A recent article  in the Washington Post detailing criticism of the World Health Organization’s handling of the H1N1 (swine) flu pandemic, suggests that “much ado was made about nothing” and that the WHO was unduly influenced by drug manufacturers who stood to gain from widespread panic over the spread of the novel H1N1 virus.

Yet in a separate, sparsely circulated news article released last week, India reported that the number of swine flu cases jumped dramatically in June.  During the week of June 8-14, the country recorded 168 H1N1 cases with 14 deaths.  In comparison, from June 21-27, there were 345 new cases of H1N1 flu with 17 deaths. Somewhat alarmingly, the virus appeared in parts of India that were minimally affected last year. 

The news from India came at a time when over 25% of the H1N1 vaccine produced last year for the United States, a staggering 40 million doses worth over $250 million, was destroyed because it had expired.  An additional 30 million doses will likely also expire without being used.  If added to the 40 million doses slated for destruction this week, it means that almost half of the vaccine produced for the U.S. will have gone to waste. 

Despite unprecedented publicity by the World Health Organization, and an international campaign to encourage immunization against the novel H1N1 virus, a vast number of people remain unimmunized against H1N1.  Should we be concerned?  If the recent news out of India is any indication, H1N1 has not gone away and may become front page news once again in the coming flu season, typically late November thru March.

Scientists cognizant of the Spanish flu timeline from early 1918 until 1920, during which time three separate strains of the influenza virus emerged – with the second being the most deadly – are quick to point out that the novel H1N1 virus from last year could easily mutate and cause widespread devastation in an unimmunized population. Should this occur, the waste of millions of unused vaccine, and the consequential reluctance of manufacturers to mass produce any more doses, could have catastrophic consequences in the months ahead.

Travelers should keep in mind that it is flu season in many parts of the world, and that those travelling to the Southern hemisphere in particular should pay close attention to regions reporting increased H1N1 activity.  Ask your physician about obtaining the H1N1 vaccine, particularly if you are pregnant or have a chronic illness such as asthma or HIV/AIDs.  Criticism of the World Health Organization notwithstanding, it is still premature and historically unjustifiable to write off the novel H1N1 pandemic as a fabrication for the benefit of vaccine manufacturers.

Photo by Jeremy Brooks

Prompted by allegations that the swine flu pandemic was oversold to promote vaccine sales, researchers at the National Institutes of Health in Bethesda MD have released their assessment of the mortality associated with the H1N1 virus in the U.S during the past flu season. In their own words:

“We conclude that the 2009 A/H1N1 pandemic virus had a substantial health burden in the U.S. over the first few months of circulation in terms of years of life lost, justifying the efforts to protect the population with vaccination programs. Analysis of historic records from three other pandemics over the last century suggests that the emerging pandemic virus will continue to circulate and cause excess mortality in unusually young populations for the next few years.”

Relying on the fact that the average age of an H1N1 victim (37) is far younger than the average of a typical seasonal flu victim (76), researchers calculated that in the U.S. H1N1 cost nearly 2,000,000 years of life versus 600,000 for the seasonal flu.

In an interview with New Scientist magazine, researcher Lone Simonsen warns that most people killed in the 1968 pandemic died in its second wave, and advises vaccination. It’s autumn now in the southern hemisphere, and H1N1 is returning. We will keep tracking its progress for our globally mobile readership.

The flu season in the northern hemisphere has reached its midpoint, and the latest news suggests that the H1N1 outbreak has peaked in most if not all countries. Among the 208 countries where H1N1 has appeared, peak intensity persists in Poland, Serbia, Georgia and Ukraine. H1N1 vaccine is now widely available in the U.S., and many countries in western Europe are cancelling orders for additional vaccine because a single dose has been found to be effective. It’s likely there are continuing vaccine shortages in many developing countries, so travelers to these destinations should not expect to have access to the vaccine while abroad. It’s no surprise that manufacturing and distributing vaccine on a global scale at “break-neck speed” has produced widespread delays and surpluses and shortages.

If you haven’t had a shot, it’s still worth considering (especially if you are under age 30) as world health authorities warn that another wave of H1N1 remains a possibility. Plus, immunizing today is likely to give you some level of protection against related strains in years to come. Of course, everyone always needs to weigh the risks of side effects. Our species may weather this season’s attack without enormous social disruption and loss of life, but we’ve certainly been reminded that luck often outweighs all our furious efforts to protect ourselves.

The news from the Centers for Disease Control (CDC) this week is encouraging.  It appears that H1N1 activity has temporarily peaked, with 43 states reporting widespread activity (down from 46 last week).  However, the CDC also cautions that the numbers could pick back up after the holidays when the seasonal flu usually takes off.  In an effort to remind people to take steps to prevent their chances of catching anything,  the CDC has launched the Travel Health Campaign–posters,  e-cards and specific information for those studying abroad during flu season.  In addition, flu.gov offers several widgets that can be distributed to help spread the word.

In case you are traveling this week, here is the WHO’s worldwide situation update indicating disruption of healthcare services due to the flu.    

Hopefully anyone with flu-like symptoms will stay homes holiday, but in case they don’t, here are some tips to protect yourself.  Wash your hands frequently, keep your hands away from your eyes and face and avoid contact with anyone who appears to be sick.

Happy travels!

In H1N1 news this week:

Freakonomics charts how H1N1 has impacted this year’s flu season.

The Wall Street Journal blog offers perspective on the number of H1N1 cases reported so far this year. 

New Scientist offers a point to ponder in their article suggesting that the common cold has helped tame “the swine” in Europe.

If this news has you looking for the vaccine, Google is ready with a new tool in their flu trend arsenal:  the flu shot finder.

And if you are sick, but can’t decide if it’s a cold, the seasonal flu or H1N1, consult this chart and analyze your symptoms.

As always, for a global report on H1N1, visit with the WHO.

When the news broke that 2,500 schools in Iraq have been closed in response to H1N1 outbreaks, we couldn’t help thinking how susceptible we all are to headlines, sound bites and video clips. As H1N1  washes over the northern hemisphere, we have some friendly advice: Instead of just tuning into the news, tune into the facts via the resources that the U.S. Department of Health and Human Services has compiled.  Flu.gov is a hype-free site full of valuable information and answers to your questions, such as “Can a cockroach carry the H1N1 virus?”

Maybe your seasonal allergies are affecting you differently than they did last fall; maybe you’ve been sprayed with H1N1 via the coughs and sneezes of a germ-spreading co-worker; or maybe, you just don’t feel well.  In an effort to help those who are concerned that they may be infected with H1N1, the Department of Health and Human Services has added an online self-evaluation to Flu.gov.  This may be a better alternative than risking sitting next to someone who actually does have it (or some other contagious ailment) while sitting in your doctor’s waiting room. 

In just a few questions, this Severity Assessment will let you know if you probably do or probably don’t have the flu and will offer you advice on getting further treatment. 

Do you think this is an effective way of triaging flu victims?

The H1N1 news this week provided some tech news, entertainment, and reassurance:  Google is taking advantage of its view from the top of the world to map the global flu trends; the Dalai Lama has adopted the fist-bump; and according to recent reports, only a small number of people infected with H1N1 are getting really sick from it. 

Google explores flu trends around the world.  

Who’s on the “fist bump” bandwagon? 

Most people who get H1N1 don’t require serious medical treatment.

What was your favorite story this week?

Recent articles, like the one that ran last Friday in USA Today, explore trip cancellation insurance benefits in relation to the H1N1 flu and along the way create the potential for some misunderstandings. To sort out the subtleties, HTB takes a look at a typical product — TripProtector from HTH Worldwide.

The pandemic exclusion clause contained in the TripProtector plan applies strictly to trip cancellation, trip interruption or travel delay benefits. If a member feels threatened by pandemic flu and decides to cancel her trip prior to departure or to cut her trip short, the policy does not cover the associated travel expenses. Or, if a member’s travel is delayed because of circumstances arising from the pandemic, the policy does not cover the associated travel expenses. But if that person becomes ill while traveling, with H1N1 or any other pandemic infectious agent, TripProtector covers the associated medical costs, including evacuation for medical treatment, if necessary.

By definition, pandemics affect a large swathe of the population, so many trip cancellation carriers anticipate a potential avalanche of claims related to H1N1. Some carriers have decided to take this risk; others have not. We are not aware of any policies that exclude medical treatment for pandemic flu while you are traveling.

Here on the Healthy Travel Blog, we’ve been talking about H1N1 readiness and flu prevention when traveling overseas.  And for good reason.  The “swine flu” is the first pandemic in 41 years and all Americans should be educated about H1N1 both domestically and when traveling out of the country.

A recent poll administered by HTH Worldwide indicates that more than one-third of international physicians are anticipating a shortage of the H1N1 vaccine this fall in their country.  This is certainly not the best news for those who regularly travel abroad, or are overseas for the semester.  These health care providers also dispelled the idea that production of the H1N1 vaccine would interfere with regular production of the seasonal flu vaccine.  Fortunately, about two-thirds of the doctors polled say they expect an adequate supply of seasonal flu vaccine in their country this year.  Unfortunately, physicians from developing countries are more pessimistic, expecting shortages of both vaccines.

Despite concerns over potential shortages, physicians are preparing themselves to care for more patients this fall.  Nearly half of respondents in adult primary care and pediatrics reported increased preparations to treat larger numbers of patients with seasonal flu and H1N1.  These doctors are increasing office hours and staff personnel and accepting patients without appointments.

Who responded to this poll?  English-speaking, international HTH physicians from more than 50 countries like the United Arab Emirates, Thailand, Belize, France, Argentina, Egypt, China, Croatia, India, Pakistan, Spain, Japan, Peru, Brazil, Tunisia and Vietnam, to name a few.

This survey shows that international doctors are taking both seasonal influenza and H1N1 very seriously.  Only time will tell if there is enough of both vaccines, but the medical community is preparing to help more patients than ever.  The majority of respondents are advising patients in their areas who believe they are infected with H1N1 to schedule an appointment with a private physician or visit a public health facility designated specifically to treat those with H1N1. 

If you are an HTH member traveling overseas and think you may have influenza or H1N1, contact HTH to schedule you an appointment with a local, pre-qualified doctor who speaks English.  And you won’t have to worry about paying for your treatment out of pocket.

This is the first glimpse we’ve offered of what international physicians are thinking in terms of preparing for both common influenza and H1N1 treatment this fall.  We will continue to track this issue in an effort to best prepare and educate our customers and readers.