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Swine flu deaths: What you need to know

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black_flu_580857969.jpgSwine flu deaths: What you need to know

Risk of swine flu deaths may be the ultimate concern for most people during this H1N1 flu pandemic. Becoming well informed of this risk can help people decide what preventative measures they need to take to reduce that risk.  The U.S. government has had its own assessment and has decided that people would be better off being vaccinated with H1N1 flu vaccine.  However, each individual should make his own decision to best protect himself.  To that end, it is important to understand the risk of death from H1N1 flu.

From what the United States Centers for Disease Control and Prevention (CDC) has reported thus far, it is evident that the so-called H1N1 flu is no more risky than seasonal flu; at least in some sense.  However, H1N1 flu differs from the seasonal flu in that it appears to be more active in warmer climates; it also hits the young harder.  Luckily, the overall risk of swine flu deaths is tiny compared to many other risk factors, such as highway traffic accidents and infant mortality in the first six months of their lives.

Compared to adults, children are at higher risk of dying from complications of H1N1 virus, according to the CDC.  As of Sept, 2009, the number of deaths among the U.S. children under the age of 18 years from H1N1 infection has increased to 76, with 19 deaths reported in the past week, according to Anne Schuchat, M.D., Director, National Center for Immunization and Respiratory Diseases for the CDC.

Of the 19 deaths, two were reported in Maryland, three were in Tennessee, seven in Texas and one each in Alaska, Arizona, Colorado, Florida, North Carolina, Oklahoma and Wisconsin. Of these deaths, 16 were associated with H1N1 flu while the subtype of the remaining three was undetermined.

The CDC has not released any information regarding the disparities of H1N1 flu among different ethnic groups in the past month. This information is important because it helps people to have a clear picture of the risk these groups are facing.  

Based on the detailed report of the first 36 pediatric deaths from H1N1 published in the Morbidity and Mortality Weekly Report for the week ending Sept. 9th it seems that the overwhelming majority of the deaths occurred in children with serious, pre-existing medical conditions.

Twenty-two, or 92 percent, of the 24 children with high-risk health conditions who died between April and August inclusively had neurodevelopmental conditions e.g. developmental delay or cerebral palsy, the CDC reported.  Children with these conditions are also at higher risk of other types of flu, editorialists for the government's weekly report say. Other conditions implicated in these deaths include chronic pulmonary condition, congenital heart disease, metabolic or endocrine condition, immuno suppression, and multiple neurodevelopmental conditions. Of the remaining 12 children, ten children's health conditions were not reported and two were obese. Of the ten children with no high-risk helath conditions reported, eight children got co-infected with another pathogen.

Of the 23 children who had received culture or pathology tests, 43 percent were found to suffer bacterial co-infections. This observation suggests that people with the viral infection should try to avoid secondary infection; that is, getting infected with bacteria and other types of viruses. The likely pathogens associated with flu include S. aureus, S. pneumoniae, and S. pyogenes, according to the report.

From the MMWR report, a couple of observations were noticed:

1) Hispanics and Blacks are at higher risk. Of the 36 deaths reported earlier, 18 of the victims were either Black or Hispanic; both are minorities in the United States.  This observation prompts us to raise the question: why are these minority children at higher risk for the swine flu deaths and flu infection in general?

2) Antiviral treatment commonly with Oseltamivir did not seem to help reduce the risk of swine flu deaths.  Treatment received after 2 days of illness onset appeared to be particularly ineffective at reducing the death risk. Of the 36 children, 16 had received flu treatment compared to 12 who did not receive treatment.

There is no answer to the question of why children, particularly Black and Hispanic children and children with neurodevelopmental disorders are at higher risk of the death from the 2009 novel H1N1 virus.  The CDC does not seem to have a clear answer for this.  One convenient explanation circulated in the media is that children have not acquired immunity through previous exposure to similar flu strains.  That sounds like a reason, but evidence has emerged that lack of previous exposure to certain flu strains may not be the only reason. Why?

Vitamin D Theory

John Cannell, M.D., a vitamin D expert and president of Vitamin D Council suggested in his monthly newsletter released on Sept 5 that vitamin D deficiency may be the X factor for the elevated risk of pediatric deaths from H1N1 flu and possibly other types of flu as well.  

Why should vitamin D be so important?  Cannell and his colleagues have thoroughly reviewed previous studies in a virology journal and concluded that infection of all types of influenza is associated with the lack of sun exposure; in other words, having low serum vitamin D levels.  Previous studies have shown that sufficient levels of this nutrient are needed for cells to produce antibacterial peptides that are involved in the so-called innate immunity against flu viruses.

Cannell said neurodevelopmental disorders such as epilepsy, cerebral palsy and mental retardation are all associated with childhood vitamin D deficiency.   Children with these conditions tend to stay indoors and when they go out, they may use sunblock to prevent the skin from being exposed to sunlight, both leading to vitamin D deficiency.  That is possibly why children with these health conditions are susceptible to severe H1N1 flu complications.

The Vitamin D theory can also be used to explain why Blacks and Hispanics are at higher risk for the H1N1 flu.  Hispanic and Black children, actually more than the majority of children in other ethnic groups alike are likely vitamin D deficient.  Darker pigmentation is one of the reasons these children tend to suffer from vitamin D deficiency.

Can we use vitamin D to prevent H1N1 flu or H1N1 flu death?

Again, Cannell has reported on Sept 16 in his newsletter that two physicians, one in Wisconsin and the other in Georgia, suggested that vitamin D supplementation can be the key to H1N1 flu prevention.

Norris Glick, M.D. of Central Wisconsin Center in Madison told Cannell in his email that 274 residents at his health care facility took vitamin D supplements and were monitored regularly for their plasma vitamin D levels; as a result, only two residents developed influenza-like illness and had positive tests for H1N1 during a period of observation. This compares to 103 of 800 staff members during the same period who were not required for the supplementation. This huge difference may be due likely to use of vitamin D supplements.

Dr. Ellie Campbell, who also responded to Cannell's vitamin D theory, told Dr. Cannell in an email of a similar observation.   She said she told her patients to take 2,000 to 5,000 IU of vitamin D regularly and monitored their serum levels to make sure her patients had sufficient Vitamin D in their blood.  Campbell shared office with another physician. Her office mate did not do the same thing to his patients.  When H1N1 hit George, none of her patients came to see her for H1N1 virus infection while the other physician was seeing one to 10 cases per week of influenza-like illness.

Can vaccination help protect against H1N1 flu?

The CDC has made it clear that the swine flu vaccine is the best way to prevent H1N1 flu.  The Food and Drug Administration has approved four H1N1 flu vaccines.  One troubling fact about these vaccines is that the number of subjects in clinical trials is quite small (a couple of thousand) and the subjects ARE healthy. What this means is that we do not know how much these vaccines could help SICK children or children with high-risk health conditions.

It's fair to say most healthy children do not need any medical intervention and can recover from the H1N1 flu in a natural way.  Polls have revealed that the majority of Americans believe that H1N1 flu is just another flu virus and the risk it poses is similar to that from seasonal flu.  Surveys found only 40 percent Americans said they would definitely get H1N1 flu vaccine and about 43 percent or so of parents said they would give  their children the flu shots, even though the CDC has repeatedly said that the vaccines are safe and has urged All Americans to get vaccinated.

Getting infected with this mild form of H1N1 virus actually may be a good thing for HEALTHY people.  Cannell said that Blacks and Hispanics were less likely to die from the Spanish flu pandemic because many of them had exposed themselves to similar yet less virulent strains, possibly because of their vitamin D deficiency before the Spanish flu pandemic that was caused by an unusually virulent and deadly influenza A virus strain of subtype H1N1.

Should we worry about the risk of swine flu deaths?

The United States has reported at least 3,873 deaths from complications associated with flu, primarily the H1N1 virus, including at least 28 pregnant women, the Washington Post reported on Oct 10.  The risk of the swine flu deaths is relatively tiny compared to other causes of death.

In the U.S. about 30,000 infants younger than 6 months or 0.6 percent infants in that age group die each year from all causes. According to the U.S. Department of Transportation's National Highway Traffic safety Administration, 43,200 people died from motor vehicle traffic crashes in 2005.


By David Liu - davidl at foodconsumer.org, and editing by Rachel stockton - rachels at foodconsumer.org



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