Global Flu and You

A History of Influenza

George Dehner

• Publisher: Reaktion Books
• Year: 2013
• ISBN:
  9781780230573
• Topic: Biological Sciences
• Subtopic: Science General
• Index: Biological Sciences

Winter brings snow, ice, and freezing temperatures, but these climatic conditions are also the harbingers of another time of year: flu season. We all know the signs—chills, fever, sore throat, muscle pains, coughing—and hope that this common illness will make us sick for only a few days. But though the flu may seem harmless, influenza results in between 250, 000 and 500, 000 deaths every year and can spread virulently around the world. In pandemic years, the flu can kill millions. The recurrence of the Spanish Flu virus, the appearance and spread of Bird Flu, and the 2009 Swine Flu have heightened concerns about the dangers posed by flu pandemics. Drawing on his extensive research into influenza pandemics, George Dehner refutes the idea that these are a new phenomenon. In Global Flu and You, he traces the origins of the disease and outlines the societal and cultural changes that enabled the virus to become an epidemic threat. He reveals that while medical and scientific breakthroughs in studying and protecting against the virus have made rapid progress, demographic, economic, and technical changes have served to speed up and amplify the potential impacts of an influenza pandemic. Accessibly written for any reader, Global Flu and You exposes the facts and fictions of an illness we could all succumb to and is a must-read for anyone concerned with their own—and the world's—health.

References

Introduction

1 Transcript of Statement by Margaret Chan, Director-General of the World Health Organization, 11 June 2009, available at www.who.int/mediacentre, accessed 10 June 2011.

2 The nomenclature for influenza will be discussed in chapter One.

3 Such an accounting does not include those with mild or unnoticeable infections of Bird flu so the real rate is certain to be lower. Still, the very serious and often deadly course of infection with Bird flu is alarming. See “Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1), reported to WHO, 2003–2012,” available at www.who.int, accessed 25 June 2012.

4 “Swine Influenza A (H1N1) Infection in Two Children-Southern California, March–April 2009,” Morbidity and Mortality Weekly Report, LVIII/15 (24 April 2009), pp. 400–02.

5 Governments worldwide had about 220 million doses of antivirals in stock at the time of Chan’s announcement. The WHO had reserved enough Tamiflu to treat 5 million people. “Graphic: Antiviral Stockpiles,” Reuters.com (30 April 2009), available at http://blogs.reuters.com, accessed 13 June 2011.

6 For example, in the United States 40 million doses—nearly a quarter of the ordered production—were never used and ended up being destroyed. See Mike Stobbe, “Millions of Vaccine Doses to be Burned,” for the Associated Press in The Virginia Pilot (2 July 2009), p. AI, accessed via LexisNexis Academic, 13 June 2011; see also “40m Doses of H1N1 Vaccine to be Destroyed,” UPI.com,, available at www.upi.com, accessed 13 June 2011.

7 The CDC estimates that there were about 12,500 deaths in the U.S. attributed to 2009 H1N1 influenza as compared to 36,000 flu-related deaths per year on average. See “2009 H1N1 Flu,” www.cdc.gov, accessed 13 June 2011. The WHO reported (as of 6 June 2010) over 18,000 laboratory-confirmed deaths from 2009 Swine flu from 214 countries. While certainly a vast undercounting of the pandemic’s real toll, the low numbers do provide indications that the pandemic was mild. See “Global Advisory Committee on Vaccine Safety, 16–17 June 2010,” Weekly Epidemiological Record, LXXXV/30 (23 July 2010), pp. 285–8.

8 Mark Honigsbaum, “Was Swine Flu Ever a Real Threat?,” Telegraph.co.uk (2 February 2010), accessed 18 June 2012; Imogen Foulkes, “WHO Faces Questions over Swine Flu Policy,” BBC News Europe (20 May 2010), available at www.bbc.co.uk/news, accessed 18 June 2012.

9 Symptoms from CDC website, “Flu Symptoms and Severity,” available at www.cdc.gov/flu, accessed 15 June 2011.

10 For names see Charles Creighton, A History of Epidemics in Britain, vol. II: From the Extinction of Plague to the Present Time [1891] (New York, 1965), pp. 304–14, and John F. Townsend, “History of Influenza Epidemics,” Annals of Medical History, n.s. V/6 (November 1933), pp. 539–42.

11 Aside from the dramatic Spanish flu pandemic, the average case fatality rate for an influenza infection, even in a pandemic year, is <1 per cent. See Jeffrey K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases, XII/1 (January 2006), p. 15.

12 See the 1803 Temple West illustration “An Address of Thanks from vthe Faculty to the Right Hon. Mr Influenzy for his Kind Visit to the Country,” at http://medphoto.wellcome.ac.uk, image L0009997. Influenza, with its proclivity to facilitate secondary pneumonia infections, prompts elevated mortality among the elderly. See David S. Fedson, Andre Waida, J. Patrick Nicol, and Leslie L. Roos, “‘The Old Man’s Friend,’” The Lancet, CCCXLII/8870 (28 August 1993), p. 561.

13 For CDC estimates see “Prevention and Control of Influenza with Vaccines,” Recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010, available at www.cdc.gov, accessed 13 June 2011; for estimated costs see Noelle-Angelique M. Molinari et al., “The Annual Impact of Seasonal Influenza in the U.S.: Measuring Disease Burden and Costs,” Vaccine, XXV (2007), pp. 5086–96; for global estimates of mortality see Scott P. Layne, “Human Influenza Surveillance: The Demand to Expand,” Emerging Infectious Diseases, XII/4 (April 2006), p. 562.

14 The genetic elements that underlay seasonal and pandemic influenza will be discussed in chapter One.

ONE

Know Your Enemy

1 The following discussion of the virus is drawn from L. R Haaheim, “Basic Influenza Virology and Immunology,” in Introduction to Pandemic Influenza, ed. Jonathan Van-Tam and Chloe Sellwood (Oxford, 2010), pp. 14–27; Karl G. Nicholson, “Human Influenza,” in Textbook of Influenza, ed. Karl G. Nicholson, Robert G. Webster, and Alan J. Hay (Oxford, 1998), pp. 219–64; and Edwin Kilbourne, Influenza (New York and London, 1987), pp. 25–56.

2 Unless specifically noted otherwise, the following description of the human immune system is drawn from Jan C. Wilschut, Janet E. McElhaney, and Abraham M. Palache, Influenza, 2nd edn (Edinburgh, 2006); Darla J. Wise and Gordon R Carter, Immunology: A Comprehensive Review (Ames, IA, 2002); Mary S. Leffell, Albert D. Donnenberg, and Noel R Rose, eds, Handbook of Human Immunology (Boca Raton, FL, 1997); and James A. Marsh and Marion D. Kendall, eds, The Physiology of Immunity (Boca Raton, FL, 1996).

3 Replication estimates from Claude Hannoun, keynote lecture at “After 1918: History and Politics of Influenza in the 20th and 21st Centuries,” Rennes, France, 25 August 2011.

4 As Shanks and Pyles describe it, this immunity production process is a very Darwinian survival of the fittest model. The antibody with the best match is stimulated to produce more, and because the production of this “best match” has variation, it eventually results in an antibody that is a perfect fit for the target. See Niall Shanks and Rebecca A. Pyles, “Evolution and Medicine: The Long Reach of ‘Dr Darwin’,” Philosophy, Ethics, and Humanities in Medicine, II/4 (2007).

5 For the definitive account of smallpox’s eradication see F. Fenner, D. A. Henderson, I. Arita, Z. Jezek, and I. D. Ladnyi, Smallpox and its Eradication (Geneva, 1988).

6 The following discussion of the genetics of the influenza virus is drawn from Kilbourne, Influenza, pp. 111–56; Nicholson, Webster, and Hay, eds, Textbook of Influenza; Washington C. Winn Jr, “Influenza and Parainfluenza Viruses,” in Pathology of Infectious Diseases, vol. I, ed. Daniel H. Connor, Francis W Chandler, David A. Schwartz, Herbert J. Manz, and Ernest E. Lack (Stamford, CT, 1997), pp. 221–7; and Haaheim, “Basic Influenza Virology and Immunology,” pp. 14–27.

7 John Holland, Katherine Spindler, Frank Horodyski, Elizabeth Grabau, Stuart Nichol, and Scott VandePol, “Rapid Evolution of RNA Genomes,” Science, n.s. CCXV/4540 (26 March 1982), pp. 1577–85.

8 The connection between avian waterfowl and influenza viruses was first proposed by Graeme Laver and Robert Webster in a series of studies in the late 1960s and early ’70s. For an overview of the people and processes involved in developing this theory of an avian home of influenza see William Graeme Laver, “The Origin and Control of Pandemic Influenza,” Perspectives in Biology and Medicine, XLIII/2 (Winter 2000), pp. 173–92. For a commemoration of Graeme Laver see Robert G. Webster, “William Graeme Laver,” Biographical Memoirs of Fellows of the Royal Society, available at http://rsbm.royalsocietypublishing.org, accessed 5 June 2011.

9 It should be noted that some mutants of the H5N1 strain circulating in Eurasia since 1997 (colloquially called Bird flu), has been found to cause levels of mortality in duck and geese populations from time to time.

10 See R. G. Webster, K. F. Shortridge, and Y. Kawaoka, “Influenza: Interspecies Transmission and Emergence of New Pandemics,” FEMS Immunology and Medical Microbiology, XVIII (1997), pp. 275–9.

11 Homo Sapiens also have some sialic acid alpha 2,3 receptors, but they are located deep in the lungs making both infection of these cells difficult because of their location and transmission of the virus to oth...