2009 H1N1 pandemic influenza for dialyzors: Update – Outlook

Cross posted from my blog:

I have a H1N1 Pandemic flu article (or download a PDF version) up on Home Dialysis Central (HDC) in advance of the HDC H1N1 webinar presentation I'm giving on Wednesday September 23 (8PM Eastern/5PM Pacific). Take a look and let me know your questions so that I can be sure to address them on Wednesday.

Here is the article:

2009 H1N1 pandemic influenza: Update – Outlook – Preparedness
By Bill Peckham

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This year, besides the seasonal flu, we face a new flu virus that has already spread around the globe. You can take steps to protect yourself and your loved ones from both types of flu. About influenza Influenza, or "flu", is type of virus that affects birds and mammals and can spread to people. In humans, there are two main types of flu: A and B, and both can circulate at the same time. Type A and B flu causes seasonal breakouts nearly every winter.

Type A flu viruses are divided into subtypes based on two proteins on the surface of the virus:

Hemagglutinin (H)
Neuraminidase (N)

Viruses spread by taking over cells in the host's body. The H protein is like a 'key' used by the virus to get inside the host cell. Once inside it can take over the cell and produce more virus. The N protein is the 'key' used by the virus to break out and spread once it has reproduced.

There are 16 H proteins and 9 N proteins.¹ In theory, any H protein can combine with any N protein to form a new subtype of flu. In practice, most type A flu in humans is caused by the subtypes H3N2 or H1N1.² These are the two seasonal flu subtypes we have faced in recent years.

Flu subtypes can be further broken down into strains. Right now, we have two strains of H1N1, a seasonal strain and the new strain: pandemic H1N1. Pandemic H1N1 virus bears little resemblance beyond its name to the seasonal flu. It is a new combination of bird, human, and swine viruses.

We have all been exposed to the seasonal H1N1 virus over the years. But, the pandemic H1N1 strain is novel: it has changed enough that our immune systems can't recognize or effectively fight it.

All flu viruses—and, so, all flu seasons—are unpredictable. The novel H1N1 virus is the first novel flu strain in more than 40 years. Since most of us have no immune protection against this new virus, it has spread very quickly. Within two months of its first appearance, the World Health Organization (WHO) declared a pandemic: a global outbreak.³

Update
Unlike a "normal" year, this year we had H1N1 flu through the summer. Now with schools starting, we're seeing more cases. Places where schools started in August—ILINet Region 4 (FL, GA, AL, NC, SC, TN, KY, MS)—are seeing the largest numbers of cases. In other regions, cases are declining or increasing slowly.⁴

The novel H1N1 flu is causing severe illness. The Centers for Disease Control and Prevention (CDC) note: "To date, most severe cases and deaths have occurred in adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older."⁵ The CDC and WHO warn that pandemic H1N1 poses an extra risk for those with health problems—like chronic kidney disease (CKD).⁶ If you are on dialysis or have a transplant, take steps to avoid this year's flu.

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I can't seem to get the articel to format correctly and have to run off to work
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