Tag Archives: influenza porcina

AH1N1 in Chile, a Scientist’s Perspective

A few days ago, a Chilean biologist commented on an earlier post in this series (see the original discussion here) and I asked him if he would be willing to answer some questions from a scientist’s perspective and in a way that would go beyond the official statements issued by the Ministry of Health.

Pablo Astudillo, the biologist behind Astu’s Science Blog, agreed and here is our interview.

MS: My understanding is that the disease was originally thought to be the same Swine Flu that is commonly passed among pigs, but that the name has been changed to AH1N1 because it is in fact a human virus (from what I have read, only human viruses are classed as Type A and are not transmitted between humans and animals). Your comment left me wondering if it is a case of the same virus adapting/mutating from animal to human, or is it a case of more advanced research revealing that it had been misidentified originally?

PA: OK, from the beginning… The AH1N1 virus did not originate from humans or birds. This virus was born from a succession of events that allowed genetic material to be recombined (which means, in laymen’s terms, that several pieces of DNA are “copied and pasted”). These events can happen in many organisms in which two or more viruses are able to enter. Pigs have this characteristic; they present two specific receptors in the tracheal epithelium cells that are recognized by human and avian influenza viruses.

The AH1N1 virus originated in pigs in such a way, but was then transmitted to humans. This has been happening for a long time, and it is believed that events like this have been responsible for many pandemic influenzas, including the Spanish flu in 1918.

In theory, the AH1N1 virus can infect ANY animal with receptors that are able to recognize the virus in cells from the tracheal epithelium. I don’t know if cats and dogs have these receptors. One myth that has to be corrected is: this virus is not new… it is evolving constantly.

MS: You said that the majority of cases in Chile are asymptomatic… so how were they identified? If the flu produces no symptoms, is it dangerous? What is the greater concern about the transmission of asymptomatic diseases? Along the same line, will contracting the virus allow the person to develop immunities for a worse or related case of the flu?

PA: I am not familiar with the clinical features of the AH1N1 influenza, but some things can be discussed. As soon as Chile’s health authorities identify a person with AH1N1 influenza, they contact the relatives and friends who have been in touch with the infected person and run tests to determine whether they are positive for the virus. That’s why we have many positive asymptomatic cases.

The greater concern to authorities is, obviously, the public impact of having too many cases, especially when we are a few months from a presidential election.

For medical doctors, the concern is having an overloaded public hospital system. Santiago’s winter season is complicated; the cold, the viruses and the pollution create a scenario where many old people and children die from pulmonary diseases.

To scientists, the concern is with respect to the opportunity of the virus to evolve and develop a new mutation that can be dangerous to humans. Nonetheless, some evolutionary biologists claim that such viruses are quickly eliminated from the ecological niche because they kill their hosts. However, if a virus produces more than a cold and fever, obviously we have to be prepared.

Finally, indeed, becoming infected with this virus will allow humans to produce antibodies that can be useful in future infections. But if a new strain of the virus harbors a mutation in the protein recognized by the antibody produced, the said antibody is useless.

MS: You said the index case is the small boy with no known direct exposure. What does “index case” mean in laymen’s terms? What is the scientific concern here? From what I have read, flu viruses are transmitted through airborne contact; could he simply have sat next to the wrong person on the bus? Or are they concerned that there is another form of transmission that is not understood?

PA: In this case, the “index case” refers to the first patient identified. The virus is transmitted through contact, from saliva, sneezes, kisses, etc. But you should ask a medical doctor for detailed information. The virus does not fly through the air. I mentioned the concerns above.

MS: You say the public health system “claims” we are ready… do you agree? It sounds like you have your doubts…

PA: At this point, that question is irrelevant. We have 199 confirmed cases, making us the 5th country in the world** with more cases of AH1N1 influenza. The system claimed that “we are ready,” but the explosive increase in cases says otherwise. [**At the time this was posted, Chile had just dropped to 6th place.]

MS: Why, in your opinion, does Chile have so many cases? Apparently we are number 2 behind Mexico in Latin America. I wonder how much has to do with (1) more travel means more exposure (although I have no way to prove that Chileans travel abroad more than other Latinos), and (2) how much it has to do with more advanced methods of identification….

PA: Well… The authorities claimed that we had suffered the same as New York: we had infected children in schools. Children are more exposed to other children while in class, playing games, going to parties, etc. That explains the explosive increase in positive cases. The parents and relative of those children then quickly became infected.

In fact, a few days ago the authorities said that around 75% of the cases were children related with the outbreak in schools of Vitacura, Santiago. But with 199 cases, it is more difficult to establish relationships. My guess is that it has nothing to do with Chilean people traveling more often than other South Americans.

About the identification methods, one thing that Chilean authorities claimed was that we have more advanced and faster methods for detection of the virus. That’s a political lie. The diagnostic method is simple, fast, reliable, and, above all, a standard procedure in every university with biology or molecular biology laboratories. Claiming such a thing is not only a lie, but also a vain way to explain the irresponsibility of the authorities. As soon as the first cases were detected in schools, the authorities should have suspended school activities.

The Original Posts for Swine Flu in Chile:

May 28, 2009: AH1N1 (Swine Flu) in Chile: Update Part 4

May 22, 2009: Swine Flu in Chile Part 3: Update on Chile

April 29, 2009:  Swine Flu in Chile Part 2: Update on Chile

April 28, 2009:  Swine Flu in Chile Part 1:  So far, so good

AH1N1 (Swine Flu) in Chile: Update Part 4

A month ago we here in Chile thought we were in good shape. As the numbers of AH1N1—then called Swine Flu—soared in the US and Mexico, Chile remained flu-free. How things change in a month’s time.

The latest update from the Ministry of Health (6PM on Thursday, May 28 ) reports 199 confirmed cases, 2 serious, no deaths. Almost all of the cases are confined to the Metropolitan Region (Santiago), and the majority those affected are school-age children with mild cases; many in fact are asymptomatic.

It is important to bear in mind that it is winter here in Chile and we are in the midst of the normal flu season. Furthermore, Santiago is prone to significantly high amounts—oh who are we kidding—let’s just be honest and say disgusting—amounts of air pollution during the winter months. We usually get some respite when it rains, but because this is an abnormally dry winter, the air quality is much worse than normal, further adding to situations of respiratory distress and apparently lowering resistance to illness.The Ministry has stated that 90% of the flu cases reported in Chile have been defined as AH1N1 and that this strain is replacing seasonal flu.

There have been no deaths to date, although two severe cases have been reported. Both patients—one in Santiago and one in Puerto Montt—are connected to artificial respirators.

The first and most widely discussed serious case is that of a 38-year-old woman who is currently in a Santiago hospital suffering from Catastrophic Respiratory Failure. The severity of systems in a woman thought otherwise healthy originally baffled the authorities, but it was later discovered that she had been following an alternative diet that involves taking Candlenut (Aleurites moluccana), also known as Kukui and Indian Walnut (Nuez de la India in Spanish). This Asian plant has been used medicinally for centuries, although it is known to have toxic properties. Ingesting sustained doses over a period of time as a diet not only lowered her caloric intake to dangerous levels (one source said 600–800 calories per day), but also altered her immune system and placed her at particular risk for this virus. The second severe case is a man in Puerto Montt who has presented bilateral pneumonia.

Latest Governmental Actions

New actions taken this week including announcing that public schools will not close their doors and that more effective hand-washing campaigns will be implemented in the schools. Liquid soap will now be provided in all school bathrooms (flip that around and the logic implies that there was no soap before… which, by the way, is not at all unusual in public places).

The health screening procedures in the airports (thermal scanners, etc.) will be removed from Chile’s ports of entry as of June 1, citing that the virus has already established itself within the country and further screening is therefore ineffective.

The World Health Organization figures as of May 28, 2009:

15,510 cases worldwide in 53 countries with 99 deaths.

Current Top 10:

US                   7927 / 11 deaths
Mexico         4910 / 85
Canada         1118 / 2
Japan             364
UK                  203
Chile              165  (**now 199)
Australia      147
Spain              143
Panama        107
Argentina      37

**The number of cases reported in the UK has recently surpassed the number in Chile, which since dropped from fifth to sixth place in reported cases worldwide.

The Original Posts for Swine Flu in Chile:

May 22, 2009: Swine Flu in Chile Part 3: Update on Chile

April 29, 2009:  Swine Flu in Chile Part 2: Update on Chile

April 28, 2009:  Swine Flu in Chile Part 1:  So far, so good

For a Related Post, see:

May 29, 2009: AH1N1 in Chile, a Scientist’s Perspective


Swine Flu in Chile: Update Part 3

This story has been updated. For more current information, see:

May 28, 2009: AH1N1 (Swine Flu) in Chile Part 4

For earlier versions, see
April 29, 2009:  Swine Flu in Chile Part 2: Update on Chile

April 28, 2009:  Swine Flu in Chile Part 1:  So far, so good

For a Related Post, see:

May 29, 2009: AH1N1 in Chile, a Scientist’s Perspective

Swine Flu in Chile Update Part 3

It was bound to happen. Chile is now among the world’s 41 countries with confirmed and reported cases of Swine Flu—excuse me—the Flu Once Known as Swine and Now Called Novel Human Influenza A (H1N1) (such an annoyingly long and fumbly name—I must admit, I much preferred the porcine moniker).

Despite the best of intentions, one of the outcomes of globalization, of living in this fast-paced jet-lagged world is that not only ideas, experiences, and consumer goods—but diseases as well—are transported much faster and much farther than ever before.

29 cases of A (H1N1) in Chile

Chile now has its first confirmed cases of the dreaded flu, all concentrated in the Metropolitan, Valparaíso, and O’Higgins Regions.

The first 2 cases were identified on May 17 when 2 women who returned from the Dominican Republic on the same flight presented symptoms. That number has since risen to 29. No related deaths have been reported.

Chile uses a special thermal imaging scanner to monitor all passengers entering the Arturo merino Benítez Airport in Santiago and identify anyone who may have a fever at the time of entering the country. According to the Ministry of Public Health, as of Thursday, May 21, some 39,600 people—passengers and crew—had been checked.

Much of the initial panic surrounding the virus has waned as more is learned about what it is and how it spreads. A (H1N1) appears to spread in the same manner as regular seasonal flu: through the coughs and sneezes of those who are infected. The symptoms are similar, but since it is a new strain, no vaccination is yet available for it and the general population has no natural immunity to it, so more people may fall ill.

The usual recommendations and health precautions still apply:

  • Wash your hands with soap and/or alcohol gel.
  • Avoid enclosed places and those with a high flow of people (what to do about planes? Subways? Rush hour buses? Easier said than done in an overcrowded city! See the Metro Crush)
  • Use disposable tissues and throw them away
  • Be aware of any health updates

Chile is currently in the midst of its annual early-winter flu season, and many people are affected by the usual run-of-the-mill cold symptoms (sore throat, stuffy or runny nose, cough) and flu ailments (headache, body ache, chills, fever, fatigue). The new virus may present all of these as well as possible diarrhea and vomiting.

The Center for Disease Control recommends seeking immediate medical attention should any of the following symptoms appear:

  • Fast or difficult breathing
  • Bluish or gray skin
  • Pain or pressure in the chest or abdomen
  • Sudden dizziness
  • Confusion
  • Severe or persistent vomiting
  • Flu-like symptoms improve but then return with fever and worse cough

If you are in Chile and suspect that you or someone close to you is sick, call
SALUD RESPONDE: 600 360-7777
before going to a health center.

INTERNATIONAL SITUATION

According to the World Health Organization (WHO)   11,034 cases of
A (H1N1) had been officially reported in 41 countries, including 85 deaths as of the evening of May 21, 2009.

The majority of the cases have been identified in the following countries:

United States:     5,710 cases, 8 deaths
Mexico:                 3,892 cases, 75 deaths
Canada:                     719 cases, 1 death
Japan:                        259 cases
Spain:                          111 cases
United Kingdom:   109 cases
Costa Rica:                  20 cases, 1 death
France:                         16 cases
Germany:                    14 cases
Colombia:                   12 cases

Out of curiosity, I wonder why Chile’s 29 cases weren’t mentioned? What other countries were left off this list?

For More Information:

– Chilean Health Ministry:  www.minsal.cl; www.pandemia.cl
– World Health Organization: www.who.int
– Center for Disease Control and Prevention: http://www.cdc.gov/
– Chilean Epidemiological Society: http://www.sociedad-iih.cl/

**See what Leigh, at Crooked Compass, wrote about her experience in the airport**

Swine flu in Chile: so far, so good

This post has been updated, see also:

May 28, 2009: AH1N1 (Swine Flu) in Chile: Update Part 4
May 22, 2009:  Swine Flu in Chile: Update Part 3
April 29, 2009: Swine Flu Part 2

For a Related Post, see:

May 29, 2009: AH1N1 in Chile, a Scientist’s Perspective

Original Post April 28, 2009: Swine flu in Chile Part 1: so far, so good

This is not the kind of post that would normally appear in Cachando Chile, but with all the furor about Swine Flu (Influenza Porcina in Spanish), this information may be useful.

The good news is that as of this writing, no cases have been confirmed in Chile. Five cases have been discarded and another 8 are being investigated. All people entering the country from Mexico and the US are being screened to prevent a local outbreak.  Like everywhere else in the world, the news is full of reports on the flu (“gripe,” pronounced GREE-pay), but I’ve yet to see any face masks on the street or any signs that daily activity has altered. Life continues as usual here in Santiago.

The US Embassy sent out a Warden Message yesterday, April 27, that included the following information:

The Government of Chile has taken measures in response to the outbreak of swine flu in the United States and Mexico. Officials of the Chilean Health Ministry have begun screening passengers arriving in Chile from the U.S. and Mexico, both by ship and by airplane, for symptoms of flu. Screening includes the use of passive infrared fever scanners.

If necessary, adult travelers arriving in the Metropolitan Region (Santiago) who are suspected of having swine flu will be transferred immediately for evaluation to¨the “Hospital del Tórax,” and minor travelers will be taken to “Hospital Calvo Mackenna,” and all travelers arriving at Regions outside the Metropolitan Region will be transferred to the tertiary care hospitals (base hospitals) in those regions.

More information on the Chilean Government measures is available in Spanish on the Ministry of Health‘s web site.