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What is a pandemic?
A disease epidemic occurs when there are more cases of that disease than normal. A “pandemic” is a worldwide epidemic of a disease, according to the World Health Organization.
Pandemics can be either mild or severe in the illness and death they cause, and the severity of a pandemic can change over the course of that pandemic.
An influenza pandemic may occur when a new influenza virus appears against which the human population has no immunity. With the increase in global transport, as well as urbanization and overcrowded conditions in some areas, epidemics due to a new influenza virus are likely to take hold around the world, and become a pandemic faster than before.
WHO has defined the phases of a pandemic to provide a global framework to aid countries in pandemic preparedness and response planning.
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WSU health officials were anticipating an increase in suspected cases of the influenza A(H1N1) virus when classes resumed in the fall, and that’s what they got.
On Monday, the first day of classes, 10 students sought treatment for flu-like symptoms, said Dr. Bruce Wright, director of Health and Wellness Services at WSU.
Officials are awaiting test results to determine if the students have the H1N1 virus, the so-called Swine Flu, but given the timing of their symptoms, Wright said, that seems likely. According to the Washington State Department of Health, about 98 percent of those coming down with influenza A right now have the H1N1 virus. On Friday a WSU sorority member was diagnosed with influenza A and in the past couple days two other confirmed cases of influenza A were reported on the WSU campus.
Typically, Wright said, the flu season begins in October and winds down in February. But, he said, new cases of A(H1N1) have been reported around the world throughout the summer, causing the World Health Organization to raise the pandemic alert for the A(H1N1) flu virus from a phase 5 level to a phase 6 level on June 11. Phase 6 is the WHO’s highest level of alert and indicates that a global pandemic is underway.
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Steps to avoid getting the flu
 WSU health officials recommend that people follow these common sense guidelines for reducing or preventing the spread of the A(H1N1) virus:
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The term influenza pandemic is defined as a virus that has spread globally — on two or more continents. The term is not dependent upon the severity of the virus. In this case, most occurances of the A(H1N1) flu have been found to be relatively mild.
Prepared for increase
“The H1N1 outbreak has been going on all summer,” Wright said, “so we expected an uptick when students came back.”
WSU health officials have been doing outreach throughout the summer and especially in the last two weeks as students were returning to campus. Along with distributing information about how to reduce the spread of the H1N1 virus, officials have also been distributing bottles of hand sanitizers to the residence halls and Greek houses. Since one symptom of the H1H1 virus is a fever, health officials have also been distributing thermometers to the various student housing venues on campus. Health officials are also distributing face masks to people who are sick but need to be in close contact with other people.
Fran Martin, director of the Whitman County Health Department, said her department is working with WSU and is monitoring the situation. So far, she said, those infected with the A(H1N1) virus all seem to be students returning to the Palouse from other areas.
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One of the best ways to prevent the spread of the A(H1N1) virus is for those who might be infected to stay home, said Dr. Bruce Wright, director of WSU Health and Wellness Services. Students might balk at missing class, especially at the beginning of the semester, he said, but it is critical that anyone experiencing flu-like symptoms take steps to reduce contact with others.
The Center for Disease Control recommends that people with influenza-like illness symptoms should keep away from others as much as possible for at least 24 hours after fever is gone, except to get medical care or for other necessities. The fever should be gone without the use of fever-reducing medicine.
Others should avoid close contact (i.e. being within about 6 feet) with persons with influenza-like illness.
“We are dealing with an outbreak of a new form of influenza in a susceptible population,” Wright said. “At this point we just want to avoid further spread and contain this as much as possible,” he said.
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oung and old at risk
According to Wright, the A(H1N1) virus seems to be particularly contagious among young people, most likely because it is a new strain of flu and young people have immune systems that have had less exposure to the various flu viruses. Older people, he said, might have some cross-over immunity from earlier bouts of the flu or from flu shots.
Typical symptoms can include fever plus at least cough or sore throat and possibly other indicators like runny nose, body aches, headaches, chills, fatigue, vomiting and diarrhea. In other words, signs similar to those associated with most influenza virus infections.
While typical symptoms can last from a few days to a week, in most cases there is no particular treatment beyond over-the-counter pain medication, such as Tylenol, or a decongestant. The WSU students currently suspected of having the A(H1N1) virus are recovering in Pullman, Wright said, though several might be returning to their hometowns to be cared for by family. None of them have been hospitalized.
Those most at risk from the A(H1N1) virus continue to be those with compromised immune systems, people with diabetes, or severe asthma, as well as the very young and the elderly. Anyone experiencing severe symptoms, including shortness of breath or difficulty breathing should see a doctor immediately.
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Worldwide update on A(H1N1) Following is the weekly update by the World Health Organization issued on Aug. 21, and based on statistics gathered through Aug. 13. More information on the worldwide spread of the A(H1N1) virus can be found at http://www.who.int/en/
As of this week, there have been more than 182,000 laboratory confirmed cases of pandemic influenza H1N1, 1799 deaths, in 177 countries and territories have been reported to WHO. As more and more countries have stopped counting individual cases, particularly of milder illness, the case number is significantly lower than the actually number of cases that have occurred. However, through the WHO monitoring network, it is apparent that rates of influenza illness continue to decline in the temperate regions of the southern hemisphere, except in South Africa where pandemic influenza H1N1 appeared slightly later than the other countries of the region. Active transmission is still seen in some later affected areas of Australia, Chile and Argentina even as national rates decrease.
Areas of tropical Asia are reporting increasing rates of illness as they enter their monsoon season, as represented by India, Thailand, Malaysia, and Hong Kong, four places in the region which have active surveillance programs. Tropical regions of Central America, represented by Costa Rica and El Salvador, are also seeing very active transmission.
In the northern temperate zones, overall rates are declining in both North America and Europe though the virus is still found across a wide area throughout both regions and pockets of high activity are being reported in 3 U.S. states and a few countries of Western Europe.
It has been noted throughout the temperate zones of the southern hemisphere, which are now passing out of their winter season, that when pandemic H1N1 began to circulate, the relative importance of seasonal strains, represented by H3N2 in nearly all countries, rapidly diminished and pandemic H1N1 became the dominant strain. Some seasonal H1N1 strains were reported but were even less common than seasonal H3N2. It is too early to tell if this co-circulation of multiple strains will continue into the coming season of the Northern Hemisphere but it appears very likely that pandemic H1N1 will be the dominant influenza virus in the early part of the winter months.
Many countries including Australia, Canada, New Zealand, and the U.S. have noted that their indigenous peoples appear to be at increased risk of severe disease related to pandemic influenza. While it still has not been clearly determined how much of the increased risk observed in these groups is due to issues related to access to care, high rates of chronic medical conditions that are known to increase risk, or other factors, countries with indigenous and other vulnerable populations should carefully evaluate the situation and consider ways to mitigate the impact of the pandemic in the coming season in these populations.
WHO has also been notified of 12 cases of oseltamivir resistant virus. These isolates have a mutation in the neuraminidase (referred to as H275Y) that confers resistance to oseltamivir, though the viruses remain sensitive to zanamivir. Of these 8 have been associated with oseltamivir post exposure prophylaxis, one with treatment of uncomplicated illness, and two have been from immunocompromised patients receiving oseltamivir treatment. These isolated cases have arisen in different parts of the world (Japan 4, USA 2, China, Hong Kong SAR China 2, and 1 in Denmark, Canada, Singapore and China), and there are no epidemiological links between them. There is also no evidence of onward transmission from these cases.
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For related news and information:
- WSU Health and Wellness website
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08-25-09 Seattle Times – Swine flu to hit 50% of us?
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08-26-09 Fox News – Colleges prepare for H1N1
