Influenza

It has been a little more than 100 years since the discovery of viruses by Martinus Beijerinck. In that time, more than 5,000 different viruses have been discovered and studied. One of those viruses, influenza, has been a scourge to humanity even before we knew it existed. Influenza has caused local epidemics and worldwide pandemics since well before it was discovered. Between 1918 and 1919, influenza killed between 20 and 40 million people worldwide, more than the World War occurring at the time. At the time of the 1918 pandemic, it was believed that the disease was caused by other agents, like the bacteria Haemophilus influenzae. It wasn’t until the 1930’s that the influenza virus was discovered and grown in chicken eggs. In the 1940s, an influenza vaccine was developed and used widely on soldiers during World War II. More

Recent furor around research on the H5N1 virus strain that has caused influenza in birds and rare cases of severe influenza in people may have died down for the time being after last week’s meeting of a group of experts assembled by the World Health Organization. They recommended that two different groups involved in what has come to be seen as controversial research should publish their findings in full. A halt on the bird flu research in question and publication of those data is still in place, however, and will likely last a few months longer.

To date, this H5N1 virus is not efficiently transmissible among humans – in fact, humans generally have been infected only after close contact with infected poultry. But virologist Ron Fouchier at Erasmus Medical Center in Rotterdam manipulated the virus so that it became easily transmissible between ferrets via airborne droplets. (Ferrets are a useful standin for humans in influenza studies.) A team headed by Yoshihiro Kawaoka at the University of Madison-Wisconsin accomplished similar results: both papers were under review for publication by science journals before the controversy developed. More

A Novartis Vaccines and Diagnostics, Inc., manufacturing facility in North Carolina has geared up to produce pandemic influenza vaccine made from mammalian cell lines, rather than from the traditional hen egg-based methods that have been used for more than 50 years. The plant, open since November 2009, was dedicated in a December 12 ceremony after Novartis submitted a Biological License Application for the vaccine to the U.S. Food and Drug Administration. The cell-based system and production methods are similar to those that have been licensed and used for seasonal influenza vaccine in Europe since 2007. More

It’s National Influenza Vaccination Week, and we’re taking a look back to 1918, the time of the “Spanish” influenza pandemic. When the illness emerged, several useful vaccines had already been developed: smallpox, typhoid fever, and rabies, for example. Scientists and physicians tried many different approaches to develop influenza vaccines during the pandemic even though the cause of influenza was not clear. We look at several of them below.

No other epidemic has claimed as many lives as the Spanish influenza epidemic in 1918-1919. Worldwide, at least 40 million people died as this virulent illness swept through city after city (some estimates put total deaths closer to 70 million). Newspaper reports described people dying within hours of first feeling ill. The mortality rate was highest among adults under age 50, who were, for unknown reasons, particularly vulnerable to serious disease resulting from this strain of influenza.

The first reported cases of an unusual influenza appeared in U.S. Army camps in Kansas in early spring 1918. Later that spring, officials reported large numbers of cases from Europe, though this flu did not seem particularly dangerous. However, influenza became more deadly in late summer. Soon waves of infection moved through towns, nations, and continents, overwhelming hospitals and medical personnel. Because of wartime censorship, reports of influenza were not widely distributed, but news from Spain continued to flow. The name Spanish influenza came from the devastating effects of the flu in Spain in autumn 1918. More

On October 12, the Philadelphia Neurological Society held one of its regular meetings at The College of Physicians of Philadelphia and invited Paul A. Offit, MD, to speak to the membership. Offit, chief of infectious diseases at The Children’s Hospital of Philadelphia (CHOP), vaccine developer, and advisor to The History of Vaccines, greeted the membership with his first slide and title of his talk: “Why are neurologists scared of vaccines?”  Though Offit’s title was tongue-in-cheek, it spoke to a tension he has perceived between neurology and vaccinology. More

Going to the movies is a time-honored way of getting away from the vagaries of work and home life and inhabiting a different and exotic place. I don’t know if car mechanics can really enjoy chase movies or cowboys can appreciate Westerns, but as a specialist in Infectious Diseases, I rarely get a chance to see someone plying my trade inside the multiplex. There are spoilers ahead, so read on cautiously if you have not yet seen Contagion and plan to go.

The new Steven Soderbergh movie, Contagion, is a fairly realistic guesstimate of what might happen if a highly contagious, new infectious agent started moving around the world and destroying people willy nilly like a marauding tornado. While there has never been an infection quite like “MEV-1” as depicted in Contagion, the question of how we would respond as a medical community and as a society is a worthy one to address. Whether the answer is right or wrong – well, let’s hope we never find out.

From an Infectious Diseases angle, the infection in Contagion is crafted to be highly transmissible and fatal. This would be like a hybrid of the 1918-1919 pandemic flu, Nipah virus and SARS. The end of the movie shows the mechanism via which MEV-1 began to infect humans, and it is highly reminiscent of Nipah and SARS. Thus has some built-in credibility as it builds on diseases that we already understand. It is also eerily reminiscent of the most recent big flu outbreak (A/California/2009 H1N1) where the virus contained elements that came from birds, pigs and people. The rapidity of spread lends the movie much of its terror, but is not far off the rapidity of spread of influenza. Similarly, the incubation period and time to death is also reminiscent of the 1918-1919 pandemic flu. So the film-makers have done their homework and created a plausible disaster scenario. More

The so-called Spanish influenza pandemic of 1918 was one of the worst natural disasters in history. Estimates of total death counts vary, but it is commonly stated that the virus infected about one-third of the world’s population and killed about 50 million – possibly as many as 100 million. Researchers have long been interested in learning more about the virus and what made it so deadly, and genetic analysis has been a large part of that effort. In 2005 the full genome sequence of the virus was published, and research has continued from that point.

The virus behind the 1918 pandemic was an H1N1 strain; in fact, it was the only H1N1 strain to cause a pandemic in the 20th century. (Pandemics that began in China in 1956 and Hong Kong in 1968 were caused by H2N2 and H3N2 strains, respectively.) It was unusually severe, and in an unexpected result for an influenza virus, tended to kill healthy young adults rather than the typical flu victims – the very old and the very young. This contributed to the initial fear when novel H1N1 appeared in 2009, particularly since the number of deaths per age group early in the outbreak skewed heavily toward young adults. More

Two important vaccine meetings were held September 11 and 12 at The College of Physicians of Philadelphia. The September 12 meeting entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies was sponsored by the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. Speakers focused on vaccine development and distribution for biological threats and how the emergency preparedness experiences with A/H1N1 provided lessons that might inform future preparation for similar public health emergencies. More

Today the History of Vaccines staff -- that's two of us -- went out together to get the seasonal influenza vaccine. The drugstore at the corner offers walk-in shots for $27.99, and so we took a pre-lunch field trip. Our health insurance will reimburse us for most of the cost of the immunization. More

Two important vaccine meetings are being held at The College of Physicians of Philadelphia. The first meeting occurs September 12, and is entitled Research Integrity Challenges in Vaccine Development and Distribution for Public Health Emergencies. Sponsors include the Department of Health and Human Services, the Office of Research Integrity, Drexel University, University of Pennsylvania Center for Bioethics, and The College of Physicians of Philadelphia. The second meeting on September 13 is part of the National Vaccine Program Office's effort to gather stakeholder input. Regional stakeholders are invited to attend sessions and share their experiences with immunization, particularly around racial and ethnic disparities, risk communications, and adolescent and adult vaccines. The information gathered at this meeting will help guide the implementation of the National Vaccine Plan as well as inform local and regional vaccine groups on barriers and successes in immunization. More