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Are We Ready for an Avian Flu Pandemic in America?
Different influenza strains spread around the world annually. Every so often a strain tough enough to kill millions emerges, and experts believe the world is overdue for another pandemic and it could happen soon than later. Scientists at The Scripps Research Institute, the Centers for Disease Control, and the Armed Forces Institute of Pathology have now identified what many had feared. The researchers have found what they described as a possible pathway for a particularly virulent strain of the avian flu virus H5N1to gain a foothold in the human population.
According to the study, published on March 16, 2006 by ScienceXpress, the advance online version of the journal Science; Of the H5N1 strains isolated to date, the Viet04 virus was found to be closely related to the 1918 virus HA, which caused some 50 to 100 million deaths worldwide.
Michael T. Osterholm is Director of the Center for Infectious Disease Research and Policy, Associate Director of the Department of Homeland Security's National Center for Food Protection and Defense, and Professor at the University of Minnesota's School of Public Health.
Annual influenza epidemics are like Minnesota winters — all are challenges, but some are worse than others. No matter how well we prepare, some blizzards take quite a toll.
If an influenza pandemic struck today, borders would close, the global economy would shut down, international vaccine supplies and health-care systems would be overwhelmed, and panic would reign.
— Michael Osterholm Ph.D., M.P.H.
Osterholm says that, "A number of recent events and factors have significantly heightened concern that a specific near-term pandemic may be imminent. It could be caused by H5N1, the avian influenza strain currently circulating in Asia.
The Sum of All Fears
At this juncture scientists cannot be certain. Nor can they know exactly when a pandemic will hit, or whether it will rival the experience of 1918-19 or be more muted like 1957-58 and 1968-69. The reality of a coming pandemic, however, cannot be avoided. Only its impact can be lessened. Some important preparatory efforts are under way, but much more needs to be done by institutions at many levels of society."
Dating back to antiquity, influenza pandemics have posed the greatest threat of a worldwide calamity caused by infectious disease. Over the past 300 years, ten influenza pandemics have occurred among humans. The most recent came in 1957-58 and 1968-69, and although several tens of thousands of Americans died in each one, these were considered mild compared to others. The 1918-19 pandemic was not. According to recent analysis, it killed 50 to 100 million people globally. Today, with a population of 6.5 billion, more than three times that of 1918, even a "mild" pandemic could kill many millions of people.
An influenza pandemic has always been a great global infectious-disease threat. There have been 10 pandemics of influenza A in the past 300 years. A recent analysis showed that the pandemic of 1918 and 1919 killed 50 million to 100 million people, and although its severity is often considered anomalous, the pandemic of 1830 through 1832 was similarly severe — it simply occurred when the world's population was smaller. Today, with a world population of 6.5 billion — more than three times that in 1918 — even a relatively "mild" pandemic could kill many millions of people.
The Killer Within
Professor Robert G. Webster, is a virologist and is Chair of the Rose Marie Thomas Center, St. Jude’s Children’s Hospital, Memphis, Tenn., he is also one of the few bird flu experts confident enough to answer the key question: Will the avian flu switch from posing a terrible hazard to birds to becoming a real threat to humans? Webster says, "This humble flu virus is the threatening one. If I wake up any morning worrying about any virus it is that one. We don’t know when it is coming, we know it will come, we don’t know how severe it will be, We know it could be very severe, in fact it could be catastrophic."
"Pandemic Influenza hits mankind, perhaps three times a century," says Webster, "certainly that was our experience in the 20th century. We had those three times, in 1968 it was moderate, in 1957 it was somewhat more severe, and in 1918 it was extremely severe killing more people worldwide than were killed in the World War I."
In the 1918 pandemic, it is now believed that somewhere between 50 and 100 million people were killed worldwide. Given the size of the world population at that time, that is between 2 ½% and 5% of the world’s population was killed within that period. Webster says that if we had a pandemic of that scale today, "...given the world’s population, we would have somewhere 175 and 300 million people who would die in a period of one to two years. Now, that’s more people than were actually killed by all of the wars and all of the murderous governments in the world combined, throughout the entire 20th century, and those people would die, not in 100 years, but in one to two."
Neurological problems were seen then, and the workshop noted that there has been little change in preparedness today. The failure to test out conditions for avian influenza has been a concern.
H5N1 is Stalking Humankind
According to Dr, Henry Niman, president of Recombinomics, one of the nation’s leading vaccine manufactures says, "Although modern lab techniques allow for very specific sub-type testing of clinical samples and isolation of the etiological agent, the lack of surveillance remains scandalous."
Dr. John Wood is director of England’s National Institute for Biological Standards and Control (NIBSC) puts it bluntly ".....We have to understand the H5N1 Virus, no doubt about it, we have no immunity. We know it has a very bad track record, it kills birds, it kills tigers, we’ve heard, it kills other animal species, it kills man."
The question is, what adaptation or mutation would the H5N1 virus need to make to enable it to jump from human to human? Virologist Dr David Fetson, U.S. Department of Public Health says that, "The influenza virus always has the capacity to change its spots. The eight genes that comprise the influenza virus particle are changing all the time. They are changing because this is the way the virus manages to escape immunity in a population that would otherwise suppress its existence. So, in order to continue to thrive, to continue to spread, to go from year to year, the virus has to change. It is always seeking ways to escape the defenses of whatever the host might be. Whether it’s a bird ... or a human. So, according to Fetson the real danger and potential nightmare for humans is that part of that mutation process includes a combing with another type virus, one that is already "human friendly".
Dr. Klaus Steuir - Director, World Health Organization’s Global Influenza Group-Global Surveillance Network, adds "A very peculiar feature of this virus, actually of every virus, is that the genetic material does not exist in one "bowl" ... one piece. It’s segmented in eight segments. These eight segments are important for the virus to create its progeny in the host. What is feared now is that these eight segments from this avian flu virus would merge with the eight segments of a human influenza virus. So the progeny virus would then have a few pieces from here and a few pieces from there and if it all fits very nicely together, the progeny virus would have the transmit ability of a normal influenza virus which is very high and the pathogenicity avian virus and that is the scenario that we are very concerned about." This may have or at very best is beginning to have happen already.
The Economic Impact
Ian Welsh is a Lecturer in the School of Social Sciences at Cardiff University. He has a BA Hons. in Social Science at Middlesex Polytechnic and completed his PhD at Lancaster University. He comments on the World-wide impact of a Flu Pandemic.