H1N1... an update

Its tough to call this an update, since I haven't commented on H1N1 (aka Swine Flu) online yet, but I'll call this an update, since we're all aware of its presence. Our awareness has begun to pick up recently thanks in part due to the recent spike in activity. In fact, it seemed that last weekend, an explosion of activity, at least from my vantage point in North Texas, commenced.

I had a niece, a cousin-in-law, some friends of my family (their children specifically) and a few others report having swine flu or influenza-like-illness (ILI - as termed by the CDC) all within the last week. This sudden increase in activity is correlated to an increase in reports from the CDC as shown on this chart: (Note-- these figures are based off of serious cases that require hospitalization as a percent of visits.)

Source: CDC (Posted September 25, 2009, 1:30 PM ET, for Week Ending September 19, 2009)

Apparently, for this time period, nearly 99% of people in the US who have the flu have tested positive for H1N1. (See chart below.) So, what this all boils down to is that if you get the flu, chances are you've got swine flu. The same is true for most of the globe, except for most of Africa and parts of the Middle East where the regular flu outpaced H1N1 by a 3:1 (or greater) margin. I should point out that even there H1N1 has started to increase in activity, and I'm afraid those numbers are only going to continue their trend.

(Valid for the US)	Week 37
No. of specimens tested	9,744
No. of positive specimens (%)	2,326 (23.9%)
Positive specimens by type/subtype
Influenza A	2,324 (99.9%)
A (2009 H1N1)	1,395 (60.0%)
A (subtyping not performed)	907 (39.0%)
A (unable to subtype)	17 (0.7%)
A (H3)	1 (0.1%)
A (H1)	4 (0.2%)
Influenza B	2 (0.1%)

Source: CDC

Now, this ratio is likely going to change as the regular flu season get up and going. There are several possibilities that could make things interesting (though not in a good way) once that does happen. For one, if you get H1N1, would it still be possible for you to catch the regular flu, or is there enough of a genetic similarity to keep you immune? It makes sense that since the regular flu vaccine won't keep you from getting H1N1, then the opposite may be true. Therefore, you could get both types in the same season.

The other possibility is that the two could combine. Its hard to guess whether or not a combination of the two would make matters worse or not. It could be possible that if they combine, then the regular flu vaccine could help prevent the combo from spreading. On the other hand, it could render both vaccines ineffective, or less effective. I do want to note that my niece was officially diagnosed with both influenza A (which covers H1N1) and B. Which, that doesn't sound like a good thing (certainly neither for her nor for the higher chance of a cross mutation.) {Update: I wanted to let you know that my niece has fully recovered, and was much better after about 3-4 days. Also, her parents and sister haven't contracted the disease either (yet.)}
It would seem to make sense that the disease could mutate into multiple possibilities, but only a few of those survive to pass itself on to others. After all, its not like Mother Nature has some hidden war room, where she has a section called "Infectious Diseases" where she commands her minions, with the accent of an old evil British sounding lady, to update the H1N1 code and hit a Hong Kong poultry market with the famous "mu hahahaha" evil laugh to end her sentence. The reality is that when something, like a virus, mutates, the chances are that it does so multiple times, across the globe, with similar, though not necessarily exact, mutations. Each one of those mutations will have a different chance to survive, depending on its environment, nearby carrier agents, and so on. Its the sum of all of those chances that causes something new enough to happen that our collective immune system wouldn't recognize it.

So, my recommendation is to get both vaccines as soon as its available for you. As it is, I'll personally have to wait until after just about everyone else, since I'm older than 24, younger than 60, male (therefore not pregnant ;-) ) and I don't have frequent contact with children.
My prediction: expect H1N1 to peak in the US around Thanksgiving (due to having already spread itself rapidly, combined with the release of a vaccine coming in October.) This will be just in time for the beginning of the regular flu season. The regular flu season will be less active than normal, thanks in part due to the awareness of the public leading to a higher percent off people getting their flu shots. Globally, things may not be so rosy, especially in developing countries, like in Africa and SE Asia. The one saving grace there is that most of the people that live there, live near the Equator, and therefore the virus may not survive as long in the normal environment.

For further reading please see:

US CDC:
http://www.cdc.gov/h1n1flu/updates/us/

WHO H1N1 overview:
http://www.who.int/csr/disease/swineflu/en/

WHO H1N1 situation updates:
http://www.who.int/csr/disease/swineflu/updates/en/

Thanks for reading this! If you have an opinion about what you've read, please comment below!