sexta-feira, maio 08, 2009
What at first appears an absurdity — seeking out infection with swine flu instead of avoiding it — is being actively debated on flu Web sites and by some flu experts.
Infectious-disease specialists say they understand the logic: surviving the current, apparently mild strain of the virus may be protective if a more virulent strain emerges next fall. But they are generally against it.
Dr. Anne Moscona, a flu specialist at Weill Medical College of Cornell University, said she had been called by a reporter for a women’s magazine “asking if mothers should hold swine flu parties, like chickenpox parties.”
(Chickenpox parties, at which children gather so they can all be infected by a child who has the pox, are often held by parents who distrust chickenpox vaccine or want their children to have the stronger immunity that surviving a full-blown infection affords and are willing to take the risk that their child will not get serious complications.)
“I think it’s totally nuts,” Dr. Moscona said. “I can’t believe people are really thinking of doing it. I understand the thinking, but I just fear we don’t know enough about how this virus would react in every individual. This is like the Middle Ages, when people deliberately infected themselves with smallpox. It’s vigilante vaccination — you know, taking immunity into your own hands.”
The idea has arisen from the history of the 1918 Spanish flu. A mild spring outbreak was followed by two deadly waves in the early and late winter of 1918-1919. Some believe, although there is little evidence beyond anecdotal reports in old newspapers, that those who got sick in the first wave were less likely to get sick in the second and third.
Many cite as the source of their thinking the book “The Great Influenza,” a history of the 1918 pandemic by John M. Barry.
Mr. Barry, in a telephone interview, said he had never publicly suggested deliberate self-infection, “but I used to joke with my wife, and I may have jokingly said it in speeches, that if a virus emerged and looked mild, I’d be on an airplane to Indonesia.”
He referred to Indonesia, he explained, “because that’s where the action is with H5N1.” The highly pathogenic H5N1 is the avian flu strain circulating in poultry in Indonesia, Egypt and China, occasionally passing into and killing people. Since 2002, international health authorities have feared that it will become pandemic.
Those toying with the idea of self-infection with the current H1N1 swine flu strain now circling the globe doubt that there will be enough effective vaccine to stop the virus if it returns in the fall, especially if it swaps genetic material with the H5N1 strain or has picked up resistance to the antiviral drug Tamiflu. Even if drug makers switched to making a vaccine against a pandemic strain now, their total capacity is enough to make only one to two billion doses in a year, the World Health Organization said Wednesday. Triage decisions would have to be made about which of the world’s six billion people got the vaccine.
The online debates are often over details. Should you wait to self-infect till the season’s end, when the virus has evolved into the strain most likely to return in the fall? Should you get Tamiflu and take it at the first symptom? Should you check to see if local hospitals are empty, in case things go wrong and you need to be on a ventilator?
Michael Olesen, chief of infection control at Abbott Northwestern Hospital in Minneapolis and a flu pandemics expert, said he was not planning to seek out infection but was “taking a passive approach to getting infected.”
When he heard about the outbreak in Mexico, he said, he bought extra N95 face masks and had been planning to wear one on a flight to Detroit soon.
“Now I’m thinking of taking my chances” and forgoing the mask, he said. “That’s a change from a week ago. I think to myself, yeah, I’ll be miserable for a week — but that’ll beat maybe being seriously sick later.”
One of the first open debates of the idea of intentional self-infection was on Effect Measure, a public health blog with many posts by thoughtful people who say they are clinicians, epidemiologists, veterinarians and other professionals, sometimes in government, but who post under pseudonyms to speak freely.
On April 28, a user calling herself OmegaMom posted: “Just a quick note — I just got a Tweet from a mom suggesting ‘swine flu parties’ because the U.S. version seems to be a mild version. Can you speak to the utter insanity of doing this, please?”
Several posters weighed in to say it would be foolish given the number of deaths in Mexico, the lack of information on the virus and the unpredictability of flu.
The chief moderator of another blog, flutrackers.com, who posts as Florida1, said one of her members, GaudiaRay, had raised the idea for debate three days ago. She called him at home, she said, and he told her he had decided not to put his family at risk.
Dr. Andrew T. Pavia, chairman of the pandemic influenza task force of the Infectious Diseases Society of America, opposes self-infection.
“Twenty years ago, it might have made some sense,” he said, “and with 20/20 hindsight, getting infected in the spring wave of 1918 probably would have been highly protective.” But by getting deliberately infected, “you’d really be jumping into the unknown,” he said.
The Centers for Disease Control and Prevention has not posted guidance on the question yet, but Dr. Richard E. Besser, the agency’s acting director, was asked about it this week and said, “We don’t have a firm answer, but it’s our belief that protecting people from this infection is the right way to go.”
In any case, many experts noted that there was a big flaw in any self-infection plan: it is not easy to find and cuddle up to someone with swine flu. There were only 642 confirmed cases in the country as of Wednesday.
One obvious place to look would be St. Francis Preparatory School in Queens, the epicenter of New York’s outbreak.
The principal, Brother Leonard Conway, was asked if any of his students had been asked to spare a few germs.
“I have not heard of anyone being approached,” he replied in an e-mail message. “That surely is a different idea.”
This article has been revised to reflect the following correction:Correction: May 8, 2009
An article on Thursday about the young age of people who have developed serious