WHO pandemic definition too broad, doctor contends

[Guest guest]

WHO pandemic definition too broad, doctor contends

Infectious disease specialist suggests in article that World Health

Organization's loose definition could lead to false alarms

Stuart Paterson, Globe and Mail, Nov. 02, 2009

The World Health Organization's definition of what constitutes a pandemic is too

broad, according to an article published this week.

Gross, infectious disease specialist with the Hackensack University

Medical Center in New Jersey, has penned an editorial for the British Medical

Journal's Clinical Evidence in which he suggests that the WHO's loose definition

could lead to false alarms.

The WHO changed their definition last year, Dr. Gross said. Previously, a

" shift " in the virus would have to occur, meaning a new subtype of the virus

would have to appear in order for a pandemic to be declared.

A subtype is represented in the H and N numbers of a flu virus' name, such as

H1N1. Another example is avian flu, which is categorized as H5N1 or,

technically, as Influenza A/H5N1.

Now, with their recent change, Dr. Gross said the WHO has made the definition

too vague. " They said a new animal or human-animal strain could qualify as a

pandemic strain. That's too non-specific. " He said neither shifts nor drifts,

which are subtle changes in the virus' makeup, are mentioned specifically in the

guidelines for declaring a pandemic.

As of this year, the WHO defines a pandemic as occurring " when an animal

influenza virus to which most humans have no immunity acquires the ability to

cause sustained chains of human-to-human transmission leading to community-wide

outbreaks. Such a virus has the potential to spread worldwide, causing a

pandemic. "

Dr. Gross says the new definition could lead to false alarms and that " any minor

change, any minor drift could be considered a pandemic. "

He also pointed out that, even in a medical dictionary, the definitions for the

terms " pandemic " and " epidemic " are not clear, with no guidelines set on the

number of people who need to be affected to reach either status, and no specific

mortality rate.

In their 2009 Pandemic Influenza Preparedness and Response document, the WHO

defined a pandemic as simply " an epidemic on a global scale. "

Dr. Gross said, " H1N1 has been around for most of this century, except for 20

years mid-century, from 1957 to 1976. Nobody knows where it went, but then it

re-appeared in '76. "

He said that since 1977, H1N1 has been included in seasonal flu vaccines, along

with H3N2.

However, Dr. Gross said the current strain of H1N1 has undergone a significant

drift in its makeup, thereby making humans less resistant to it.

" A seasonal flu causes about 36,000 deaths, " he said, referring to statistics in

the United States. " The difference with what's going on right now is we have

more morbidity and mortality among young children and young adults. Usually,

it's the other end of the age-spectrum that's affected. "

The WHO pandemic document includes statistics for the three major pandemics of

the 20th century. The worst was the Spanish Flu of 1918-1919, which also

targeted young adults and killed 2 to 3 per cent of those who contracted it,

worldwide.

" Influenza is different from most other human viruses, " he said. " When you get

the measles vaccine, that lasts for a lifetime because the virus is genetically

stable. " Influenza, on the other hand, is not as stable because its genetic

makeup is split into pieces. If one strain meets another, the pieces mix

together. " When it comes out, who knows what it's going to look like? "

" We just need a better definition of all of this, " Dr. Gross said. " It's really

kind of amazing after all these years that it's not clearer. "

http://www.theglobeandmail.com/life/health/h1n1-swine-flu/who-pandemic-definitio\

n-too-broad-doctor-contends/article1348100/

[Guest guest]

Wouldn't it seem that the current H1N1 is a continuation/reemergence of the 1918

pandemic?

http://www.news-medical.net/news/20090630/Research-examines-history-of-H1N1-and-\

provides-cautionary-tale-about-the-use-of-extinct-viruses.aspx

>

> WHO pandemic definition too broad, doctor contends

> Infectious disease specialist suggests in article that World Health

Organization's loose definition could lead to false alarms

> Stuart Paterson, Globe and Mail, Nov. 02, 2009

> The World Health Organization's definition of what constitutes a pandemic is

too broad, according to an article published this week.

>

> Gross, infectious disease specialist with the Hackensack University

Medical Center in New Jersey, has penned an editorial for the British Medical

Journal's Clinical Evidence in which he suggests that the WHO's loose definition

could lead to false alarms.

>

> The WHO changed their definition last year, Dr. Gross said. Previously, a

" shift " in the virus would have to occur, meaning a new subtype of the virus

would have to appear in order for a pandemic to be declared.

>

> A subtype is represented in the H and N numbers of a flu virus' name, such as

H1N1. Another example is avian flu, which is categorized as H5N1 or,

technically, as Influenza A/H5N1.

>

> Now, with their recent change, Dr. Gross said the WHO has made the definition

too vague. " They said a new animal or human-animal strain could qualify as a

pandemic strain. That's too non-specific. " He said neither shifts nor drifts,

which are subtle changes in the virus' makeup, are mentioned specifically in the

guidelines for declaring a pandemic.

>

> As of this year, the WHO defines a pandemic as occurring " when an animal

influenza virus to which most humans have no immunity acquires the ability to

cause sustained chains of human-to-human transmission leading to community-wide

outbreaks. Such a virus has the potential to spread worldwide, causing a

pandemic. "

>

> Dr. Gross says the new definition could lead to false alarms and that " any

minor change, any minor drift could be considered a pandemic. "

>

> He also pointed out that, even in a medical dictionary, the definitions for

the terms " pandemic " and " epidemic " are not clear, with no guidelines set on the

number of people who need to be affected to reach either status, and no specific

mortality rate.

>

> In their 2009 Pandemic Influenza Preparedness and Response document, the WHO

defined a pandemic as simply " an epidemic on a global scale. "

>

> Dr. Gross said, " H1N1 has been around for most of this century, except for 20

years mid-century, from 1957 to 1976. Nobody knows where it went, but then it

re-appeared in '76. "

>

> He said that since 1977, H1N1 has been included in seasonal flu vaccines,

along with H3N2.

>

> However, Dr. Gross said the current strain of H1N1 has undergone a significant

drift in its makeup, thereby making humans less resistant to it.

>

> " A seasonal flu causes about 36,000 deaths, " he said, referring to statistics

in the United States. " The difference with what's going on right now is we have

more morbidity and mortality among young children and young adults. Usually,

it's the other end of the age-spectrum that's affected. "

>

> The WHO pandemic document includes statistics for the three major pandemics of

the 20th century. The worst was the Spanish Flu of 1918-1919, which also

targeted young adults and killed 2 to 3 per cent of those who contracted it,

worldwide.

>

> " Influenza is different from most other human viruses, " he said. " When you get

the measles vaccine, that lasts for a lifetime because the virus is genetically

stable. " Influenza, on the other hand, is not as stable because its genetic

makeup is split into pieces. If one strain meets another, the pieces mix

together. " When it comes out, who knows what it's going to look like? "

>

> " We just need a better definition of all of this, " Dr. Gross said. " It's

really kind of amazing after all these years that it's not clearer. "

>

http://www.theglobeandmail.com/life/health/h1n1-swine-flu/who-pandemic-definitio\

n-too-broad-doctor-contends/article1348100/

>