I get a lot of questions about influenza, especially this year of the H1N1 pandemic. In an AFP editorial Jonathan Temte, MD, PhD writes an excellent summary of the “12 Basic Rules of Influenza” written for physicians, but very appropriate for the informed patient to be understand.
To me the most impressive thing about the H1N1 pandemic was how fast it became a worldwide problem. In the 1919 Great Influenza the epidemic spread with unprecedented speed as soldiers moved around the world. Fortunately so far the virulence of the current H1N1 strain does not seem to rival the strain of 1918-19. If it had even close to as high a mortality rate, with the speed of spread it would have been an unprecedented disaster. In 2009, everyone moves around the world, on commercial airlines and by automobile. The initial reports from Mexico were followed in rapid succession by reports from all over North and South America, and around the world. Here is an animated map of case reports in the US early in the epidemic. If there is a lesson for public health officials, it is that we now have a small planet, and that any illness spread from person to person by droplets (coughing and sneezing) is probably not a problem that can be contained to a limited area. We as a healthcare system and as a nation will need to anticipate the rapid worldwide spread of any such epidemic.
The second thing that impressed me was the mobilization of the pharmaceutical capability to mass produce a new immunization. From the initial isolation of the H1N1 virus in April, to the production, testing and eventually distribution and administration of vaccine was just over 6 months. To me this seems remarkable. None-the-less to speed up the process that usually takes several months longer and to manufacture vast quantities of this vaccine was remarkable. I tip my hat to the rapid decision-making, the appropriation of funds, and the hard work of many who made this happen. Now I hope a focus of research will be to design a process for production of an immunization in a new process that will be even faster to mass produce, and ideally avoid the problem of immunization of people with egg allergy.