The print edition of Newsweek magazine for May 18, 2009, examined the nation's most recent health scare, with an eye on how Wisconsin figured into the equation. That story, by science writer Laurie Garrett (author of 1995's The Coming Plague: Newly Emerging Diseases in a World Out of Balance), seemed to implicate Wisconsin as the birthplace of swine flu, which as of May 29 had infected some 1,370 Wisconsinites, 100 of those in Dane County.
But that's wrong.
Garrett's story leads with a 17-year-old male from Sheboygan, who came down with the H1N1 virus in the fall of 2005. H1N1 is currently circulating the world under the somewhat misleading name "swine flu" (more on that later). Around Thanksgiving, the teenager helped family members butcher pigs at a local slaughterhouse. Around this time, the boy's family brought a live chicken into their home during a cold snap.
By early December, the boy was sick with the flu; he was treated at a local hospital and recovered fully. But blood samples sent to the Centers for Disease Control (CDC) revealed that "the influenza virus that infected the Wisconsin lad was unlike any previously seen," Garrett wrote. "It appeared to be a mosaic of a wild-bird form of flu, a human type and a strain found in pigs."
It was H1N1, with genetic material from a human flu first found in New Caledonia in 1999, an unknown bird flu, plus two types of swine flu that have been circulating in Wisconsin and Asia the past several years.
It's easy to read the Newsweek piece and conclude that the Sheboygan teen was the unlucky "incubator" of our current swine flu outbreak. He was exposed to pig, avian (the chicken) and human flu, which recombined in his body to form H1N1. Then that flu went "underground" for a time, only to reappear in Mexico this April with a vengeance.
"That's absolutely false," says Stephanie Marquis, spokeswoman for the Wisconsin Department of Health Services. "The H1N1 influenza that we're seeing today may be a similar strain to what has previously been in the swine population. But the person in 2005, in Wisconsin, was an isolated case. He may have had a version of the H1N1 virus. But he didn't infect anyone else."
The state investigated once CDC reported that the teen had H1N1. Family, friends and health care workers came back negative for H1N1 exposure, as did local swine herds.
Dr. Jeff Davis, the state's epidemiologist for communicable diseases, agrees "it would be incorrect to infer that the virus isolated from a human in Wisconsin in 2005 is the same virus as the H1N1 virus currently circulating."
As swine flu, and the heated media reporting of it, gained momentum across the world, people apparently came to the conclusion that pigs were the problem. So the government of Egypt ordered all 300,000 of the nation's pigs killed.
Swine flu - which as of May 27 had infected 6,764 people nationwide, causing 10 deaths - has had repercussions for hog farmers here.
Donna Gilson, a spokeswoman for the state Department of Agriculture, Trade and Consumer Protection (DATCP), says that within days of the first news accounts in April, the price of Wisconsin market hogs dropped 18%. By mid-May, prices were nudging back up, but Wisconsin farmers lost tens of thousands of dollars.
On April 30, DATCP Secretary Rod Nilsestuen announced in a statement that people can't get H1N1 from eating pork. "This is not swine flu," he wrote. "The virus does not exist in hogs."
That's true, but only to a point.
Actually, pigs, birds and people harbor all sorts of flu viruses. While it's easier to pass those viruses within a species, they can and do jump species, recombine and form new strains, which can then be passed back and forth.
"There are 144 different possible combinations of the HN influenza across the spectrum of swine, humans and avians," says Gilson. "And in each combination, there are multiple strains as well. It's this particular [current] strain that's novel and hasn't been found in pigs in the U.S." The transmission is occurring from person to person, not person to pig or vice versa.
But the name swine flu wasn't chosen by mistake. "It's called swine flu because at least part of the virus is similar to an influenza virus that does exist in pigs," notes Dr. Tom Schlenker, director of Public Health Madison and Dane County. "So it's an assumption that's made, that it must have crossed over from pigs to humans at some point."
H1N1 also has an avian flu component. As Schlenker explains, "The assumption is that these genetic components combined in some way, at some point, and then went through some further transformation, so they could be transmissible among human beings."
When a flu virus jumps from pigs to people, says Schlenker, it will usually mutate somewhat in its new host. The infected person may then start spreading this mutated form to other people.
The good news, says Schlenker, is that the outbreak has not been as bad as some feared. None of the 70 or so people confirmed to have N1H1 in Dane County have been hospitalized. "And all of them have already recovered or are recovering right now."
In September 1988, a 32-year-old woman from Burlington was hospitalized for pneumonia. She was pregnant and previously healthy, yet died eight days later. She also had H1N1 flu virus in her system.
"Four days before getting sick," the CDC reported, "the patient visited a county fair swine exhibition where there was widespread influenza-like illness among the swine. In follow-up studies, 76% of swine exhibitors tested had antibody evidence of swine flu infection, but no serious illnesses were detected among this group."
The CDC does not attribute the woman's death to H1N1. But the first death in the U.S. from the current form of H1N1 was a pregnant woman from Texas.
Schlenker agrees that pregnant women are especially vulnerable. "That applies to all influenza," he says. "There are certain categories of people that are at higher risk, and that includes pregnant women. Anybody with any immune deficiency, including HIV or someone who's on cancer chemotherapy or for any reason has a diminished immune system."
Schlenker's best advice is to treat H1N1 like any other flu bug. Rest, liquids and over-the-counter medications should help people past the most common symptoms (fever, headache, dry cough, sore throat, nasal congestion, body aches and/or tiredness). While there's no H1N1 vaccine, recovery does seem to be speeded by two anti-viral drugs, oseltamivir and zanamivir, both of which require a doctor's prescription.