Whether speaking of a 58-year-old man or a 38-year-old woman, or a little boy of 9, officials announcing swine flu deaths are almost always quick to note “underlying health  conditions” may have contributed to the fatal outcome. Asthma, heart disease, diabetes, maybe even obesity are among the conditions used to help explain why swine flu infection is hospitalizing and killing younger people, people who would be expected to make a full recovery from seasonal flu.

It could create the impression that only the sickly are dying from the new H1N1 flu virus — a claim no one is making. To the contrary, many, including the World Health Organization, say between one-third and one-half of swine flu deaths have occurred in people who were previously healthy. But how healthy is previously healthy? The answer depends on who you ask.

Dr Anand Kumar is a critical care specialist who has been treating swine flu cases in embattled intensive care units (ICU) in several Winnipeg hospitals. He says a small portion of the ICU patients look like flu’s typical victims, people with health conditions know to be badly exacerbated by a bout of influenza. But more are younger and — until they got sick — healthier than flu patients hospitals typically see during a regular influenza season. “For the most part, these young, relatively healthy people aren’t marathon runners or anything like that,” he admits. “They’re normal people…. If you asked them ‘Are you healthy?’ they’d say ‘Yeah, pretty healthy.”‘

Dr Michael Gardam, head of infectious disease prevention and control for Ontario’s public health agency, believes the constant refrain of “underlying conditions” bespeaks a sort of wishful thinking, an attempt to explain away the unusual age range of the people the new virus is sending to hospital or to the morgue. “That’s the story that I think people haven’t really registered,” says Gardam. “We’re clinging to these ‘Oh, they had underlying illness, therefore it’s OK.”‘ “But … I would argue that the 30-year-old with mild asthma — how big of an  underlying illness is that compared to again the 80-year-old person with bad lung disease from smoking, who’s got heart disease? That’s the usual group that unfortunately gets really sick with flu, not this healthy adult group.” You’ll find little argument that this virus, at this time, is causing more severe disease in people far younger than those normally hospitalized and killed by flu or its complications in a typical flu season.

“This is not a disease of older adults. There’s no question,” says Dr. Allison McGeer, an influenza expert with Toronto’s Mount Sinai Hospital. “For people under 50, this is a significantly more severe disease than seasonal flu. For people over 50, it’s much better,” she notes. But are the people under 50 who are being badly hit by the virus specimens of perfect health or are many of them already shaded by the broad umbrella known as “pre-existing health conditions?” How you view a condition like asthma — seen in 41 per cent of the hospitalized cases in New York City — may influence how you answer that question. “A lot of that is about labelling people,” McGeer admits. “Half of me doesn’t want you to think you’re diseased if you have asthma, and the other half of me wants you to get your flu vaccine because you’re at increased risk.” “How do you walk that line?”

Year in and year out, public health authorities get plenty of evidence many people who have some health issues plunk themselves firmly on the “healthy” side of the divide. Scans of people with asthma, diabetes and other conditions, and women who are pregnant forego the flu shots public health officials urge them to get, suggests Dr Scott Harper, an influenza expert with New York City’s Department of Health. New York City has had one of the biggest swine flu outbreaks to date. As of Tuesday [16 Jun 2008], more than 700 New Yorkers have been hospitalized with swine flu and 23 people in the city have died from infections. With those kinds of numbers, one might expect to see patterns emerge. But Harper says in fact the department believes that many of the health conditions known for years to increase the risk posed by flu are being seen in the people suffering serious disease with swine flu. “The majority of deaths that are being seen have well recognized underlying health risks,” he insists. “Those that don’t may have and we just haven’t seen them yet. And then we may also find new risk factors, but they have not yet been adequately described analytically to be able to say it’s a legitimate risk factor.”

One such potential new risk factor is obesity. An early study from the US Centers for Disease Control suggested it may be contributing to poor outcomes in people who contract the new H1N1. The WHO is concerned about that possibility. “Obesity is now a huge global problem,” says Dr Nikki Shindo, an expert with the WHO’s global influenza program. “And if obesity is a risk factor, then I would be very much worried about some of the populations that are living with obese conditions.” Four of the people who died in New York City were obese. Still, Harper says it’s too soon to say whether that’s a risk factor in and of itself, or if some of the things that go hand-in-hand with obesity — like early heart disease, like diabetes – — are the real risk factors. Teasing out that answer will be tough but necessary, he says, noting that knowing who is truly at the most risk from this virus will dictate who stands where in the queue for swine flu vaccine once it becomes available and who should get priority access to antiviral drugs.

A GAO report issued on May 22, 2008 (GAO-08-821T, HIGH-CONTAINMENT BIOSAFETY LABORATORIES, DHS Lacks Evidence to Conclude that Foot-and-Mouth Disease Research Can be Done Safely on the U.S. Mainland reviews the background of foot and mouth disease (FMD) research in the U.S. and elsewhere. This report questions the basis for the Department of Homeland Security (DHS) support for the movement of FMD virus and research from the current location at Plum Island Animal Disease Research Center (PIADC) to the newly announced National Bio and Agro-Defense Facility (NBAF) site managed by Kansas State University. In the GAO report, concern was raised regarding a study where DHS relied on a secondary study that the United States of Agriculture (USDA) commissioned and that a contractor conducted in May 2002. This study examined the question of whether it is technically feasible to conduct exotic disease research and diagnostics, including FMD and rinderpest, on the U.S. mainland with adequate biosafety and biosecurity to protect U.S. agriculture? Some significant problems existed in the conduct of this study. Nonetheless, DHS continues to cite to this study as supporting the closing of PIADC, and being the basis of support for the $450 million facility funded to Kansas State University. Various concerns are raised by GAO regarding this USDA study and the readership of this blog is encouraged to read the report in detail and the GAO criticisms.

At the heart of the debate is the question as to what existing laws and statutes govern the site for FMD research in the United States? DHS assumed control of PIADC on June 1, 2003 based on authority granted by the Homeland Security Act of 2002. On January 30, 2004 DHS was instructed by Homeland Security Presidential Directive / HSPD-9 (Defense of United States Agriculture and Food) to undertake several actions to protect United States agriculture and food systems, and improve infrastructure to both natural and intentional acts which would erode U.S. agriculture. DHS has identified PIADC as “reaching the end of its life cycle”, and as lacking critical capabilities to continue as the primary facility for such work. DHS initiated actions to replace PIADC which was judged as antiquated using the following authority, specifically clause (24), cited from HSPD-9.

Research and Development (numbers in parenthesis are paragraph markings as appearing in HSPD-9)

(23) The Secretaries of Homeland Security, Agriculture, and Health and Human Services, the Administrator of the Environmental Protection Agency, and the heads of other appropriate Federal departments and agencies, in consultation with the Director of the Office of Science and Technology Policy, will accelerate and expand development of current and new countermeasures against the intentional introduction or natural occurrence of catastrophic animal, plant, and zoonotic diseases. The Secretary of Homeland Security will coordinate these activities. This effort will include countermeasure research and development of new methods for detection, prevention technologies, agent characterization, and dose response relationships for high-consequence agents in the food and the water supply.

(24) The Secretaries of Agriculture and Homeland Security will develop a plan to provide safe, secure, and state-of-the-art agriculture biocontainment laboratories that research and develop diagnostic capabilities for foreign animal and zoonotic diseases.

(25) The Secretary of Homeland Security, in consultation with the Secretaries of Agriculture and Health and Human Services, shall establish university-based centers of excellence in agriculture and food security.

The above citation is very important at several levels. Nowhere in HSPD-9 is FMD mentioned directly. However, DHS states authoritatively that FMD virus and research will be housed at the NBAF. The Secretary of Agriculture is directed to assist DHS in plans to upgrade biocontainment and diagnostic capabilities without reference to other legal obligations. Most importantly, nowhere in HSPD-9 is it mentioned that PIADC should be closed and research relocated. This brings us to the point of asking: what exactly is the authority conveyed through a Presidential Directive? These documents are referred to in different ways in Presidential Directives depending on the administration occupying the Executive Office. From the White House briefing room we cite: “PRESIDENTIAL ACTIONS In this section you will find official actions by the President that have a significant impact on how the federal government functions but do not require legislation or Congressional approval . . . ”

Herein is the problem and this problem was referenced, but not detailed, by the GAO study. FAD research and the legal justification to establish and maintain PIADC is well documented in 21 USC 113a. United States Code (U.S.C.) is a compilation and codification of the general and permanent federal law of the United States. Specifically 21 USC 113a states:

“The Secretary of Agriculture is authorized to establish research laboratories, including the acquisition of necessary land, buildings, or facilities, and also the making of research contracts under the authority contained in section 427i(a) of title 7, for research and study, in the United States or elsewhere, of foot-and-mouth disease and other animal diseases which in the opinion of the Secretary constitute a threat to the livestock industry of the United States: Provided, that no live virus of foot-and-mouth disease may be introduced for any purpose into any part of the mainland of the United States (except coastal islands separated therefrom by water navigable for deep-water navigation and which shall not be connected with the mainland by any tunnel) unless the Secretary determines that it is necessary and in the public interest for the conduct of research and study in the United States (except at Brookhaven National Laboratory in Upton, New York) and issues a permit under such rules as the Secretary shall promulgate to protect animal health, except that the Secretary of Agriculture may transport said virus in the original package across the mainland under adequate safeguards, and except further, that in the event of outbreak of foot-and-mouth disease in this country, the Secretary of Agriculture may, at his discretion, permit said virus to be brought into the United States under adequate safeguards.”

The above is literally the law of the land, and violations of this law are punishable through an assortment of penalties including Contempt of Congress. Returning to the topic, where exactly did DHS assume precedent to establish and award the NBAF contract? From the prior discussion the legal precedent is very clear – - only the Secretary of Agriculture or Congress can allow FMD virus to be moved from PIADC onto the mainland. This was established by law in 1949, and this law is still on the books and in effect. With reference to the Secretary of Agriculture, two questions arise. With the erosion of authority over FMD virus research, does USDA, or DHS, assume the obligations of indemnification should FMD escape biocontainment and damage U.S. agriculture? What is the consequence of actions by the current Secretary of Agriculture on binding commitments made by future Secretaries of Agriculture? Should plans for NBAF proceed and the existing PIADC be razed on the basis of “reaching the end of its life cycle”, and as lacking critical capabilities to continue as the primary facility for such work just to have a future Secretary of Agriculture reverse the decision, the ugly reality emerges of “what options exist”? In short, none! And, US agriculture will lack a FMD research program which could assist in vaccine development should this FAD occur at some time in the future.

This leaves open the question of: why has the U.S. Congress not been proactive in the award of the NBAF facility contract, and why is Congress not diligent in the enforcement of existing U.S. Code? Without bias, we assume that FMD research is suitably placed at PIADC consistent with existing law. Moreover, infrastructure upgrades could revitalize this facility, possibly at a fraction the cost of a site based on the mainland. NBAF is currently funded at an estimated cost of $450 million, which is considerable. However, an estimated loss of $1 billion could occur to the economy of the State of Kansas should FMD virus escape containment and impact the State. The latter figure was derived from a Kansas State University publication (Pendell et al., The Economic Impacts of a Foot-and-Mouth Disease Outbreak: A Regional Analysis. J. Agricultural and Applied Economics, 39:19-33. 2007).

In conclusion, a key question remains unanswered – - why is this blog the only source asking these questions?

The following is [1] a statement of the research program of the United States Department of Agriculture (USDA) Agricultural Research Service (ARS), and [2] the outcome of a study of the cross-reactivity of serum samples from US pigs against the new swine origin 2009 H1N1 influenza virus (S/O H1N1). The results of this analysis indicate that pre-existing immunity induced by swine influenza viruses circulating in the US may not protect pigs against the new S/O H1N1 influenza virus presently circulating in people.

Soon after the emergence of the H1N1 virus in April 2009, ARS scientists at the National Animal Disease Center in Ames, Iowa began research using virus samples provided by the Centers for Disease Control and Prevention (CDC). The 1st step was to evaluate whether current US H1N1 swine influenza vaccines can protect pigs from infection with the 2009 H1N1 influenza virus circulating in people. This research study also evaluated whether pre-existing titers in pigs previously infected with endemic H1N1 swine influenza viruses circulating in the US could protect against the 2009 H1N1 influenza virus.

Classical swine influenza virus infections are enzootic among pigs in North America. Sporadic cases of human infection with swine influenza virus have been reported in the United States and elsewhere. Worldwide, more than 50 human cases of swine influenza virus infection, mostly due to classical swine influenza virus, have been documented in the past 35 years, with the greatest risk of infection among people with occupational exposure to live pigs.

Experts believe pigs can act as a “mixing vessel” for the reassortment of avian, swine and human influenza viruses and might play an important role in the emergence of novel influenza viruses that could be capable of causing a human pandemic similar to the virus in the current outbreak.

Between the 1930s and the 1990s, the most commonly circulating swine influenza virus among pigs — classical swine influenza A, known as H1N1 — underwent little change.

However, by the late 1990s, multiple strains and subtypes of triple reassortant swine influenza viruses — whose genomes include combinations of avian, human and swine influenza virus gene segments — had emerged and became predominant among North American pigs. The 2009 H1N1 influenza virus is also a triple reassortent, but its lineage is different than the H1N1 influenza viruses currently circulating in US pigs.

Background:
The genetic makeup of swine influenza viruses is identical to other influenza A viruses and consists of 8 segments of RNA that code for different proteins. Influenza viruses have the ability to exchange these segments, creating new genetically different viruses. Two major surface glycoproteins (proteins with a carbohydrate attached) called hemagglutinin (H) and neuraminidase (N) are how influenza A viruses are identified. These glycoproteins also determine the host range, antigenicity and the pathogenicity of the viruses. The hemagglutinin and neuraminidase proteins are important targets for diagnostics and are used to designate the subtype of the virus.

Currently, 16 different hemagglutinins and 9 neuraminidases have been identified. The majority of these viral subtypes are found in waterfowl, with only a few combinations being found in humans and swine.

Swine influenza virus (SIV) is one of the primary causes of respiratory disease in growing pigs and can lead to major economic losses. Currently, only H1N1, H1N2, and H3N2 subtypes are circulating in the US swine population.

Pigs have long been considered a potential source for new and novel influenza viruses that infect humans, as they have receptors on their cells that bind both mammalian and avian influenza viruses, increasing the opportunity for the exchange of genetic segments of the virus.

Previously, CDC has reported about one case of human infection with a swine influenza virus every one to 2 years.

Recent ARS research results: 2009 H1N1 influenza virus: ARS researchers tested serum samples from pigs previously infected with US swine influenza viruses or vaccinated with commercial vaccines to determine whether US commercial swine herds are susceptible to the new swine origin (S/O) H1N1 influenza virus. They found that there was limited cross reactivity against the new S/O H1N1 influenza virus. This suggests that pre-existing immunity induced by swine influenza viruses previously circulating in the US may not protect pigs against the new S/O H1N1 influenza virus presently circulating in people. Importantly, vaccines currently used to protect pigs on US swine farm operations against swine influenza viruses may not be effective against the new S/O H1N1 influenza virus.

If and when a pandemic of H1N1 swine flu hits, vaccines might be the world’s best hope for softening the blow. But major uncertainties cloud the prospects for vaccines against the new  strain. No pandemic vaccine yet exists, and it is unclear how much vaccine would have to be available, and by what time, to have any impact. Should manufacturers halt the production of seasonal influenza vaccine to focus on a pandemic version, and if so, when? And is there any way to ensure that people around the world have an equal chance to get the new vaccine?

These topics have been the subject of frantic, almost daily discussions among scientists, vaccine manufacturers, regulatory agencies, and the World Health Organization (WHO) over the past few weeks. But so far, there are few concrete answers, in part because no one knows just how severe a threat the new virus poses, or how difficult it will be to mass-produce a vaccine. One thing is certain, however: There won’t be nearly enough vaccine to protect all the world’s citizens, and the question of who has first dibs could get ugly, says David Fedson, a former pharma executive and influenza vaccine expert living in France.

Almost all seasonal flu vaccine is made using a clunky, 50-year-old process, in which companies adapt the virus to multiply in hens’ eggs, grow the virus in eggs, then purify the  key antigens needed to make vaccine—the hemagglutinin and neuraminidase molecules that stick out from the virus’s surface. In all, the process takes more than 5 months. This is also how at least the vast majority of a pandemic vaccine will be made, because promising alternative production strategies won’t be ready in time.

Immediately after isolating the new H1N1 strain, the U.S. Centers for Disease Control and Prevention and other labs began producing a “seed stock” of virus, which will be given to manufacturers in a few weeks for vaccine production. But how much pandemic vaccine will they be able to produce once they get going? A study funded by the Bill and Melinda Gates Foundation, whose main outcomes were announced in February, gives an indication. The study, carried out by Adam Sabow of the consulting company Oliver Wyman, in collaboration with WHO and the International Federation of Pharmaceutical Manufacturers & Associations, showed that all manufacturers combined can currently produce some 680 million doses of seasonal flu vaccine per year—a number that is expected to grow to at least 1.4 billion by 2014.

It’s not easy to translate that figure into doses of pandemic vaccine. The number depends, among other things, on how successfully scientists can make the new virus grow in eggs, how much antigen is needed for an adequate vaccine response, and whether a so-called adjuvant can reduce the amount of antigen needed per shot. But Sabow’s study concluded that in the most likely scenario, the world’s vaccinemakers combined could produce almost 2.5 billion doses of pandemic vaccine in the first year.

Assuming, as many scientists do, that two shots would be needed for adequate protection— as opposed to one for seasonal vacine—that means there would be enough for 1.2 billion people, less than 20% of the world’s population, that first year. The study was based on the assumption of a pandemic of H5N1 avian influenza, but the figures are not expected to be vastly different for swine flu.

Achieving that output assumes, however, that vaccine manufacturers immediately stop their production of seasonal vaccine, which they are now making for 2009–10, and go full-bore on a pandemic vaccine—a very unlikely scenario. In reality, WHO has to weigh the risk of a shortage of seasonal vaccine, and the increased risk of disease and death that would ensue, against the threat posed by the new strain. For the moment, the new virus doesn’t appear to be highly virulent, but that could change over time. After a relatively mild first wave in the spring of 1918, the Spanish flu returned with a vengeance in the fall.

“It’s a devilish dilemma,” says Jaap Venema, global project director influenza at vaccine producer Solvay in the Netherlands. At a press briefing last week, WHO vaccine expert Marie-Paule Kieny said the agency is in close contact with manufacturers; some are further along with their seasonal production than others, and those might switch first to pandemic vaccines while others do so later.

How to ensure equitable distribution of the vaccine is trickier still. Since the threat of an avian influenza pandemic became urgent 6 years ago, a few developing nations have been fighting hard to ensure they will have access to vaccines if a pandemic strikes. Indonesia even went so far as to refuse participation in WHO’s system for virus sharing in an attempt to wrest hard guarantees from the agency. WHO responded with a plan to increase production capacity in the developing world, which is now home to some 13% of the global vaccine production capacity—but the plan is still in its infancy. To ensure equal access, WHO Director-General Margaret Chan has called for “international solidarity,” and Kieny says WHO is already talking to donors and major global health funders about ways to buy vaccine for the world’s poorest.

But there are some major obstacles. Several countries already have first dibs on any pandemic vaccine. In 2006, for instance, the Dutch government signed a contract with Solvay  guaranteeing that it gets the first 16 million doses of a pandemic vaccine to protect its own population. Other governments have signed similar deals, Kieny says, so “the books  of the manufacturers are already quite full.”

In addition, the governments of the countries with a flu vaccine plant in their territories will be under tremendous political pressure to protect their own populations first, Fedson predicts. “You don’t need a contract,” he says; “all you need is an army” to prevent the vaccine from going across the border. Thus, even rich countries like Sweden and Spain that lack a vaccine plant could find themselves empty-handed, he says.

Unfortunately, there are few alternatives for the moment. Most flu vaccine manufacturers are working to replace the antiquated chicken-egg technology with a cell-based method, in which the vaccine virus is grown in mammalian cells. This has several advantages: Manufacturers are less dependent on the supply of chicken eggs—which is difficult to increase quickly and can become vulnerable during bird flu outbreaks—and it could shave 10 weeks from the 22 weeks now needed to make influenza vaccine using eggs.

But although more practical and cleaner, cell-based vaccines don’t promise a major boost in production capacity. Moreover, success with the technique has been slow to come, despite more than $1.5 billion in U.S. Department of Health and Human Services contracts to several companies to fund clinical trials of cell-based vaccines and scale up manufacturing. “The cell-based vaccines are coming, but we’re not going to see them for this pandemic,” says influenza expert Arnold Monto of the University of Michigan School of Public Health in Ann Arbor. Other recombinant vaccines that could truly lead to an explosion in production capacity are even further down the road, says John Treanor of the University of Rochester’s School of Medicine and Dentistry in New York state.

That means that, at least for now, the world is still dependent on chicken eggs.

Assessing the Severity of an Influenza Pandemic

The major determinant of the severity of an influenza pandemic, as measured by the number of cases of severe illness and deaths it causes, is the inherent virulence of the virus. However, many other factors influence the overall severity of a pandemic’s impact.

Even a pandemic virus that initially causes mild symptoms in otherwise healthy people can be disruptive, especially under the conditions of today’s highly mobile and closely interdependent societies. Moreover, the same virus that causes mild illness in one country can result in much higher morbidity and mortality in another. In addition, the inherent
virulence of the virus can change over time as the pandemic goes through subsequent waves of national and international spread.

Properties of the virus

An influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. This creates an almost universal vulnerability to infection. While not all people ever become infected during a pandemic, nearly all people are susceptible to infection.

The occurrence of large numbers of people falling ill at or around the same time is one reason why pandemics are socially and economically disruptive, with a potential to temporarily overburden health services.  The contagiousness of the virus also influences the severity of a pandemic’s impact, as it can increase the number of people falling ill and needing care within a short time frame in a given geographical area. On the positive side, not all parts of the world, or all parts of a country, are affected at the same time.

The contagiousness of the virus will influence the speed of spread, both within countries and internationally. This, too, can influence severity, as very rapid spread can undermine the capacity of governments and health services to cope.

Pandemics usually have a concentrated adverse impact in specific age groups. Concentrated illnesses and deaths in a young, economically productive age group will be more disruptive to societies and economies than when the very young or very old are most severely affected, as seen during epidemics of seasonal influenza.

Population vulnerability

The overall vulnerability of the population can play a major role. For example, people with underlying chronic conditions, such as cardiovascular disease, hypertension, asthma, diabetes, rheumatoid arthritis, and several others, are more likely to experience severe or lethal infections. The prevalence of these conditions, combined with other factors such as
nutritional status, can influence the severity of a pandemic in a significant way.

Subsequent waves of spread

The overall severity of a pandemic is further influenced by the tendency of pandemics to encircle the globe in at least 2, sometimes 3, waves. For many reasons, the severity of subsequent waves can differ dramatically in some or even most countries.

A distinctive feature of influenza viruses is that mutations occur frequently and unpredictably in the 8 gene segments, and especially in the hemagglutinin gene. The emergence of an inherently more virulent virus during the course of a pandemic can never be ruled out.

Different patterns of spread can also influence the severity of subsequent waves. For example, if schoolchildren are mainly affected in the 1st wave, the elderly can bear the brunt of illness during the 2nd wave, with higher mortality seen because of the greater vulnerability of elderly people.

During the previous century, the 1918 pandemic began mild and returned, within 6 months, in a much more lethal form. The pandemic that began in 1957 started mild, and returned in a somewhat more severe form, though significantly less devastating than seen in 1918. The 1968 pandemic began relatively mild, with sporadic cases prior to the 1st wave, and remained mild in its 2nd wave in most, but not all, countries.

Capacity to respond

Finally, the quality of health services influences the impact of any pandemic. The same virus that causes only mild symptoms in countries with strong health systems can be  devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and understaffed.

Assessment of the current situation

To date, the following observations can be made, specifically about the H1N1 virus, and more generally about the vulnerability of the world population. Observations specific to H1N1 are preliminary, based on limited data in only a few countries.

The H1N1 virus strain causing the current outbreaks is a new virus that has not been seen previously in either humans or animals. Although firm conclusions cannot be reached at present, scientists anticipate that pre-existing immunity to the virus will be low or non-existent, or largely confined to older population groups.

H1N1 appears to be more contagious than seasonal influenza. The secondary attack rate of seasonal influenza ranges from 5 per cent to 15 per cent. Current estimates of the secondary attack rate of H1N1 range from 22 per cent to 33 per cent.

With the exception of the outbreak in Mexico, which is still not fully understood, the H1N1 virus tends to cause very mild illness in otherwise healthy people. Outside Mexico, nearly all cases of illness, and all deaths, have been detected in people with underlying chronic conditions.

In the 2 largest and best documented outbreaks to date, in Mexico and the United States of America, a younger age group has been affected than seen during seasonal epidemics of influenza. Though cases have been confirmed in all age groups, from infants to the elderly, the youth of patients with severe or lethal infections is a striking feature of these early outbreaks.

In terms of population vulnerability, the tendency of the H1N1 virus to cause more severe and lethal infections in people with underlying conditions is of particular concern.

For several reasons, the prevalence of chronic diseases has risen dramatically since 1968, when the last pandemic of the previous century occurred. The geographical distribution of these diseases, once considered the close companions of affluent societies, has likewise shifted dramatically. Today, WHO estimates that 85 per cent of the burden of chronic diseases is now concentrated in low- and middle-income countries. In these countries, chronic diseases show an earlier average age of onset than seen in more affluent parts of the world.

In these early days of the outbreaks, some scientists speculate that the full clinical spectrum of disease caused by H1N1 will not become apparent until the virus is more widespread. This, too, could alter the current disease picture, which is overwhelmingly mild outside Mexico.

Apart from the intrinsic mutability of influenza viruses, other factors could alter the severity of current disease patterns, though in completely unknowable ways, if the virus continues to spread.

Scientists are concerned about possible changes that could take place as the virus spreads to the southern hemisphere and encounters currently circulating human viruses as the normal influenza season in that hemisphere begins.

The fact that the H5N1 avian influenza virus is firmly established in poultry in some parts of the world is another cause for concern. No one can predict how the H5N1 virus will behave under the pressure of a pandemic. At present, H5N1 is an animal virus that does not spread easily to humans and only very rarely transmits directly from one person to another.

A recent Food and Agriculture Organization (FAO) Media Release about the detection of A/H1N1 virus in pigs in Canada is presented below.  The release also was distributed by ProMED.

As a point of interest, ProMED is one of the largest publicly available emerging disease and outbreak reporting systems in the World.  Currently, ProMED posts are read by over 50,000 subscribers in over 187 countries.

Introduction

In light of the H1N1 (formerly known as swine flu) virus outbreak, consumers should have an understanding of the influenza virus from a pork producer perspective, and the steps that US swine producers routinely utilize to keep pigs healthy.

Influenza background from the pork industry perspective

• Pork producers have occasionally battled an influenza virus that is transmitted among pigs. Pig influenza within a swine herd generally presents as a relatively mild respiratory disease and treatment is initiated in consultation with the herd veterinarian.

• Very rarely, swine influenza can be transmitted from pigs to humans (zoonotic transmission).

• Although rare, the Centers for Disease Control reports several past cases where an influenza virus originating in swine passed from human to human.

• It appears as if pigs can be infected from humans who are shedding the current H1N1 virus, as evidenced by a case in Canada.

Many routine practices employed by US swine producers prevent, not only swine influenza, but other diseases as well.

• Most animals are housed in like-aged groups to reduce disease transfer from older pigs to younger pigs. Buildings are temperature-controlled and scientifically designed to keep pigs clean, safe and protected from predators, disease and extreme weather.

• Producers utilize all-in-all out production where a building is completely emptied, washed, and disinfected between groups of pigs. This practice serves as a further measure to break disease cycles on pig farms.

• As part of the National Pork Board’s Pork Quality Assurance (PQA) program, pork producers develop and follow a herd health plan in cooperation with a licensed veterinarian. The herd health plan may include influenza vaccine among other disease prevention vaccinations. Most US pork packers require producers to maintain PQA certification.

• Producers practice biosecurity to prevent diseases from traveling into or out of a facility. In the event of a disease outbreak, pigs confined in an enclosed building are much easier to quarantine than are pigs housed in the open.

Conclusion

Contemporary swine production practices and biosecurity measures are well suited to reduce the spread of diseases, including the current H1N1 influenza virus. Confined production greatly reduces the opportunity for conventional and zoonotic disease transfer because of limited animal-to-animal and animal-to-human contact, and serves as an effective disease isolation mechanism when diseases do occur.

Dr. Henning had a letter posted in USA Today combating myths about beef and global warming.

Here is Dr. Henning’s letter.

Why the shift in scrutiny from our use of fossil fuels to the carbon footprint of our food? USA TODAY’s article, Eating can be Energy Efficient, too, repeated the fashionable claim that switching to a “low-carbon diet” would make a meaningful reduction in a person’s carbon footprint (Life, April 22).

Yet the Environmental Protection Agency reports that all U.S. agriculture, including livestock and crops, accounts for only 6% of U.S. greenhouse gas emissions.  I find the article seriously in conflict with this report.

The experts cited in USA TODAY’s article claim to understand the impact of animal agriculture on carbon emissions, yet they ignore how tightly intertwined our animal and crop production systems are.

For example, how will we replace livestock manure used to fertilize our crops without resorting to fossil fuel-derived fertilizers? What happens to feeds that are unsuitable for humans and the use of byproduct feeds? And, knowing that 85% of U.S. grazing land isn’t suitable for crop production, do we know if we can support ourselves on the cropland that remains? What gasses are produced in the decomposition of the unused plants and in crops such as rice?

Advocating the seemingly easy and convenient solution of low-carbon diets to solve the environment dilemma might be tempting, but have we assessed the nutritional impact for reducing our major sources of balanced proteins in children?

Environmentally conscious consumers should continue to enjoy lean meat with confidence, knowing they are doing the right thing for their bodies and for the environment.

Posted on USA Today at 12:09 AM/ET, April 30, 2009.

With the media reporting increased numbers of swine flu cases daily, it is time for the swine industry to maintain and, perhaps, expand the strict biosecurity procedures already in place.

It is important to stress that this new strain, H1N1, has not been seen in the U.S. swine herd, so NO pigs have been found to be infected or sick with the virus. This is a completely new strain encompassing three different forms of flu: human, avian and swine. There is no evidence that it causes any type of illness in swine, and pork products remain completely safe. These two facts are becoming lost in the maelstrom of publicity about the effect of the virus on humans, and its continued spread around the world. And, unfortunately, many news reports are choosing to show “cute” photos of swine as they report on the implications of the virus to humans. All of this has a negative impact on the swine industry, inferring that swine are at risk.

This widespread attention makes it timely for producers to check their biosecurity measures and make sure they are being enforced. Extra vigilance is vital to protect the U.S. swine population, and to reassure an uneasy public.

The University always maintains very stringent biosecurity in its herds, and in carefully assessing any potential risk from this human virus, we have decided to reevaluate our procedures and pay more attention to visitors and employees who may be demonstrating signs of upper respiratory disease—fever, coughing, aches and pains, etc. These people will be discouraged from entering our facilities.

Swine producers should continue to follow the procedures they have in place to ensure the safety of their herd and their employees, and to prevent the introduction of the new strain of swine influenza virus type H1N1 into operations. Because it is humans who are sick with the virus, you will want to make sure your biosecurity practices place special emphasis on monitoring all persons who have access to your operation for the protection of your animals and your operation’s workers.

As with all biosecurity plans, each should be unique to individual farm settings. There is no “one size fits all” plan. Evaluate your operations, the risks associated with your operations, and consider some or all of the following procedures:

- Limit the access of people to essential personnel (farm employees, veterinarians and essential service people);

- Implement policies that prevent employees presenting signs of flu-like illness from having contact with the pigs or other people on the operation; encourage them to seek medical attention and report if other family members have symptoms;

- Prevent access of international visitors or people who have recently returned from international travel, particularly from travel to Mexico – this should not be limited to people who have had contact with animals, but should include anyone who has traveled internationally;

- Implement a shower in-shower out procedure and the use of farm-specific clothing and footwear for employees entering the barns.  At minimum, employees should don farm footwear and completely wash hands and arms before having contact with the pigs;

- Enforce heightened personal hygiene practices including frequent hand washing for all people in contact with pigs;

- Provide personal protective equipment – face masks or respirators, eye protection, gloves, and enforce their use.

- Establish contact with the herd veterinarian to discuss other biosecurity practices that are merited by this event, and immediately contact your veterinarian with any unusual symptoms.

- Pay attention to proper ventilation to reduce the exposure of pigs to viruses from other pigs and to reduce their exposure to human influenza viruses.

- Vaccinate pigs against the influenza virus.

It is important to remember that USDA makes it clear that swine influenza viruses have never been found to be transmitted by food or through the consumption of pork or pork products. In their statement they reminded everyone that cooking pork to an internal temperature of 160 degrees kills all viruses and other foodborne pathogens. The CDC website has the same information about the safety of eating pork, as does the World Health Organization.

Each day brings new reports of human virus incidences and new speculation about its spread. In today’s world of instant media coverage, it is sometimes hard to discern the facts from the rhetoric.  As we progress through this time of heightened concern, I urge you to check out the facts by turning to trusted sources of information.

There are numerous websites with access to additional information, including the College of Agricultural Sciences with its most recent news release. Visit those listed below to learn more:

http://agsci.psu.edu/news/spotlight/swine-flu

http://www.pork.org/

http://www.usda.gov/wps/portal/!ut/p/_s.7_0_A/7_0_1OB?contentidonly=true&contentid=2009/04/0130.xml

http://www.cdc.gov/swineflu/?s_cid=swineFlu_outbreak_internal_001

www.who.int/csr/disease/swineflu/en/index.html

http://live.psu.edu/tag/swine_flu

Feedstuffs

Dr. Werner may be contacted at:  jrw140@psu.edu

As readers of my blog have observed, I have not posted a blog for a few months.  About all that could be written about the battle over application of rbST in the dairy industry in the United States, and defending the freedom of dairy farmers to use safe and effective technologies has been discussed.  The stories currently being written by opponents of this biotechnology are simply a rehash of a rehash…nothing new.  This all has been chronicled in Terry Etherton Blog on Biotechnology.

There are other issues confronting society and agriculture that are enormous challenges and merit debate about how to solve them.  One pressing issue that looms on the horizon pertains to how the global village is going to feed a growing world population.  Projections are that between now and 2050, the world’s population will grow from 6.5 billion to about 10 billion people  (International Service for the Acquisition of Agri-Biotech Applications – ISAAA).  Another “metric” that hammers home the challenge that lies ahead is that the amount of cultivable crop land for food production (on a per capita basis) is plummeting.  In 1966, there was about 0.45 hectares (ha) per person in the World – in 2050 the projections are that this will be approximately 0.15 ha (ISAAA).

The shrinking land base (on a per capita basis) is very problematic.  Many presume that climatic conditions will be stable and not adversely affect food production.  That is not a given, however.  In addition, geo-political strife is ever present, and affects food production and distribution.  Moreover, it is not easy to predict future conflicts and what impact they might have on the food system.  The other “wild card” that has a huge potential impact to up heave food production is a targeted strike on food production via a bioterrorism attack.

The question society confronts is very simple – how are we are going to feed the growing World population?  I don’t think many would endorse the idea of chopping down more rain forest to expand acreage for food production.  Science and new innovations are needed – new technology-based products will have to be developed and applied.  A key target for application of new science-based solutions will be to improve food production efficiency, i.e., more apples per tree, more milk per unit of feed consumed by a dairy cow, etc.

An “ugly” reality intertwined in this issue is the cost of discovering and developing the science, and distributing the new technologies (and food) to both developed and developing countries.  This will be enormously challenging!  Will developed countries be willing to cover the costs to do this?  Is there the political “will” to do this?

The current world-wide economic crisis is a daunting problem.  A March 5, 2009 editorial in the New York Times (The Crisis at Home and Abroad) observed that the European Union’s wealthy members rejected calls for a bailout from its poorer members.  This is not encouraging illustration that rich countries will provide assistance to poorer or developing countries.

Another emerging challenge is that there is evidence that cereal crop reserves are decreasing.  If there are a couple of “bad” food production cycles in the World, the amount  of food reserves becomes critical.

These issues are going to be the ones that I focus on in my blogs over the next few months.  The issue of feeding the growing World population is complex.  In addition, many consumers in developed countries simply don’t see the “problem” because their grocery store shelves are full.  I wonder what would happen in America if consumers went to the grocery store and only half of the food was there?