Flu: Endemic, Epidemic and Pandemic I’m standing in line at work waiting for my annual flu shot and

thinking about numbers. About 36,000 Americans die each year from flu. With a national population of 288 million my chances of dying from flu are about one in ten thousand. Actually, my chances are even less because ninety percent of flu deaths occur among people aged 65 and older. Given the numbers, I probably do not need a flu shot. But I’m also in line to help protect the elderly and the chronically ill. If I get vaccinated, I’m not likely to contract the flu and pass it on to others less able to fight it off. That’s the beauty of the “herd immunity” effect: the vaccinated protect the unvaccinated simply by not catching and passing on infections. There seems to be enough flu vaccine this year for everyone who wants the vaccine. There have been shortages in the past. There could be in the future. Twenty years ago, there were 25-30 vaccine companies in the U.S. and 5 or 6 that made flu vaccine. Today, there are five U.S. companies and only two or three foreign and domestic sources of flu vaccine. The current vaccine is a mix of two viruses from last year’s flu season and a new virus expected to be circulating this year. They are: A/New Caledonia/20/1999/H1N1-like, B\Shanghai/36/2002-like, and this year’s A/California/7/2004/H3N2-like. The vaccine recipe changes from year to year depending on data from a worldwide surveillance system, some committee guesswork, and a Rube Goldberg production process that involves growing the viruses in tens of thousands of chicken eggs. The 2005-2006 vaccine does not include the potentially dangerous bird flu virus, H5N1. So maybe I’m standing in the wrong line. Maybe I should be in line at the University of Maryland Medical School where an experimental H5N1 bird flu vaccine is being tested.

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H5N1 is the bird virus discovered in Hong Kong in 1997, and which has been spreading across China, Asia and Eastern Europe to kill 150 million domestic birds. The virus also has killed about 120 people, and has a mortality rate of about 50 percent. The great dread among scientists and governments is that this virus, with its high mortality rate, could mutate to acquire high transmissibility, and suddenly spark an influenza pandemic. In preparation for such an event the federal government announced plans to spend $7.1 billion on pandemic preparedness and released a 396-page pandemic plan (pandemicflu.gov). Will it work? Is there still time? A federal health official told MSNBC, “Delays in these aggressive and accelerated development programs are not unexpected or unprecedented.” Of course, nothing may happen. Or we could be looking at the wrong virus. Other viruses have been making the jump from bird to human. A virus known as H9N2 emerged in Hong Kong in 1999. Another, H7N7, appeared in the Netherlands in 2003. Then, of course, there is the Mother of All Bird Flu Viruses, the H1N1 strain that wiped out five percent of the planet’s population during the catastrophic 1918 pandemic. By 1919 it had disappeared: destroyed by survivors’ immune systems or buried with the dead. H1N1 was gone, but not forgotten. And a few weeks ago it was resurrected through a combination of slick molecular genetics and old-fashioned grave robbing. Like Dr. Frankenstein’s monster, the H1N1 virus was literally stitched together from bits and pieces of genetic material extracted from the lungs of long-dead soldiers and a woman buried in the permafrost of 1918 Alaska. The viral menace that swept across the globe 87 years ago is back and sitting in a laboratory at the Centers for Disease Control in Atlanta, Georgia.

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Why resurrect such a contagious and virulent creature? Scientists are hoping to learn more about its origin and what molecular quirks made it so deadly. So far, the virus has not given up many of its secret, except to show that it is deadly to mice and human lung cells. This is dangerous research with a dangerous pathogen. Mary Shelley’s Dr. Frankenstein said of his own research, “When I found so astonishing a power placed within my hands I hesitated a long time concerning the manner in which I should employ it.” Of course, Frankenstein’s creature eventually escaped. Accidents happen. In 2004 there were three separate lab accidents involving the escape of the SARS virus. In April 2005 hundreds of samples of the 1957 pandemic Asian flu virus were mailed accidentally to labs all over the world. The 1977 Russian flu likely was caused by the accidental release of a sample of the 1950 epidemic flu strain. Sometimes we have more to fear from our own cleverness and technologies than we do from the vagaries of Mother Nature.

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