NationStates Jolt Archive

Yes, for all of you who think it's going to be a simple case of the flu, and nothing to worry about, think again. The last time around, it killed more people than the World War it coincided with (WW I).

http://news.ft.com/cms/s/74ebe9d6-35cd-11da-903d-00000e2511c8.html

Killer flu of 1918 caused by bird virus
By Clive Cookson, Science Editor
Published: October 5 2005 19:32 | Last updated: October 5 2005 19:32

World flu pandemicThe virus responsible for the 1918 Spanish flu pandemic, which killed an estimated 50m people worldwide, has been reconstructed by genetic engineering in a high-security US laboratory.

Preliminary studies show that it is an avian flu virus that mutated to spread quickly between people just as many experts fear will happen soon with the current H5N1 strain of bird flu in Asia. Details of the project are published today in the journals Science and Nature. The US National Institutes of Health approved the research, despite its apparent risk, because it will help scientists find new treatments for the most dangerous types of flu.

The Centres for Disease Control laboratory in Atlanta made a live virus with the full genetic sequence of Spanish flu, using an engineering technique called “reverse genetics” developed at Mount Sinai Hospital in New York.

“We felt we had to recreate the virus and run these experiments to understand the biological properties that made the 1918 virus so exceptionally deadly,” said Terrence Tumpey, head of the CDC team. “We wanted to identify the specific genes responsible for its virulence, with the hope of designing antivirals or other interventions that would work against virulent influenza viruses.”

The key genetic data for the experiment came from the Armed Forces Institute of Pathology in Washington DC. Over the past eight years scientists there have pieced together the entire Spanish flu genome, from viral fragments isolated from preserved lung samples of patients who died in 1918 and from a female victim whose body was fortuitously frozen in Alaskan permafrost.

Many of the flu viruses circulating today were descendants of the H1N1 strain that swept the world in 1918 so the population still had some protective immunity against it, said Jeffery Taubenberger, leader of the AFIP team. “It is unlikely that a1918-like virus wouldbe able to cause a pandemic today.”

The research suggests that Spanish flu arose in a different way to the viruses that caused the other two 20th century pandemics. In 1957 and 1968 an existing human virus underwent genetic mixing with a bird virus to produce a new “reassorted” strain in one step.

In 1918, however, an entirely avian virus gradually adapted to function in humans through a sequence of mutations. Although the analysis is incomplete, about four to six mutations seemed to have taken place in each of the eight viral genes, Dr Taubenberger said.

Ominously, the H5N1 strain currently circulating in Asia is undergoing similar humanising mutations though it has not accumulated as many changes as Spanish flu.

■ Health officials in Jakarta and Hong Kong on Wednesday said tests had shown H5N1 virus in apparently healthy chickens in Indonesia. Until now it had been thought that chickens quickly sickened and died when infected with H5N1. The presence of infected but symptomless chickens could complicate the fight against bird flu

no im not going to worry about it.

I guess I'm one of those that thought flu was simple. Maybe not anymore. What do people die from? Pneumonia? Dehydration?

Personally I think we could use a nice global pandemic. It's getting crowded and people are getting angry and violent.

I guess I'm one of those that thought flu was simple. Maybe not anymore.
Too many people confuse colds with the flu. Flu itself has huge variability and can be almost as weak as a cold to strong enough to kill millions.

An average of about 36,000 people per year in the United States die from influenza
http://en.wikipedia.org/wiki/Influenza

I guess I'm one of those that thought flu was simple. Maybe not anymore. What do people die from? Pneumonia? Dehydration?

Primarily pneumonia. Dehydration and malnourishment typically occured in overwhelmed remote communities where the adult population died and the kids were unable to fend for themselves. One anecdote tells of one old woman who was the last survivor of her remote northern community - she froze to death. Some died of animal attacks after pets got hungry.

The "best" thing about the pandemic of 1918 is that it felled the young, vigourous healthy adults, and tended to leave behind the very young and the very old. Exactly the combination to cause the biggest impact.

Edit: I guess I should provide some sources:

http://en.wikipedia.org/wiki/Spanish_Flu
http://www.stanford.edu/group/virus/uda/
http://www.pbs.org/wgbh/amex/influenza/

I guess I'm one of those that thought flu was simple. Maybe not anymore. What do people die from? Pneumonia? Dehydration?
Influenza-Associated Fatality Reports
Case 1. In January, a previously healthy male teenager had onset of fever, nasal congestion, cough, nausea, vomiting, and leg pain. He took over-the-counter (OTC) medications containing pseudoephedrine and acetaminophen that evening and the following morning. On that morning, he was found unresponsive and was transported to an ED, where he could not be resuscitated. ED laboratory tests showed a markedly elevated white blood cell count (WBC) of 34, 000 cells/mm3, (normal range: 4,000--10,500 cells/mm3) with a neutrophilic predominance, a substantially elevated troponin of 98.5 ng/ml (normal range: 0--0.39 ng/ml), and a negative toxicology screen. Evaluation of autopsy specimens indicated interstitial pneumonia and focal myocyte necrosis without frank myocarditis. IHC of respiratory epithelial cells of bronchi from centrally located lung tissue was positive for influenza A virus. Review of available records revealed no history of influenza vaccination.

Case 2. In January, a previously healthy girl aged 6 years with a 1-day history of fever, sore throat, and cough was examined by her primary-care physician and noted to have harsh upper airway sounds. A rapid test of a throat swab for Group A Streptococcus was negative. The patient received oral prednisone for the treatment of croup and an OTC cold medicine containing acetaminophen without salicylates. Later the same day, she complained of leg pain. The next morning, she was found apneic. When paramedics arrived, the patient was in cardiopulmonary arrest and was intubated, resuscitated, and transported to an ED. Her WBC count was 15,900 cells/mm3. She was transferred to the pediatric ICU, where she died the same day. A viral culture of an endotracheal aspirate was positive for influenza A virus that was antigenically similar to the vaccine strain A/New Caledonia/20/99 (H1N1)-like. A bacterial culture of a throat swab taken at her primary-care physician's office was positive for Group A Streptococcus. Evaluation of autopsy specimens indicated bronchopneumonia with numerous intracellular bacteria in the intra-alveolar infiltrate. IHC of bronchiolar epithelial cells from lung tissue was positive for influenza A virus but negative for Group A Streptococcus. Review of available records revealed no history of influenza vaccination.

Case 3. In February, a girl aged 5 years with no underlying health conditions had onset of a low-grade fever. During the evening, she became disoriented and lethargic and vomited at least seven times. She had recently completed a course of amoxicillin for treatment of streptococcal pharyngitis. The patient received medications containing ibuprofen; no information about aspirin exposure was available. On arrival to an ED the next day, she had a temperature of 104.1º F (40.05º C) and a WBC count of 13,100 cells/mm3 and again vomited. Antibiotics were administered. A nasopharyngeal swab was positive for influenza A virus by a rapid antigen test, and treatment with oseltamivir was initiated. Liver function tests showed an elevated aspartate transaminase of 494 U/L (normal range: 20--45 U/L) and elevated alanine aminotransferase of 383 U/L (normal range: 5--25 U/L). The patient's neurologic status deteriorated rapidly, and she progressed to respiratory arrest. After intubation, a computerized tomography scan indicated uncal herniation. The patient died 19 hours after admission. Autopsy was declined. A viral culture of the nasopharyngeal specimen obtained during the hospitalization was positive for influenza A virus that was antigenically similar to the vaccine strain influenza A/ New Caledonia/20/99 (H1N1)-like. The patient's illness was consistent with influenza-associated encephalopathy; however, Reye syndrome could not categorically be ruled out because no autopsy was performed. Review of available records revealed no history of influenza vaccination.

Case 4. In February, a boy aged 2 years with a history of resolved reactive airway disease had onset of a fever and cough. The next evening and on the third morning, the patient received a children's formulation of an OTC combination cold medication. After several hours of lethargy, the boy was found unresponsive at home. Paramedics transported the child to the hospital, where attempts to resuscitate were unsuccessful. A postmortem lung swab was positive for influenza A virus by a rapid antigen test, but viral culture was negative. Evaluation of autopsy specimens indicated tracheobronchitis and massive brain edema without evidence of inflammation. IHC of respiratory epithelial cells of trachea and bronchi from centrally located lung tissue was positive for influenza A virus. The patient had not been vaccinated against influenza.

Sometimes pneumonia, sometimes apparently it just kills your brain.

http://www.medscape.com/viewarticle/461148

I've worried about this for a while now. Hopefully it won't be for a few years, by which time we should be better prepared for it. However, they reckon it's not a question of if it happens, but when.

I saw a documentary on this a couple of years back, apparently they traced the 1918-1920 flu epidemic to a British field hospital in 1916 France. They even located the war grave of one of the first dozen victims.

Apparently, to feed the huge British and French armies, pigs, geese and other animals were bred in captivity in vast numbers, and kept in adjoining pens. One such area was sited next to a field hospital and barracks. Something like 100,000 men living in filthy conditions amidst the animals, in an area covering a few square kilometres, a tent city, basically.

In those conditions, people's immune systems are not at their best, and the virus had years in which to adapt. Then it went wherever the soldiers went.

It appears that the modern variant has been spawned in the same conditions in SE Asia, and is becoming endemic through the migratory pattern of birds. During the next few years, it will be seeking a successful mutation.

Flu season is always like a trip to Vegas for me.....I have an infamously horribly disappointing immune system, and there is ALWAYS a shortage of flu shots in my area once they get past the "high risk" people (and somehow this here girl who spends half of her life at the doctor or in the hospital for immune failings isn't "high risk"....?). The last few years they were actually OUT after that. So it's a total gamble.....will I get sick? How long will it last? Will it develop into something even more uncomfortable?

Most importantly, how many nights straight will the fever pains keep me awake?

Yeah, totally looking forward to this winter.... [/sarcasm]

It's scary to think about, but we best not be alarmed. This could turn out to be nothing. At most, I'd have governments stockpile Tamilflu. Vaccines are useless if these viruses mutate all the time. Besides, there are a lot of other health concerns, like Ebola or Marburg.

Yes, for all of you who think it's going to be a simple case of the flu, and nothing to worry about, think again. The last time around, it killed more people than the World War it coincided with (WW I).

Actually, if you read the article closely, it does not say that the Spanish Flu of 1918 is the same as the current avian flu. In fact, it says that they are different viruses: The 1918 flu was an H1N1 virus, while the bird flu is an H5N1 virus. Yes, they're both avian flus, but they are completely different strains of avian flu, not the same thing - all that "avian flu" means is that it's a flu that comes from birds.

I'd actually feel better if this was the 1918 flu again, since all of my grandparents and great-grandparents had the 1918 flu, and all of them survived. Which means that I likely have at least some genetic immunity to it. The bird flu, on the other hand, seems to have never hit the human population before, so it has a wide-open field to play in.

:eek: