Talk:Influenza/Archive 2

Diagnosis
This section was thin and I have added to it. In addition, I have added a Bayesian approach to the diagnosis that utilizes CDC data for seasonal changes in prevalence. Badgettrg 05:20, 5 December 2006 (UTC)

Prevention and treatment
I split these sections and organized the treatments. Note that the prevention section is in need of a discussion of using neuraminidase inhibitors for either prophylaxis or post-exposure prophylaxis. Badgettrg 05:23, 5 December 2006 (UTC)

It's a small thing, but I don't see any mention anywhere of how long the virus is shed by an infected person. Seems like knowing how long you're contageous for would be an important thing to know as far as preventing further spread. When do you start shedding virus, versus when you start showing symptoms, and how long does it continue? How does taking antivirals affect that, if anyone knows? Anyone looking up influenza because they have it or someone they know has it would likely want to know that. Critterkeeper 05:24, 15 March 2007 (UTC)

Added to the "Vaccination and infection control" section. TimVickers 05:43, 15 March 2007 (UTC)

Potential Edit War
Perhaps I'm mistaken, but it appears to me that an edit war is beginning to brew; like I've said, perhaps I'm mistaken, but I've seen almost 10 reverts happen in the past 2 minutes. This needs to be dealt with. BishopTutu 00:21, 1 January 2007 (UTC)
 * It's not an edit war, it's just the regular shitstorm of vandalism that hits every page featured in the Today's Featured Article section of the Main Page. GeeJo (t)⁄(c) &bull; 00:32, 1 January 2007 (UTC)
 * Well, I don't wish to sound uptight, but shouldn't something, at least, be done about it? BishopTutu 00:37, 1 January 2007 (UTC)
 * Please see Main Page featured article protection, and the discussion on the talk page. --Fsotrain09 01:26, 1 January 2007 (UTC)
 * Well, I guess that, quite frankly, I should just shut up; It'll be promptly and accordingly dealt with, I presume. BishopTutu 01:45, 1 January 2007 (UTC)
 * It's better that way BishopTutu. I found that given the amount of press this place gets, new users are always on here trashing the place and showing their friends how they are "1337 hax0rz". If you speak out about it, you just come off as another whining user. I tried to stop a flame war once and instead got banned for a week cause I was "not part of the solution, merely another problem". Unless you have access to dynamic IPs, proxies, and multiple accounts to get around the bans; don't bother sticking your head out... it'll only get chopped off by some over-zealous op. Ghostalker 10:14, 1 January 2007 (UTC)
 * I suppose it would be pointless to point out that you're contributing nothing right now, as well. Tuviya 17:18, 1 January 2007 (UTC)

Image Display Issues
I am having an issue where the Specific Death Rate graph in the history section obscures some of the text in the paragraph. This is affecting viewing for me in IE and firefox in 1024x768. Is anybody else having this issue and if so can someone with a little more expertise than myself fix it. Andystar23 02:49, 1 January 2007 (UTC)
 * I had the same issue as that, on Firefox (though only when I had the window at about two-thirds screen size). I think it was more an issue with the image above, and as such, I think it's fixed now (as in it's OK for me). Can you check see if it's gone for you? :-). --86.130.21.79 03:26, 1 January 2007 (UTC).
 * Thanks, looks fine now Andystar23 10:18, 1 January 2007 (UTC)

--82.8.58.73 04:13, 1 January 2007 (UTC)

Western medicine
Not a topic I'm pursuing, just noticed that Influenza is the featured article today, and that the slant of the entire article is about Western science and medical treatment as if it is the end-all and be-all of medical treatment. As a person who suffered brutally from the effects of antibiotics on my immune system and became chronically susceptible to flus, I was impressed when a Chinese painter (also a genuine, traditional Taoist master, trained in China) informed me that going back to the original Yellow Emperor's book on medicine, the Chinese have had medicine for treating the entire range of these complaints....ranging from the common cold through the 'ague' to full-blown influenza of most common varieties. It works by boosting the strength of the meridians related to what we call the immune system This medicine (Yin Chiao ) is very cheap ($3Canadian for 120 tablets) and usually will clear the flu in three doses of the medicine, which usually means overnight. Caveats are that according to 'chi types' (wet, dry,hot, cold etc) there are a few people who will not respond to this treatment, but the Chinese Herbalists have a tea, which is brewed up and will help not only these people, but also the more severe super-flu which has been circulating....the one that lasts for around a month. For those who cannot manage to get past the hubris and pride about western science, I would much prefer they read Bruce Holbrook's Stone Monkey than embarrass themselves by directing tackling me in efforts to insist upon the superiority of Western medicine. The simple fact is that there are some things it simply cannot do at this time, and other systems can. My interest is in what actually help sick people, not in participating in ideological debates. I have nothing invested in the faith that rationalists have in their scientific philosophy, or of defending Oriental medicine, nor of entering any debate about it.

I'm writing this simply because this medicine is one of a number remedies I've seen that work, but Western medicine would rather ignore than use in the mean time while they come up with a 'scientific' remedy.

chriss Nessmuk 08:46, 1 January 2007 (UTC)

Wikipedia is not a Soapbox, so these kind of diatribes are inappropriate. In addition to this, Wikipedia's neutral point of view policy demands that we do not give undue weight to fringe theories. The vast majority of people who know about such issues subscribe to the western medicine viewpoint. If there are a few that don't, that's bound to happen - I'm sure there are some people who think Jehovah is a goddess-figure, but you're not going to see a huge section about that here or anywhere else, because it's not a common belief. Also, I think it's sort of funny to be using a device like a computer on a framework like the internet, and then still use scare quotes around the word 'scientific'. I have never used a homeopathic computer, but maybe you have...? :) Tuviya 17:22, 1 January 2007 (UTC)

Yes, but Wikipedia is supposed to have multiple countries... Hence the "This article is on a non-national view-point" tag. --½¹²³€½¾¡⅛£¼⅜⅝⅞™±°¿ 17:29, 1 January 2007 (UTC)
 * IMHO, that tag is not valid. It's not like the rest of the world treats or sees flu differently than 'the West'.  They use plenty of 'western' medicine in China and the other Oriental nations as well.  Tuviya 17:40, 1 January 2007 (UTC)


 * When I can't see because it is too dark in my home, I don't light a bunch of candles as my first resort. I do not know the ins and outs of how a lightbulb works, but I still turn one on when it gets dark. Because at some point in history, someone somewhere took the time, did the research, and invented the lightbulb. Scientists today are much like Joseph Swan and Thomas Edison( lightbulb inventors).  They are looking for a cure, figuring out what works and what does not. So instead of insulting the people who are actually trying to find a cure, perhaps you could help them along by suggesting yours. Also, if "Western medicine" looked into your chinese herbalist method of dealing with influenza, perhaps they would find a 'scientific' explanation for how it works.  Just because science has not proven the "how" of a particular treatment, it does not mean that people are not willing to try something new(or old). V.E. 24.247.247.186 00:22, 2 January 2007 (UTC)


 * The scientific method is applied worldwide, therefore using data from scientific studies does not favour any one part of the world more than another. TimVickers 01:00, 2 January 2007 (UTC)

History
I don't know how firm these dates are for the 19th century flu epidemic. St. Therese of Lisieux reported that flu devastated her convent in the winter of 1990-1, not the previous year. Three deaths, probably elderly nuns (out of maybe a dozen or so?). Nearly everyone was sick at one time. Is is possible the epidemic listed for the previous year was still ongoing? Student7 23:31, 11 January 2007 (UTC)
 * I think you mean 1890, don't you? The best source I can find source states "Pandemic influenza was recorded in 1830–3, 1898–1900, and four times in the 20th century (Fig. 2). It is not appropriate to detail these events in the present text, but full accounts for the latter half of the 19th century can be found in the literature (Jordan 1927; Burnet and Clark 1942; Pyle 1986; Patterson 1987).." C.W. Potter, A history of influenza. J. Appl. Microbiol. 91 (2001), pp. 572–579. link Hope this helps. TimVickers 23:48, 11 January 2007 (UTC)


 * Thanks Tim. I was off by a century! I was referring to the table under "History," where it explains that the flu, believed to be H2N2, struck in 1889-1890. The nun's account is supposedly a year later. It is, of course, "anecdotal." Still, it seemed pretty serious there. I like your ranges better because they are longer. Maybe the table's should be expanded? I'm not really familiar with the data. Just thought I'd throw that in. Student7 03:40, 12 January 2007 (UTC)


 * What's the reference? You can add the data with the reference if you want. TimVickers 05:08, 12 January 2007 (UTC)

Taubenberger thinks 1889 was H3N8, he should know, he has many unpublished pre-1918 virus-sequence segments. The Next Influenza Pandemic Can It Be Predicted? Jeffery K. Taubenberger, MD, PhD; David M. Morens, MD; Anthony S. Fauci, MD JAMA. 2007;297:2025-2027.

the 1580 outbreak has recently been assumed to have been pertussis rather than influenza: http://asclepio.revistas.csic.es/index.php/asclepio/article/viewFile/57/59 Gsgs2 (talk) 10:25, 21 December 2007 (UTC)gsgs2

Clitoris redirect
"clitoris" redirects to the influenza page. i would fix it, but i don't know how (yet...still getting my feet wet). 71.126.101.8 03:33, 2 January 2007 (UTC)


 * Thanks. It has been fixed. WAS 4.250 05:23, 2 January 2007 (UTC)

Taxonomy
Is there any reason that the taxonomy box is not displayed on this page? See Yellow fever for an example... -Ravedave (Adopt a State) 18:31, 25 January 2007 (UTC)


 * None I know of, you would be most welcome to go ahead and add the taxonomy to the infobox. TimVickers 18:35, 25 January 2007 (UTC)


 * This article is about the disease. We have seperate articles about the causative agents. Those articles should have taxoboxes. See the navigation box at the bottom of the article for a list of such articles. The taxobox at Yellow fever should be deleted as that article is also about the disease and not about the virus that causes the disease. I suppose one could put the taxobox at Orthomyxoviridae in the Microbiology section of Influenza. But isn't the article long enough already? WAS 4.250 19:27, 25 January 2007 (UTC)
 * Does Orthomyxoviridae need to be made the "main article" of the Microbiology section? There is quite a bit of confusing overlap. I believe that the taxobox belongs on this article and the Orthomyxoviridae page. The separation of the virus and the symptoms of a virus articles seems strange to me, unless the "sub article" structure is used. -Ravedave (Adopt a State) 20:07, 25 January 2007 (UTC)
 * Sometimes a disease and its causitive agent are so tied together they are best treated together - and sometimes they are not as when distinct seperate things can cause a single disease (like flu). But a disease is not something with an evolutionary history and a causitive agent is not something to be cured. As for what "belongs" - the answer is whatever is best for our readers. Reasoned judgement is always better than trying to find or invent some rule. WAS 4.250 05:59, 26 January 2007 (UTC)

Egyptian origin of influenza as a pandemic disease of humans?
Influenza is a disease associated with the close proximity of water fowl, pigs and humans, and its origin as a pandemic disease may be due to the development of agricultural systems that allow the mixing of these animals and their wastes. Some of the first archaeological evidence for this agricultural system is during the Amarna Period of Ancient Egypt, and the pandemic that followed this period throughout the Ancient Near East may have been the earliest recorded outbreak of influenza. However, the precise nature of this Egyptian plague remains unknown and Asia has also been suggested as a possible site of origin of pandemic influenza in humans.


 * I've asked for some help from the Ancient egypt page as I'm not sure how accurate this is. TimVickers 21:24, 21 February 2007 (UTC)


 * All known pandemic flu is caused by Influenzavirus A. Influenzavirus A is endemic in birds and judging by its genetics, has been since before humans existed. It is currently believed that Influenzavirus A is capable of jumping directly from birds to humans and causing a pandemic. Thus there is no logical reason to believe that flu pandemics did not occur in prehistory prior to agriculture. Well, such "pandemics" as could be supported by the human population. Agriculture allowed for dense rather than sparse populations, and the invention of writing allowed for someone to write about contagious disease. There is no reason to believe that contagious flu did not exist prior to agricultureand prior to writing. One could define "pandemic" so it can't exist prior to the human densities made possible by agriculture, but that's semantics. WAS 4.250 06:02, 22 February 2007 (UTC)


 * The first part of the paragraph I am happy with, as it is reasonably well-established that pigs are the most common intermediate host in the emergence of new strains of influenza. I've added another reference here and done some thorough checking. The suggestion that this co-localisation of the three hosts occurs most commonly in Asia and may have first occurred in Asia is also well supported. What I cannot find any good references for is the suggestion that this first occurred in Ancient Egypt. I propose leaving this on talk for a while and if nobody provides a reliable source for the Egyptian sentence then we cut this and replace the rest. TimVickers 17:24, 22 February 2007 (UTC)


 * None of this belongs in the history section and probably does not belong in this article at all. We have articles an intensive farming and on flu research and on ancient egypt. Speculation in disease in ancient egypt goes there since there is no way any claim about flu in ancient egypt is anything other than speculation. There is a great deal of concern about intensive farming's role in the creation and spread of disease (including flu) - vaccination, use of poultry shit as fish food, wet markets mixing geese and chicken and pigs, humans living in close quarters to animals in asia - but the flu article is not the place for this as there are many details and cultural practises and political issues that need to be handled right to do justice to the issue. I tried at Social impact of H5N1 to get into this a little. The section Economic impact might be able to use an additional sentence or two about farming practices, but not the history section where it is original research and speculation. "it is reasonably well-established that pigs are the most common intermediate host in the emergence of new strains of influenza" is no longer true altho it was formerly asserted prior the the latest researches due to H5N1 which have cast a considerable amount of doubt on many former theories about flu as now we know it is far more complicated than we had thought and flu has far more ability to mutate and jump species than had been thought. "that this co-localisation of the three hosts occurs most commonly in Asia and may have first occurred in Asia is also well supported" is the old theory that was commonly believed but is now believed to be but one part of a much larger puzzle that we are only beginning to get an outline of. "History of flu research" comes to mind here.  WAS 4.250 19:18, 22 February 2007 (UTC)

A couple more points: What you are discussing is specific to Influenzavirus A which is but one of the three flu causing species, which adds a little to this not being the best place for it. What we know about pigs possibly being a mixing vessel for flu is that "Avian influenza HA bind alpha 2-3 sialic acid receptors while human influenza HA bind alpha 2-6 sialic acid receptors. Swine influenza viruses have the ability to bind both types of sialic acid receptors." The rest is speculation. Guesswork that was thought adequate but now is recognized as inadequate. For example, it was just recently learned that humans too have the ability to bind both types of sialic acid receptors (just not as many and not as available as they are mostly deeper in the respiratory system) so humans can be their own mixing vessel and don't need pigs for that honor. WAS 4.250 19:29, 22 February 2007 (UTC)


 * From a 2005 review "The participation of intermediate hosts in the process of generating influenza strains with pandemic potential is poorly understood but generally regarded as critical. Pigs have long been considered as potential “mixing vessels” that favor reassortment between human influenza strains and those from other animal species.24,25 This hypothesis is based on documented disease outbreaks in swine caused by either avian or human influenza viruses, particularly of the H1N1 and H3N2 subtypes. Further support comes from laboratory studies that show that swine are susceptible to infection by many subtypes of avian influenza.26 In recent years it has become apparent that domestic poultry can harbor AI viruses with the capacity to infect humans.27–32 Experimental data suggest that some domestic poultry act as unapparent amplifiers of influenza viruses with pandemic potential when infected without showing signs of disease. Studies in quail show that they can be efficient at spreading reassortants containing human flu genes. Ducks can carry H5 viruses that transmit to humans but also do not always exhibit signs of disease.33–35 In the light of evidence of human infection with AI, the possibility that humans may act as mixing vessels must not be overlooked. Thus, the genesis of pandemic influenza strains is likely a multistep process that may require considerable time. In some cases it may involve the exchange of genomic information among multiple influenza subtypes or strains circulating in different animal species at the same time.36" link I think you are right here, since we have no single clear model of how pandemic strains emerge, and little idea of how traditional farming practices influence these processes, the above passage is too definite for the hazy state of our knowledge.

How about

Influenza is a disease associated with the close proximity of water fowl, pigs and humans, and its historical origin as a pandemic disease may be due to the development of agriculture, which would have facilitated the mixing of these animals and their wastes. However, the precise nature of poorly-documented plagues is impossible to determine, so defining the prevalence of influenza in the ancient world is impossible. As today's new influenza strains commonly originate in Asia, this region may have been the place where the first pandemic strains originated, but conditions in the ancient world may have differed dramatically from those today.

How about a direct quote from WHO or CDC? They keep up to date. WAS 4.250 00:07, 23 February 2007 (UTC)

Re. Ancient Egyptian animal agriculture
Hi Tim! Sorry for the late reply, I haven't been active on Wikipedia lately. Pigs, cattle, waterfowl and sheep were all raised in ancient Egypt and to varying degrees included in the diet. Pigs had been domesticated since the Predynastic period. There was some restriction on their consumption, but there is evidence that they were consumed at least by the poorer classes and were used in farming. Eugen Strouhal (1992) Life in Ancient Egypt is a good place to start. Strouhal is a physical anthropologist who's worked extensively on ancient Egyptian diseases and epidemics, though I can't recall if he mentions an outbreak of the flu. Also, Houlihan (1996) Animal World of the Pharaohs and AUC Egyptologist Salima Ikram are both great sources on ancient Egyptian fauna and animal domestication. Hope this helps. — Zerida 05:52, 26 February 2007 (UTC)

"change in the virus"
"change in the virus, with each of these pandemics being caused by a major genetic"

I'm dissatisfied with terminology that does not adequately indicate it is the addition of a new varient (rather than the wholesale replacement of existing varients) because there is a misunderstanding that H5N1 and other subtypes are one thing genetically and when it changes that it is all now that new genetic type; when H5N1 is in fact creating new varients that are each co-evolving and the impact of this is since it has become endemic in nonhumans, even if it does mutate into a pandemic strain, the pre-pandemic strains still exist and can mutate again and again and again ... Unless it nysteriously dies out, this is literally the evolution of something new and permanant in Influenzavirus A. There has never, so far as we know, been a highly pathogenic strain of Influenzavirus A endemic in the wild. And this one is still learning to adopt to new species. The multiple co-evolving strains of Influenzavirus A is essential to understanding Influenzavirus A. It doesn't "change" to a new strain. It adds and deletes strains from its existing arsenal of thousands(?) of antigenetically distinct strains maintained in thousands(?) of species of birds and mammals. WAS 4.250 19:23, 27 February 2007 (UTC)


 * Is the new version better? TimVickers 19:37, 27 February 2007 (UTC)


 * Yes. Great job. Thanks. By the way, congrats on becoming admin. And you also have my symphathy. It's mostly a thankless job that earns you nasty people as enemies. WAS 4.250 20:47, 27 February 2007 (UTC)


 * But it does mean that looking after the FAs will be a bit easier. If I can help out, just get in touch. TimVickers 20:53, 27 February 2007 (UTC)

Image:H5n1 spread (with regression).png
Hi all. I talked with User:Waitak about the appropriateness of the regression curve in the context of WP:ATT, but he wants a general consensus between editors of Influenza articles. I think that the regression - and especially the choice of which regression to use - probably falls astray of WP:ATT since it "propose(s) unpublished ideas or arguments" or, alternatively, is "unpublished synthesis of published material". What do you guys think? —AySz88\^ - ^ 05:39, 13 March 2007 (UTC)


 * If it remains then it needs to be clarified that it is NOT a scientific projection but instead is merely something nonlinear to compare the data curve to. The curve is useful to me in indicating that the billions of dollars spent are helping to keep the number of human deaths lower than they might have been. Perhaps its meaningfulness is too uncertain to keep. Or maybe we should just say: Regression curve:uncertain meaningfulness. WAS 4.250 07:25, 13 March 2007 (UTC)

I agree this is inappropriate. Unless we have more data, the best way of presenting these figures is to join the points. That adds no additional interpretation. TimVickers 13:52, 13 March 2007 (UTC)


 * Curve fitting is definitely not 'original research' in any meaningful sense. Just put on the image description page what you fit to and what the parameter values are. It may be debatable whether the regression curve is useful, though. Opabinia regalis 23:40, 13 March 2007 (UTC)


 * The problem is, although the curve is not really meaningful, it suggests a meaning and a use that isn't there - that there is some reason to believe that the rate of deaths is exponential and will be in the future. Is there some (expert's) reason why exponential should be chosen as opposed to, say, logistic? —AySz88\^ - ^  05:04, 19 March 2007 (UTC)


 * Yeah, choosing one curve over another is the issue. A straight line fits with most people's instinct. Yet exponential is more common in these biological type situations - until a limiting factor is reached - when the curve becomes logistic. And when there is genetic adaptation involved such as is occuring with H5N1, there can be a series of S shaped curves as it fills an ecological niche, stalls, mutates, and fills yet another niche. All in all, this is biological evolution on the fast track; doing all its tricks in months rather than millenium. Exponential is the right comparison curve yet there is a significant problem with implied meaning. WAS 4.250 05:53, 19 March 2007 (UTC)


 * In an unrestrained epidemic, where each case infects multiple new people, exponential growth will obviously result. However, if some of the population are immune or the rate of infection in similar to the rate of death/cure there can be a linear growth in the number of cases. Furthermore, this is the cumulative number of cases, not the actual number of cases in any one year. TimVickers 15:26, 19 March 2007 (UTC)

Pliny's silence about influenza
I've been thumbing thru this ancient antecedent of Wikipedia, & according to one of its translators (W.H.S. Jones), Pliny the Elder does not mention influenza: "The ordinary infectuous fevers -- smallpox, measles, scarlet fever, diptheria, enteric, influenza -- were apparently unknown" (Loeb trans., vol. 6, p. ix). This may not mean that Influenza was unknown to the Romans; Jones later notes that "it is curious that Pliny makes so few references to the common cold" (p. xv). Having read some lengthy chunks of his Natural History, I think it must be pointed out that Pliny sometimes reveals that he is more likely to trust what his written sources over what his own personal experience show. I'm not sure if this helps with the article. -- llywrch 02:01, 15 March 2007 (UTC)

FYI
This http://www.ganfyd.org/index.php?title=Flu has an interesting but incompatible copyright license. Right now we cover flu better, but we should keep an eye on it. 4.250.168.212 21:50, 19 March 2007 (UTC) (WAS 4.250)

Flu virus mutation
I could use some help.

I had thought that the current dominate strain of HPAI A(H5N1) sometimes called Asian lineage HPAI A(H5N1) was identical with "Genotype Z" but apparently there is a "Genotype V" which stayed endemic in China and did not die out and is now threatening to breakout and possibly play a major role.

I'm too tired to fully deal with this now, but I've gathered some sources and stuff.


 * related articles
 * H5N1 genetic structure
 * Fujian flu


 * Sources
 * http://nationmultimedia.com/2007/03/24/national/national_30030134.php
 * http://www.cdc.gov/ncidod/EID/vol11no10/05-0644-G1.htm
 * http://www.nap.edu/books/0309095042/html/123.html#p2000c2099960123001
 * http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1316012
 * http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=EBI&pubmedid=16473931
 * http://www.cdc.gov/eid/content/13/3/506.htm
 * http://72.14.253.104/search?q=cache:-SSH3pq_PLEJ:www.cdc.gov/eid/content/13/3/pdfs/506.pdf+H5N1+%22genotype+V%22+%22genotype+Z%22&hl=en&ct=clnk&cd=4&gl=us
 * http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1316012
 * http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=EBI&pubmedid=16473931
 * http://0-www.cdc.gov.mill1.sjlibrary.org/eid/content/13/3/506.htm
 * http://www.nap.edu/openbook.php?isbn=0309095042&page=119
 * http://www.nap.edu/openbook.php?isbn=0309095042&page=123
 * http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15661149
 * http://72.14.253.104/search?q=cache:mUerM2Qd3e8J:www.prbo.org/cms/docs/birdflu/Chen_et_al%255B1%255D._2004_Nature.pdf+H5N1+%22genotype+V%22+%22genotype+Z%22&hl=en&ct=clnk&cd=20&gl=us
 * http://www.medpagetoday.com/InfectiousDisease/URItheFlu/tb2/2891
 * http://www.oie.int/eng/info/hebdo/AIS_34.HTM
 * http://www.poultry-health.com/fora/toner0603.htm

WAS 4.250 07:44, 24 March 2007 (UTC)

"Experts see double threat from flu strains

Summary:Experts yesterday voiced concern over the possibility that the two different genotypes, called "sub-clades", of the H5N1 bird-flu virus found in Thailand could meet and merge into an unknown and "unpredictable" mutated form.

Chulalongkorn University has found that a virus sample from Nakhon Phanom province in the Northeast was of a strain newly observed in Thailand and more closely related to H5N1 strains that have been circulating since 2005 in southeast China. In contrast, H5N1 samples from Phichit province in the lower North region were similar to the cluster of samples isolated during 2004 and 2005 outbreaks in Thailand and Vietnam, said Professor Yong Poovorawan, author of the Chulalongkorn University study. The viruses isolated from Phichit belonged to genotype Z, whereas the virus isolated from Nakhon Phanom belonged to genotype V, he wrote in his report. The latest bird-flu outbreak, in the Northeast province of Mukdahan, has raised concerns that the genotype V virus from the Northeast could spread to meet with the genotype Z virus endemic in the lower North and Central region, said veterinarian Rakthai Ngampak, head of the Department of Livestock Development's Bird Flu Control Centre. Although the results of DNA sequencing of the virus samples taken from Mukdahan are yet to be known, it is very likely that they are the same strain found in Nakhon Phanom, given the way the virus killed poultry, Rakthai said. Yong and Rakthai agreed that the consequences of a new strain of H5N1 emerging from the mixing of the two genotypes might or might not be serious. However, Professor Pilaipan Puthavathana, a virologist at Mahidol University's Siriraj Hospital, said: "It won't be good if the two genotypes meet and mix."

But it looks like they have already mixed before:

"Phylogenetic analysis also revealed that the viruses isolated from migratory ducks at Poyang Lake belonged to two different H5N1 genotypes: Z (MDk/JX/1653/05, MDk/JX/1657/05, MDk/JX/1701/05) and V (MDk/JX/2136/05, MDk/JX/2295/05, MDk/JX/2300/05). The matrix (M), nonstructural (NS), polymerase acidic (PA), polymerase basic (PB) 1, and PB2 genes of isolates from an outbreak at Qinghai Lake in central China (represented by BH goose/QH/65/05; genotype Z) clustered with those of MDk/JX/1653/05 (genotype Z), whereas the HA, NA, and NP genes of the Qinghai Lake isolates grouped with those of MDk/JX/2136/05 (genotype V), both of which were isolated from Poyang Lake in January and March 2005, respectively. Thus, all eight gene segments of viruses from the Qinghai Lake outbreak in central China can be traced to the H5N1 viruses isolated from migratory ducks at Poyang Lake in southeast China, ≈1,700 km distant, indicating that migratory birds can disseminate the virus over long distances." 

So long as both Z and V are endemic, they can continue to mix and each time produce new variations. I'm not sure how to write this up or where to put it. WAS 4.250 18:26, 24 March 2007 (UTC)

Spelling
Just a point about the english language; flu isn't a word, it's an abreviation. I will wait to gauge popular opinion but I would sujest that all the references to flu are changed the 'flu. MHDIV ɪŋglɪʃnɜː(r)d  ( Suggestion? | wanna chat? ) 15:03, 19 June 2007 (UTC)


 * Nonsense WAS 4.250 17:13, 20 June 2007 (UTC)


 * The OED lists both versions as nouns. flu The version lacking the apostrophe is the one now in most common usage. TimVickers 17:25, 20 June 2007 (UTC)

Proposal for new influenza categories
Hello, I notice that the assignment of influenza related pages to categories is a little disorganized. I would like to suggest that we create additional subcategories and reorganize exisiting pages to categories. My proposal is below. Any comments? Regards&mdash;G716  &lt;T·C&gt; 04:16, 18 October 2007 (UTC)

Proposed new influenza categories
Here are the new categories I am suggesting, with indentation indicating a subordinate relationship between categories.

Influenza
 * Avian influenza
 * Influenza viruses
 * Influenza A subtypes
 * H5N1
 * Influenza treatment
 * Influenza vaccines
 * Influenza pandemics
 * Deaths by influenza (not shown in table below for sake of space. Would remain unchanged.)
 * Mammalian influenza

Existing categories that would be retired:
 * Category:Neuraminidase inhibitors

Here's how I think the suggested categories would be further categorized &mdash;G716  &lt;T·C&gt; 05:16, 18 October 2007 (UTC)

Assignment of influenza topics to categories
This table shows how existing pages are assigned to categories now, and how I propose assigning them to new categories.

Comments
Things have multiple aspects. "Influenza" is a type of disease. It is a medical category. "H5N1" is a subtype of a species. It is a biology category. "Avian flu" is an epidemiology and a public health category as is "mammal flu" and relates both to biology and medicine (which quite naturally relate to each other). I see no value in artificially deleting categories from the bottom of article pages based on an imposed artificial hierarchy. The solution to the problem that you see is not a reduction in the number of categories at the bottom but an increase in them and and increase in the types of categories. You could create separate hierarchies for each aspect. For biology, the H5N1 category would be in the category Orthomyxoviridae. For medicine, the Flu category would be in the category Diseases of the respiratory system and so forth. WAS 4.250 13:44, 18 October 2007 (UTC)
 * Thank you for your thoughtful comments. I agree with all you say, especially about the need to clarify distinctions among medical, biology and epidemiology categories. However, I do want to clarify that I am not suggesting reducing the number of categories.  I want to increase the number of categories by adding categories: Avian influenza, Influenza viruses (or even better: Orthomyxoviridae), Influenza A subtypes, Influenza treatment (or possibly Influenza antiviral drugs), Influenza vaccines, Influenza pandemics, Mammalian influenza. My goal here is two-fold: make the 'influenza' categories more meaningful, reduce (or eliminate) the current confusing (to me) multiple assignment of pages to categories and sub-categories, and generally make navigation around this topic easier (OK, that's threefold).  Thanks again for your help, Regards&mdash;G716  &lt;T·C&gt; 02:57, 19 October 2007 (UTC)
 * Go for it. Be bold. Do it. Implement a vision. Wikipedia benefits most most from boldness. It's easy to tweak something not quite right. It is harder to create that something in the first place. Don't worry about getting it perfect. Do your best. ... Just add rather than delete. WAS 4.250 05:22, 19 October 2007 (UTC)

Looks good to me—kudos on taking it upon yourself to do this. I am, however, not really fond of "Influenza treatment"—to me, it would be more logical to keep Flu treatment in and create, say, a. Other than that, I have no objection (why should I? :) Fvasconcellos (t·c) 16:19, 19 October 2007 (UTC)

redirect/merge this article and human flu
Please see Articles for deletion/Human flu. "Human flu" is used on these pages to mean the subset of Orthomyxoviridae that create influenza in humans and are endemic in humans. It also serves to contrast with horse flu, pig flu, dog flu, cat flu, and bird flu. Each type of flu, named after what it is endemic in, has unique aspects to it. The flu article is very human-centric, but it is not the human flu article. Perhaps much of this article should be merged into the human flu article for the sake of consistancy? Or leave well enough alone? Or what? WAS 4.250 15:16, 21 October 2007 (UTC)

Wrong Magnification
These are incorrect, the original magnification of the electron micrographs was probably around 70,000 but no account has been taken for the extra magnification of the final positive print. To me, (and I have seen hundreds of electron micrographs), on my screen and when this article is printed the final magnification is more like 200,000! I would change the legends to read "approximate magnification x 200,000". GrahamColm 06:58, 1 November 2007 (UTC)


 * The virons are roughly 1 cm across on my screen and if we take the virion diameter to be 100 nm (makes things simpler), this corresponds to a 100,000-fold magnification. Is that about right? Tim Vickers 16:29, 1 November 2007 (UTC)

Yes Tim, I concur. I tracked down the original on the CDC site but they don't give the magnification details, which is a pity. During my time as an electron microscopist, I always wrote these details on the back of all the prints I made. The thumbnail is around 100,000 fold (which is a good number) - the original is more like 200 -250K. Best wishes User:GrahamColm


 * OK, article corrected to 100,000x thank you. Tim Vickers 19:14, 1 November 2007 (UTC)

You guys are making assumptions about the size of the screen that this page is being displayed on and counting on the image text being updated if the image is resized here or elsewhere (eg in a printed context). I recommend that the image text say something that remains true regardless of the size of the screen that this page is displayed on (projected on a classroom wall for example). WAS 4.250 21:27, 1 November 2007 (UTC)


 * This is a valid point. To remain true, there should be a scale marker embedded in the image saying something like "bar = 100nm". This is the way it is usually done. But I am reluctant to edit the original images as they are not mine. If the images are projected the teacher would have to say what the final magnification is on their screen. Or should we put an approximate 100nM bar into the the micrographs? We can do this but it would not be exact. Comments please User:GrahamColm


 * How about using the width of the image as the bar? Say "The width of the image is 1000 nm" or whatever it is. WAS 4.250 23:26, 1 November 2007 (UTC)

Seasonality
Viral seasonality is fascinating, complex and not restricted to Influenza virus. In the UK you can set your calender by Respiratory syncytial virus, it comes every November and stays for around four weeks. Rotavirus prefers the late winter/early spring, Enterovirus the summer as do enteric Adenovirus and Varicella zoster virus. Before we had the MMR vaccine, Measles infections had a dramatic peak every three years. None of these have been given a convincing explanation. I'm not suggesting any changes to the article; it's good that it remains a little vague about this. --Graham Colm Talk 19:37, 5 December 2007 (UTC)


 * Viral seasonality - it's a redlink, are you tempted Graham? Tim Vickers (talk) 19:46, 5 December 2007 (UTC)

I found a recent, open-access journal article on the seasonality of influenza at: http://pathogens.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.ppat.0030151 The work was featured in the NY Times. Besselfunctions (talk) 01:35, 6 December 2007 (UTC)


 * That is already in the article I'm afraid, reference number 62. Tim Vickers (talk) 02:33, 6 December 2007 (UTC)

Spanish Flu - H1N1 Article Number of Deaths Inconsistency
Just a quick note. The H1N1 article states that "50 million to 100 million people worldwide" were killed by the strand while this article says 40 million. I just thought we might want to address the inconsistency. I realize there are often different figures found depending on where you look. The H1N1 article does have a citation (although I prefer more thanone especially for statistics like this). Maybe a citation for this article might be a good idea, or both could acknowledge the varied numbers? --jenlight (talk) 14:22, 13 January 2008 (UTC)


 * I'm a bit confused by your question. This article states:
 * "The most famous and lethal outbreak was the so-called Spanish flu pandemic (type A influenza, H1N1 subtype), which lasted from 1918 to 1919. Older estimates say it killed 40–50 million people[17] while current estimates say 50 million to 100 million people worldwide were killed.[18]" Tim Vickers (talk) 23:34, 13 January 2008 (UTC)


 * Was it the table you were talking about? I changed this to reflect the more detailed figures given in the text. Tim Vickers (talk) 23:36, 13 January 2008 (UTC)

Article fails to link WP article on 'Influenza vaccine'
The link is in the sub-heading of the section on "Vaccination and infection control" Tim Vickers (talk) 01:08, 29 February 2008 (UTC)

Article fails to note preventive potential of vitamin D
See, e.g.,

Cannell JJ, Vieth R, Umhau JC, et al (2006). "Epidemic influenza and vitamin D". Epidemiol. Infect. 134 (6): 1129–40. doi:10.1017/S0950268806007175. . —Preceding unsigned comment added by 68.166.205.54 (talk) 02:57, 11 March 2008 (UTC)


 * See the third paragraph of the Seasonal variations section. It even contains that exact review! :) Tim Vickers (talk) 03:19, 11 March 2008 (UTC)


 * I am not that user but perhaps it should get more weight? Additionally the section on closing schools seems like it was just tacked on at the end, it should get its own paragraph and have more detail. I like the article tho.--90.208.224.168 (talk) 14:38, 15 September 2008 (UTC)


 * It isn't commonly used as a way of preventing influenza, so I think it is given about the right amount of weight in the article. Tim Vickers (talk) 17:24, 15 September 2008 (UTC)

Symptoms Error
To my understanding, it is a common misconception that nausea and vomiting are associated with the flu. See online articles on influenza offered by eMedicine, Medline Plus, and WHO. —Preceding unsigned comment added by 70.181.148.205 (talk) 01:45, 12 March 2008 (UTC)

http://www.cdc.gov/flu/professionals/acip/clinical.htm says "Uncomplicated influenza illness is characterized by the abrupt onset of constitutional and respiratory signs and symptoms (e.g., fever, myalgia, headache, malaise, nonproductive cough, sore throat, and rhinitis). Among children, otitis media, nausea, and vomiting also are commonly reported with influenza illness." WAS 4.250 (talk) 21:36, 12 March 2008 (UTC)


 * Well, doesn't mention vomiting as a symptom in children, but I found a reference that says influenza B can cause abdominal pain. Tim Vickers (talk) 22:09, 12 March 2008 (UTC)

hello, good work —Preceding unsigned comment added by 130.231.103.15 (talk) 11:48, 22 March 2008 (UTC)

Pandemic rewrite in progress
I will be recommencing my rewrite of the Influenza pandemic article in the coming weeks.

This article has multiple flaws in regards to readability, inability to stay on topic, inability to summarise (instead of parrot) references, length, tone, prose etc. that have been repeatedly picked up but not acted upon by passing editors.

Assistance in finding suitable references to use in the redraft would be appreciated, as too would any assitance in wikicode and prose.

I have an in-progress draft of sections and arrangement in my userspace here. User:ZayZayEM/Flupandemic.

At the moment I would appreciate focus on what sections may be missing from my master plan, or what sections are not appropriate.

I will be writing up the "History" section first. Help in finding appropriate references on historic influenza pandemic information not included in the present article (i.e. pre-1900s) would be most helpful.

Thank you.--ZayZayEM (talk) 23:51, 20 October 2008 (UTC)

It would be great if the people who helped made this article better could help ZayZayEM with his efforts on this. Thank you. WAS 4.250 (talk) 10:47, 21 October 2008 (UTC)


 * As I mentioned currently looking for sources that explicitly deal with pre-1900s (ie. prior centuries, but also ancient texts, the best I have is information from old versions of Equine influenza referring to great influenza plagues of past, but not very reliable).
 * Also after sources that explicitly state that Influenza A is the primary virus responsible bfor pandemics.
 * Trying to keep as much to official health org websites, textbooks and peer review. Avoiding news level articles will help keep language intelligent, clear, and appropriately reflecting opinions of key opinion leaders.--ZayZayEM (talk) 11:29, 21 October 2008 (UTC)

is the best one I have found. E-mail me through my userpage if you need a Pdf of the article. Tim Vickers (talk) 20:38, 21 October 2008 (UTC)

Recursive Referencing
Hi, I am have never edited Wikipedia before, so I'm not too sure how this works. Apologies if I get this wrong. Anyway, being the pedantic academic I am, I was checking up on the references for this article, and the third reference, to a website called ScienceDaily, which lists this article as its main reference. Indeed it would appear to have been directly copied from a previous version. This seems a bit of a problem to me. The reference in question relates to the number of people killed. It's currently numbered as reference number 3, the page can be accessed at: http://www.sciencedaily.com/articles/s/spanish_flu.htm I'm not disputing the data, although it would appear to be somewhat higher than estimates I have seen in traditional textbooks (Whitford, David puts it at a more conservative 20 million in Proteins: Structure and function, 2005, ISBN13: 978-0471-49894-0 if you're interested). I don't know if someone would want to fix this or something. Thanks. 82.42.82.87 (talk) 23:11, 24 February 2009 (UTC)


 * Hi there, I'm an academic as well, so references are as important to me as they are to you! I'm a bit confused by your comment though, at present reference number 3 is "Seasonal Flu vs. Stomach Flu", which isn't a reference dealing with the 1918 mortality, those mortality references are (ref 20) and this report from the National Academies (ref 21). Where in the article did you see this Science Daily reference? Tim Vickers (talk) 00:29, 25 February 2009 (UTC)


 * The link for the NAP report (ref 21) was incorrect, hopefully it will link to the correct article now. Tim Vickers (talk) 00:33, 25 February 2009 (UTC)


 * Ah, I see. You were talking about the article on the 1918 flu pandemic, not this one on influenza. I'll go and correct that reference. Tim Vickers (talk) 00:37, 25 February 2009 (UTC)

Mutation rate
If the mutation rate is 1 in 10000 and the virus length is about 10000 nucleotides as the article states, the probability for new viruses to carry at least one mutation is 1 - (1 - 1/10000)10000 which is about 63%. While this is surely a high rate, it is by far not enough to explain why "nearly every newly-manufactured influenza virus is a mutant". I am not a biologist, but I assume that either one of the following informations must be wrong and should be corrected.
 * the RNA-dependent RNA polymerase makes a single nucleotide insertion error roughly every 10 thousand nucleotides
 * the approximate length of the influenza vRNA is about 10 thousand nucleotides
 * nearly every newly-manufactured influenza virus is a mutant —Preceding unsigned comment added by 87.196.38.74 (talk) 02:22, 19 March 2009 (UTC)


 * Reworded to "the majority of", which fits all these facts. Tim Vickers (talk) 17:06, 19 March 2009 (UTC)

Influenza-like illness
Influenza-like illness redirects here; someone please expand this article to explain this term. --Una Smith (talk) 23:41, 25 April 2009 (UTC)


 * Nevermind. I have expanded Influenza-like illness into an article.  --Una Smith (talk) 18:09, 26 April 2009 (UTC)

Use of colon in first paragraph
"The name influenza comes from the Italian: influenza, meaning "influence" (Latin: influentia)." I see nothing at Colon (punctuation) that justifies the use of the colon following "Italian". Am I overlooking something? Nurg (talk) 09:09, 27 April 2009 (UTC)


 * Adding the colon after Italian in that sentence seems wrong - although I think you're happy enough with the one after Latin? I'll edit the page. --84.13.35.30 (talk) 20:23, 28 April 2009 (UTC)


 * following up on this - virion is singular for virus and virus is plural. The words virions and viruses don't really exist! Blacknail (talk) 01:15, 2 May 2009 (UTC)

Please protect the page
As of Mon Apri 27, I've noticed some morons are vandalizing the page. This is definitely not the moment. Can the admins please protect the page? —Preceding unsigned comment added by AmadorUSA (talk • contribs) 15:40, 27 April 2009 (UTC)

I've tagged it for you so that one of the admins will take a look. I guess the Mexican swine flu has got to people...--Elen of the Roads (talk) 22:26, 27 April 2009 (UTC)

Strain Naming System Section?
I was wondering if it was worth making a section on why strains (e.g. H5N1, H1N1) are named as they are - or at least, a link to an article about it, or the articles on the proteins these numbers are derived from? It takes a fair bit of digging around to actually find any sort of answer, and I fear that I don't know enough from the odd article I've found to say what the difference between H1 and H2 is! --84.13.35.30 (talk) 20:26, 28 April 2009 (UTC)


 * True, although it is mentioned in the caption of the second image in the "Microbiology" section, and expanded a little in the section on "Structure, properties, and subtype nomenclature". Tim Vickers (talk) 20:46, 28 April 2009 (UTC)

HxNy
I guess my question is the same like the one above: What do the x and y in HxNy stand for? Terms like H5N1 are used all the time without a proper explanation. I think it's only appropriate if it were explained (more extensively than is now the case in the Microbiology section). The Seventh Taylor (talk) 06:54, 11 May 2009 (UTC)

Update
Information related the new "Swine Flu" strain needs to be updated.  Rgood erm  ote    20:07, 29 April 2009 (UTC)


 * I've been trying to keep this article quite general, and maintain the 2009 swine flu outbreak as the more up-to-date summary of current events. Still needs some rewriting and probably condensation of the H5N1 material. Tim Vickers (talk) 20:09, 29 April 2009 (UTC)


 * I noticed, but it always helps to let others know that an update is needed and needs to be maintained. I'll join you in maintaining the updates when I have more time on hand (probably not today sorry). I should change that tag to current event instead though.  Rgood erm  ote    20:12, 29 April 2009 (UTC)

Air sanatisers
I googled this for Air sanitizer and unluckly the returned information is little (link) --58.38.41.157 (talk) 13:52, 30 April 2009 (UTC)


 * There is no point in adding a redlink to a "See also" section. Write the article first and then we can see if it is relevant to influenza. Tim Vickers (talk) 16:04, 30 April 2009 (UTC)

Catching the swine H1N1 while it's still mild may be protective
There is as yet no vaccine for the swine-hybrid H1N1. Though we have a looming pandemic strain evolving to be more contagious and likely to get deadlier, authorities are undecided about whether to actually start a vaccine now. They now lean to instead finishing the Fall seasonal vaccine.

Until an effective vaccine becomes available, the situation is a race among increased swine H1N1 contagiousness versus human containment and vaccine development efforts, all against swine H1N1's likely acquisition of Tamiflu resistance from current human H1N1 and its possible future acquisition of deadliness genes from bird-flu H5N1.

For now, whether it will be contained, and if so exactly when may become more contagious and break out, when it will get Tamiflu-resistant, and when a vaccine will ship in quantity are known unknowns, and evolving developments to watch.

It's now relatively mild and 100% treatable if you start Tamiflu or Relenza antivirals promptly. As long as it stays treatable, and depending on vaccine and containment developments, it might actually be lowest-risk to get antivirals in hand and then find a way to catch a case of it (but only while it remains still relatively mild and treatable. Here's why:


 * The thing viruses are best at is becoming more contagious and eluding containment. Thankfully, they do this in part by becoming milder and less noticeable, and so less likely to be treated or quarantined.


 * Even if it's getting more contagious and going to break out of containment, it might stay contained until there is a vaccine. Mexico says it's getting fewer cases, as it applies containment measures and early Tamiflu treatment.  If it's contained (and stays that way instead of getting more contagious, breaking out, and becoming dangerous), waiting would be the best strategy.


 * Even it it breaks out of containment, so long as news reports show it seems likely to stay mild until after a vaccine is released, the ideal strategy would likely still be to wait for the vaccine.


 * But if it's clear that almost everyone's going to get the new flu long before the vaccine, comes out, and especially if any scattered reports of drug-resistance start to be seen, then having Tamiflu on hand (or Relenza) and catching it early while the drugs still knock it out could be the better strategy. Typically, immunity to novel pandemic influenza doesn't develop until the second exposure (or third). If you wait until after it acquires Tamiflu resistance, it may be too risky to catch it even though the drug-resistant strain may later pick up the deadly H5N1 bird flu genes and come back contagious, drug-resistant, and deadly.  What you don't want to do is to later catch that drug-resistant or deadlier form when you didn't first get the milder form so your immune system could learn to recognize it.


 * Actually catching it probably builds more robust immunity than a vaccine. Catching a flu builds mucosal and cellular immunity, as well as humoral (blood antibody) immunity.  If you think it's safest to wait for vaccine, it might provide additional immunity if you were to catch the mild form after getting your shots, when you are (mostly) immune.


 * It would matter who caught it from. They used to have measles parties at the house of the kid who had the mildest case.  If you can trace a line of transmission along 2 or 3 links and they were all just mild sniffles, you might want to get next in line, Tamiflu in hand.  —Preceding unsigned comment added by 69.3.11.51 (talk) 17:09, 1 May 2009 (UTC)


 * Your argument contains many faulty assumptions and misunderstandings, moreover it is original research that does not belong in this encyclopedia. Unless you have specific suggestions on how to improve this article on influenza, I will archive your comments. Tim Vickers (talk) 17:31, 1 May 2009 (UTC)


 * Thanks, Tim. What didn't you agree with?
 * If original research has some chance of keeping people alive, would the "break all rules" master rule trump the "no original research" rule?
 * I think it has possible survival value, and others may agree with me. Might you not censor it until a few others have a chance to weigh in?
 * Of course the specific suggestion on improving the article would be to lay out the progression of, e.g., the Spanish Flu which came in waves, where cities that had extensive exposure to the first, milder wave had some protection against the later deadly second wave. There are two good reasons to expect that deadlier later waves are possible or probable; 1) Tamiflu resistance genes are nearly ubiquitous in circulating human H1N1, ready to be picked up by reassortment; and 2) deadly bird flu H5N1 genes are spread through most of the world in chickens, and are found in the pigs in Indonesia, which may serve as mixing vessels to combine them with the contagious swine variant.  Some may agree with me that this information is valuable to them.

"Swine Influenza" or "Swine Flu" (A/H1N1-2009)
Its a MUTATION of the euro-asiatic influenza virus already knew years ago... i mean the virus scientifically named as "Influenza A virus subtype H1N1", responsible for the 1918 flu pandemic, that killed some 50 million to 100 million people worldwide (A/H1N1-1918).--. 18:10, 4 May 2009 (UTC)


 * I'm sorry, I'm not sure what you are trying to say. Is part of this article inaccurate? Tim Vickers (talk) 19:57, 4 May 2009 (UTC)

"Epidemic and Pandemic Spread"
the article reads Roughly three times per century, a pandemic occurs, which infects a large proportion of the world's population and can kill tens of millions of people (see history section). Indeed, if a strain with similar virulence to the 1918 influenza emerged today, it could kill between 50 and 80 million people.[112] however, according to sources (which I do not have at hand, however will find as soon as possible) there is insufficient robust evidence, or records of mortality, from the 1918 influenza pandemic. I think that this article is a mix of paraphrasing of a lancet article, and personal opinion and should be highly criticised considering the current global climate with regards to influenza viruses. —Preceding unsigned comment added by Shuggyg (talk • contribs) 20:07, 5 May 2009 (UTC)


 * I was paraphrasing the Lancet article, which states


 * If you want a Pdf copy of the Lancet article please e-mail me. I'm OK with weakening this statement a little, as I agree that this is just one analysis. How about "Indeed, one study estimated that if a strain with similar virulence to the 1918 influenza emerged today, it might kill between 50 and 80 million people." Tim Vickers (talk) 20:21, 5 May 2009 (UTC)

Question
Can someone please explain, what is the way in which the human body fights, overcomes and recovers from an infection of flu? Steve Csnewman (talk) 19:29, 7 May 2009 (UTC)


 * Influenza has no defense against acquired immunity, so once the body produces antibodies that recognise the virus the infection can be cleared. Tim Vickers (talk) 19:40, 7 May 2009 (UTC)


 * Antibodies are special molecules cleverly designed to stick to a specific target (such as the common flu virus) and raise the alarm to other cells that are part of the immune system: "I caught a nasty germ!  You kill it!"  Infants' immune systems have not learned to recognize any germs.  Infants fed breastmilk receive protective antibodies from the mother (or milk donor), however, if the mother has previously acquired immunity.  This is called passive immunity, and is transient.   proposes emergency passive immunization:  cause dairy cows to produce antibodies in their milk, and have people drink the raw milk.  See also, , ... --Una Smith (talk) 05:49, 11 May 2009 (UTC)

Transmission and Prevention
There needs to be considerable extra information in these areas to help readers better understand the routes of transmission and how they can avoid infection.

Some preliminary observations: The picture of the sneeze does not show how people actually sneeze. In most cases, before a sneeze, the head tilts upwards, but during the expiratory phase, the held actually points downwards. This means most of the droplets tend to direct towards the floor.

Many official publications on infection control use the terms Droplet transmission Droplet nuclei transmission and Contact transmission

Perhaps there should be sub-sections on this and aligning the terminology with the most accepted form.

There is also a need to recognize that talking (and breathing) also generate aerosols.

It would be useful to have a more quantitative estimate of the relative risk (for say, two people standing face to face one meter apart.) Perhaps of the form: A sneeze is equivalent to talking for x hours A cough is equivalent to talking for x hours

It is surprising to see no mention of height as a factor in the spread of respiratory infections (I'm not an epidemiologist) If height did confer an advantage, then it could be deduced that droplet transmission was more important than droplet nuclei transmission (and high heels would then be a recommended part of protection against infection). As it does not appear to have been noted, then it appears likely that droplet nuclei transmission may be more important than thought.

The survival of the influenza A virus on some surfaces is noted but there is no data for gloves. There must be some published figures somewhere, but I would expect the figures to be hours. Although some public policy recommends the use of gloves, it would seem that bare hands would reduce the transmission of influenza better than gloves.

On the prevention side, there is not yet any discussion of respiratory protection and the conflicting advice by WHO and US CDC. The US CDC advises against the use of surgical masks as respiratory protection, but the WHO seems more concerned with the higher cost of N95 respirators – about ten times the cost of surgical masks, but capable of much higher levels of protection IF properly fitted.

I'm traveling and don't have the references to support much of my notes at hand. —Preceding unsigned comment added by Deeuubee (talk • contribs) 12:42, 9 May 2009 (UTC)

This is not a medical textbook
This article is written as if it were a student's medical textbook. Patient, although proper under certain contexts, isn't nearly as proper as victim. Patient refers to a person being treated by a doctor. This isn't always necessary. This may be happening on every medical related article. --74.196.152.123 (talk) 21:13, 22 June 2009 (UTC)
 * "Victim" is considered... "victimizing" language by our Manual of Style. In this particular article, all instances of "patient" are appropriate:
 * "Two decision analysis studies suggest that during local outbreaks of influenza, the prevalence will be over 70%, and thus patients with any of these combinations of symptoms may be treated with neuramidase inhibitors without testing": "patient" is appropriate, as it refers to people who present for treatment with a set of symptoms
 * "All three findings, especially fever, were less sensitive in patients over 60 years of age": "patient" is appropriate, as it refers to participants of clinical studies and subjects of case reports
 * "In hospitals, quaternary ammonium compounds and bleach are used to sanitize rooms or equipment that have been occupied by patients with influenza symptoms": "patient" is clearly appropriate, as it refers to people who were admitted to hospital.
 * There you go :) Fvasconcellos (t·c) 21:53, 22 June 2009 (UTC)

Victim is unavoidable victimizing language, as it describes a person being afflicted by an illness. The term itself invokes sympathy, but it is appropriate. Also, this describes how such a technicality can be senselessly exploited, like editing articles is some kind of regulated game. It is a lot more complicated than that, and hundreds of thousands or millions of people frequent Wikipedia on a weekly average. It belongs to the community, not picky nerds. 74.194.224.252 (talk) 21:03, 18 July 2009 (UTC)


 * This article receives four to six thousand page views. WP:MEDMOS is the manual of style from Wikipedia's Medical Wikirpoject, which houses the editorial community. However, you're referring to the readership community right? Anyways, you said "Patient, although proper under certain contexts, isn't nearly as proper as victim." You're right, patient (noun) is defined as "A person or animal who receives treatment[...]". Not everyone gets to treatment and from an epidemiological context that can be a problem. However "victim" does not seem to right either, the tone is inappropriate, and has six alternative meanings, and five of them are completely wrong with one in a gray area. What I've seen used is "individual" rather than either "patient" or "victim". It is exacting, entails few secondary meanings for the sake of accuracy, and is not uncommon in scientific contexts. 22:05, 18 July 2009 (UTC)

1989-1990 flu epidemic
Is there any information on this epidemic, which appears to be the most severe of the previous 20 years. I've been unable to find even the virus subtype involved. The press has briefly mentioned that it caused about 30,000 deaths in the UK. article Lifung (talk) 15:14, 20 July 2009 (UTC)


 * I guess it might have been a bad flu season in Britain, but it wasn't a pandemic as I can't find any reference to this in the literature, see for example A history of influenza. Tim Vickers (talk) 17:23, 20 July 2009 (UTC)


 * According to the BBC, 1989-90 was the most recent epidemic (but not pandemic) of flu prior to this year. article At the time, I was in the middle of the USA, and caught it in late December.  No known social contact with anyone who had been to Europe, but could have come from a stranger. Unable to find any information outside of the UK. Lifung (talk) 05:38, 21 July 2009 (UTC)


 * I suppose each year's flu season is an "epidemic", although they aren't usually described as such. This report (link) describes the most common strains in the 1989-1990 season and notes that it was particularly severe in the UK. The strain responsible was an influenza A H3N2 subtype. Tim Vickers (talk) 15:38, 21 July 2009 (UTC)

Does soap "inactivate" influenza virus or just flush it away?
My understanding is that soap is useful because it makes it easier to flush virus (and other things) off your hands, not that it directly inactivates the virus. I'm not a doctor. —Preceding unsigned comment added by 24.6.228.80 (talk) 23:30, 1 September 2009 (UTC)


 * Soap will disrupt the structure of the virus particles, making them non-infectious. It will also remove surviving viruses from your hands, so I'd say that it does both. Tim Vickers (talk) 23:40, 1 September 2009 (UTC)

'Influence' - of what?
Perhaps the article should make mention, in its etymology of the word 'influenza,' that it refers to the 'influence' of the stars (see |'Planetary 'Planetary Miasms: The Astrology of the 1918 Influenza Pandemic')? —Preceding unsigned comment added by 83.138.172.72 (talk) 18:43, 17 August 2009 (UTC)


 * See Influenza. Tim Vickers (talk) 18:58, 17 August 2009 (UTC)


 * Thanks, Tim (and for not thwacking the 'heresy'). Thing is, the etymology is normally 'up front,' not drooping down into the 'History' - but that could, in fact, now I think on, be the inquisitorial influence. —Preceding unsigned comment added by 83.138.172.72 (talk) 19:57, 17 August 2009 (UTC)


 * Yes I know, the history used to be first, but the article was rearranged a while ago. I'm still not 100% sure the new section order is an improvement, but I suppose it does follow the manual of style. Tim Vickers (talk) 20:01, 17 August 2009 (UTC)


 * I didn't see anything about etymology in that link; but an unspoken convention seems to demand it at the starticle. —Preceding unsigned comment added by 83.138.172.72 (talk) 21:06, 17 August 2009 (UTC)

Etymology
The current entry doesn't seem to have got it quite right, yet, and may even be straying towards underestimating Old World intelligence. Surely the principal reason the disease got its mysterious moniker is that its cause was not obvious, being limited neither to infection by contact nor seasonal weather conditions.

' ''The word Influenza comes from the Italian language and refers to the cause of the disease; initially, this ascribed illness to unfavorable astrological influences. Changes in medical thought led to its modification to influenza del freddo, meaning "influence of the cold".'' '

'Changes in medical thought,' or the effect of Inquisitorial clampdowns? Influenza del freddo? I'd like to see that referenced, but even then, it looks like evidence of some kind of cover-up.

' ...The word influenza was first used in English in 1743 when it was adopted, with an anglicized pronunciation... '

Likely, admittedly, but there's proof that it's guesswork on this editor's part! No-one knows for certain how words were pronounced in that epoch, do they? —Preceding unsigned comment added by 83.138.172.72 (talk) 13:54, 19 August 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) 00:09, 3 September 2009 (UTC)

Is sensitivity/specificity table correct and/or complete?
If one takes the table at face value, at least 71% of people who do not have influenza have a cough and at least 59% have nasal congestion. That doesn't really pass the smell test for the general population, so I'm thinking this is probably among people who come in to a doctor or clinic thinking that they may have the flu. I don't have access to the referenced article so I can't see how they chose their samples. What is the population they chose their samples from? Shouldn't this be mentioned along with the table? Dawfedora (talk) 00:57, 14 November 2009 (UTC)

Influenza in different countries and languages
I think it would be a good idea to list common names for influenza in different countries and languages.

With the current H1N1 outbreak, and still latent possibility of an avian flu pandemic, it would be helpful for people to know what influenza is called in other countries.

This could fit next to the etymology section, where catarrh and grippe are mentioned.

Particularly, beside the medical term influenza, in Mexico other names used are: catarro, gripe or gripa. Not to be confused with resfriado (common cold).

This would help people who are travelling to other countries, not to say Wikipedia should be a travelling information agency. 189.175.206.49 (talk) 18:49, 12 October 2009 (UTC)

Origin of the 1918 Flu Pandemic according to the History Channel
In a History Channel documentary about the 1918 Flu Pandemic, it said that the soldiers in Fort Riley contracted an early version of the Virus via smoke fumes from a burning pile of animal manure. Then, when they were shipped over to Europe, the Virus mutated to become more lethal.

What I find interesting about this is the Heat Resistance Factor: The Virus survived the combustion process to become transmitted through the smoke. --Arima (talk) 23:26, 22 September 2009 (UTC)


 * That sounds highly unlikely to me. Could you provide a transcript or some kind of independent verification? Tim Vickers (talk) 01:27, 23 September 2009 (UTC)
 * This does seem unrealistic and unusual to me, I'll have to look into this. Thanks for sharing this information. Tyrol5  [Talk]  20:03, 23 September 2009 (UTC)


 * That sounds like the usual standard of reliability and objectivity seen on the "pseudo-History" channel.124.197.15.138 (talk) 18:51, 21 November 2009 (UTC)


 * My mistake, everyone. I just realized that the Documentary I was referring to was made by PBS, not the History Channel.--Arima (talk) 23:01, 3 June 2010 (UTC)

Face masks
Here is a new primary study that provides evidence were we currently say it is unknown. They found that masks in the general population decrease transmission between household contacts. Doc James (talk · contribs · email) 14:12, 21 November 2009 (UTC)

Photograph of "sneeze"
The photograph clearly shwo a cough, not a sneeze. It should either be renamed or deleted.124.197.15.138 (talk) 18:52, 21 November 2009 (UTC)


 * The CDC say it is a sneeze. Search for 11162 here to get the original. Tim Vickers (talk) 00:48, 22 November 2009 (UTC)

Diagnosis
Currently there is no section on diagnosis. Doc James (talk · contribs · email) 18:18, 23 November 2009 (UTC)


 * No separate section, but it is discussed in the section on Influenza. Tim Vickers (talk) 18:26, 23 November 2009 (UTC)


 * The diagnosis can be tricky. There is also a differential diagnosis and this would be a good place to merge Influenza-like illness   Doc James  (talk · contribs · email) 18:07, 24 September 2010 (UTC)

FA
Above it says this is an FA but no little star on the article page? Doc James (talk · contribs · email) 18:41, 23 November 2009 (UTC)


 * Odd, must have been removed some time. I've put it back. Tim Vickers (talk) 18:52, 23 November 2009 (UTC)

Sweating
When a person sweats during fever, it is a sign of dehydration in my opinion. Fever is the result, in my opinion, of an accelrated heartrate. This is something I believe that has been missed and can easily verified by simply taking your patient who has a fevers pulse, even if they have been resting, thier pulse should be abnormaly high, esp if your patient is sweating profusely.

When you excersize also your inducing a mild temperature, proven by simply grabbing an excersize bike and doing exersize until you build up a sweat and monitoring your heart and using a medical thermometer to check your temp. ITs both healthy and unhealthy (can be fatal) to sweat, as sweating helps with weight loss during excersize and I believe you are evaporating the water content out of the blood during the process of sweating, your essentialy loosing blood wich is where water from your sweat is comming from. You can verify in patients who die of fever related illnesses if they are loosing the equivalant of 5 pints or near weight to verify this statement. also I believe aspirin is working as a blood thinner to reduce fever by reducing the amount of wieght of blood by making the blood thinner, making the blood easier for the heart to pump.

Heartrate controls body heat, high heartrate=high temeprature/excersize/high activity, low heartrate=cool body temperature/sleep state/inactivity

Poisions may be excreeted through sweating but this can be dangerous also as it is a sign of dehydration, your body is loosing fluids when you sweat (water). A great portion of the human body constists of water content.

when your patients are sweating during sickness OR HAVE A FEVER, this is when mandatory drinking water and eating food need to be initiated. Many viral deaths I believe are happening because of malnutrition and dehydration. Have them eat bland foods such as top ramen noodles without the spicey packs or unsalted crackers, this will help reduce toxins in the blood and remove acids in the stomach and help strengthen thier immune system. Vomiting is also seen as healthy and can be unhealthy as well as patients are not getting food if they are profusely vomitting, expelling calories they need to survive. This along with loosing fluids in the form of sweat and evaporation from high temperature may be what is leading patients to viral related deaths.

When your patients have a fever is when they need to be mandatory drinking and eating. Once youve proven that a patients pulse is erraticaly high during fever (esp sweating) you may administer a mild/strong sedative (this is for doctors to read), this should help if fevers reach critical levels. Drawing blood should prevent further fever symptoms, do not draw blood during a high temperature fever, when fever has stabilized, as it is the increase of blood density/mass that is causing the heart to pump harder and faster, the virus registering as an increase of blood. The same things happen when you put water into a balloon, the balloon becomes harder to squeeze. I believe the high heartrate is a result of the heart having to pump harder due to an increase of blood.

A mild/strong sedative may be used once youve proven this to yourself to aleviate critical fever levels this would lower the heartrate and drop the bodys core temperature.

In sweating related deaths, evaporation of the blood and water content in the blood may be also leading to death in viral outbreaks along with dehydration and malnutrition. You may burn more calories during viral outbreaks due to high heartrate and high body temperatures and need more food/water than you realize, as your fluid content is beeing evaporated as fever temperatures and evaporation of water temperatures are synonymous.

Will a doctor please help me out by taking your patients pulserate who has a fever, esp when they are sweating. It should go from extreems of being extremely high to abnormaly low. your body is simply trying to reduce blood weight by evaporating the blood, blood also evaporates at the same temperature of a fever as it largely consists of water. patients dying should be loosing weight in the range of 5 pints of blood, this would be because of water content expelled during sweating during a fever wich is actualy blood loss, as that is where water/sweat is actualy comming from. —Preceding unsigned comment added by Funnydude71 (talk • contribs) 23:33, 28 November 2009 (UTC)

Public health issues
Public health issues need more attention in this article I think. --Scriberius (talk) 09:42, 20 June 2010 (UTC)
 * Yes feel free to expand them. Doc James  (talk · contribs · email) 18:05, 24 September 2010 (UTC)

Please include in the legend of figure (fixed)
Please include link to Influenza virus nucleoprotein (RNP) in the legend of figure. Biophys (talk) 04:34, 15 October 2010 (UTC)
 * Which legend of which figure? Doc James  (talk · contribs · email) 05:58, 15 October 2010 (UTC)
 * Sorry, I did not realize that article was only semiprotected. Fixed.Biophys (talk) 14:54, 15 October 2010 (UTC)

First use of term "influenza"
The previous version had a spurious date of 1743 for the first use of the term in English, referencing an amateur etymological dictionary somewhere on the web. The real date is 1703 according to Creighton's History of Epidemics. A reference has been added for this and also one for the first use of grippe by Molyneux in 1694. Penpal3 (talk) 10:28, 23 November 2010 (UTC)

The influenza article should link WP's art on influenza vaccination rather than its general article on vaccine
Vaccinations against influenza are usually given to people in developed countries[12]

Linking WP's art on influenza vaccination rather than its general article on vaccine would be much more helpful in this context. —Preceding unsigned comment added by 68.165.11.114 (talk) 23:15, 15 October 2010 (UTC)