Monday, April 27, 2009

Why the hullabaloo about Swine Flu?

I already wrote a little bit about it here. But if you would like I can recap for you.

Swine Flu normally doesn't spread to humans, but this type does. Even crazier is that this type can be spread between humans. To quote the CDC

"The viruses contain a unique combination of gene segments that have not been reported previously among swine or human influenza viruses in the U.S. or elsewhere. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment of infection with swine influenza viruses. The H1N1 viruses are resistant to amantadine and rimantadine but not to oseltamivir or zanamivir. It is not anticipated that the seasonal influenza vaccine will provide protection against the swine flu H1N1 viruses. "

New viruses are formed when a minimum of two viruses merge. Pigs are known to be especially efficient genetic recombinators. The new swine virus has gene segments of the bird flu, one gene segment from a human flu and two gene segments from a pig virus.

But when I hear everyone talking about bioterrorism tests I tend to chuckle nervously. Why?
Well, for one even though this may be a "Never Before Seen" Virus, we have only been surveilling very aggressively over the last few decades....

The second reason I chuckle is because it makes all this Personalized Medicine for prevention and DTC Genomics look REAL silly. As in not nearly as important as stopping a pandemic......

The Sherpa Says: If you haven't been to Mexico or in contact with the people from San Diego, Kansas, NYC, TX, or the 1 case in Ohio. Stop, take a deep breath and relax. Wash your hands and call your doctor if you feel ill......

7 comments:

Anonymous said...

Yes, personalized medicine isn't an urgent thing like trying to stop a pandemic. There are no emergencies in the field of genetics. The lack of urgency an importance compared to other specialties in the medical field is why I decided not to bother becoming a genetic counselor or a clinical geneticist and become a pathologist instead.

N/A

Melleez said...

I am in Australia and do have a question. Are you aware if it is the Cytokine Storm that is killing these folk ? We wer just declared on Pandemic alert in Qld.

Anonymous said...

I am in Australia and do have a question. Are you aware if it is the Cytokine Storm that is killing these folk ? We wer just declared on Pandemic alert in Qld.

Steve Murphy MD said...

melz,
I agree. The people dying in mexico are 20-40, just like the 1918 flu. These people clearly are bunring themselves to death with ARDS etc. Tough to fight that though. We have studied antioxidants, steroids, propofol, etc.....nothing worls well

-Steve

Red Herring said...

To Anonymous: As a clinical geneticist, I have to take exception to the notion that there are no genetic emergencies. Try MSUD, glycine encephalopathy, MCAD, Trisomy 13, Ambiguous genitalia, MCA of unknown cause. Urgency can also come up when a woman is schedules for prophylactic mastectomy and needs guidance about prophylactic oophorectomy.

To the Sherpa-meister: What if flu severity could be predicted by GWAS? What about the pharmacogenomics of anti-virals? All medicine, including ID, has an important genetic angle. In 2149, personalized medicine will deeply inform the public health response to pandemics. Don't despair because it's not ready in 2009.

Steve Murphy MD said...

@ Red,
Mike Murray actually has a nice "mock case" of GWAS markers etc. predicting the likelihood of developing ARDS with infection.

Useful here I agree in a "few" years. What my point was intended to mean is, people aren't so motivated to go get DTC genomics or even PGx testing if they are afraid of getting Swine Flu......

National and personal priorities change when you are threatened with a pandemic. This is yet another reason why Genetics gets the short end of most sticks.....for now.

BTW @Anonymous, I agree with Red. Try managing someone with an ammonia of 9000.....
Oh wait, pathologists are not exactly doing intense clincal management, are they?

-Steve

Sujan Patricia said...

H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. Symptoms of swine flu are similar to those caused by other influenza viruses. Health authorities across the globe are taking steps to try to stem the spread of swine flu after outbreaks in Mexico and the United States. The World Health Organization has called it a "public health emergency of international concern."