talk) 17:55, 4 August 2009 (UTC)


 * I also have learned that the general public who have not been following the situation closely all believe the disease is invariably "mild" and are shocked to learn that instead the "moderate" designation is applied, with good reason. —Preceding unsigned comment added by 64.105.0.123 (talk) 21:55, 4 August 2009 (UTC)


 * Some refs:


 * page 6 of the | PAHO report is reporting between 41%-47% of fatalities without underlying conditions in Mexico, Argentina and Chile (n=481 cases)


 * WHO is warning pregnant women to be subject to an increased risk of severe or fatal illness


 * A comprehensive overview about worries and measures in connection with H1N1 by Doc Gurley


 * And don't miss this very good guideline on why to care and what to do, also by Doc Gurley


 * I bring the refs and you formulate the statements? FHessel (talk) 06:46, 5 August 2009 (UTC)


 * Per the WHO link above: "Danger signs in all patients"


 * "Worldwide, the majority of patients infected with the pandemic virus continue to experience mild symptoms and recover fully within a week, even in the absence of any medical treatment. Monitoring of viruses from multiple outbreaks has detected no evidence of change in the ability of the virus to spread or to cause severe illness.


 * "In addition to the enhanced risk documented in pregnant women, groups at increased risk of severe or fatal illness include people with underlying medical conditions, most notably chronic lung disease (including asthma), cardiovascular disease, diabetes, and immunosuppression. Some preliminary studies suggest that obesity, and especially extreme obesity, may be a risk factor for more severe disease."


 * The other links you included were to a doctor's blog and a Latin American-focused medical report. Came across this good summary of the Swine flu to date: Forbes.com.  --Wikiwatcher1 (talk) 20:58, 5 August 2009 (UTC)

the Continent Africa have deaths?
In the Continent Africa have deaths? In the site WHO speaks that there were no deaths in the African continent.

http://www.who.int/csr/don/2009_08_04/en/index.html —Preceding unsigned comment added by 189.122.206.22 (talk) 02:10, 5 August 2009 (UTC)


 * The WHO reference, which you refer to has been updated last on July, 31. Our table also contains news reports, when health officials are cited in the reports. From that moment on it takes a couple of days, until finally WHO is notified and it takes again some time until WHO updates its numbers. Thus there can be a time lag of 1-2 weeks between Wikipedia and WHO.


 * Yes, there are two deaths in South Africa in the meantime.


 * FHessel (talk) 16:14, 5 August 2009 (UTC)

Which portion of the population is most affected?
Can someone in the know, with citations, create a section in the main article on which portions of the population are most affected by the virus? Most likely fatalities...etc. I've been told that the very young and the very old are the most affected. Today I was told that due to this being similar to a 1970 outbreak, the old are less affected as they have immunity, and that it is my age group (20-30) year olds that are most at risk. Lots of confusing information out there. PLEASE DON'T ANSWER ME ON THE TALK PAGE! Not interested in creating a discussion. --Dmg46664 (talk) 10:34, 6 August 2009 (UTC)

Globalise
Certain sections of this article about a worldwide pandemic are excessively focussed on the US, and the actions and comments of its Government and media. The 'Response' section strikes me as particularly bad: though passing mention is made of other countries, I wonder if it shouldn't be made clearer that it is not only the US (with the WHO) that is preparing a vaccine, that it is not just the US workforce that will be affected or have opinions about staying away from public gatherings, and that schools and airlines elsewhere are presumably responding too?

Betdud (talk) 12:18, 6 August 2009 (UTC)


 * I think this happens because people tends to add information concerning to her own country and many users here are from US. I am from Chile, I added some information on Southern hemisfere and nobody complained so I recommend posting what you consider apropiate about your country's response from reliable sources so we can make a better article. Mathetic (talk) 17:25, 6 August 2009 (UTC)

School Closures in India
Include information about school closures in India: Swine flu scare has lead to schools being shut in Pune and New Delhi. At least four schools in Pune, Maharashtra are being kept shut for a week. The government is discussing what policy should be followed before announcing school closures.

ExpressIndia News Report OutlookIndia News Report

Ingle.atul (talk) 11:46, 7 August 2009 (UTC)

The numbers about Brazil are ABSURDLY OUT OF DATE
Check it, you guys. —Preceding unsigned comment added by 189.30.98.210 (talk) 01:43, 9 August 2009 (UTC)

The article should begin with introductory comments and the table of contents rather than with a table of cases
The article should begin with introductory comments and the table of contents rather than with a table of cases —Preceding unsigned comment added by 66.167.61.12 (talk) 02:35, 9 August 2009 (UTC)

Tamiflu preservative
Forgive me if I've missed this information but what preservative is used in Tamiflu or any other vaccine used to treat Swine Flu? The NNii says that influenza vaccine is "manufactured with thimerosal as a preservative", does Tamiflu contain thimerosal? Thanks. Mimi (yack) 20:54, 9 August 2009 (UTC)

School Closures in Brazil
In Brazil, the government suspended the classes in all the public schools and colleges until August 10th. About four days after this decision, the government changed the date to August 17th. Even the particular schools and colleges decided to suspend their classes, although most of people still take buses, subway and trains without masks and alcohol 70%. —Preceding unsigned comment added by 189.25.66.13 (talk) 23:38, 9 August 2009 (UTC)

1st reported death in Rep of Ireland (éire) caused by Swine Flu Virus H1N1
News reports on national stations confirm the 1st death in Ireland due to contraction of the H1N1 Swine Flu Varient. A young girl in Dublin died this morning (Aug 8th 2009).

Wikipedia needs to have its page on the 2009 Swine Flu Pandemic adjusted to show this change on its global map.. The page in question is registered at:

http://en.wikipedia.org/wiki/2009_swine_flu_outbreak

The global map at the time of typing shows Ireland as having only confirmed cases and does NOT take this news into account.

Please adjust accordingly.

Yours in good faith and with appreciation,

Adrian O'Brien jaffser@gmail.com —Preceding unsigned comment added by 86.45.74.179 (talk) 15:18, 8 August 2009 (UTC)

An Irish vaccine comes forth!
Read this- ! —Preceding unsigned comment added by 86.25.10.69 (talk) 08:42, 12 August 2009 (UTC)

Vaccines approved and their ingredients
(1)	Novartis patent information – Pub. No.: US 2009/0047353 A1, Pub. Date: Feb. 19, 2009 1.1	Abstract – The invention seeks to avoid components in split vaccines that could cause an excessive Th2 response. Thus the invention provides an immunogenic composition comprising a split influenza virus antigen and a Th1 adjuvant, wherein the antigen is preferably prepared from a virus grown in cell culture (e.g., it is free from egg proteins.) 1.2	Split virions – (Disclosure of the Invention) 1.2.1	0007…the clinical and epidemiological features of ORS are suggestive of hypersensitivity, and so it has been proposed that the vaccine may upset the natural Th1/Th2 balance, 1.2.2	0008 …the invention seeks to minimize the possibility that a split vaccine might cause an excessive Th2 response. In a situation where influenza vaccines have to be produced in a hurry (e.g. after a pandemic outbreak) then pressures on manufacturers might inadvertently result in the release of vaccines that suffer from the same problems as the partially un-split aggregated Canadian batches from 2000-01. 1.3	The Split Influenza Virus Antigen 1.3.1	0032 – The influenza virus may be a reassortant strain, and may have been obtained by reverse genetics techniques. 1.3.1.1	 Reverse genetics techniques [e.g. 16 – 20] allow influenza viruses with desired genome segments to be prepared in vitro using plasmids. 1.3.1.2	… they involve expressing (a) DNA molecules that encode desired viral RNA molecules 1.3.1.3	(b) DNA molecules that encode viral proteins 1.3.1.4	… it is also possible to use a helper virus to provide some of the RNA and proteins. 1.3.2	0036 – may include one or more RNA segments 1.3.2.1	from a A/PR/8/34 virus (typically 6 segments from A/PR/8/34, with HA and N segments being from a vaccine strains, i.e. a 6:2 reassortant). 1.3.2.2	from a A/WSN/33 virus, 1.3.2.3	or from any other virus strain useful for generating reassortant viruses for vaccine preparation 1.3.3	0037 – viruses used as the source of the antigens are grown on cell culture. 1.3.3.1	Mammalian origin 1.3.3.1.1	origin include, but are not limited to, hamster, cattle, primate (including humans and monkeys) and dog cells. 1.3.3.1.2	Cell types may be used, such as kidney cells, fibroblasts, retinal cells, lung cells, etc. 1.3.3.1.3	Hamster cells – BHK21 or HKCC 1.3.3.1.4	Monkey cells – African green monkey – kidney cells – Vero cell line. 1.3.3.1.5	Dog cells – kidney cells – MDCK cell line. 1.3.3.1.6	Thus suitable cell lines include, but are not limited to: MDCK; CHO; 293T; BHK; Vero; MRC-5; PER C6; WI-38; etc. 1.3.3.2	Preferred 1.3.3.2.1	 MDCK cells (28-31), derived from Madin Dabry canine kidney; 1.3.3.2.2	Vero cells derived from African green monkey (Cercopithecus aethiops) kidney 1.3.3.2.3	or PER C6 cells [35] derived from human embryonic retinoblasts. 1.3.3.3	Less-preferred 1.3.3.3.1	Ducks (e.g. duck retina) 1.3.3.3.2	Hens e.g. chicken embryo fibroblasts 1.3.3.3.3	Examples include avian embryonic stem cells… chicken embryonic stem cells. 1.3.4	0043 – trace amounts of host cell DNA may be present. 1.3.5	Oil-in-Water Emulsion Adjuvants 1.3.5.1	0100 – Emulsions can include oils such as those from animal or vegetable source. 1.3.5.1.1	Vegetable oils include nuts, seeds and grains, peanut oil, soybean oil, coconut oil, and olive oil, the most commonly available exemplify the nut oils 1.3.5.1.2	Jojoba oil obtained from the jojobean. 1.3.5.1.3	Seed oils include safflower oil, cotton-weed oil, sunflower seed oil, sesame seed oil and the like. 1.3.5.1.4	Grain group, corn oil is the most readily available but the oil of other cereal grains such as wheat, oats, rye, rice, teff, triticale and the like… 1.3.5.1.5	Fats and oils from mammalian milk are metabolizable and may therefore be used. 1.3.5.1.6	Fish oils – For example, cod liver oil, shark liver oils, and whale oil such as spermaceti. 1.3.5.1.7	Squalene, the saturated analog to squalene is also a preferred oil. 1.3.5.2	0107 – A submicron emulsion of squalene, Tween 80, and Span 85, also including an immunostimulatory oligonucleotide. 1.3.5.2.1	Emulsion by volume can be about 5% squalene, 1.3.5.2.2	About 0.5% polysorbate 80 1.3.5.2.3	And about 0.5% Span 85 1.3.6	Pharmaceutical Compositions 1.3.6.1	0113 – The composition may include preservatives such as thiomersal or 2-phenoxyethanol … (i.e. less than 5mcg/ml) mercurial material e.g. thiomersal-free. 1.3.6.2	0119 – The inclusion of a preservative is preferred in multidose arrangements. 1.3.6.3	0144 – Multiple doses will typically be administered at least 1 week apart. 1.3.6.4	0145 – Vaccines produced by the invention may be administered to patients at substantially the same time as: 1.3.6.4.1	Measles vaccine, a mumps vaccine, rubella vaccine, a MMR vaccine, a varicella vaccine, a MMRV vaccine, a diphtheria vaccine, a tetanus vaccine, a pertussis vaccine, a DPT vaccine, a conjugated II. Influenza type a vaccine, an inactivated poliovirus vaccine, a respiratory syncytial virus vaccine, a pneumococcal conjugate vaccine, etc. 1.4	Modes for carrying out the invention 1.4.1	Oil-in-Water Emulsion Adjuvant Favouring Th1 Response 1.4.1.1	Human Trials 1.4.1.1.1	0161 – split influenza vaccines were adjuvanted with an oil-in-water emulsion having an organic phase made of two oils (a-tocopherol and squalene). And an aqueous phase of phosphate buffered saline (PBS) containing Tween80 as emulsifying agent. 1.4.1.1.1.1	2.5% sqalene (v/v) 1.4.1.1.1.2	2.5% a-tocopherol (v/v) 1.4.1.1.1.3	0.9% polyoxyethylene sorbitan monooleate (v/v) (Tween80) 1.5	References (The contents of which are hereby incorporated by reference. 1.5.1	Page 14 – 15. 1.5.1.1	1. An immunogenic composition comprising a split influenza virus antigen and a Th1 adjuvant, wherein the antigen is prepared from a virus grown in cell culture and does not include any egg proteins. (see 1.3.3.1.6 and 1.3.3.1.7) 1.5.1.2	 3. The composition of claim 1, wherein the composition is free from ovalbumin, ovomucoid and chicken DNA. 1.5.1.3	 4. The composition of claim 1, wherein the virus is grown on a cell culture of a cell line selected from the group consisting of: MDCK; Vero; and PER.C6.  (see 1.3.3.1.7) 1.5.1.4	 8. The composition of claim 1, wherein the adjuvant includes a tocopherol.  (see 1.4.1.1.1.2) 1.5.1.5	 9. The composition of claim 8, wherein the tocopherol is DL-[alpha]-tocopherol.  1.5.1.6	 10. The composition of claim 1, wherein the adjuvant is in the form of an oil-in-water emulsion. (see 1.4.1.1.1) 1.5.1.7	 13. The composition of claim 1, wherein the influenza virus antigen is prepared from an influenza virus obtained by reverse genetics techniques. 1.5.1.8	 16. The composition of claim 1, wherein the adjuvant comprises of 3-O-deacylated monophosphoryl lipid A (3dMPL) 1.5.1.9	19. The composition of claim 1, being substantially free from mercurial material. (see 1.3.6.1) 1.5.1.10	20. The composition of claim 1, including between 1 and 20 mg/ml sodium chloride. 1.5.1.11	23. The composition of claim 22, wherein the buffer(s) include: a phosphate buffer; a Tris buffer; a borate buffer; a succinate buffer; a histidine buffer; or a citrate buffer. 1.5.1.12	30. The composition of claim 11, wherein the emulsion includes squalene, a tocopherol, and polysorbate80. (2)	Individual ingredients referenced in the Novartis patent. 2.1	Tocopherol – Vitamin E (not known if tested in a vaccine environment) – Side effects – 2.1.1	… in high doses. An increased risk of bleeding has been proposed, particularly in patients taking blood-thinning agents such as warfarin, heparin, or aspirin; or in patients with vitamin K deficiency. Recent evidence suggests that regular use of high-dose vitamin E supplements may increase the risk of death (from "all causes") by a small amount,    http://www.healthline.com/natstandardcontent/vitamin-e-1 2.1.2	Rats treated with weekly oral doses of about 50 mg of a vitamin E concentrate were found to have fatty changes in the liver. In addition, intimal sclerosis of the aorta was seen, with the over-development of collagenous tissue at the base of the aortic valve and in the medial coat of the aorta (Marxs et al., 1947). 2.1.3	Rats given high doses of alpha-tocopherol had elevated liver cholesterol levels and altered tissue fatty acids (Alfin-Slater et al., 1972). 2.1.4	Groups of weanling female Wistar rats were fed diets containing 0, 25, 250, 2500, 10,000, or 25,000 IU vitamin E/kg diet for 8 and 16 months. Vitamin E depressed body-weight gain at concentrations of 10,000 and 25,000 IU/kg diet, and increased relative heart and spleen weights were seen at 8 months and 16 months, respectively. There was an increase in plasma alkaline phosphatase and a decrease in the ash content of bone after 16 months at these two dose levels. Prothrombin time was reduced at 12 months, but not at 9 or 16 months. Urinary excretion of creatine and creatinine was normal at 11 months. No histological examinations were reported (Yang & Desai, 1977). 2.2	Squalene - MF59, a proprietary adjuvant containing squalene – 2.2.1	 A link between the health problems of Gulf-War veterans and possible presence of squalene in vaccines received by these soldiers has been suggested. One published report has suggested that some army veterans who received anthrax vaccines developed anti-squalene antibodies and that these antibodies caused disabilities. http://www.who.int/vaccine_safety/topics/adjuvants/squalene/en/index.html 2.2.2	Analysis of additional personnel revealed that in all but one case (19/20; 95%), ASA were restricted to personnel immunized with lots of vaccine known to contain squalene. Except for one symptomatic individual, positive clinical findings in 17 ASA-negative personnel were restricted to 4 individuals receiving vaccine from lots containing squalene. ASA were not present prior to vaccination in pre-immunization sera available from 4 AVIP personnel. Three of these individuals became ASA positive after vaccination. These results suggest that the production of ASA in GWS patients is linked to the presence of squalene in certain lots of anthrax vaccine. 2002: Asa Pamela B; Wilson Russell B; Garry Robert F, Antibodies to squalene in recipients of anthrax vaccine. Experimental and molecular pathology 2002;73(1):19-27. 2.2.3	Squalene is a cholesterol precursor, which stimulates the immune system nonspecifically. We demonstrate that one intradermal injection of this adjuvant lipid can induce joint-specific inflammation in arthritis-prone DA rats. Histopathological and immunohistochemical analyses revealed erosion of bone and cartilage, and that development of polyarthritis coincided with infiltration of ß+ T cells. – Our demonstration that an autoadjuvant can trigger chronic, immune-mediated joint-specific inflammation may give clues to the pathogenesis of rheumatoid arthritis, and it raises new questions concerning the role of endogenous molecules with adjuvant properties in chronic inflammatory diseases. (American Journal of Pathology. 2000;156:2057-2065.) © 2000 American Society for Investigative Pathology The Endogenous Adjuvant Squalene Can Induce a Chronic T-Cell-Mediated Arthritis in Rats, Barbro C. Carlson*, Åsa M. Jansson*, Anders Larsson, Anders Bucht * and Johnny C. Lorentzen* , From the Department of Medicine,*Unit of Rheumatology, Karolinska Institutet, Stockholm; the Department of Medical Sciences, University Hospital, Uppsala; and the Department of Biomedicine, Division of NBC Defense, Defense Research Establishment, Umeå, Sweden 2.3	Polysorbate80 – surfactant 2.3.1	According to the MSDS sheet at Science lab.com, section 11: Toxicological Information, it was tested for inhalation and ingestion and was shown to be slightly hazardous on skin contact, ingestion and inhalation. However these are minor compared to other potential side effects of its use especially in an intravenous or immunologic setting. In the same section of toxicological information it states that it may cause reproductive effects, it may cause cancer, and may be a mutagenic, (change the genetics), in animals… http://www.sciencelab.com/xMSDS-POLYSORBATE_80-9926645 2.3.2	PubMed.Gov a service of the U.S. Library of Medicine and the National Institute of Health, a report shows that neonatal rats were injected with small doses of polysorbate 80 and the results were major effects on the reproductive organs of the rats, resulting in infertility. http://www.ncbi.nlm.nih.gov/pubmed/8473002?dopt=Abstract 2.3.3	PubMed studied Polysorbate 80 in an intravenous vitamin mix given to a pregnant woman who suffered anaphylactic shock where polysorbate 80 was identified as the causative agent, http://www.ncbi.nlm.nih.gov/pubmed/16400901?dopt=Citation 2.3.4	and yet another study showed two patients who developed hypersensitive reactions to red blood cell growth hormones and subsequent skin testing indicated polysorbate 80 as the culprit. This finding might have implications in the recent increase in the incidence of pure red cell aplasia. http://www.ncbi.nlm.nih.gov/pubmed/15958049?dopt=Abstract 2.4	3-O-deacylated monophosphoryl lipid A (3dMPL) - If MPL is immunogenic, it raises the possibility of a dangerous "cross reaction." The human body is full of lipids. Antibodies and immune cells responding to MPL might also respond to other lipids in the body, thus breaking tolerance for endogenous lipids (those native to the human body) and initiating autoimmunity. 2.5	Thiomersal – Ethyl mercury 2.5.1	Public concern had been expressed about the health effects of mercury exposure of any sort, and the elimination of mercury from vaccines was considered a feasible means of reducing an infant’s total exposure to mercury in a world where other environmental sources of exposure are more difficult or impossible to eliminate (e.g. certain foods). http://www.medicine.manchester.ac.uk/immunise/elearning/workshop/Appendix4.pdf 2.5.2	Used as a preservative in vaccines, thimerosal has been linked to autism and other neurodevelopmental disorders in children. Thimerosal carries risk of serious adverse effects because it contains mercury, which can be neurotoxic at certain levels. Behind uranium, mercury is the second most toxic substance known to man. http://www.adrugrecall.com/thimerosal/thimerosal.html 2.6	Sodium Chloride - also known as common salt, table salt, or halite, is an ionic compound with the formula NaCl. 2.7	Tris buffer - TromeThamine, USP is chemically designated 2-amino-2-(hydroxymethyl)-1, 3-propanediol, a solid readily soluble in water, also classified as an organic amine buffer. http://www.drugs.com/pro/tham.html 2.7.1	Animal reproduction studies have not been conducted with tromeThamine. It is also not known whether tromeThamine can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. TromeThamine should be given to a pregnant woman only if clearly needed. 2.7.2	It is not known whether this drug is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Tham Solution is administered to a nursing mother. 2.7.3	have not been performed to evaluate carcinogenic potential, mutagenic potential or effects on fertility. 2.8	L-Histidine - is an essential amino acid that cannot be formed by other nutrients, and must be in the diet to be available to the body. Most often recognized as a precursor to the allergy symptom producing hormone histamine, both histidine and histamine have essential roles in the body beyond tormenting allergy sufferers. 2.9	Sodium borate – Borax 2.9.1	Introduction, Paragraph 5 – Prior to the study reported here, there had been an earlier study that suggested borate exposure was associated with symptoms of acute respiratory irritation, such as dryness of the mouth, nose, or throat; dry cough; nose bleeds; sore throat; productive cough; shortness of breath; and chest tightness. Acute and Chronic Respiratory Effects of Sodium Borate Particulate Exposures, David H. Wegman, Ellen A. Eisen, Xiaohan Hu, Susan R. Woskie, Ralph G. Smith and David H. Garabrant, Environmental Health Perspectives, Vol. 102, Supplement 7: Health Effects of Boron (Nov., 1994), pp. 119-128 2.9.2	Label Precautionary Statements – Harmful – Possible risk of harm to the unborn child, possible risk of impaired fertility, irritating to eyes, respiratory system and skin, target organ(s): Central Nervous System, Kidneys. Material Safety Data Sheet, Copyright 1997, Sigma Chemical Co., Aldrich Chemical co., Inc. Fluka Chemie AG. http://www.palomar.edu/ehs/Chemistry%20MSDS/SODIUM%20BORATE,%20DECAHYDRATE.pdf 2.9.3	Potential Health Effects – Mallinckrodt Baker, Inc., Prepared by: Strategic Services Division, http://www.sefsc.noaa.gov/HTMLdocs/SodiumBorate.htm 2.9.3.1	Inhalation: Causes irritation to the respiratory tract. Symptoms may include coughing, shortness of breath. 2.9.3.2	Ingestion: May cause nausea, vomiting, diarrhea, muscular spasms, dullness, lethargy, circulatory depression, central nervous system depression, shock, kidney damage, coma, and death. Estimated lethal dose 15 to 20 grams. 2.9.3.3	Skin Contact: Causes irritation to skin. Symptoms include redness, itching, and pain. May be absorbed through the skin with possible systemic effects. 2.9.3.4	Eye Contact: Causes irritation, redness, and pain. 2.9.3.5	Chronic Exposure: Prolonged or repeated ingestion or skin absorption may cause anorexia, weight loss, vomiting, mild diarrhea, skin rash, convulsions, and anemia. 2.9.3.6	Aggravation of Pre-existing Conditions: No information found. 2.10	Span 85 – Sorbitan trioleate – (Tween 85) – surfactant – 2.10.1	the hematological examination revealed anemia corresponding to the histological findings of the bone marrow. Biochemical analysis displayed the significant increase and/or decrease of enzyme values in 200.0 mg/kg group. Morphology showed the swelling, vacuolization and granuloma of the spleen, hepatic granuloma, the increase of reticulum cells and granuloma in the bone marrow. Embolism and thrombus were also found in the pulmonary and tail veins probably due to an artifact caused by the i.v. injection. Study on subacute toxicity of intravenous sorbitan trioleate (STO) in Wistar rats. Yamamoto H, Tsutsui K, Shimada K, Yamanishi Y, Imai S., J Toxicol. Sci. 1983 Nov;8(4):301-10 2.11	*Aluminum salts – Aluminum phosphate and/or aluminum hydroxide 2.11.1	Aluminum phosphate - http://www.webmd.com/ 2.11.1.1	Phosphate salts can irritate the digestive tract and cause stomach upset, diarrhea, constipation, and other problems. Do not take phosphate salts unless prescribed by a healthcare professional if: 2.11.1.1.1	You have kidney disease 2.11.1.1.2	You have heart disease. 2.11.1.1.3	You have high or low calcium blood levels. 2.11.1.1.4	You have high phosphate blood levels. 2.11.1.1.5	You have a condition which causes the body to retain fluid (edema), including heart failure, liver problems (cirrhosis), and other conditions. 2.11.2	Aluminum hydroxide – Aluminum hydroxide side effects - http://www.drugs.com/mtm/aluminum-hydroxide.html 2.11.2.1	Aluminum overdose - Seek emergency medical attention. 2.11.2.1.1	Symptoms of an aluminum overdose include weight loss, decreased appetite, general feeling of sickness, muscle weakness, kidney failure, and softening of the bones. 2.11.2.2	Stop taking aluminum hydroxide and seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of your throat; swelling of your lips, tongue, or face; or hives). 2.11.2.3	Other, less serious side effects may be more likely to occur. Continue to take aluminum and talk to your doctor if you experience constipation. Increased fluid intake may lessen constipation 2.12	*QS21 – Saponin – 2.12.1	QS-21 induced mild local erythema, induration, and tenderness lasting 24-72h in all patients at the 100-mcg dose. The 200-pg dose of QS-21 was associated with local tenderness and inflammation lasting 2-10days in all patients as well as mild flu-like symptoms, including low grade fever (<38.5°C), headache, and myalgia lasting 8-24h after most immunizations. No neurological abnormalities or other side effects were observed. [CANCERRESEARCH55, 2783-278 July 1, 1995], GM2-KLH Conjugate Vaccine: Increased Immunogenicity in Melanoma Patients after Administration with Immunological Adjuvant QS-21, Friedheim Helling,2 Shengle Zhang, Ann Shang, Sucharita Adluri, Michele Calves, Rao Koganty, B. Michael Longenecker, Tzy-J. Yao, Herbert F. Oettgen, and Philip 0. Livingston 2.13	Histidine and Polysorbate80 - Background: There are no pharmacologic strategies to prevent embolism bubble-induced blood clot formation. The authors conducted experiments to measure thrombin production in sheared whole blood in the presence and absence of bubbles and three surface-active compounds. The time-dependent enhancement of thrombin production presented in figure 1B also appears in the data obtained using quiescent whole blood samples with and without exposure to histamine, as is depicted in figure 2A. Only means ± SDs of the peak fluorescence intensity data (emission wavelength, 460 nm) for each group at each time point are shown. The level of blood activation increased slightly more than 2-fold in the untreated quiescent sample after 30 min. In the histamine-treated sample, thrombin production increased more than 5-fold from the baseline value after 30 min. After the initial time point, significantly more thrombin was formed in the histamine-activated samples (P < 0.004 in all cases). Anesthesiology: Volume 100(1)January 2004pp 77-84, Surfactants Attenuate Gas Embolism-induced Thrombin Production, Eckmann, David M. Ph.D., M.D.*; Diamond, Scott L. Ph.D.† (6)	Other pandemic influenza vaccines approved by the EMEA (European Medicines Agency) and their ingredients. http://www.emea.europa.eu/htms/human/pandemicinfluenza/vaccines.htm 6.1	Baxter – Celvapan 6.1.1	Celvapan is a Vero cell-derived, monovalent, whole virion, inactivated vaccine containing 7.5 μg/dose of Haemagglutinin (HA). The whole virions of Influenza type A as the active ingredient is inactivated both by formaldehyde and UV-irradiation and purified on a sucrose density gradient. 6.1.2	The Active Substance is the Vero cell-derived, formaldehyde- and UVinactivated and sucrose gradient purified whole virions of influenza virus. 6.1.3	Additional components of the active Substance are 6.1.3.1	Tween 80, 6.1.3.2	Sodium Chloride and 6.1.3.3	Tris-buffer (TBS, containing Trometamol). 6.2	GlaxoSmithKline Biologicals – Pandemrix 6.2.1	Split influenza virus, inactivated, 6.2.2	propagated in eggs, haemagglutinin 6.2.3	AS03 adjuvant composed of 6.2.3.1	squalene (10.68 milligrams), 6.2.3.2	DL-α-tocopherol (11.86 milligrams) and 6.2.3.3	polysorbate 80 (4.85 milligrams) 6.2.4	Excipients: 6.2.4.1	It contains 5 micrograms thiomersal 6.2.4.2	Suspension vial 6.2.4.2.1	Polysorbate 80 6.2.4.2.2	Octoxynol 10 6.2.4.2.3	Thiomersal 6.2.4.2.4	Sodium chloride (NaCl) 6.2.4.2.5	Disodium hydrogen phosphate (Na2HPO4) 6.2.4.2.6	Potassium dihydrogen phosphate (KH2PO4) 6.2.4.2.7	Potassium chloride (KCl) 6.2.4.2.8	Magnesium chloride (MgCl2) 6.2.4.2.9	Water for injections 6.2.4.3	Emulsion vial: 6.2.4.3.1	Sodium chloride (NaCl) 8 6.2.4.3.2	Disodium hydrogen phosphate (Na2HPO4) 6.2.4.3.3	Potassium dihydrogen phosphate (KH2PO4) 6.2.4.3.4	Potassium chloride (KCl) 6.2.4.3.5	Water for injections 6.3	Novartis – Focetria 6.3.1	Influenza virus surface antigens [purified viral proteins] (haemagglutinin and neuraminidase) 6.3.1.1	propagated in eggs 6.3.1.2	expressed in microgram haemagglutinin 6.3.2	Adjuvant MF59C.1 containing 6.3.2.1	squalene 9.75 milligrams 6.3.2.2	polysorbate 80 1.175 milligrams 6.3.2.3	sorbitan trioleate 1.175 milligrams 6.3.3	List of excipients 6.3.3.1	Sodium chloride, 6.3.3.2	Potassium chloride, 6.3.3.3	Potassium dihydrogen phosphate, 6.3.3.4	Disodium phosphate dihydrate, 6.3.3.5	Magnesium chloride hexahydrate, 6.3.3.6	Calcium chloride dihydrate, 6.3.3.7	Sodium citrate, 6.3.3.8	Citric acid, 6.3.3.9	Water for injections 6.4	GlaxoSmithKline Biologicals – Daronrix 6.4.1	Pandemic influenza vaccine (whole virion, inactivated, adjuvanted) 6.4.2	propagated in eggs 6.4.3	 haemagglutinin 6.4.4	 adjuvanted by aluminium phosphate 0.45 milligrams Al3+ 6.4.5	and aluminium hydroxide, hydrated 0.05 milligrams Al3+ 6.4.6	Thiomersal 50 micrograms 6.4.7	List of excipients 6.4.7.1	Sodium chloride 6.4.7.2	Disodium phosphate dodecahydrate 6.4.7.3	Potassium dihydrogen phosphate 6.4.7.4	Potassium chloride 6.4.7.5	Magnesium chloride hexahydrate 6.4.7.6	Thiomersal 6.4.7.7	Water for injections 6.5	GlaxoSmithKline Biologicals – Prepandrix 6.5.1	Prepandemic influenza vaccine (split virion, inactivated, adjuvanted) 6.5.2	propagated in eggs 6.5.3	 haemagglutinin 6.5.4	AS03 adjuvant composed of 6.5.4.1	squalene (10.68 milligrams), 6.5.4.2	DL-α-tocopherol (11.86 milligrams) and 6.5.4.3	polysorbate 80 (4.85 milligrams) 6.5.5	contains 5 micrograms thiomersal 6.5.6	Suspension vial: 6.5.6.1	Polysorbate 80 6.5.6.2	Octoxynol 10 6.5.6.3	Thiomersal 6.5.6.4	Sodium chloride (NaCl) 6.5.6.5	Disodium hydrogen phosphate (Na2HPO4) 6.5.6.6	Potassium dihydrogen phosphate (KH2PO4) 6.5.6.7	Potassium chloride (KCl) 6.5.6.8	Magnesium chloride (MgCl2) 6.5.6.9	Water for injections 6.5.7	Emulsion vial: 6.5.7.1	Sodium chloride (NaCl) 6.5.7.2	Disodium hydrogen phosphate (Na2HPO4) 6.5.7.3	Potassium dihydrogen phosphate (KH2PO4) 6.5.7.4	Potassium chloride (KCl) 6.5.7.5	Water for injections 6.6	GlaxoSmithKline Biologicals – Not Named 6.6.1	Prepandemic influenza vaccine (split virion, inactivated, adjuvanted) 6.6.2	propagated in eggs 6.6.3	 haemagglutinin 6.6.4	AS03 adjuvant composed of 6.6.4.1	squalene (10.68 milligrams), 6.6.4.2	DL-α-tocopherol (11.86 milligrams) and 6.6.4.3	polysorbate 80 (4.85 milligrams) 6.6.5	Excipients: 6.6.5.1	It contains 5 micrograms thiomersal 6.6.5.2	Suspension vial: 6.6.5.2.1	Polysorbate 80 6.6.5.2.2	Octoxynol 10 6.6.5.2.3	Thiomersal 6.6.5.2.4	Sodium chloride (NaCl) 6.6.5.2.5	Disodium hydrogen phosphate (Na2HPO4) 6.6.5.2.6	Potassium dihydrogen phosphate (KH2PO4) 6.6.5.2.7	Potassium chloride (KCl) 6.6.5.2.8	Magnesium chloride (MgCl2) 6.6.5.2.9	Water for injections 6.6.5.3	Emulsion vial: 6.6.5.3.1	Sodium chloride (NaCl) 6.6.5.3.2	Disodium hydrogen phosphate (Na2HPO4) 6.6.5.3.3	Potassium dihydrogen phosphate (KH2PO4) 6.6.5.3.4	Potassium chloride (KCl) 6.6.5.3.5	Water for injections

“circulating among pigs on other continents for years”??
This is what a sentence toward the end of our lead paragraph says, more fully: “There is also evidence that the new strain had been circulating among pigs on other continents for years before infecting humans.”

The new strain? No way. This is simply not correct. The previous triple-reassortant strain, now that has been circulating for years. That is the strain that makes pigs sick and can occasionally be transmitted pig-to-human, but does not spread readily human-to-human. The new strain, which is the strain currently making people sick, is a combination of the triple-reassortant with genetic material from a Eurasian pig influenza virus.

See Robert Belshe, New Eng J Med, June 18th http://content.nejm.org/cgi/content/full/360/25/2667

And, to add to the conclusion, some news stories simply repeat the buzz phrase “triple-reassortant.” But, that is only the first part of the story!

I am planning to delete the above sentence from our lead paragraph. And I encourage people to read Belshe’s article, draw their own conclusions, and see if there are parts we might wish to add to our article. Cool Nerd (talk) 19:40, 10 August 2009 (UTC)

Under 18's.
Teleperformance Bangor co.Down are recruiting under 18's in the call centre for the national pandemic flu line. I myself am 17 years old, but I will not disclose my name for legal reasons. they treat us like slaves where we have to sit for 30 min staring into our computer screens doing nothing, until a phone call from people that think they may have the flu, we are not allowed to read a book, or doodle, or read a newspaper or magazine, we have to sit for 30 min doing nothing until these calls. The people that are 16 are asked sometimes to stay on till 11o'clock pm and sometimes midnight, I myself had to work 6 days a week, from 4pm-12am.

The training we are given is very simplistic and not satisfactory, we are talked to for about 3 hours and then dismissed, not even shown how to use the phones.

Spread this on the BBC news, etc. I will update when needed.

Thanks, Zodiac. —Preceding unsigned comment added by 62.173.119.59 (talk) 14:20, 11 August 2009 (UTC)

You meant this firm in Northern Ireland that is shown on this job's shop site ? Generally, most telesales firms are crap. They dock your pay if you go to the loo to often, have dangerously ill- designed chairs, bully staff in to doing involuntary overtime and have 40 hour + weeks on average!--86.25.10.69 (talk) 08:52, 12 August 2009 (UTC)

First head of state to get it
Was just wondering if people think its notable enough to mention the first head of state to catch it somewhere in this article? and is there another article listing notable people who have it? BritishWatcher (talk) 23:21, 12 August 2009 (UTC)

What defines someone as being notable? Do they have to be a politican? Professional athlete? Actor? By the time this pandemic is done, it's likely that hundreds of millions of folks around the globe will have been affected--including thousands of such 'notables'. Given, then, that determining who belongs on the list would be a nightmare, and maintaining such a list may be even more so, I'd say this isn't a very good idea. —Preceding unsigned comment added by 75.147.156.165 (talk) 15:25, 13 August 2009 (UTC)

Shouldn't the title be 2009 influenza pandemic
This is AFAIK an encyclopedia, after all. -- Egil (talk) 10:32, 13 August 2009 (UTC)

Immunity to H1N1
After being diagnosed, and recovering from swine flu is a person likely to be immune to getting the virus again? —Preceding unsigned comment added by 98.174.211.45 (talk) 14:53, 13 August 2009 (UTC)

Yes, unless the virus mutates to a different form. However, this article is to discuss the article, and not swine flu itself. Be careful next time (: 78.184.33.230 (talk) 20:13, 13 August 2009 (UTC)

Color indicators?
-- Jeandré (talk), 2009-08-12t15:38z


 * That's a brilliant idea! I support it! -- 78.184.33.230 (talk) 17:45, 12 August 2009 (UTC)


 * On the face of it, this sounds great. But the reality is, maintenance would likely be a headache, and--possibly of greater importance--given that only certain countries are providing that trend data, the table would be very cluttered and even more unreadable. 75.147.156.165 (talk) 15:27, 13 August 2009 (UTC)


 * I agree maintenance would be difficult for newbies because it involves templates and table markup and requires people to understand the key to change. I think the colours make it easier to read if everything is vertically aligned unlike now where it's all over the place. -- Jeandré (talk), 2009-08-13t15:48z


 * I'd support that, is a good idea. What regards the maintenance: at the moment I am doing most of the maintenance for this column, and I have no problem with the color indicators. So, just go ahead! Another point: 'Sporadic' does not actually belong in the list, it is there only temporarily, until ECDC has adapted its reporting to WHO standards. FHessel (talk) 09:08, 14 August 2009 (UTC)


 * Okay, maintenance isn't a problem anymore. Anyone prefer the current version where it isn't vertically aligned?
 * S(poradic) removed from legend. Should "N(o activity)" go back to dark green one level below light green? Over time as all become "N(o activity)", will this column be deleted then or will it be replaced with what the worst situation was (except for trend which will have to be deleted) and its date? -- Jeandré (talk), 2009-08-14t15:06z


 * I like N with light green, it is less obtrusive. But I think the intensity '*' = low-moderate should be green too, because that is the standard. Actually I was thinking about having two entries, one being ' ' in green for low and one being '*' in yellow for moderate. ECDC and PAHO are differentiating between low and moderate, only WHO is putting both together. But without color I could not do that, because there is no difference between low intensity and no entry at all. And adding one asterisk to each seemed to much ('****' !!).


 * And what will happen to the column in the future? I would really like to know something about the future...


 * FHessel (talk) 20:23, 14 August 2009 (UTC)


 * There has to be a way to distinguish between low-mod and low intensity that's not just colors because blind users' readers may not indicate colors, and text browsers may not either. We could use something plain like i1 i2 i3 i4 which readers and text browsers can handle, or Unicode characters like  ⁎ ⁑ ⁂ ⁑⁑, ↑⇑⤊⟰, or ①②③④. -- Jeandré (talk), 2009-08-15t23:24z, -- Jeandré (talk), 2009-08-16t13:54z


 * As a software developer with much experience and training in user interfaces, I know that oftentimes showing off one's skills can be fun (I've certainly done it myself). But in the case of a very popular item that hasn't undergone too many changes--such as this table--suddenly adding bells and whistles isn't always a good idea: it adds to page weight; it creates confusion; it decreases readability. In short, it may add little if no value. People who are well-versed in user interfaces know there's more to creating highly useable pages than merely lining up columns or coloring them in. (And ridiculing those who question such eye-candy as "newbies who lack understanding of table markup and change" is somewhat less than charitable, don't you think?) At any rate, you've already started the project; let's see how well it works. Sqlman (talk) 15:10, 16 August 2009 (UTC)


 * I didn't mean it as showing of, I just found it hard to compare the indicators because they weren't vertically aligned, so I figured aligning them would also make it easier for others to compare. I didn't mean to ridicule - when I was a newbie using cell templates and markup was difficult so I figured it would be for other newbies also. -- Jeandré (talk), 2009-08-16t15:22z


 * It will take some time for other Wiki editors to get used to the new interface, especially for the newcomers. When the column for the intensity of the cases was introduced I couldn't understand how to read it.  Maybe some people might find that information interesting, while others might not.  For now I would like to see how the new interface works for the next few weeks.  I supposed you will be available to update the information and change the colours as and when possible. Roman888 (talk)  03:44, 17 August 2009 (UTC)

On portuguese wikipedia http://pt.wikipedia.org/wiki/Pandemia_de_gripe_A_de_2009_no_Brasil Say 16833 cases and 339 deaths in Brazil http://portal.saude.gov.br/portal/arquivos/pdf/boletim_influenza_se_31_11_08_2009.pdf —Preceding unsigned comment added by 189.15.201.190 (talk) 18:17, 17 August 2009 (UTC)

Contradicting Facts done Wrong?
Within the first few paragraphs, the article cites two sources appearing to be contradictory- but could work if better written. Right now it looks very unprofessional.

-Original-

The U.S. Centers for Disease Control and Prevention (CDC) notes that most cases worldwide have been mild so far and most hospitalizations and deaths have been of persons that also had underlying conditions such as asthma, diabetes, obesity, heart disease, or a weakened immune system. Then again, Dr Anne Schuchat from CDC thinks, "this is a virus that's capable of causing a spectrum of illness that includes severe complications and death." "It's very important we take this virus seriously."

-Proposed Fix-

The U.S. Centers for Disease Control and Prevention (CDC) notes that most cases worldwide have been mild so far and most hospitalizations and deaths have been of persons that also had underlying conditions such as asthma, diabetes, obesity, heart disease, or a weakened immune system. However, on the same token, Dr. Anne Schuchat, director of the National Center for Immunization and Respiratory Diseases, stated in a July 24 briefing, "This is a virus that's capable of causing a spectrum of illness that includes severe complications and death. It's very important we take this virus seriously." —Preceding unsigned comment added by Cards2009 (talk • contribs) 05:06, 14 August 2009 (UTC)

Swine Flu Vaccines a NWO Hoax?
I know, the question probably sounds irrelevant, but think about it. As we know, there is little to no difference between regular flu and swine flu. However, because it's kind of trendy, many doctors probably feel the urge to report regular flu cases as swine flu (don't forget doctors are just some humans who went through medical school; they're not gods and they're not infallible). The question is how come all of a sudden pharmaceutical companies and government are so insistent on vaccinating people en masse when the disease we're dealing with is hardly deadlier than what most people have been getting almost every other winter for years. I don't want to be a doomsayer, but you do your research on the New World Order conspiracy theory.

And by the way, since the shots are going to be for free, and we all know there's no such thing as a free lunch, I wonder what they'll actually put inside those vaccines. —Preceding unsigned comment added by 85.130.46.55 (talk) 19:33, 9 August 2009 (UTC)


 * Totally. I bet the vaccines are full of carcinogens and cause instant steralisation, so the NWO can stamp out the common masses and leave themselves unvaccinated, alive, and able to reproduce.  It's also likely that some varients of the vaccine will cause the recipients to actually become pigs, to provide ample pork for our evil overlords.  Once 90% of the common masses are either dead or pigs, they'll mastermind a dastardly plot to remove the last remnants of humanity using sharks with laser beams on their foreheads.  Finally, when there's only one person left, they'll use their inner-Thetan powers to turn the last human to stone, mould them into a pyramid capstone, and use them to channel unbelievable amounts of energy from the Earth itself, using ley lines and flux capacitors.  Then they'll have a garden party.  Troubling indeed. 213.249.239.31 (talk) 02:43, 11 August 2009 (UTC)


 * Nearly two-thousand people have died from this and you clowns are making jokes of this shit. The question is irrelevant.  Take your black helicopters elsewhere. Dinkytown (talk) 05:08, 11 August 2009 (UTC)


 * My point was that whereas seasonal flu kills between a quarter of a million and half a million people yearly, this thing has so far - in the six months since its first appearance in March - killed less than two thousand people. Just how am I not supposed to be suspicious?!? Or, take for example cancer, which kills several million people yearly - why aren't governments putting as much money into cancer research and prevention as they are putting into buying vaccines for this swine thing? Wouldn't it make more sense to focus on helping stop the far-deadlier cancer epidemic than this? Plus, let's not forget that any such epidemic is a great opportunity for pharmaceuticals to rake it in quick... —Preceding unsigned comment added by 85.130.46.55 (talk) 10:13, 11 August 2009 (UTC)


 * Have I mentioned lately how much I loathe the guesstimate fatality figures which are responsible for this kind of ill-informed nonsense? Regular flu *doesn't* kill 500k a year. Experts guess that half a millionish deaths are due to the flu per year. Purely a guess. And you can easily argue against it due to the nature of the beast. Even if you could and did test every fatality for flu in the month preceding death, deciding how you weight flu's influence on the death is a matter of personal opinion. A judgment call. Since flu so rarely kills by itself, it's all nebulous grey space. What's interesting about swine flu is that we're having some healthy folks die -- which almost never happens with seasonal flu. Those "mere" two thousand deaths are real deaths, and are deaths that wouldn't have happened without the pandemic. Were this, say, monkey pox, we'd have no problem grasping the gravity. Because it's called "flu", we have this odd myopia (which many experts gleefully encourage) which makes us believe that anything less than a quarter million confirmed fatalities is no big deal. Really dead is really dead. Guessed dead is hyperbole.68.111.62.56 (talk) 22:42, 12 August 2009 (UTC)


 * So you say that "those "mere" two thousand deaths are real deaths," right? Well then, how would you comment on the fact that "France... has not registered any deaths directly linked to the virus?" Taken from http://www.etaiwannews.com/etn/news_content.php?id=1018308&lang=eng_news&cate_img=316.jpg&cate_rss=news_Health —Preceding unsigned comment added by 85.130.46.55 (talk) 10:32, 13 August 2009 (UTC)


 * The reason the vaccine is being offered for "free" in many countries is that the cost of vaccinating the population is much lower than the medical and economic costs of people getting the flu. A lot of places offer the "normal" flu vaccine for free too; the reason there's a separate vaccine for this strain is that it was too late to add it to the normal flu vaccination for this year. —Preceding unsigned comment added by Ashartus (talk • contribs) 22:30, 13 August 2009 (UTC)


 * Dear Unsigned at 85.130.46.55,


 * To be kind, yes, there are times that all is not as it seems, and goverment isn't always noble and right, everything associated with science when it is connected to big pharma isn't always benign, and a skeptical mind isn't a bad thing.


 * HOWEVER, informed analysis is vital. If one does even a rudimentary review of the science regarding H1N1, and of the concerns about how it may affect people over the next few years, as well as possible mutations, and possible mutations with H5N1, then it is obvious that the concerns are real and merited.


 * To say "As we know, there is little to no difference between regular flu and swine flu" is false. There are a great number of differences, and they have been well established and documented. To have a skeptical mind is not to ignore fact, nor is to conjecture 'possible' alternatives that have no basis in fact. Of course drug companies are happy to make profits, of course goverments want to 'look good' and 'save money', which are not always compatible goals for them.


 * Finally, yes vaccines are problematic, they are not the %100 safe, %100 panacea that some people want them to be. That does NOT mean that they are 'evil'. Polio is a perfect example. Those that fear ANY risk, and don't vaccinate their children, have no idea what living through a polio epidemic would be like.


 * Immunization and drugs that combat flu may have risks, and preparation for the worst does not necessarily mean the worst may happen. I do know, without questions, that if goverments did not act properly as they are doing now, and their is a very high fatality rate, or, the H1N1 virus mutates to something far more severe, we will no doubt hear how it is a goverment conspiracy to reduce population, or that it is to eradicate much of the poor populations, etc.

Peace is the official sign of swine flu. —Preceding unsigned comment added by 76.180.207.51 (talk) 03:51, 18 August 2009 (UTC)


 * While your concern is noted, which is what I think you were looking for, for the sake of everyone you continue to talk to, here or elsewhere, please do your homework on the topic, and seperate fact from fiction. And yes, I actually have researched conspiracy topics and New World Order theories quite a bit. 198.103.184.76 (talk) 13:29, 14 August 2009 (UTC) Oops, thought I was signed in. The above unsigned was actually Kavri (talk) 13:40, 14 August 2009 (UTC)

Spain
Upgrade the information, now there are 26.000 infected in Spain: http://www.lavanguardia.es/ciudadanos/noticias/20090814/53764046444/la-gripe-a-afecta-a-26.000-espanoles-mas-de-la-mitad-infectados-en-la-ultima-semana.html

There are now 21 deaths, again check the rtve.es website. —Preceding unsigned comment added by Eboke (talk • contribs) 16:41, 14 August 2009

"new H1N1" refs?
The current ref doesn't mention it being "officially named the "new H1N1"". Anyone have a source for that?

Shouldn't it use the slightly better dabbed Pandemic H1N1/09 virus instead? -- Jeandré (talk), 2009-08-19t21:43z


 * Good points. Since the CDC page itself doesn't refer to it as any kind of "official" title, and using the word "novel" is just describing it as being new, maybe we should just delete "officially named" and replace it with something safer like "referred to as a new H1N1 virus." It's interesting that their title also has "Swine flu" in parentheses so they apparently recognize the common usage by the mass media. --Wikiwatcher1 (talk) 22:18, 19 August 2009 (UTC)


 * There is no tidy, pat, official strain name because the pandemic is due to a clade, not a discrete entity. See this NCBI genome project. --Una Smith (talk) 19:39, 21 August 2009 (UTC)

"Are all these direct quotes encyclopedic"
Im curious as to wether all these direct quotes are encyclopedic. this article is starting to read like a suspense novel. shouldn't 99 percent of these quotes in the article be paraphrazed rather then gloom and doom direct quotes. For instance... "oh my god the world is going to end help help" to leading scientists have speculated up to one third of the US poplulation will become infected and that the vast majority of all cases are mild and recovery is relativly quick. (and quote) Also, Who cares who the exact person is that said every single comment. reference where they are from.. CDC, WHO, Homeland Security or whoever and source it.. If people want to know the irrelevant info of who the exact spokesman is.. they can look at the source..what is important is the message the person is trying to get across.. What do you all think? -Tracer9999 (talk) 20:56, 21 August 2009 (UTC)


 * Agree mostly. Would suggest you doing a few revisions as examples. I've noticed that being an evolving news story unlike most static-topic articles, after a while it's easier to trim exact dates and names into a simpler summary format. As for paraphrasing instead of quoting, that also has problems as you've noticed in your edits (i.e. "extremely" instead of actual "relatively"). Paraphrasing works on longer detailed descriptions that can be condensed to fewer words, but for short and succinct subjects where the quotes are concise, it's safer to leave them as quotes IMO so long as this stays an ongoing news event. --Wikiwatcher1 (talk) 00:13, 22 August 2009 (UTC)

Redirect restored
The term "Swine flu" was redirected to Swine influenza a few days ago without discussion or notice. This topic about which article is most appropriate for this term was discussed last month but the reasons should be obvious by comparing the articles. The same user, User:Doorvery far has made a number of other redirects from numerous articles relating to Swine flu to the Swine influenza article. Maybe someone can find some of the earlier discussions and add them here so the user realizes why those redirects should be changed. --Wikiwatcher1 (talk) 07:29, 14 August 2009 (UTC)


 * Actually, the redirect was restored to where it belongs: Swine influenza.  See Talk:Swine flu and Talk:Swine influenza.  --Una Smith (talk) 14:55, 21 August 2009 (UTC)

Copied archival discussion - New name poll?
I think the current name may be doing a large number of information seekers a disservice so would suggest a new poll. The goal is to simply get people wanting Wiki's Swine flu article to where they were intending to go - namely, to this article. There's reason to suspect that a large percentage don't, based on what I see in search information.

For example, a Google search for "swine flu" will direct them, after the CDC sites, to "Swine influenza" as the key article, with this one as a sub-category. A quick reading of the lead for that article will show it will not help most "swine flu" searchers with its heavy focus on pigs. While there is a "main" article link at top, I suspect that a large percentage don't use it. The Wikipedia stats for July show that the "Swine influenza" article got about 31,000 readers per day, while this one averaged 20,000, implying that up to 33% didn't bother to go any further. A Wiki search for "Swine flu" also goes to "Swine influenza."

Using a seo tool like Wordtracker shows that of the searches over the last month that included the word "flu," over 75% were within a search for "swine flu" and its related symptoms, while only 0.16% were part of "flu pandemic." A Google search within either News or Web shows that "Swine flu" is used by far most of the time within article titles.

So the point in all this is that a large percentage of people hoping to learn about "swine flu" by using this article, are never getting here. It's not just a matter of what's "correct" or preferred by the CDC, but of giving readers the information they want and probably need. My thinking is that the best way right now to do that would be to have this article include the term "Swine flu" in its title. Thoughts? --Wikiwatcher1 (talk) 23:15, 25 July 2009 (UTC)


 * Strongly agree. I've ended up more than once on the animal swine flu page.  That page should be re-named "Animal swine flu." or "Swine flu in animals."  This page should be named Swine Flu Pandemic, 2009.  It will likely end up "Swine Flu Pandemic, 2009-2011.  —Preceding unsigned comment added by 64.105.0.247 (talk) 14:39, 27 July 2009 (UTC)


 * Mildly disagree. Although I discover myself again and again, that media (and partly official sources too) still use the term 'swine flu', often in phrases like "A/H1N1, also named 'swine flu'", I found, that many switched to H1N1, or just 'el gripe' or 'el virus' in the spanish sources. Consequently I have changed my news searches, which had originally included the term 'swine flu', because I began missing articles. Furthermore it regularly strikes me, that the usage of 'swine flue' or 'Schweinegrippe' appears to be somehow archaic or old fashioned (s.o., who took part in the discussion in April/early May and is back now, using the same vocabulary he did once).


 * My quick google news search resulted to: 12% using swine flu (or similiar) but not the term H1N1, whereas 69% using H1N1 but not swine flu (or similiar). I only searched news, because the google search itself includes all old publications and usage has changed over time. The detailed results were: H1N1=208451, swine flu=48819, swine flu-H1N1=18572, Schweinegrippe=11667, Schweinegrippe-H1N1=6844, gripe porcina=8293, gripe porcina-H1N1=3015, grippe porcine=3754, grippe porcine-H1N1=364.


 * Looking at the wikipedia pages, I find, that the links are prominent enough. There is one link right in the beginning of 'Swine influenza' plus a second one, when you go to "3. History / 3.6 2009 outbreak in humans". That should be enough to give every interested reader the chance to go right where he wants.


 * But I think, that the redirect of 'Swine flu' in WP should link to the page '2009 flu pandemic' instead of 'Swine influenza', because I guess(!), that for 99% of humans the term 'swine flu' has got its meaning only in connection with the current pandemic and not with other (earlier) outbreaks of swine influenza.


 * Summary: Change name: NO - Change redirect: YES


 * FHessel (talk) 06:54, 28 July 2009 (UTC)

Interesting survey: "More than half of U.S. adults turn to the Internet when they have health or medical questions, according to a survey from the Pew Research Center. More alarmingly, a survey in April found that 50 percent of doctors turn to Wikipedia for medical info."

Unless there is disagreement, we should have the term "Swine flu" redirected to this article instead of "Swine influenza" for all the reasons given. It apparently needs an admin to make the change. Any volunteers? --Wikiwatcher1 (talk) 17:48, 31 July 2009 (UTC)

Perhaps people were curious about the swine flu in general when they stopped at that page. Swine flu should redirect to the article about swine flu. We can make a notice at the top of that page bigger, but swine flu should not redirect to this page.  hmwith  τ   18:35, 31 July 2009 (UTC)


 * Don't agree. Before the "swine flu" epidemic started, the Swine influenza article was averaging less than 10 readers per day.  Afterwards, including this month, it's averaging over 25,000 readers each day.  That means that only .04% of the readers of that article were intending to read it, as opposed to this article. I'm personally amazed that a search for "Swine flu" is still redirecting readers to where they clearly don't want to go. --Wikiwatcher1 (talk) 18:51, 31 July 2009 (UTC)

Am hoping that User_talk:Jauerback, who created the redirect, can respond to my question of why he chose the target. As the figures above imply, it's likely that many thousands of readers each day are being "mis-directed." --Wikiwatcher1 (talk) 18:58, 1 August 2009 (UTC)
 * There was a consensus of one on my creation of the redirect. :)  Okay, that's only the partial truth.  The real reason (which is only available in the deletion history) is because of this:

(diff) 08:55, July 20, 2009. . Oxicleanfanatic (talk | contribs | block) (54 bytes)  (moved Swine flu to Swine flu is nothing to be worried about: unless you're really old or really young or very ill)
 * I assumed that this was probably not correct and further assumed that it was supposed to be redirected to Swine influenza (incorrectly, it seems). If this is a discussion to redirect it back to Swine flu is nothing to be worried about: unless you're really old or really young or very ill, then I disagree, otherwise I honestly have no opinion.  Do as you will.  Jauerbackdude?/dude. 01:40, 2 August 2009 (UTC)

Straw poll to redirect "Swine flu" to this article
The original redirector (new word?) has unlocked the redirect allowing it to be edited.
 * For
 * Per above comments. --Wikiwatcher1 (talk) 02:38, 2 August 2009 (UTC)
 * Have taken the liberty of redirecting "Swine flu" to this article in meantime. --Wikiwatcher1 (talk) 17:18, 2 August 2009 (UTC)


 * Against

--Wikiwatcher1 (talk) 07:45, 14 August 2009 (UTC)

Propose a new solution: Disambiguation Page for 'Swine Flu'
Re-direct 'Swine Flu' to its own disambiguation page, since 'Swine Flu' technically primarily means 'Swine Influenza' but the current H1N1/Pandemic situation means that many will use it to search for one of the several related articles. This also allows people to find which article most suits their interests, as they may want to know more about the virus, or the pandemic.

Swine Flu may refer to:


 * Swine Influenza, an infection by any one of several types of swine influenza virus. Swine influenza virus (SIV) is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2, and H2N3.
 * Pandemic H1N1/09 virus, a new swine-origin influenza A(H1N1) virus strain responsible for the 2009 flu pandemic.
 * 2009 flu pandemic, a global outbreak of a new strain of a influenza A virus subtype H1N1.
 * Influenza A virus subtype H3N2, a SIV strain causing the Hong Kong Flu.

It saves a lot of bickering, and in my opinion, gives the user more information, in a clearer format, to help them find what they are looking for. I've ordered the items from most technically correct, through to most weak link (not many people would use 'swine flu' to find out more about the flu virus behind the Hong Kong flu, but, it is relevant). Kavri (talk) 17:38, 14 August 2009 (UTC)

P.S. - It is my favourite solution for the problem P.P.S. - see 'Birdman' if you want to see what a disambiguation page on its own (not linked from a main article) looks like.


 * The options list, IMO, is more likely to cause confusion. I mentioned above, "before the "swine flu" epidemic started, the Swine influenza article was averaging less than 10 readers per day. Afterwards, including this month, it's averaging over 25,000 readers each day. That means that only .04% of the readers of that article were intending to read it, as opposed to this article."  I'm sure the same ratios would apply to any other articles that focused on medical and genetics details as opposed to today's issue of the Swine flu.


 * It seems that no matter how we try to juggle the terminology, the stats show that around 999 out of every 1,000 "Swine flu" informaton seekers are looking for this article for all the reasons above. It's the only one that's 100% focused on today's Swine flu problems and includes references from its first outbreak through Tamiflu and vaccines. There's no comparison with the other articles for a general description.  And for the 1 out of a 1,000 that wants to know the DNA/RNA structure of an H1N1(A) virus cell with full-color drawings, we have links at the top of the page. But the best way to get readers to this article would be to add the word "Swine" to the title. It's the most common term now used by the media worldwide when they want to read about the "flu": example of current news for "flu." --Wikiwatcher1 (talk) 18:45, 14 August 2009 (UTC)

I think that a pure disambiguation is best. It is a common technique on Wiki to resolve these conflicts. Most wiki users should be accustomed to the concept. I WOULD put the pandemic article as the first choice, due to likely popularity at this time.Tinfoil666 (talk) 18:53, 14 August 2009 (UTC)


 * Any editor is free to make Swine flu (disambiguation) and then try moving it via WP:RM. --Una Smith (talk) 19:48, 21 August 2009 (UTC)

If you really hate the idea of a Disambiguation Page, then...
Re-direct 'Swine Flu' to 'Swine Influenza' and then have the following:

Seriously though, the Disambiguation Page is the better of the two. Really. Kavri (talk) 18:19, 14 August 2009 (UTC)

Redirected back to Swine influenza
In case anyone hadn't noticed, "Swine flu" once again has been redirected back to Swine_influenza by some other editor of that article. It was unilateral without discussion or any reason given. I responded yesterday on their talk page asking for some explanation but no comments yet: Redirect questioned --Wikiwatcher1 (talk) 17:32, 19 August 2009 (UTC)


 * Not one but two other editors have restored the redirect back to where it belongs, Swine influenza.  I also fixed .  This article has about 80 other redirects pointing to it, which is more than enough.  I am sorry that anyone here feels readership of 2009 flu pandemic is not as high as they would like, but concerned editors might remedy that by improving this article.  Perhaps get it to FA quality, eh?  Please stop trying to inflate page views by misusing redirects. --Una Smith (talk) 14:55, 21 August 2009 (UTC)


 * Thanks for your reply Una, but your comments dealt with none of the issues stated on the talk page. All of the issues are key and give clear logical rationales why "Swine flu" searches are for information about the pandemic, not the virus cell. By completely avoiding any of the issues and facts and merely bringing up some OT and unrelated opinions instead, you have in effect admitted that the continual redirects may be erroneous and misleading and can't be defended with any logical reasons. --Wikiwatcher1 (talk) 19:26, 21 August 2009 (UTC)


 * Readers who are not looking for information about the 2009 flu pandemic, not swine influenza, can use the hatnote at the top of the page. --Una Smith (talk) 19:46, 21 August 2009 (UTC)

User:Una Smith continues to redirect "Swine flu" to "Swine influenza", which are basically two different subjects and very different articles. Although they have redirected with the summary statement saying they have discussed this, there has in fact been no discussion or any response by the user to clear redirect questions. If anyone else assumes that "swine flu" is about the pandemic, not the pig influenza virus, feel free to comment. --Wikiwatcher1 (talk) 03:52, 23 August 2009 (UTC)
 * Continual redirects

First death in Greece
Update the tables/maps. The greek ministry of health confirmed today (08-22-2009) the first death. The patient had both heart problems and the H1N1 virus.

Also, the total number of cases has risen to 1,670, according to the last press-conference given by the minister of health. —Preceding unsigned comment added by 94.64.160.120 (talk) 08:18, 23 August 2009 (UTC)


 * But the greek ministry of health itself says that the death is not attributed to H1N1, but to underlying conditions of the person who died. The patient was being hospitalized with severe heart problems and got the swine flu just 2 days before he died. I don't think that this stands as a H1N1 death. 79.166.233.31 (talk) 19:37, 23 August 2009 (UTC)


 * EISN consider it to be a death caused by H1N1. I also think it's most due to heart disease the "victim" suffered from. —Preceding unsigned comment added by 94.64.139.140 (talk) 13:30, 25 August 2009 (UTC)

Additional Data on Ages Affected?
CDC claims that ages 6mos to 24 are 'disproportionately' targeted, but I cannot find any data on this.

Has anyone seen hospitalizations or death statistics broken down by age group that could be added? Wpjonathan (talk) 15:36, 25 August 2009 (UTC)

Updating the graphs of case progression
Referring to File:Influenza-2009-cases.png and File:Influenza-2009-cases-logarithmic.png.

I have been updating these from WHO information for a while now but will no longer be able to do so. If they continue to be used then I encourage others to update them. The source Excel file is here (2007 version) and it is fairly self explanatory. |→ Spaully τ 18:16, 5 July 2009 (GMT)

I would like to recommend to use a power of 10 logarithm for the logarithmic chart as it would be easier to visualize then a power of 2. —Preceding unsigned comment added by 82.128.216.246 (talk) 14:35, 27 August 2009 (UTC)

Typos
Please fix this typo. Thank you!

"Initial availability of vaccines is expected by mid-October, although healhcare workers and people most at risk would likely get them first"

✅. Thanks for pointing it out. VI talk 15:52, 26 August 2009 (UTC)

South Korea
Fatalities due to the outbreak of H1N1 Influenza A type virus in South Korea has increased from two (2) to three (3) persons. The third victim is a 67-year-old who died of H1N1-incorporated pneumonia. Please verify this information. Thank you. —Preceding unsigned comment added by Benhpark (talk • contribs) 11:29, 27 August 2009 (UTC)

WHO Warns Of Severe Form Of Swine Flu
I have not checked the references, but we may want to update the material to reflect new observations.

http://www.nytimes.com/reuters/2009/08/28/world/international-uk-flu-pandemic.html

99.254.216.48 (talk) 19:35, 28 August 2009 (UTC)


 * Sorry, I checked - this article is actually incorrect. They made a mistake when they read the WHO release. No cause for (additional) concern.

Yogiudo (talk) 00:31, 30 August 2009 (UTC)

Page size
This article now exceeds 400k (with images). It is virtually unreadable to users on slow connections, and is a heavy burden on Wikipedia's servers. Please remove large sections to daughter articles and leave concise summaries in place. Thank you. Jehochman Talk 08:12, 29 August 2009 (UTC)


 * Thanks to Wikiwatcher for splitting out some of the content into new articles. I've gone through and done a swift copy editing job. Many facts and specifics are still needed.  Please help where you can! There is much room to improve the quality of this article. Jehochman Talk 11:37, 30 August 2009 (UTC)


 * A lot of cites were removed when summarizing and can easily be put back. But many are lengthy so maybe we can review the details needing cites to see if the facts themselves may not be needed or whether they all require citing. There are actually a lot of other factoids elsewhere in the article that were condensed with the cites trimmed off - see diffs example. --Wikiwatcher1 (talk) 18:42, 30 August 2009 (UTC)

Table
A table showing the confirmed cases/deaths has now been removed. Why? (217.42.240.189 (talk) 13:25, 30 August 2009 (UTC))


 * It was removed to improve usability, and is now linked prominently in the section about global cases. The article was vastly too large, preventing people on slow connections from being able to view the page. The table was quite large.  This article is an introduction to the subject. It need not, and cannot, include every fact. It should summarize and link to other articles that contain full details. Jehochman Talk 13:49, 30 August 2009 (UTC)

Thank you for replying.

Reply: So is there another section for the table only? (217.42.240.189 (talk) 15:40, 30 August 2009 (UTC))


 * At least move the table to another new article page if it's removed. The table (is mostly) the reason why I come to read this page. Talk 09:30, 30 August 2009 (UTC)


 * Here it is: 2009 flu pandemic by country. Jehochman Talk 17:22, 30 August 2009 (UTC)

Thanks (217.42.240.189 (talk) 23:15, 30 August 2009 (UTC))

This is ridiculous, Most people come to this article to check that table... Are you trying to protect Brazil or Argentina??? —Preceding unsigned comment added by 72.0.222.216 (talk) 23:54, 30 August 2009 (UTC)

I have to agree, the main reason I and I guess the majority of people come to this article is to check the table. I think if it is going to be relocated then the link should be obvious and prominent. —Preceding unsigned comment added by 210.4.124.28 (talk) 00:07, 31 August 2009 (UTC)

Change the title of this article to flu, fluz, new flu, or novel flu!
First Flight HS (talk) 23:47, 30 August 2009 (UTC) who

Origin of the virus
The virus origin has not been proven yet. Most experts conclude that the virus outbreak started somewhere in north America so i would recommend to mention this fact in the article.

Where is the map with de swine flu dedad´s? —Preceding unsigned comment added by 189.102.14.195 (talk) 01:37, 31 August 2009 (UTC)

Dates
Could somebody who has either the time or a script standardize and complete all the date formats. We need to include the year, 2009, in any dates or with any months. Jehochman Talk 18:26, 31 August 2009 (UTC)

Removing the table: Possible solutions
When I came back to WP today after a long weekend, first I saw was, that the table is missing. Now, it was expectable, that this would happen again!

To explain the history: Now there are two main points of concern: So, are you really planning to keep back the most wanted content from the majority of users, just to comply with the needs of a (small?) minority? I understand, that there is a need to reduce the size of the article, but we should not throw out the baby with the bath water!
 * There have been several attempts to remove the table or move it to another place (see archives both of this page and Template:2009_flu_pandemic_table).
 * In all these instances long discussions between many editors have resulted in leaving the table, where it was.
 * Various comments of less involved Wikipedians emphasize, that the table is the main reason to check the article on a regular basis. (See as a current example the spontaneous comments in Talk:2009_flu_pandemic)
 * The table itself is very hard to find now. I experienced that myself. And if you do not know, that the table exists, you will never get there.

As far as I see, there are two possible solutions:

1. A disambiguation page. The user searches 'swine flu' or 'H1N1' and gets to a disambiguation page, where he can decide, whether he wants to see

-information about the virus itself

-summarized information about the current outbreak with links to further details

-information about the actual situation including death statistics

2. Reducing the table in size and putting it back in place. I could easily live with a drastically shortened table (even 3 or 4 lines would be enough) and collapsing all the rest. I do not know, though, whether this will reduce the initial loading time of the page.

But something has to be done. As it is now, hardly any new user will find this table. So we are hiding a very valuable piece of information.

Let me finally say: I think that boldly moving the table by a user, who has not at all participated earlier, is coming on quite strong after all these discussions and the difficultly obtained consensus.

FHessel (talk) 09:59, 31 August 2009 (UTC)


 * We cannot have articles, especially heavily trafficked articles, that are half a megabyte downloads. That just ruins it for a great many users because the page loads too slowly.  The table is excessive detail for this article, and it's just too damn big when combined with everything else on the page. If you can cut down the table drastically, and link to full detail, that would be a possible solution. I'm not familiar enough with the data to make a proper summary of it. Jehochman Talk 10:26, 31 August 2009 (UTC)


 * Also, I am the creator of Template:Collapse top and Template:Collapse bottom. Those merely hide the information temporarily.  They do not reduce the size of the download.  To conserve bandwidth, we need to create a short version of the table, and then link to a full version.  I think that would be a great solution. Jehochman Talk 10:34, 31 August 2009 (UTC)


 * I just added a quick infobox with very obvious links as a temporary (or perhaps permanent) measure. Jehochman Talk 10:45, 31 August 2009 (UTC)


 * I extended the infobox and added aggregated information on deaths by region. Thus it has become 'cut down drastically' and it links to full detail. We still have information about the actual situation right at the top of the article, and the user can easily find the details. That satisfies everybodies needs, as far as I can see.


 * If you (Jehochman) would like to improve the formatting (I am not so familiar with that). It would be fine to have the header bolded, and a horizontal line before the nav-box.


 * Just to explain: The second link, you had put in the box is not even close as important as the link to the table, so I removed the other one for not confusing the users.
 * FHessel (talk) 12:39, 31 August 2009 (UTC)


 * Brilliant! Thank you very much.  As you suggested, I tried to touch up the formatting. Jehochman Talk 15:31, 31 August 2009 (UTC)


 * THANK YOU, THANK YOU, THANK YOU for finally shrinking that table enough that one can see beyond it to catch a glimpse of the article. —Preceding unsigned comment added by 0cdcnctx& (talk • contribs) 02:53, 1 September 2009 (UTC)

Too much weight given to British study
I think we are giving too much weight to the British study of the safety of using antiviral drugs in children, covered in ref #73. That article was given very little space on the front page of the Los Angeles Times, much less than was given to the story about the hunt for Ryan Jenkins. This really isn't proof of extended coverage.

There have been a few articles in The Guardian, but the google news archive shows hardly anything else after August 12. I think it's better not to go into the findings, and just mention that most of the safety data about the possible side effects in children comes from a study done in July. Ottre 04:58, 1 September 2009 (UTC)

Germany
Are there specific reasons that in Germany we witness a large number of swine flu cases without any fatalities (27 August 2009), whereas the situation in other countries seems to be quite different? --84.141.249.44 (talk) 08:59, 27 August 2009 (UTC)

We had a lot of (private) discussions about this fact. The following reasons might add to it: FHessel (talk) 17:31, 31 August 2009 (UTC)
 * Germany is - despite the high number - still trying to trace all cases, thus the number of confirmed cases might be much closer to the number of infected people than in other countries.
 * A big proportion of these cases are 'imported cases'. Now, traveller are not quite the average of the population, at least in terms of chronic diseases, pregnancy and maybe also obesity. Therefore the risk of death might be (much?) smaller in this sample of people, than in the general population. This would naturally change, as soon as local transmission is starting off.
 * Germany has a good medical care. Hospitals are not far away. People are trusting the healthcare system and they are visiting their doctor or the hospital, when they are ill (this in opposite to countries like Chile for example). People are being given antiviral medication, when they need it (but this happens in most other countries, too). Severe cases of A/H1N1 first require mechanical ventilation. When their condition worsens, they cannot be ventilated any more and they need an ECMO-place, otherwise they die. These ECMO places are very rare and ECMO patients stay there for several weeks. As soon as the ECMO places are used up, mortality increases all of a sudden. (Not long ago they flew a patient from the UK to Sweden (as far as I remember), because all ECMO places in the UK were in use.)
 * And finally don't forget, that death cases are usually the result of a hospitalization of 1-4 weeks (in exceptional cases even much longer). Thus the deaths we observe today are the result of the infections some time ago. Therefore also the speed of infections is playing a part, but I admit, that this cannot explain differences between Germany and the other world.

An addendum: In many cases I had the impression, that countries are not having fatalities for a long time, but as soon, as they had the first one, it suddenly speeds up. Best example is Japan. Japan was one of the countries, having big infection numbers without fatalities (2nd to Germany). For a long time this situation seemed to be quite stable, until about two weeks ago the had their first death. Now there are 7 already. To me this is looking like a non-linear (and even a non-exponential) system behavior. The availability of ECMO places is a nonlinear factor. Draw your own conclusions. FHessel (talk) 17:40, 31 August 2009 (UTC)

Update: The first patient in Germany who is in a life-threatening condition:

http://www.general-anzeiger-bonn.de/index.php?k=loka&itemid=10490&detailid=634633

http://www.bild.de/BILD/news/2009/09/02/schweinegrippe/hg-leben/erster-deutscher-patient-ringt-mit-dem-tod.html

FHessel (talk) 09:19, 2 September 2009 (UTC)

Germany counts "contact-persons with flu like illness" of a laboratory confirmed H1N1 case as confirmed H1N1 cases!

Like many countrys they dont test any case no more, but unlike other countrys they count this suspected cases as confirmed cases. The argument for this behaviour is, IF YOU HAVE FLU, YOU HAVE SWINE FLU and not any seasonal flu. 93.131.11.75 (talk) 22:03, 6 September 2009 (UTC)


 * ... which is true in >>99% of cases at this time of the year (compare the CDC fluview percentages of seasonal and pandemic flu). So, deduct a maximum maximum of 100 cases of erroneously confirmed cases and you still get a number well beyond 16,000. FHessel (talk) 10:33, 7 September 2009 (UTC)


 * I think there are much more then 100 "erroneously" cases because at the same time the RKI changed the count-rules the number of confirmed cases raised so extreme.


 * At the time the rki changed the rules, german papers headlined the "explosions" of cases and explain it with the new counting rules. By Flutrackers.com some people now think, the german goverment hide the deaths. They compare the >40.000 to the 121 death in Europe with zero deaths and >17.000 cases in germany. So you might came to this conclusion that the goverment hide something. But the explanation is even more simple: The country`s have only different definition of H1N1 cases. I think the German counting-definition is more acceptable and realistic then others.


 * You cant compare the death per cases rate between germany and europe very well, when the counting rules are so different.


 * Hard data you can generally only have with the numbers of death, hospitalization or rate of ILI.


 * The number of cases are not very informative, cause the virus is so mild by the most of the infected and have such a high infection rate and so you cant really count them. 93.131.154.120 (talk) 23:21, 7 September 2009 (UTC)


 * Your example with japan is a good one. I think also, with the first death some more will follow in short time.
 * Also i like your argument with the holiday: Mostly healthy people go on journey. But on the other hand: young people in france and UK had also holiday and make party in spain, go to the disco and may have "close contact" to other ;) 93.131.154.120 (talk) 23:29, 7 September 2009 (UTC)

Influenza prevention
This is not really about this article but it is a call for help on a related article, influenza prevention. My hope is to eventually have this article put into the "In the News" section, but it does not yet have appropriate content nor is it of high enough quality. I would like a consensus for this article and experienced editors to improve it. Any helpful edits to this article are greatly beneficial. Thank you. Sagan666 (talk) 00:08, 3 September 2009 (UTC)

I've heard this quote circulating the media for a while, "...and most countries could see swine flu cases double every three to four days for several months until peak transmission was reached" I think this quote should be removed since it is clearly wrong. Assuming 4 months, with 3 days for doubling, that is 1 trillion cases (2^40) from 1 case in 'most countries.' Leaving this quote in removes credibility right away from the prevention section RabidRabbit23 (talk) 07:11, 7 September 2009 (UTC)

Second person content
Last paragraph on this sentence: http://en.wikipedia.org/wiki/2009_flu_pandemic#Home_treatment_remedies

It's this: "You cannot prevent or treat the flu, colds, or sinus problems by taking antibiotics, large doses of vitamins and minerals, such as vitamin C or zinc, or taking herbal remedies, such as echinacea.", but it sounds more like a set of instructions than an encyclopedia entry, forgive me, i don't know the specific term for that.

It should be this: "The flu, colds, or sinus problems cannot be prevented or treated by taking antibiotics, large doses of vitamins and minerals, such as vitamin C or zinc, or taking herbal remedies, such as echinacea." Mile92 (talk) 04:20, 5 September 2009 (UTC)

2009 flu pandemic in Historical context
It would be nice to see data of the 2009 flu pandemic in the table in Historical context paragraph.

For example WHO reports Cumulative total as of 30 Aug 2009 over 254206 confirmed cases and at least 2837 deaths (http://www.who.int/csr/don/2009_09_04/en/index.html).

I know, the numbers are changing and also it would need some explanatory notes about "confirmed cases". 93.99.133.34 (talk) 08:45, 7 September 2009 (UTC)

If in a historical context then this should not even be a pandemic at all. 1918 killed 50 million people within a few years, 1957 killed at least 2 million and 1968??? Killed over a million. I believe we should rewrite this as a severe virus and not a pandemic. Not to that level yet. Do you agree??? —Preceding unsigned comment added by Matthurricane (talk • contribs) 04:47, 8 September 2009 (UTC)

Whether it is defined as a pandemic or not is not for Wiki to determine but WHO. They have done this so that is the correct title. —Preceding unsigned comment added by 202.40.210.130 (talk) 06:37, 8 September 2009 (UTC)

== whether the test for swine flu will be negative after 2 doses of tamiflu tablets?89.108.61.234 (talk) 07:02, 9 September 2009 (UTC) ==

07:02, 9 September 2009 (UTC)~

Straw poll: Importance of current news link
The following link was removed with the explanation, "Does not belong here." Since this is obviously a personal opinion as it states no general Wiki guidelines or rules about why, some feedback from others might be useful. IMO, since the article is about a newsworthy and constantly evolving topic, a simple link to current news is valuable. In any case, most of the material used in the article is from earlier news sources, and whenever the CDC or WHO publishes statements, it also becomes a news item.

Quick straw poll to keep or remove: For recent news about Swine flu

Keep. --Wikiwatcher1 (talk) 17:44, 11 September 2009 (UTC)
 * Remove Seems silly to have an advertisement for google news at the beginning of an encyclopedic article.  Daniel.Cardenas (talk) 19:34, 11 September 2009 (UTC)
 * Remove Hatnotes are for internal wikilinks, not external links. The hatnote was nonstandard; it's not disambiguatory, nor is it a notice about the article's content. It is well-intentioned, but it violates Wikipedia conventions. --Cyber cobra (talk) 21:00, 11 September 2009 (UTC)

People think that the swine Flu has too much hype, but in actual fact this flu is a global outbreak that can and may kill many people. I believe that it should be treated more seriously. —Preceding unsigned comment added by 86.46.193.129 (talk) 13:20, 13 September 2009 (UTC)

Keep. Yes indeed, potentially, a potentially very serious outbreak, and should be treated seriously. Cool Nerd (talk) 20:21, 13 September 2009 (UTC)


 * An external link as a hatnote is specifically against Wikipedia guidelines: see WP:Hatnote, the example is extremely similar. --Cyber cobra (talk) 21:28, 13 September 2009 (UTC)

And we balance, say, 100,000 additional human lives lost versus the Wiki guidelines by. . . And I know you guys don't look at it that way. You think the emphasis on formality helps, even on a rapid developing event like this. I just don't see it. Cool Nerd (talk) 23:43, 13 September 2009 (UTC)
 * I don't even see how the link helps. How would the external link be superior to, say, linking to our organized timeline article? And wouldn't information on prevention be more useful than just random news? --Cyber cobra (talk) 02:13, 14 September 2009 (UTC)


 * The following, about a relapse with high fever being a danger sign (so far a good authoritative source regarding only children), may be our first really useful information. This is something people can do something about.   Cool Nerd (talk) 18:20, 14 September 2009 (UTC)

WHO estimated time table for vaccine
Production and availability of pandemic influenza A (H1N1) vaccines World Health Organization, Up-to-date as of 12 July 2009 (Originally posted on 2 May 2009 and revised on 27 May 2009) . . “How quickly will pandemic influenza A (H1N1) vaccines be available for use? “The very first doses of influenza A (H1N1) vaccine usable to immunize people, from one or more manufacturers, are expected as early as September 2009.” . . “What is the global manufacturing capacity for a potential influenza A (H1N1) pandemic vaccine? “Based on a global survey made by WHO on 15 May 2009, a maximum of 4.9 billion doses potentially could be produced in 12 months, but only if several assumptions are met. First, full global manufacturing capacity is devoted to this production. Second, production yields for influenza A (H1N1) vaccine are similar to those usually obtained for seasonal vaccines. Third, each manufacturer uses the vaccine formulation that is most "dose-sparing" (i.e. using a smaller quantity of active principle). A more conservative estimate of global capacity is at least 1 to 2 billion doses per year. The numbers of persons who might be vaccinated will not be known until it is determined whether one or two doses of the vaccine will be needed to achieve protection.” ..

Please note, this was WHO's estimate as of July 12th. We might be able to find more recent estimates. Cool Nerd (talk) 23:25, 13 September 2009 (UTC)

Kathleen Sebelius says mid-Oct for U.S.
Sebelius Says Flu Vaccines May Be Available by Early October, Bloomberg, Brendan Murray, Sept 13: '“We’re on track to have an ample supply rolling by the middle of October, but we may have some early vaccine as early as the first full week in October,” Sebelius said on ABC’s “This Week” program today.'

How about Britain, France, India, China, etc.? Cool Nerd (talk) 23:38, 13 September 2009 (UTC)

Wasted
Unless something changes the vaccine is going to waste. Public opinion is that the flu scare has been overblown. People aren't even going to bother to get vaccinated. Also many people already had the swine flu and don't need a vaccine.
 * "In the U.S., all the flu that is circulating now is the H1N1 virus," said ABC News Senior Health and Medical Editor Dr. Richard Besser on "Good Morning America" Wednesday. "If you've had the flu; you've had the swine flu."

http://www.abcnews.go.com/Health/SwineFluNews/swine-flu/story?id=8525109 There are other articles that say if you had a little cough over the summer, then it was swine flu.

If the virus mutates then the vaccine is still going to waste. Daniel.Cardenas (talk) 01:43, 14 September 2009 (UTC)


 * But a vaccine may prevent the virus from mutating, in this way: Everyone who gets the swine flu is a pull on the slot machine. A person gets the swine flu and it's then possible one of the viruses in his or her body mutates in a random direction that happens to be more lethal.  Unlucky for the person, and unlucky for the rest of us, too.  Not likely, but possible.


 * And the less people who get swine flu in the first place, the less likely this scenario is.


 * So far, we have been lucky. There have been some fatalities but far fewer than there could have been.  For most people, it's been a mild illness (but be warned, if you relapse with fever, that may be a secondary bacterial infection.  See the above.)   Cool Nerd (talk) 18:52, 14 September 2009 (UTC)

One dose for vaccine?
This is a new change. Previously, the talk had been two doses to receive protection. Cool Nerd (talk) 23:51, 10 September 2009 (UTC)

One Dose, Not Two, May Do for Swine Flu Vaccine Single Dose Vaccine Would Mean More to Go Around, Researchers Say, DAN CHILDS, ABC News Medical Unit, Sept. 10, 2009


 * " .  .  .  The new vaccine, which was found to give protection against the novel strain of the H1N1 influenza virus within eight to 10 days after administration, has been in development only since May. The first human trials of a candidate vaccine began in Australia in late July.  .  .  .  "

vague corporate speak on vaccine?
from our lead paragraph (before I changed it a little and included the Sept 10th information):

"As of August 2009, WHO did not expect to have a full vaccine before the end of 2009, and vaccines available sooner would be limited and given first to healthcare workers, pregnant women, and other higher risk groups. Two or three injections would be required for maximum immunity from both the swine flu and seasonal flu. There was also concern if the new virus mutated further, it could become more virulent and less susceptible to any new vaccine."

It's subtle, but look at it. " . . . did not expect to have a full vaccine . . . " Does that mean the vaccine is only going to provide partial protection? Well, all vaccines only provide partial protection. Does it mean protection will not run in the 90-percentiles? No, probably will, maybe even the high 90s. What it means is that there will be a limited number of doses. Well, why don't we go ahead and say that!

"Two or three injections would be required for maximum immunity from both the swine flu and seasonal flu." Why are we blurring those together. Before the research released on Sept 10th, it looked like one injection for seasonal and two for swine. Again, we don't we go ahead and say that!

With corporate communication, it's "accurate," as far as it goes. There's nothing really particularly wrong about it. But then, there's nothing really particularly right about it either. Cool Nerd (talk) 00:17, 11 September 2009 (UTC)

I personaally don't get why people are making such a big deal about it more people die of hte regular flu every year  —Preceding unsigned comment added by 204.184.246.254 (talk) 17:40, 15 September 2009 (UTC)

Anyone want to do it for real?
Anyone want to help write an article genuinely useful for parents who, say, might feel the first quiver of fear in their bowels as their child gets sick and they wonder, how serious is this swine flu business, really? Or what I've talked about above: that the standard advice for the front end (when you start to get sick) is to take it easy, to wait and see, to go to the doctor only if you're in a high risk group or if it gets worse. Whereas the advice for the back end, for children, seems to be to take it quite a bit more seriously, that if your child relapses with high fever, get that child medical care Quickly, because this relapse may be bacterial pneunomia and time makes a difference.

If we get that information out clearly and emphatically (and it may be true for adults also, but I haven't found the references), we may actually save lives. Each of us, may expend our best intellectual efforts, may use the skills we have developed and apply them to this new situation here, and when we look back, hey, we actually saved some human lives. And at the same time, we give citizens current and relevant information to make good decisions.

Instead we are worried about introducing the nomenclature earlier in the article ? ? ? Cool Nerd (talk) 22:36, 17 September 2009 (UTC)
 * While I can appreciate your sentiments, remember that Wikipedia is not a doctor and should not purport to give medical advice. We provide information, we give facts, but we should not and cannot tell a parent what to do with a sick child. The article as it stands is accurate and fairly clear, and in many ways that is the best we can do in that respect. Nikkimaria (talk) 23:30, 17 September 2009 (UTC)


 * Slightly disagree that is the "best we can do." Besides being accurate and fairly clear, it is also fairly invisible to over half a million people each month who are looking for its medical info, no doubt including some doctors.  Anyone want to venture a guess why? --Wikiwatcher1 (talk) 00:44, 18 September 2009 (UTC)
 * Okay, I'll bite: why? Nikkimaria (talk) 00:49, 18 September 2009 (UTC)
 * Answer --Wikiwatcher1 (talk) 01:15, 18 September 2009 (UTC)
 * Granted, that may be slightly problematic for some, although the pointer at the top of the page means that the page isn't by any means "invisible". It may not be the first thing that pops up, but it is readily accessible. Nikkimaria (talk) 01:39, 18 September 2009 (UTC)


 * If we say, (for children) relapse with high fever --(may be)--> pneumonia, that is both accurate information and medical advice. Better yet, might be a juicy quote from Tom Frieden or Margaret Chan saying the same thing (I do not know if either one has directly stated this).
 * Doesn't it already say that (without the quote)? You could add a quote if you could find one, so long as it's appropriate and cited. Nikkimaria (talk) 01:39, 18 September 2009 (UTC)


 * Our article is accurate as far as it goes. Where we are lacking is on completeness.  We also seem afraid of hitting the most important points first, I guess because someone might criticize us.  In general, we seem hamstrung by self-imposed rules regarding formality.   Cool Nerd (talk) 01:31, 18 September 2009 (UTC)
 * I would argue that we're not so much "afraid of hitting the most important points first" as we are concerned with building an encyclopedia article. You could add a sentence about the possibility of secondary infection in the lead if you so chose. Other than that, can you point to any specific information that is lacking, or by "lacking completeness" do you mean that certain information is not as prominent as you feel it should be? Nikkimaria (talk) 01:39, 18 September 2009 (UTC)


 * I don't want a single sentence blurred out by grayscape. I want the five or six things that might make a real difference.  This one, about relapse (in children) with high fever, is especially important since health authorities are generally telling people, take it easy, see how it goes.  Except for this.  Once again, a good juicy quote if we can find it.  Or brief story of three sentences.  Or picture.  Yeah, it's worth it.


 * And the following example, about information for pregnant women. Are we giving any specific information that really means anything?  Not last time I checked.  Cool Nerd (talk) 01:48, 18 September 2009 (UTC)

Pregnant women are a high risk group because . ..
We can make our topic headings substantial and informative. And we can then back it up by the text and references within the section.

But we seem to have a rule against this. Why? Cool Nerd (talk) 01:42, 18 September 2009 (UTC)
 * Just to clarify, are you saying we should have the above as a topic heading? We have a rule against it because, for one thing, shorter sections titles like "Treatment" and "Prevention" are succinct and still get the message across. As for the text and references part, feel free to add that to the appropriate section - there is no rule generally against referenced text, although you may run into issues of undue weight or POV. Incidentally, you're correct in saying that we don't specify why pregnant women women are high-risk (other than saying that pregnancy is an underlying condition). If you could find a source explaining this, or one that details the effects of H1N1 on the fetus, you could add a sentence or two (referenced, of course) explaining this. Nikkimaria (talk) 02:25, 18 September 2009 (UTC)
 * Yes, I think we should mix it up. I think it's perfectly okay to have some longer topic headings alongside shorter headings.  "Vaccine takes 6 months to develop" is another example of a good, substantial, informative heading.  Cool Nerd (talk) 19:58, 18 September 2009 (UTC)


 * I think pregnant women are more at risk because pregnancy can suppress the immune system. That helps protect the fetus but makes the mother more susceptible to infections. Jehochman Talk 20:01, 18 September 2009 (UTC)


 * That sounds reasonable. That sounds like the way the human body works.  Of course, we still need references.  Most of my efforts are currently on the relapse-->pneumonia connection.  Jehochman, if you want to jump in and help with this.  Or anyone else, please, find two or three good references and let's roll with it.  Cool Nerd (talk) 21:49, 18 September 2009 (UTC)
 * The longer headlines you're offering sound like something a newspaper would use. This ain't a newspaper.  It's a fact-based encyclopedia.  You wouldn't open a Britannica and see a headline like that.  Sorry just my two pence (which is my way of saying you can't disagree with anything I just said :P )  GARDEN  22:29, 18 September 2009 (UTC)
 * I'm working on a response. I can see you have a good sense of humor.  I myself also have been known to, occasionally, have a sense of humor (a little bit, from time to time that is).   Cool Nerd (talk) 16:38, 19 September 2009 (UTC)
 * Yeah, sorry, just conversations such as this can get rather tens and a little humour can go a long way in such a scenario. I would like to confirm I would be against a change to the longer headings although others may or may not disagree.   GARDEN  18:27, 19 September 2009 (UTC)
 * Remember the Star Trek episode in which Kirk, Spock, and Bones (and maybe Scotty) went down to the planet's surface and a previous mission had left the book, Chicago Gangs of the 1920s, and the imitative society took the book as a blueprint to build their society. Hey, the book tells us what to do.  No more cracks about the book.  That's what wikipedia reminds me of!  So, we have the goals of accuracy, completeness, timeliness.  And the formality of the style is equally important???  Actually, I do have a goal I might list as fourth, but it sure isn't the formality of the style.
 * Furthermore, I would advance the zen principle, if you're trying to perfectionize, you're not doing it at all. A fast moving topic like this, it is inherently nonperfect.   Cool Nerd (talk) 21:45, 19 September 2009 (UTC)

H1N1 vs. swine flu
It seems that the wording of this article uses swine flu more than the proper (and more correct) term of this virus: H1N1. Is there a reason for this, or should it be changed throughout most of the article to H1N1?

Jeb R (talk) 01:06, 19 September 2009 (UTC)


 * H1N1 is the technical name for the virus, where "Swine flu" is the common name for the illness and the topic of the article. --Wikiwatcher1 (talk) 01:14, 19 September 2009 (UTC)

I've yet to hear anyone refer to it as H1N1 in real conversation, swine flu is the best way to describe it. —Preceding unsigned comment added by Theone133737 (talk • contribs)

In children, relapse with high fever may be bacterial pneumonia
Report Finds Swine Flu Has Killed 36 Children, New York Times, Denise Grady, Sept. 3, 2009. “ .  .  . In children without chronic health problems, it is a warning sign if they seem to recover from the flu but then relapse with a high fever, Dr. Frieden said. The relapse may be bacterial pneumonia, which must be treated with antibiotics. . .  . ” [Dr. Thomas Frieden is head of CDC.]


 * Okay, a relapse possibly being pneumonia may apply to adults, too. But, let’s be a little careful and put it together piece by piece.  And if you have the time, I could use some help with the research.  Thanks.   Cool Nerd (talk) 00:05, 14 September 2009 (UTC)  Please help.  Cool Nerd (talk) 23:11, 23 September 2009 (UTC)

How did swine flu kill a healthy boy?, Antioch kindergartner's death leaves parents and doctors without answers, by CHAS SISK, THE TENNESSEAN, SEPTEMBER 14, 2009. The article is about five-year-old Max Gomez, who died even though he did not have chronic health problems.

"[page 3] .  .  .  One possibility is that H1N1 could be exacerbated by a bacterial infection. All six of the children the CDC studied who were over 5 years old but did not have a chronic medical condition tested positive for a bacterial infection in addition to swine flu.

"Health officials said they did not know enough about Max Gomez's case to say whether a bacterial infection contributed to his death.

“But they did say that when influenza combines with a bacterial infection, such as pneumonia, the patient often follows a pattern in which his symptoms start to subside but then suddenly worsen. That pattern — which includes symptoms such as vomiting, chest pain, a racing pulse, breathing trouble, bluish skin or trouble staying awake — is an indication that the flu has turned deadly, and it means a sufferer should talk to a doctor immediately.

""What you expect from ordinary flu is that it starts off bad and gets better," said Dr. Bill Paul, Metro's health director. "If that's not the case, it's worth a call.""


 * Again, it would seem like this would also apply to adults, although perhaps to a lesser extent. Please help with the research if can.    Cool Nerd (talk) 18:36, 14 September 2009 (UTC)  And (multiple quick passes!!)  Cool Nerd (talk) 20:13, 24 September 2009 (UTC)

Preparing for a Stressful Flu Season,New York Times, By TARA PARKER-POPE, September 7, 2009. “ .  .  .  In otherwise healthy children, the main warning sign is that the child seems to feel better, then appears to relapse with a high fever. This signals a bacterial infection that must be treated with antibiotics. Even though such infections are seldom severe, the child should be seen by a pediatrician as quickly as possible. . .  .  ”


 * Okay, some possible good news.  Cool Nerd (talk) 23:08, 23 September 2009 (UTC)

CDC's Morbidity and Mortality Weekly Report for Sept. 4th
Surveillance for Pediatric Deaths Associated with 2009 Pandemic Influenza A (H1N1) Virus Infection --- United States, April--August 2009, CDC's Morbidity and Mortality Weekly Report, September 4, 2009. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm

“ .  .  .  As of August 8, 2009, CDC had received reports of 477 deaths associated with 2009 pandemic influenza A (H1N1) in the United States, including 36 deaths among children aged <18 years. To characterize these cases, CDC analyzed data from April to August 2009. The results of that analysis indicated that, of 36 children who died, seven (19%) were aged <5 years, and 24 (67%) had one or more of the high-risk medical conditions. Twenty-two (92%) of the 24 children with high-risk medical conditions had neurodevelopmental conditions. Among 23 children with culture or pathology results reported, laboratory-confirmed bacterial coinfections were identified in 10 (43%), including all six children who 1) were aged ≥5 years, 2) had no recognized high-risk condition, and 3) had culture or pathology results reported. Early diagnosis of influenza can enable prompt initiation of antiviral therapy for children who are at greater risk or severely ill. Clinicians also should be aware of the potential for severe bacterial coinfections among children diagnosed with influenza and treat accordingly. All children aged ≥6 months and caregivers of children aged <6 months should receive influenza A (H1N1) 2009 monovalent vaccine when available (6).”
 * Commentary: Okay, first off, we’re actually seem to be doing a pretty good job with children (although obviously room for improvement).  36 children out of 477 total deaths is seven-and-a-half percent.  That’s smaller than the percentage of children in the general population.  My guess is that parents take better care of children than they take of themselves.  And notice children younger than five constitute 7 out of the 36 deaths, which is about nineteen percent.  Again, this is smaller than the normal percentage of younger children to all children.  I would make a similar guess, that parents and the medical system take even better care and are even more focused on the health of these younger children, and there is less pressure to get them to school in a walking wounded condition.  The tentative policy conclusion might be to keep doing a good job with these younger children (even a better job if possible), and extend this to older children and other patients.  (And real conversation and non-goody-two-shoes communication is a good start.)
 * And the other fact that really jumps out at you: “Twenty-two (92%) of the 24 children with high-risk medical conditions had neurodevelopmental conditions.” Wow, 22 out of 24.  You don’t see that often.  Cool Nerd (talk) 02:15, 18 September 2009 (UTC)

. . ." .  .  .  For this case series, invasive bacterial coinfection was defined as laboratory detection of a bacterial pathogen in a specimen from a normally sterile site or a postmortem lung biopsy.  .  .  .  ". . " .  .  .  Thirty-six pediatric deaths associated with 2009 pandemic influenza A (H1N1) infection were reported from 15 state and local health authorities† through August 8 (Table 1).§ Illness onsets occurred during May 9--July 20, and deaths occurred during May 15--July 28. Six deaths occurred in May, 25 deaths in June, and five deaths in July. Median age of the patients was 9 years (range: 2 months--17 years); 50% were male, 42% were non-Hispanic white, and 33% were Hispanic (Table 2). Seven (19%) of the 36 children were aged <5 years (five were aged <2 years), and 24 (67%) had at least one high-risk medical condition, including three children aged <5 years. Among the 24 children with high-risk medical conditions, 22 (92%) had neurodevelopmental conditions (e.g., developmental delay or cerebral palsy). Of these 22 children, 13 (59%) had more than one neurodevelopmental diagnosis, and nine (41%) had neurodevelopmental and chronic pulmonary conditions. Eight (22%) of the 36 children were aged ≥5 years with no reported high-risk conditions. Two of these eight children were reported as obese; however, height and weight measurements were not reported. "Duration of illness before death in the 36 cases ranged from 1 day to 28 days (median: 6 days). Among 31 children for whom antiviral treatment data were available, 19 (61%) received antiviral treatment, and four of those received treatment within 2 days of illness onset. Of 25 children for whom information was available, 13 (52%) had received at least 1 dose of the 2008--09 seasonal influenza vaccine, including 11 children with high-risk medical conditions. Of the 23 children with culture or pathology results reported, 10 (43%) had a laboratory-confirmed bacterial coinfection, including Staphylococcus aureus (five, including three methicillin-resistant S. aureus), Streptococcus pneumoniae (three), Streptococcus pyogenes (one), and Streptococcus constellatus (one). Among the eight children aged ≥5 years who did not have a high-risk medical condition, six had a laboratory-confirmed invasive bacterial coinfection, including four with S. aureus; the other two children either had no specimens collected or information regarding bacterial coinfection was unavailable. Among the seven children aged <5 years who died, two had a laboratory-confirmed bacterial coinfection; neither child had a high-risk medical condition."

I want to read this a couple of times. Cool Nerd (talk) 01:31, 17 September 2009 (UTC)

and maybe also in seniors (seasonal flu)
How Well Does the Seasonal Flu Vaccine Work? CDC, Page last updated: July 8, 2009. http://www.cdc.gov/flu/about/qa/vaccineeffect.htm

“How effective is the seasonal flu vaccine in the elderly? . .  .  In past studies among elderly nursing home residents, the seasonal flu shot was most effective in preventing severe illness and complications that may follow flu (like pneumonia), and deaths related to the flu. . .  .  ”

. .  .  that may follow flu (like pneumonia). ..

Please feel free to help with more research. Cool Nerd (talk) 22:50, 15 September 2009 (UTC)

Mortality rate
I cannot find the calculated fatality rate of this pandemia anywhere on the article (or related articles). I thought it was there some time ago, but I might be mistaken. Is it not there on purpose (in which case, I've probably missed the discussion about it), or was the information simply never added by chance? Would adding it based on the cases/death ratios as reported by the table at the beginning of this very article be a case of routine calculations? If not, this must be solved somehow anyway: the article reports death rates for other important pandemics... and it does not report it for the very one it's talking about?! (even while warning it might not be accurate - no, it just doesn't report it; that's not at all what any reader will expect) --LjL (talk) 12:59, 21 September 2009 (UTC)


 * If you look at our article, I think you'll find several things that should be there, but are not. And I think part of the reason is that we have a lot of focus on the desktop publishing side, and not near as much as on swine flu itself.  (And like you say, put the best estimate(s) we can find, then a quality reference or two on how accurate we can expect this to be.)   Cool Nerd (talk) 22:43, 21 September 2009 (UTC)


 * First, what you obviously are referring to with 'case/death ratio' is not the mortality, it is the case fatality. The mortality is computed by dividing the death cases by the population.


 * Second, the case fatality cannot simply be calculated by dividing the deaths by the cases. Lots of reasons for that, including many unregistered cases (overestimating fatality), not properly attributed deaths (underestimating fatality), time delay between diagnosis and death (underestimating fatality), ...


 * There has been an early study, trying to estimate the case fatality ratio . I do not know for certain, whether subsequent studies exist, but you could try to find the studies mentioned in and have a look, whether one of these also gives fatality rate estimates.


 * FHessel (talk) 08:56, 23 September 2009 (UTC)

estimated 30,000 to 90,000 influenza deaths in U.S. this winter
Officials: Older Kids Need Only One Swine Flu Shot, By Rob Stein, Washington Post Staff Writer, Monday, September 21, 2009; 1:01 PM http://www.washingtonpost.com/wp-dyn/content/article/2009/09/21/AR2009092101505.html “. . .  Although the virus appears to be causing relatively mild disease so far, experts expect many more people will get infected because most have no immunity against it. Flu contributes to about 36,000 deaths each year in the United States, but a presidential panel estimated as many as 90,000 could die this year because of H1N1. . .  .  ” Wow. That's serious. That's potentially serious. " .  .  . as many as  .  .  .  "  We still don't know for sure. But it's serious enough that we should---without overstating---do our absolute best work and play our absolute best game. Cool Nerd (talk) 23:18, 21 September 2009 (UTC)


 * That is known for more than 4 weeks now. The original source can be found here: www.whitehouse.gov/assets/documents/PCAST_H1N1_report.pdf FHessel (talk) 09:08, 23 September 2009 (UTC)


 * REPORT TO THE PRESIDENT ON U.S. PREPARATIONS FOR 2009-H1N1 INFLUENZA, August 7, 2009, page viii:
 * cause between 30,000 and 90,000 deaths in the United States, concentrated among children and young adults. In contrast, the 30,000–40,000 annual deaths typically associated with seasonal flu in the United States occur mainly among people over 65. As a result, 2009-H1N1 would lead to many more years of life lost.
 * pose especially high risks for individuals with certain pre-existing conditions, including pregnant women and patients with neurological disorders or respiratory impairment, diabetes, or severe obesity and possibly for certain populations, such as Native Americans.
 * Do we have this in our article? And are there other good sources on this angle?  Cool Nerd (talk) 14:53, 23 September 2009 (UTC)

asthma
We could have a couple of sentences saying why people with asthma are in a higher risk group. Cool Nerd (talk) 22:23, 21 September 2009 (UTC)

children with neurodevelopmental conditions
CDC's Morbidity and Mortality Weekly Report http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5834a1.htm "Twenty-two (92%) of the 24 children with high-risk medical conditions had neurodevelopmental conditions."
 * That is, of the 36 kids who have died of confirmed H1N1 in the United States as of August 8th, 22 of them had some neurodevelopmental condition. It is easily worth including this category as a risk group, with again, a sentence or a couple of sentences explaining why.   Cool Nerd (talk) 21:37, 19 September 2009 (UTC)

Report Finds Swine Flu Has Killed 36 Children, New York Times, Denise Grady, Sept. 3, 2009. " .  .  .  Children with nerve and muscle problems may be at especially high risk for complications from the flu because they cannot cough hard enough to clear their airways.  .  .  .  "
 * Posted by Cool Nerd (talk) 20:00, 24 September 2009 (UTC)

Citation tags
Since a lot of the material tagged as missing cites were added by me over the last few months I'll offer some feedback on the issue since the tags seem to clutter up the article and may confuse readers.

In paragraphs that dealt with a single topic, such as facial masks and airline hygiene, I usually added the cite to the end of the paragraph to avoid multiple cites in a single paragraph. I often paraphrased and abbreviated a long article. It looks like most of those cites are still there so the inner tags can be taken out. But I also noticed that the citations themselves were changed to the template style, which I never use since I often use the "ref name" feature for repeating cites (and I dislike templates anyway since they're long and harder to edit.) So if someone wants to remove the tags they can just check the last cite (if it still works), then make sure there were no other "ref name" links using it. It's not recommended to mix citation formats in an article and the majority of them were the shorter style originally. I'd help if the cite templates were removed. --Wikiwatcher1 (talk) 04:20, 24 September 2009 (UTC)
 * Please see WP:MOSMED. The cite.php system is preferred for good reason.LeadSongDog come howl  21:19, 24 September 2009 (UTC)


 * Agree as the source relates to medical material. And as the MOSMED says, "The Cite.php footnote system is preferred as a method of indicating your sources but is not mandatory." However, most of what the MOSMED is referring to are medical journals, books, sites, etc. where most of the sources in this article are "general news" sources.  The examples given in WP:MOSMED are distinctly medical/professional sources so for those you're probably right, but they are only a small portion. --Wikiwatcher1 (talk) 22:13, 24 September 2009 (UTC)

baseline of mild and self-limiting (most cases)
Swine flu cases expected to rise, by Don Finley, San Antonio Express-News, Web Posted: 09/25/2009 12:00 CDT.

'Dr. Fernando Guerra, director of the Metropolitan Health District. . .  ' '“I think there's still a considerable element of fear, especially for children,” Guerra said. “Parents are at times very concerned and will not recognize this to be a self-limiting, relatively minor illness if they can get through the acute phase.” 'Symptoms can usually be managed at home. But parents also need to know that if fever persists for several days or a patient has difficulty breathing or symptoms of dehydration, to seek medical attention, Guerra added. 'Two Bexar County children have died of swine flu complications in recent days — a fragile, premature baby and an otherwise healthy 14-year-old middle school student. Ten people have died here since the new flu strain first appeared here in April; three lived outside the county and sought care here.'

- The flu pandemic: What next?, Nick Triggle, Health reporter, BBC News, Sept. 25, 2009.
 * posted by Cool Nerd (talk) 20:07, 25 September 2009 (UTC).

2008-2009 Influenza Season Week 37 ending September 19, 2009 http://www.cdc.gov/flu/weekly/
 * posted by Cool Nerd (talk) 17:37, 26 September 2009 (UTC)

formal writing blurs, and becomes borderline incorrect
"Flu infections can also cause pneumonia, a life-threatening illness. In children, a relapse with high fever may indicate a secondary infection of bacterial pneumonia.[49] Reports emphasize children with chronic health problems.[50] Reports of deaths among healthy young people during the first weeks of the 2009 flu pandemic were attributed to pneumonia.[51][52]"

" .  .  .  may indicate a secondary infection of bacterial pneumonia.[49] Reports emphasize children with chronic health problems  .  .  .  "

No, that's just not correct. Please notice how we blur from relapse with high fever to children with chronic issues. And that is simply not correct. Relapse with high fever is a danger sign for all children.

(This section is the last paragraph of Symptoms and severity.) Cool Nerd (talk) 20:27, 25 September 2009 (UTC)

live section
Flu infections can also cause pneumonia, a life-threatening illness. In children, a relapse with high fever may indicate a secondary infection of bacterial pneumonia. Reports emphasize children with chronic health problems. Reports of deaths among healthy young people during the first weeks of the 2009 flu pandemic were attributed to pneumonia.

GA within grasp - 3 citations needed!
Only 3 citation-needed tags remain! If you have some spare time, please try and find citations for them. This article will have a pretty decent chance of becoming a Good Article if those last few tags can be dealt with. --Cyber cobra (talk) 01:02, 27 September 2009 (UTC)


 * I can't find them. Where are they? Jehochman Talk 12:29, 27 September 2009 (UTC)
 * You already added citations for the 2 remaining ones; earlier, I removed the third uncited statement after I made the post. --Cyber cobra (talk) 19:55, 27 September 2009 (UTC)
 * Good work! I am glad you got that last one! Jehochman Talk 20:01, 27 September 2009 (UTC)
 * Well, actually you have the chronological order wrong (I removed one of the 3 statements, then you cited the other 2), but whatever. --Cyber cobra (talk) 21:02, 27 September 2009 (UTC)
 * I was looking for the third one, but evidently you fixed it beforehand! Thanks! Shall we tell Nikkimaria to finalize the review? Jehochman Talk 22:05, 27 September 2009 (UTC)

possible explanation of why some healthy young people die
Swine flu attacks the lungs more aggressively than seasonal flu, Momento24 (Source: Reuters), 16 September 2009. “Americans who died from swine flu had infections deep in their lungs, Dr. Sherif Zaki of the U.S. Centers for Disease Control and Prevention told a meeting of flu experts, including damage to the alveoli — the structures in the lung that deliver oxygen to the blood. "This in turn caused what is known as acute respiratory distress syndrome — an often fatal development that leaves patients gasping for breath. .  .  .  ”
 * posted by Cool Nerd (talk) 20:15, 27 September 2009 (UTC)

Reinstatement of Cases By Country table
My intention is to reinstate the cases by country template by replacing the current deaths by region template. The latter has the benefit of being cleaner and smaller than the cases table, but that's its only benefit; in removing the cases by country table, we've taken away a great portion of the article's usefulness. When listed alone--that is, apart from case numbers--simple death tolls are practically meaningless. This article is about the pandemic, and a pandemic has repercussions that go far beyond simply the number of those killed by a particular virus; the lion's share of resources spent fighting a pandemic go toward stopping the spread of the disease, and that spread can really only be shown when numbers of the infected are shown. Also, regional death rates are meaningless for comparitive purposes as medical resources vary by region; what kills one in a thousand people in Europe, for instance, may kill 1 in 10 in Africa. Listing only the dead deprives Wikipedia's users of a great resource. Yes, they can currently choose to click through to find the cases by country table...but as that table is of demonstrably greater value than the deaths by region table in place now, the former should be the default presentation, with links to the secondary summary data in the current table. So, to reiterate, I plan to reinstate the cases by country template shortly. I trust all will concur. Sqlman (talk) 21:35, 25 September 2009 (UTC)


 * We had substantial discussion about this and settled on the shorter format. The problem with the huge table is web page size. Making this article too lengthy (code wise) damages usability for people on slow connections. Wikipedia is for everybody, not just those lucky enough to have broadband internet access. This page is viewed about 750,000 times per month. Jehochman Talk 08:29, 27 September 2009 (UTC)
 * It also seems plain unwieldy in length and detracts from the page layout. --Cyber cobra (talk) 08:44, 27 September 2009 (UTC)


 * I wasn't aware of 'substantial' discussion in favor of lobolomizing the cases by country table. In fact, as best I recall, the move was made boldly and nearly unilaterally, as the majority of editors were for keeping the template as it was. Yes, Wikipedia is for everyone, not just those on broadband connections. But if page size is used the major criteria in determing what information gets put on a particular page, we can follow that to its logical and absurd conclusion and not present *any* information at all; empty pages would load lickety-split on any connection. In my opinion, completeness of the data trumps page size every time, so, again, I plan on making the change to reinstate the cases by country table soon; I trust folks won't attempt to decrease the usefulness of any Wikipedia page by removing valuable and sought-after data. Your cooperation will be appreciated. Thanks! Sqlman (talk) 01:21, 28 September 2009 (UTC)
 * Please don't act just yet. There are two editors who've made large contributions to this article, Cybercobra and I, who oppose the table as too large. The argument to delete everything is fallacious. There is a happy medium. Let's discuss it. To begin, can you check the size of the table you'd like to add?  Perhaps we can find a way to make it more efficient size-wise while accomodating your suggestion. Jehochman Talk 03:08, 28 September 2009 (UTC)

one-two punch of what needs to be said: both high risk groups and relapse with high fever(including the usually very healthy)
The first paragraph of our lead has this as it's last sentence: "The illness is generally mild with some exceptions for people in higher risk groups." And then we don't talk about relapse with high fever--for previously healthy people--until the third paragraph. That's doing people a disservice. It's not just people in high risk groups who have died. Some previously very healthy people have died, and sadly probably will continue to die. We can at least do our part and give the best and clearest information that we can. Cool Nerd (talk) 23:37, 28 September 2009 (UTC)

relapse-with-high-fever-in-children---(sometimes)--->bacterial-pneumonia is a high relief item
And a lot of other items aren't. Tamiflu for pregnant women who have been exposed? That's probably more of a case of six of one, half a dozen of the other. And same with our list of symptoms, which as it now stands reads more like a laundry list. We haven't yet really made the effort to draw a distinction between, say, the flu and a cold.

Now, a relapse with high fever? That is high relief. That is clear and noticeable. The child seems to be getting better, and then boom, he or she relapses, and not just any fever, but with a high fever. (And eventually with a reference, I'd like for us to be even more specific on this. How high?  And I know it varies by the baseline of the particular child.  How high a fever does this particular child tend to get when he or she is sick?  But we might be able to add some useful specifics.)   Cool Nerd (talk) 22:36, 27 September 2009 (UTC)


 * Good work! I've gone through the sources and copy edited that material in the lead to make it as clear as possible. Further details should be added, possibly in either the lead or body of the article. Jehochman Talk 00:04, 28 September 2009 (UTC)

It seems there are too many one-off details and cites in the lead that are not covered in the body. About six cites in the lead are not cited anywhere else. This is the reverse of the correct way to do this, since the lead is to give a summary (with cites optional for controversial topics), and the detailed text and cites put in relevant sections of the body. Facts or cites in the lead that are not covered in the body should be trimmed off or relocated. --Wikiwatcher1 (talk) 01:01, 28 September 2009 (UTC)


 * Thank you, Jehochman. You improved my work.
 * " .  .  .  In addition, when influenza combines with a secondary infection such as bacterial pneumonia, an otherwise healthy child or adult who was recovering may relapse with symptoms such as high fever, vomiting, chest pain, tachycardia, difficulty breathing, bluish skin or drowsiness, and then die. Victims experiencing a relapse are advised to contact a doctor immediately.  .  .  .  "
 * Now, I'd like to take this a step further, either in the lead and/or body, and make it even more helpful. This is probably a constellation of breathing difficulties where a person is not likely to experience all of them, or not all will be emphasized in what a particular patient experiences.  I would like for us to say which are the most likely (if we can find that reference).
 * Wikiwatcher1 brings up a good point. Ideally, we'd want to cover a topic in adequate depth in the lead and then expand in the body.  Now, with a fast moving topic like this, it's going to be more the zen state of never being, always becoming!  I think t's okay to introduce new developments (with references) in the lead and then add to body, or in body and then add to lead.  Both are valid.  The important thing is to keep moving, keep working.  And secondary-infection-of-bacterial-pneumonia is easily in the top five of most important topics.  Cool Nerd (talk) 23:28, 28 September 2009 (UTC)

More details if we have them
Okay, so Jehochman's contribution was:
 * " .  .  .  high fever, vomiting, chest pain, tachycardia, difficulty breathing, bluish skin or drowsiness  .  .  ."

The current section in the lead is:
 * " .  .  .  secondary infections, such as those caused by bacterial pneumonia or a relapse of the illness with worse symptoms, are considered very serious and require medical treatment."[2]

On thinking it over, I still like Jehochman's version better. If we have more details and we can substantiate those additional details, let's go with it. The only thing I might add is, let's rewrite tachycardia as rapid heartbeat (the body's not getting enough oxygen and is trying to compensate). Cool Nerd (talk) 18:38, 29 September 2009 (UTC)
 * The layout has the TOC right after the lead and includes "Symptoms and Severity," "Prevention" etc. IMO the problem with giving too many list details in the lead is that a lot of readers want an easy-to-read summary, so a list of anything can become a barrier. Anyone who reads the lead, and wants more details about symptoms, will see the TOC section right below.  That satisfies most readers and gives editors the flexibility to expand any section's details as necessary. Good idea to explain medical terms using common language (at least in parentheses) whenever it's used, i.e. "tachycardia." --Wikiwatcher1 (talk) 20:12, 29 September 2009 (UTC)

More on secondary infection of bacterial pneumonia
28 Pregnant Women Have Died From Swine Flu: CDC, Official calls the number 'upsetting'; flu shots and antiviral drugs urged for moms-to-be, U.S. News & World Report, By Steven Reinberg, HealthDay Reporter, Posted October 1, 2009. “ .  .  .  Schuchat also addressed a CDC study released Wednesday that found that 33 percent of 77 deaths caused by the H1N1 flu resulted from bacterial pneumonia. The strain of bacteria in many cases -- streptococcus pneumonia -- is one for which there is a vaccine, she said, so adults should get the pneumococcal vaccine to prevent this complication. This holds true especially for people who have a chronic medical condition such as asthma, diabetes, heart disease and lung disease, she said. . .  .  ”
 * posted by Cool Nerd (talk) 22:45, 1 October 2009 (UTC)