In 2009 a pandemic of H1N1 flu, which became known as the swine flu, emerged in Mexico and spread to the United States. This article describes the outbreak of H1N1 flu in both nations, and presents information regarding the extent and history of the pandemic. The health care structures of the two neighboring countries dictated the spread and structure of the H1N1 pandemic, while similarities in sociological factors such as the poverty rate resulted in similar outcomes for both nations. Analysis also shows that the 2009 outbreak was complex in social expression, and did not express along clear traditionally understood ethnic and income lines.
The H1N1 virus was distinct from other regularly circulating flu viruses in that it possessed genes from viruses that normally can be found circulating in pigs (Â¶6). The symptoms of the H1N1 flu virus were similar to other flu viruses, including "fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, fatigue, and possibly vomiting or diarrhea" (Â¶2). The chief difference between the H1N1 virus and other viruses was that it spread and circulated in the summer months when normally flu infections are not prevalent, and it had a higher mortality rate.
It is believed that the H1N1 flu originated and was present in the Mexican population for months in the spring of 2009, but escaped detection through its initial spread (Masterson, 2009, Â¶5). According to Gillum and Thomassie (2009), on March 8 the Mexican government started recording and monitoring an upswing in severe respiratory illness (Â¶1). In May of 2009 the Mexican government closed all businesses, schools, and government offices for 5 days in an effort to control the outbreak (Â¶2).
The first U.S. confirmed cases were in the border states of California and Texas (Gillum & Thomassie, 2009, Â¶1). The virus spread from the border states throughout the U.S., with confirmed cases in every state by June of 2009 (Gillum & Thomassie, 2009, Â¶1). In the U.S. clusters of H1N1 cases occurred in jails, resulting in some counties suspending visiting hours to control contagion (760KFMB, 2009, Â¶1). Schools also were sources of transmission, and schools which reported clusters of transmission were closed (Moran, Magee, & Lieberman, 2009, Â¶1).
The CDC(2) (2010) chart below shows the number of U.S. influenza-associated pediatric deaths separated into both the H1N1 virus and other flu viruses. According to the chart, an additional 168 pediatric deaths representing a 2.69 increase in flu deaths occurred during the H1N1 outbreak. The CDC declared the H1N1 virus to be a pandemic. A swine flu vaccine was developed and distributed.
According to the CDC(1) people with H1N1 virus usually needed no treatment (Â¶10). When complications arose from H1N1, hospitalization was needed (Â¶10). Often a person would not realize that they have had H1N1 virus.
In the U.S., by September of 2010, there were 593 deaths attributable to H1N1 virus and 9079 hospitalizations (Gillum & Thomassie, 2009, Â¶1). 119 Mexican citizens were officially reported to have died from the H1N1 virus (Â¶4). Due to lack of health care access by a significant percentage of the Mexican population, the reported total is likely underestimated.
The H1N1 pandemic originated in Mexico. The inequity of the Mexican health care system encouraged the initial spread and anonymity of the H1N1 virus. Half of the citizens of Mexico have no health insurance, and the remainder utilize a combination of employment based and government programs to access health insurance (Barraza-Llorens, Bertozzi, Goonzalez-Pier, & Gutierrez, 2002, p. 47).
In contrast to events in Mexico, the spread of the H1N1 virus through the U.S. was closely tracked in a media blitz which permeated the national consciousness. The U.S. had been alerted to the virus by Mexican health authorities. The virus spread rapidly in the commuter nation from population center to population center.
Both Mexico and the U.S. had a fairly similar outcome from the H1N1 virus when death rates are adjusted for the different population sizes of each nation. Two reasons for the similar outcome include the relative mildness of the H1N1 virus and the similarity of the two nation's poverty rates. In 2009 the Mexican poverty rate was 13.8% while the U.S. poverty rate was 12% (Index Mundi, 2009, Â¶1).
Race and poverty level expressed in a mixed fashion in relation to incidence and mortality. The ethnic group in California with the highest number of hospitalizations for the virus was African-Americans while the ethnic group with the lowest number were whites, which would seem to correspond with known relations between poverty and ethnicity (California Department of Public Health[CDPH], 2010, Â¶7). However, the ethnic group in California with the highest mortality rate was Hispanic, with the ethnic group experiencing the lowest mortality rate Asian/Pacific Islanders (CDPH, 2010, Â¶6). Additionally, people of Native American descent were found to have a mortality rate four times higher than all other ethnic groups combined (Castrodale et al., 2009, Â¶1). The H1N1 virus expressed in a complex and mixed fashion along traditionally understood sociological categories of poverty level and ethnicity.
The similarities and differences between the U.S. and Mexico shaped the H1N1 outbreak. The virus was able to spread unnoticed in Mexico due to the lower levels of health care access in Mexico. Mexico utilized national quarantine while the U.S. quarantined specific facilities because the delay in recognition in Mexico necessitated the more extreme method utilized. The similar ultimate outcome of the virus in death toll in the two nations speaks to the similarity in poverty levels between the two nations, and also possibly again to less health care access for Mexican citizens which may have obscured the ultimate outcome in Mexico.
760KFMB. (2009, July 13). All county jails suspending visits due to spread of swine flu. Retrieved 3/20/10 from http://www.760kfmb.com/
Barraza-Llorens, M., Bertozzi, S., Gonzalez-Pier, E., & Gutierrez, J. P. (2002). Addressing inequity in health and health care in Mexico[PDF document]. Health Affairs 21(3). Retrieved 3/20/10 from http://content.healthaffairs.org/
California Department of Public Health[CDPH]. (2010). H1N1 influenza. Retrieved 3/20/10 from http://www.cdph.ca.gov/DATA/STATISTICS/Pages/H1N1Graphs.aspx
Centers for Disease Control[CDC](1), (2010). 2009 H1N1 flu ("swine flu") and you. Retrieved 3/20/10 from http://www.cdc.gov/
Eitzen, D. S., Zinn, M. B. & Smith, K. E. (2009). Social problems (11th ed.). United States of America: Pearson Education, Inc.
Flu.gov. (n.d.). H1N1 (Swine Flu). Retrieved 3/20/10 from http://www.flu.gov/
Gillum, J., & Thomassie, J. (2009). Swine flu interactives: World map, U.S. timeline and how the strain emerged. USA Today. Retrieved 3/20/10 from http://www.usatoday.com/
Index Mundi. (2009). Population below poverty line. Retrieved 3/20/10 from http://www.indexmundi.com/
Kells, T. (2009). Pandemic alert levels and swine flu outbreak: Pandemic v epidemic. Retrieved 3/20/10 from http://www.nowpublic.com/health/
Castrodale, L., McLaughlin J., Imholte S., Komatsu, K., Wells, E., Landen, M., Selvage, D., Sewell, M., Smelser, C., Thompson, D., Bradley, K., McDonald, C., Leman, R., Powell, M., Miller, T., VanderBusch, L., Kightlinger, L., Boulton, R., Lofy, K., Marfin, A.A., McClinton, R., Hoopes,
M., Kim, T., Hayes, J.M., Mahal, Z., Chao, E., Weiser, T., Cheek, J.E., Redd, J.T., Bryan, R., Jhung, M., Morrison, M., O'Leary, D., Nichols, M.. (2010, March 11). Deaths related to 2009 pandemic influenza A (H1N1) among American Indian/Alaska Natives - 12 States, 2009[Abstract]. Morbidity & Mortality Weekly Report. 2009;58(48). Retrieved 3/20/10 from http://www.medscape.com/
Masterson, K. (2009, September 10). Q&A: Where did the swine flu come from? Retrieved 3/20/10 from http://www.npr.org/
Moran, C., Magee, M., & Lieberman, B. (2009, April 28). S.D. school closed after swine flu infects student. The San Diego Union Tribune. Retrieved 3/20/10 from http://www.signonsandiego.com/