In 1918 the trench warfare and artillery fire of World War I were slowing and a new danger, Spanish Influenza, was beginning to spread throughout the globe. People were only beginning to see the effects of the worst infectious disease in history. The virus would eventually kill more than 30 million people around the world.
Today, there is another kind of influenza creeping around the world. Avian influenza has already killed 60 people in China and is steadily moving westward, with Britain reporting its first case two weeks ago. This disturbing sequence of events echoes the chaos of 1918 – and has prompted global cries for prevention and efforts to learn about the mysterious disease.
Although many experts question whether Avian influenza, called the bird flu, will become a worldwide pandemic, they all agree that it is potentially dangerous and that precautions should be taken. Boston University School of Public Health professor Wayne LaMorte said pandemics occur in 30 to 40 year cycles and another is almost inevitable.
“The large shifts in viral structure … are not predictable, but experience tells us that they occur every 30 to 40 years,” he said. “The last pandemics were 1957-58 and 1968-69, so it’s just a matter of time until another one occurs.”
Influenza is a virus composed of RNA or DNA surrounded by a shell of proteins, LaMorte explained.
Avian influenza is a contagious disease usually limited to birds or pigs, but the ability of a flu virus to mutate is what makes it dangerous, LaMorte said.
“The problem is that flu viruses change from year to year,” he said. “Mutations in the genetic core result in small or large changes in the shape of the surface proteins. As a result, our immune system may not recognize the viral proteins and may not mount an effective immune response.”
With the seasonal flu, for which many people receive flu shots, our bodies are able to “remember” the virus, and therefore “mount a rapid, effective immune response to knock it out,” LaMorte said. “Once you are exposed to a particular flu virus, you have long lasting immunity.”
LaMorte added that sometimes the virus changes dramatically.
“Sometimes the viral proteins undergo very large changes as a result of genetic recombination,” La Morte said.
“This has been observed in Asia, where agricultural practices provide an opportunity for bird viruses, pig viruses and human viruses to exchange genetic material in a way that can generate a new virus that has the capacity to bind to human cells and infect them and, at the same time, have protein shapes that humans have not been exposed to.
“When these large ‘shifts’ occur, almost all of us are susceptible to infection with the new virus, making it easy for the virus to spread world wide and cause large scale global pandemics, such as the one that occurred in 1918.”
According to the World Health Organization’s website, H5N1, the current highly infectious subtype of the original bird flu strain, has killed more than half of those it has infected. People in close contact with birds, such as farmers in China, can contract the disease, but so far the H5N1 strain has not mutated enough to jump directly from human to human.
The risk of such mutation is high, however, and every time another human becomes infected, it gives the virus a chance to better adapt. If the virus mutates enough, it will spread uncontrollably and transform into a pandemic. LaMorte predicted widespread problems from the disease if it mutated.
“If 30 percent of the population becomes ill, it will have a devastating effect on all aspects of society,” he said. “Emergency services will be markedly diminished when we need them the most, truck drivers will not report to work, so food will not be delivered to supermarkets. A pandemic like the one we had in 1918 would cause even greater disruption today than it did then.”
The World Health Organization estimated that there would be between 2 and 7.4 million human deaths if avian influenza were to become a pandemic.
“Flu viruses are spread by respiratory secretions,” he said. “So, if someone with the flu virus sneezes, you can inhale tiny droplets that contain virus. These contact the lining of your nose or throat, attach, enter the cells, begin to replicate and then the new virus particles infect more cells. The flu virus can also be spread by touching surfaces contaminated with respiratory secretions and then rubbing your eyes, nose, etcetera with your contaminated hands.”
The World Health Organization website called the current outbreak “the largest and most severe on record.”
“Never before in the history of this disease have so many countries been simultaneously affected, resulting in the loss of so many birds,” the site stated.
The severity of the H5N1 strain is the driving force behind the search for a vaccine and the virus is entirely curable if an appropriate vaccine is administered before the sickness has had an opportunity to develop, LaMorte said.
“Until recently there was no specific treatment, just general supportive measures,” he said. “We now have several drugs that provide effective treatment if they are taken very early in the course of infection. The most promising of these are Relenza and Tamiflu, which prevent newly synthesized virus particles from being released from an infected cell. As a result, the infection is interrupted and symptoms abate quickly.”
Avian influenza symptoms are just like the flu: fever, sore throat and coughing, which can quickly deteriorate into severe respiratory problems and even death. Although the Boston Public Health Commission website lists steps to prevent the spread of flu, including annual flu shots, washing hands and staying home while sick, some people said more definitive steps need to be taken.
“Even though a specific threat has not yet materialized, proactive precautions are essential in preventing a potential outbreak and saving lives,” said College of Arts and Sciences sophomore Janice Glines, a biology major.
Worldwide efforts to kill and quarantine infected birds are underway, but it may just be a matter of time before H5N1 mutates and fulfills the pandemic expected soon. But experts said it is important to stay calm.
“I think there is a reason to be concerned,” LaMorte said. “But I don’t think panic is warranted or useful.”
Although the disease is dangerous, the probability of it becoming a worldwide epidemic is underscored by the amount of time the situation has remained in the spotlight, Donahue said.
“I feel like there has been too much warning for this disease to be a worldwide pandemic,” he said. “A vaccine has been developed already. Public awareness is up. If it were to jump to humans then I feel like the U.S. would have time to respond.”
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