-Caveat Lector-
from:
http://www.slackinc.com/general/idn/199705/pandemic.htm
--- Of the 57,000 Americans who died in WWI, 43,000 died as a result of
Spanish influenza.
WASHINGTON, D.C. � It was the fourth year of WWI, and Europe had been turned
into a war-scarred landscape from the English Channel to the Crimea.
In that same year another threat began that would rival the war as the
greatest killer in human history � Spanish influenza.
Recently, Defense Department scientists discovered a sample of lung tissue
from the body of an American serviceman who died of the flu in 1918. Their
hope is that the sample unlocks what made the virus so deadly and then helps
in the prediction of future pandemics.
"If you look at the natural history of influenza epidemics, they do occur
regularly,'' said Jeffery K. Taubenberger, MD, PhD, of the Armed Forces
Institute of Pathology here and one of the authors of a new report in
Science studying the 1918 pandemic. "If the records are any indication, yes
there is another pandemic coming � the question is when?''
The 1918 pandemic found its way from the farmlands of the Midwest, where
pigs had spread it to farm families � to every nation on earth, leaving
500,000 Americans and 21 million others dead. At one point, more than 10% of
America's workforce was bedridden.
"This was an unusual type of virus,'' said Taubenberger. "The hallmark of
the Spanish flu was its ability to selectively kill healthy young adults
quickly.''
The virus swept the world in three waves during a two-year period, becoming
more infectious with each new assault. In New York City alone, more than
20,000 people died during the fall of 1918. The virus spread so quickly that
scientists later learned of entire Inuit villages in remote parts of Alaska
completely wiped out by the virus. Even Western Samoa, an island in the
South Pacific, was overwhelmed by the pandemic, losing 20% of its population
in a short time. The only country on earth not affected greatly was
Australia, which had strict quarantine regulations.
"You would have to go back to the Black Death to parallel this type of
mortality,'' said Taubenberger.
Scientists of the period were at a loss to explain the pandemic and unable
to provide sound medical advice for the world's population. But researchers
looking at the virus now hope the dead soldier's lung tissue will provide
the answers that so baffled their turn-of-the-century counterparts.
Taubenberger said a key in understanding the lethality of the virus is in
its genetic coding.
"The virus carries its genes in eight pieces of RNA that are packed together
in a protein coat � so far we have only looked at four of the pieces,'' he
said. "It's a tedious process.''
Mode of transmission
One speculation was that the Spanish flu virus passed from birds to pigs and
then onto humans, a mode of transmission thought to produce the most
dangerous strains of influenza. It was not until recently, however, that
Taubenberger's genetic analysis concretely supported the antibody evidence
that the virus had in fact come from pigs.
Another hypothesis tested by Taubenberger was based on the chicken influenza
virus that quickly annihilated chicken populations in the mid-1980's. The
virus was peculiar because one of its proteins had three basic amino acids
at a location where the host's enzymes had to break a protein for the virus
to infect a cell. At that particular spot there should have been only one
amino acid, said Taubenberger. So, the scientists pursued the notion that
these three basic amino acids were clues to the virus's lethality and the
possibility they were a feature in the 1918 pandemic. But the chicken flu
also proved to be a dead end for researchers.
Taubenberger and his colleagues have spent nearly two years looking at the
flu's viral RNA, assembling and sequencing it like a biological jigsaw
puzzle, trying to determine what made it so lethal. The scientists reported
on the sequences of eight fragments of the virus, including pieces of its
major genes. So far, though, Taubenberger has analyzed only about 10% of the
virus, but he is confident of eventually sequencing and diagramming the
other 90% in the next two months.
According to military medical records, the epidemic seems to have swept
America by the late spring of 1918, when doctors reported outbreaks in
military training camps where young doughboys were drilling before heading
overseas to fight in France.
"American soldiers brought the virus to Europe,'' Taubenberger said. "Many
of the troopships were crammed with thousands of soldiers, many of whom were
already sick when they embarked. The military's primary objective was to
rush as many troops to France as quickly as possible. These ships became
floating death traps.''
The rush to get American troops to Europe had a devastating impact on the
fighting capabilities of the Army. Of the 57,000 Americans who died in WWI,
43,000 died as a result of Spanish influenza � 85% of all service-related
deaths.
In his research, Taubenberger wanted lung tissue from someone who had died
quickly, within a week of becoming ill, so particles of the virus might
still be lurking. The scientists studied 35 cases, but only the dead
soldier's tissue sample had enough of the virus left in it to be helpful.
The sample belonged to a 21-year-old private who had no previous medical
history. He died within five days of becoming infected. His lungs were
autopsied by Army doctors and the tissue sent to Washington where it sat,
untouched, for nearly 80 years.
Robert Webster, MD of St. Jude's Children's Hospital in Memphis, Tenn.,
another scientist hinting at a pandemic recurrence, concluded in a study he
conducted that all the genes of the influenza viruses of the world are being
maintained in the aquatic bird population, in gulls and ducks, and that
periodically they are transmitted to other species, including pigs and
humans.
"There's an enormous amount of influenza carried by birds," said Webster.
"The pigs act as 're-assorters,' where the influenza viruses from humans and
birds rearrange their genes and are then let loose upon the world again."
The Asian and Hong Kong flu's were the result of this type of reassembling.
Some scientists argue that swine strains, appearing in 100 year cycles,
forecast a repeat of the pandemic for sometime around the turn of the
century. In the opinion of many experts, another pandemic will occur soon.
Government planning for the big one
Currently, there is an informal, 14-member government roundtable in
Washington charged with planning for the next great pandemic. These
representatives come from the Centers for Disease Control and Prevention
(CDC), the Food and Drug Administration, the DoD, Veteran's Administration
and the National Institutes of Health. Although formed in 1993, the group's
origins date back to the 1976 Swine flu "epidemic.'' Though the Swine flu
did not take on the proportions of the Spanish flu, government officials
became concerned because there was no plan to handle another pandemic on the
scale of the one in 1918. This panel has yet to release a final plan for
dealing with another outbreak, however. Its most recent effort is a 20-page
conceptual plan put out in January of last year.
"This type of plan should be considered an evolutionary plan because its
impossible to finalize something like this due to updates and changes from
committee members and officials,'' said Peter A. Patriarca, MD, deputy
director of the Division of Viral Products at the Food and Drug
Administration.
Despite the seriousness of a potential pandemic, the group has been working
without a formal budget; the panel members calling their efforts at
predicting the next pandemic a "hobby.'' CDC researchers said this informal
arrangement should continue for the next few years since their funding has
been budgeted through fiscal 1998. The CDC has helped the committee with
$200,000.
The panel has been working with local and state health officials on such
issues as who gets vaccinated first and the nature of communication when the
pandemic strikes. Other issues include whether to allow businesses and
schools to open; how to provide care for house-bound victims; and whether
masks should be worn to prevent transmission of bacteria, which health
officials say may cause secondary infections.
"If the pandemic were to appear tomorrow, we would be ready to cope with
it,'' Patriarca said.
For more information:
Taubenberger J, Reid A, Krafft A, et al. Initial genetic characterization of
the 1918 "Spanish" influenza virus. Science.1997;275:1793-6.
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