What happened to Swine Flu?

After all the media coverage of Swine Flu had died down, I thought it would be appropriate to have a look at the current status of the Influenza H1N1 pandemic.

Once I got hold of the relevant data, it was clear that H1N1 had two major peaks in terms of cases in India, one was in mid September, 2009 and another in late December, 2009. There after the incidence of new cases has diminished considerably though still occurring.

In the last update of WHO that I could get hold of, 18097 deaths have been reported from over 214 countries. This was on 16^th May 2010.

In India, as of 11^th May 2010, there has been 31837 lab confirmed cases, with 1511 deaths. The highest number of cases occurred in December 2009. 7708 lab confirmed cases with 382 deaths. The overall case fatality rate in India is 4.75%.

Now with the data available, I did some calculations.

Month	Cases	Deaths	Case Fatality Rate
September 2009	6017	177	2.94%
October 2009	3464	140	4.04%
November 2009	4290	96	2.23%
December 2009	7708	382	4.96%
January 2010	1917	245	12.78%
February 2010	847	121	14.29%
March 2010	545	81	14.86%
April 2010	400	42	10.5%

As we can see, there has been a jump in the case fatality rate since December 2009 though the number of cases has decreased considerably. What may be the cause of these? As of now, I could not find any answers. May be I have to search a lot more.

There have been 289 cases of oseltamivir resistant H1N1 influenza as reported by WHO till 12^th May 2010. Now that’s something every one should watch out for.

Sources:

1. Situational Update on H1N1 http://mohfw-h1n1.nic.in/documents/PDF/EpidemiologicalTrendsInIndia.pdf
2. WHO-Pandemic Influenza H1N1 update 101 http://www.who.int/csr/don/2010_05_21/en/index.html
3. Consolidated status of Influenza A H1N1 11^th May 2010 http://mohfw-h1n1.nic.in/documents/PDF/SituationalUpdatesArchives/may2010/Situational%20Updates%20on%2011.05.2010.pdf

Pseudo-scientific application of medicine

To start off the blog let me recount some thing I read in the newspaper a few days back. It was T2, the supplement with The Telegraph. An article was published to help inform the public on "How to rev up your immunity to beat the heat". 

Frankly, I have not come across such pseudoscience in a long time. Forgive me for my ignorance but I didn't knew that the immune system can beat the heat. I had the belief that the temperature center of the hypothalamus (remember its a part of our brain) was responsible for keeping us cool. So I thought I was terribly misinformed or may be my memory was failing me. I opened my long neglected Physiology book. It turned out that my belief was correct. The hypothalamus does keep us cool, not the immune system.

Now what can we expect from an article which got its tagline horribly wrong?

Let me enumerate:

1.  Too much sugar is bad for immunity.
2.  Large, fatty meals are bad for immunity.
3.  Vitamin C is an antiviral.

Nothing can be more illogical. Sugar is bad for immunity? Okay, so having sugar and not washing your mouth does cause tooth decay but depressing the immune system? Thats a bit stretching the concept. The more scientific pseudo-scientists might say "Hey, infections are more common in diabetics. Don't you know?". Well what can i say, the article did not mention it was for diabetics, it was for normal people. May be as it decreases the immunity, we can give sugar to patients with rheumatoid arthritis, or what ever other diseases that are caused by over activity of the immune system? It would be a great cure, would not it? Cure arthritis by having sugar. But sadly it does not work.


Large, fatty meals are bad for immunity- for it I had to do a bit of research. Fat is linked to metabolic syndrome, diabetes, coronary artery disease, hypertension, stroke and what not but infection? That was a first. But wait, a study actually found docosahexaenoic acid (DHA), eicosahexaenoic acid (EPA) (these are omega 3 fatty acids) to actually increase the immune response. It is given in Pubmed http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696230/?tool=pmcentrez. Now I am not suggesting that we should go and eat large, fatty meals. I'm just not sure if it decreases the immunity.


Last but not the least, Vitamin C. I just love the way people talk about its antioxidant properties, how it fights bad free radicals. Well Harrison's Principles of Internal Medicine, 17th edition tells that Vitamin C might slightly decrease the duration and symptoms of viral upper respiratory tract infection. Thats might and slightly. It certainly does not have any preventive properties as suggested in the article.

The icing on the cake is about Vitamin C. "Viruses cannot survive in a Vitamin C- rich environment, making it an incredible antiviral agent". It makes me wonder. If its so, then how come so many people still die of AIDS?