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WHO Confirms Sustained Swine H1N1 Transmision in Humans
Recombinomics Commentary 23:53
April 29, 2009

Apr 27, 2009 (CIDRAP News) – The World Health Organization (WHO) today raised its official pandemic alert level from the current phase 3 to phase 4 on its 6-phase scale, saying the newly identified swine influenza virus has made a pandemic more likely but not inevitable.

The above comments describe the phase increase from 3 to 4, which left little doubt that the phase would be raised to 6 within a few days because of the spread of H1N1 swine flu out of Mexico (see updated map).  The earlier definitions used sustained transmission as the definition of phase 6.  This change was due in part to limited human to human transmission of H5N1. The repeated reports of smaller clusters dictated a change from 3 to 4, but such a change was linked to significant increases in pandemic preparedness.

The new definition, that required sustained transmission, made it clear that the progress of phases from 4 to 6 would just be a matter of days as noted in yesterday’s lengthy interview.

The pandemic is quite predictable, as detailed in the video above, has much in common with the 1918 outbreak, including the start in the late spring as a mild infection, the targeting of previously healthy adults, and the origin as swine H1N1.  Over the summer the swine H1N1 will proliferate in the southern hemisphere and recombine with H1N1 seasonal flu, leading to a much more virulent H1N1 in the fall.

Active surveillance and the developing a vaccine that targets the predicted product is critical.  Tamiflu resistance will almost certainly develop in swine H1N1, leading to a heavy reliance on a well matched vaccine.

The CDC has been quickly released swine H1N1 in humans.  Similar release of seasonal flu H1N1 in the southern hemisphere, as well as the private swine sequence database maintained by WHO consultants should also be made public immediately

Phase 6 should be announced within the next few days.

It is time for serious vaccine targeting of emerging sequences.

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