What should the government do about flu

ScienceInsider, the blog for Science magazine, has an interview with Edwin D. Kilbourne. He is an infectious disease specialist, now 88 years old, who was very much involved in the swine flu situation in the 1970s. Recall that there was an outbreak on a military base and the government immunized tens of millions of people with a vaccine which may or may not have caused a number of cases of Guillain-Barré syndrome. The decision making by the government in that situation was the case studied in The Swine Flu Affair: Decision-making on a Slippery Disease by Richard E. Neustadt and Harvey V. Fineberg.

Kilbourne recommends that we work to characterize the disease, to find a strain of the virus which is a good candidate for the development of a vaccine, and that we put a vaccine in production right away. But he also recommends that we refrain from mass immunizations until we know more about the epidemic. That sounds very appropriate.

There is a flu epidemic every year; more accurately there seem to be several epidemics each year of different strains of flu which overlap in time. Every once and a while a new strain of flu arises for which there is relatively little immunity in the population, which transmits easily and which results in serious illness and the world has a pandemic. Experience suggests that there is no question as to whether there will be another flu pandemic, but only questions of when it will occur and how bad it will be.

Remember, most respiratory infections are never diagnosed, and even when flu is diagnosed the strain of the virus causing the disease is seldom identified. Right now, because the world has been alerted, there will be a lot of epidemiological case finding and agent identification. It will be tempting to assume that the reports of increasing numbers of cases of swine flu signal a rapidly increasing epidemic, but the increase will be at least in part due to better case finding.

I have been posting for some time on flu. You can find my past posts by searching this blog using the term "flu", or by clicking on the "flu" tag below.

Some good places to get information on this and other flu epidemics are:

• ScienceInsider

• The CDC Influenza webpage

• WHO Influenza Program

• WHO Flunet*

Source of graph: "Cold weather really does spread flu," Debora MacKenzie, New Scientist, 19 October 2007.

History suggests that this is not "the big one", the strain of flu that will create a pandemic. Even if it is, we in the United States may luck out if the summer weather keeps the swine flu away, and the public health officials have until next winter to develop a campaign