Tom Nolan: Swine flu estimated to be 100 times more virulent than seasonal flu

PLOS Currents: Influenza is a journal with a difference. Mixing features of a journal with those of blogs and discussion forums it’s bound to ruffle some feathers. It describes itself as “a moderated collection for rapid and open sharing of useful new scientific data, analyses, and ideas.” Contributions are not peer reviewed other than for intelligibility, relevance and suitability. You can rate and comment on submissions and see how many other people have read them. Is this the future of research or a dangerous drop in standards? Either way, there are some interesting (and not-so interesting) things there. The most read knol (as the research is called, because it uses Google Knol’s community review function) is called “First estimation of direct H1N1pdm virulence.” It looks at incidence of ARDS due to swine flu in New Caledonia and Mauritius. The researchers suggest that infections resulting in ARDS can be used as a surrogate for the virulence of flu.

The direct lethality due to viral pneumonia gives probably the best estimate of influenza strains’ virulence, since it may vary from strain to strain, and is not due to the level of health development of a country. Furthermore, ARDS always leads to ICU, and is easy enough to diagnose and to report.
They estimate that the direct lethality of swine flu influenza is 1 in 10,000 infections, 100 times more than in seasonal influenza. But how much can we trust these results without peer review? In the comments that accompany the knol, the accuracy of this figure is challenged, but is that enough?

Vaccine update
Will the H1N1 flu vaccine be one dose or two? The Department of Health have said all along that they expect that two doses will be needed, but some manufacturers are claiming that only one will be necessary. Two of the six vaccines being reviewed this week by the Chinese health authorities for approval are single dose vaccines, their manufacturers saying that their evidence shows them to be effective with only one dose.
New guidance on vaccinations for pregnant women has been issued by the Centers for Disease Control.  It answers a variety of questions including one common one, that has been asked on this blog: ‘what safety studies have been done on the 2009 H1N1 influenza vaccine and have any been done in pregnant women?’

A number of clinical trials which test 2009 H1N1 influenza vaccine in healthy children and adults are underway. These studies are being conducted by the National Institutes of Allergies and Infectious Diseases (NIAID). Studies of 2009 H1N1 influenza vaccine in pregnant women are expected to begin in September.

Sneeze into your Elmo
President Obama and his administration have teamed up with Elmo from Sesame Street to tell the public how to prevent the spread of swine flu (apparently Miss Piggy was busy). Elmo is seen hugging US Secretary for Health and Human Services Cathleen Sebelius on one of a series of adverts. Sebelius wants you to cough and sneeze into your elbow. “Cover your sneezes with your sleeve, not your hands,”says Obama. Millions of Americans are now walking around with snot hanging from their sleeves and elbows, but at least they’re not spreading swine flu. How long will it be before we see Andy Burnham and Sir Liam Donaldson joining forces with Bob the Builder and Basil Brush?

Tom Nolan is a trainee GP in London.