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Pandemic 'already started' say Australian experts

Fergus Walsh | 12:40 UK time, Tuesday, 9 June 2009

Two experts on infectious disease in Australia say a flu pandemic has effectively already started because of the widespread number of cases there.

Robert Booy
, professor of Child Health at the University of Sydney in New South Wales, urged the World Health Organisation to take action regarding a shift from the current alert phase 5 to the top level, phase 6: "The WHO can't keep scratching their heads, they have to make a decision," he said.

Robert BooyProfessor Booy, who works at the Children's Hospital, Westmead, said the H1N1 virus was "unstoppable" and would continue to spread around the world. He expressed surprise that the WHO had not already declared a pandemic - a global epidemic of a new flu strain - because the H1N1 virus "fulfilled the criteria of community spread".

As yesterday's post made clear, the WHO has said once we have "community level outbreaks" in another region outside the Americas, then a pandemic will be declared. This means that the virus must be spreading widely, beyond schools and unrelated to travel.

Professor Booy said his neighbouring state of Victoria now had so many cases they would no longer be testing people with flu symptoms in the community, but rather limiting the test to those who needed hospital treatment. "We have community transmission in Victoria," he said.

Victoria has by far the bulk of Australia's swine flu cases. The Australian government said that of the country's 1,211 total confirmed cases, 1,011 had been reported in Victoria.

The number of cases in Australia have risen four-fold in a week. Professor Booy said this was unsurprising. "The cycle of infection is about two days. For every one person with the virus, another 1.5 people get infected, so that gets you to a four-fold rise in six to seven days".

Professor Booy said thankfully the virus was causing mostly mild symptoms. "We have had some hospitalisations, and one person in intensive care, but all are doing well," he said. Fewer than 10 of the flu cases nationwide have required hospital admission. There have been no deaths.

Raina MacIntyreRaina MacIntyre, professor of Infectious Diseases Epidemiology at the University of New South Wales, said according to the WHO's definition of a pandemic, "we are in Phase 6; technically we are there already."

But she added, "it's just a guideline, and when the definitions were devised they didn't factor in severity. I think the WHO approach is reasonable given that there would be widespread economic, tourism and trade implications if a pandemic was declared".

Professor MacIntyre explained that the traditional thinking was that a pandemic would be caused by a new haemagglutinin antigen. This is one of the surface proteins on the flu virus, and is responsible for it binding to infected cells.

"We thought it would be caused by an H5 or an H9 type, rather than H1 which is not really new. When you look at the immunological response of the various age groups, people over 65 have a good level of protection, and only people under 18 have no immunity while many young adults have little immunity."

Professor Booy, who helped draw up Australia's pandemic flu plan said "We had many assumptions and one was that a new flu virus would cause high mortality caused by something really novel. The H1 gene has been with us for centuries."

But he warned that the virus could mutate or "drift" in the coming months. "We already know of cases where people have got double infections - both H1N1 and seasonal flu - and that's what you need for viruses to reassort."

Comments

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  • 1. At 4:40pm on 09 Jun 2009, sensiblegrannie wrote:

    Let us hope that all of the mums drag their children to the doctors to update vaccinations, MMR etc. Quite a few mums have not bothered to have their children 'done' as they feel there is no risk these days. I hate to think what the flu plus measles will do. Don't forget!
    There is also an outbreak of Polio somewhere in Africa, another bug that has not gone away. We are lucky to have free vaccines.

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  • 2. At 6:20pm on 09 Jun 2009, Nitebot wrote:

    I predict a declaration by the end of the week. It's ridiculous now!

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  • 3. At 9:33pm on 09 Jun 2009, Innocent Monya-Tambi wrote:

    Most of these categorizations and definitions are in reality guidelines; and in clinical practice we usually make decisions based on various factors, including the implication and/or severity of various disease processes. Category 5 or 6 is important but let's not get too academic. I believe the focus of WHO and governments across the globe should be to utilize all resources available and treat this as if it were a pandemic. Guidelines may have to be altered in both hemispheres; but more especially in the southern with the flu season upon them. In the end the most important question is not so much as to how well defined the disease is (an important question, don't get me wrong) but a simple question of how many lives we save. We cannot afford to wait for a future retrospective study to confirm our failings now; we must be proactive in order to avert a global catastrophe.

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  • 4. At 10:35pm on 09 Jun 2009, regulo6 wrote:

    I am finding this whole thing quite difficult. As a human being, I tend to think that moving to phase 6 will be a difficult move. I think that it would send people into panic mode for something that appears at the moment to be a mild illness - but as a mother, I am struck with alarm when I hear a school only 1 mile from me has closed due to a confirmed case. The problem here is the mixed message - if it is such a mild illness why does a school have to close for seven days because of one confirmed case? I understand fully the reasons - containment of the virus, make sure that it does not spread, but as a mother, I cannot help but have the (irrational) concern - I don't want my family to get it!
    However, I am (at the moment) convinced that the authorities are doing all they can to protect us. My other concern is that my daughter is now almost compulsively obsessed with hygiene (and no, it is not me - we discuss things but I am not myself an obsessed hygenist!) continually washing her hands - and I think that has come from the whole Flu information campaign - not a bad thing but children can fret about things like this. I really hope that things will settle down, and the media do seem to have dropped it as a front page issue, but we must accept that these days we are lucky enough to be very well informed - but - better the devil you don't know?..................

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