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Pandemic Influenza Pandemic Influenza &&H5N1 Bird Flu VirusH5N1 Bird Flu Virus

DxNA LLCDxNA LLC3879 South River RoadSt. George, Utah 84790United States of America

• A worldwide disease outbreak due to a A worldwide disease outbreak due to a new influenza A virus new influenza A virus 1)1) that causes serious illness and deaththat causes serious illness and death2)2) for which people have little or no for which people have little or no

immunityimmunity

• Pandemic influenzas occur again and Pandemic influenzas occur again and again over time. again over time.

• The question is The question is when and how severe will when and how severe will the new pandemic bethe new pandemic be??

• Early detection is essential to their control.Early detection is essential to their control.

Pandemic InfluenzaPandemic Influenza

Pandemic Influenza Pandemic Influenza Historical PerspectiveHistorical Perspective412 BC412 BC

• A pandemicA pandemic influenza documented for the first time by influenza documented for the first time by HippocratesHippocrates

15801580

• The first well-documented influenza pandemicThe first well-documented influenza pandemic• Began in Asia and spread to Europe and ultimately Began in Asia and spread to Europe and ultimately

North America via AfricaNorth America via Africa• Over 90 percent of humans infected, mortality very Over 90 percent of humans infected, mortality very

highhigh

Since 1580Since 1580• 31 worldwide influenza outbreaks recorded31 worldwide influenza outbreaks recorded

17291729

• Started in Russia and spread across the world over Started in Russia and spread across the world over a three-year perioda three-year period

17811781

• Spread from China to Russia, Europe, Africa and Spread from China to Russia, Europe, Africa and North AmericaNorth America

• Infected 2/3 of the population of Rome and 3/4 of Infected 2/3 of the population of Rome and 3/4 of people in the British Islespeople in the British Isles

• High morbidity, more than 1 million deadHigh morbidity, more than 1 million dead

1889 1889

• ““Russian flu” spread from Central Asia to to the rest Russian flu” spread from Central Asia to to the rest of the world of the world

• More than 1 million dead More than 1 million dead

The 1781 and 1889 influenza pandemics The 1781 and 1889 influenza pandemics rank with the 1918 Spanish Flu as among rank with the 1918 Spanish Flu as among the most widespread and dramatic disease the most widespread and dramatic disease outbreaks in history.outbreaks in history.

““The influenza pandemic of 1918-19 The influenza pandemic of 1918-19 killed more humans than any other killed more humans than any other disease in a period of similar duration in disease in a period of similar duration in the history of the world.”the history of the world.”

Alfred W. CrosbyAmerica’s Forgotten Pandemic: The Influenza of 1918

1918 Spanish Flu1918 Spanish Flu

1918 Spanish Flu1918 Spanish Flu• An avian influenza (as is the H5N1 virus) An avian influenza (as is the H5N1 virus)

that mutated to easily infect humansthat mutated to easily infect humans

• Spread around the world in 6 monthsSpread around the world in 6 months

• 25-30% of the world population infected25-30% of the world population infected

• 50-100 million people dead50-100 million people dead

• 675 thousand dead in the United States 675 thousand dead in the United States

• Most victims healthy adults, 18-40 years oldMost victims healthy adults, 18-40 years old

• Unlike typical influenzas which mostly affect Unlike typical influenzas which mostly affect infants (0-2 years old) and elderly as well infants (0-2 years old) and elderly as well as immunocompromised peopleas immunocompromised people

20th Century Influenza Pandemics20th Century Influenza Pandemics

1957 Asian Flu1957 Asian Flu

Strain H2N2Strain H2N2

3 million dead3 million dead

1968 Hong Kong Flu1968 Hong Kong FluStrain H3N2Strain H3N2

1 million dead1 million dead

1918 Spanish Flu1918 Spanish Flu

Strain H1N1Strain H1N1

50-100 million dead50-100 million dead

Photos:Photos:US National Archives, BBCUS National Archives, BBC

Global Influenza Pandemics RecurGlobal Influenza Pandemics Recur• Multiple times per century (Multiple times per century (every 10-42 years)

• Driven by recurrent virus mutation and genetic Driven by recurrent virus mutation and genetic reassortmentreassortment

• Past 3 pandemics -- avian influenzas became Past 3 pandemics -- avian influenzas became dangerous human diseasesdangerous human diseases

• H5N1 avian influenza – considered the No.1 H5N1 avian influenza – considered the No.1 candidate for causing the next pandemiccandidate for causing the next pandemic

H5N1 Avian InfluenzaH5N1 Avian Influenza

Photo: WHOPhoto: WHO

• Highly pathogenic type now in Asia, Europe, the Middle East and AfricaHighly pathogenic type now in Asia, Europe, the Middle East and Africa• An aggressive, deadly animal disease – quickly kills entire chicken An aggressive, deadly animal disease – quickly kills entire chicken

flocksflocks• Can infect humans – so far, mostly people living and working with Can infect humans – so far, mostly people living and working with

poultrypoultry• Almost 400 known human infections – more than 240 deathsAlmost 400 known human infections – more than 240 deaths• H5N1 mortality rate possibly more than 20 times that for the 1918 H5N1 mortality rate possibly more than 20 times that for the 1918

Spanish Flu (1-2%)Spanish Flu (1-2%)• Not yet easily spread from person to personNot yet easily spread from person to person

H5N1 Avian Influenza -- BasicsH5N1 Avian Influenza -- Basics

H5N1 – Pandemic AttributesH5N1 – Pandemic Attributes

1.1. A novel (mutated and/or reassorted) virus to which A novel (mutated and/or reassorted) virus to which humans have no immunity humans have no immunity YESYES for for H5N1H5N1

2.2. The virus causes severe illness and death The virus causes severe illness and death YESYES for for H5N1H5N1

3.3. The virus can spread rapidly/easily from person to The virus can spread rapidly/easily from person to person person NOT YET NOT YET for for H5N1H5N1

H5N1 Avian so far has 2 out of 3 …H5N1 Avian so far has 2 out of 3 …

An influenza virus must have 3 attributes to An influenza virus must have 3 attributes to become a pandemic disease:become a pandemic disease:

• The H5N1 virus can spread from birds The H5N1 virus can spread from birds to mammals and in some circumstances to mammals and in some circumstances to humans.to humans.

• 391 known human cases, 247 deaths391 known human cases, 247 deathsWHO, 16 December WHO, 16 December 20082008

Photos: Photos: UNICEF, China DailyUNICEF, China Daily

Human Human InfluenzaInfluenza

VirusVirus

How can H5N1 flu develop the ability to How can H5N1 flu develop the ability to easily spread from human to human?easily spread from human to human?

Avian Avian Influenza Influenza

VirusVirus

Genetic MutationGenetic Mutation

AND/ORAND/OR

Reassortment, the genetic Reassortment, the genetic “mixing” in animals (or “mixing” in animals (or human) infected with both human) infected with both human and avian influenza human and avian influenza viruses viruses

Photo: China DailyPhoto: China Daily

(as in 1957 and 1968)

(as in 1918)

With horrible consequencesWith horrible consequences• 6 billion people today6 billion people today• But only 1.5 billion in 1918But only 1.5 billion in 1918• Rapid disease spread globally Rapid disease spread globally

via jet travelvia jet travel• Still no specific antiviral treatmentsStill no specific antiviral treatments• Still no vaccine (seasonal vaccine Still no vaccine (seasonal vaccine

NOTNOT protective) protective)

The H5N1 virus may trigger a The H5N1 virus may trigger a pandemic like the 1918 Spanish pandemic like the 1918 Spanish FluFlu

WHO Situational AssessmentWHO Situational Assessment May 2006May 2006

• Risk of an H5N1-caused pandemic is great.Risk of an H5N1-caused pandemic is great.

• The risk will persist for a long time.The risk will persist for a long time.

• When the threat will become reality cannot be When the threat will become reality cannot be predicted.predicted.

• Reduction of H5N1 morbidity and mortality will be Reduction of H5N1 morbidity and mortality will be impeded by inadequate medical supplies.impeded by inadequate medical supplies.

• Early detection and isolation the best protectionEarly detection and isolation the best protection

• So far, appropriate early warning technology So far, appropriate early warning technology weak and largely unavailableweak and largely unavailable..

““The best way to prevent international spread The best way to prevent international spread of diseases is to detect public health threats of diseases is to detect public health threats early and implement effective response actions early and implement effective response actions when the problem is small.”when the problem is small.”

Pan American Health OrganizationPan American Health Organization

Pandemic Influenza -- Current Situation and Global Pandemic Influenza -- Current Situation and Global PreparednessPreparedness