MORE THAN JUST A PORK CHOP GONE SOUTH
 
Considering our microscopic attention span, we generally prefer to inform, expound and berate in short spurts.  This Spring, however, has been anything but "silent," and screams out for more attention than usual to the devilish details.  Here's what we think we know about things flu-ish and pandemic - in 700 words or less.
 
All original influenza images courtesy of Cynthia Goldsmith, Centers for Disease Control, Atlanta, GA.
 
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- ORIGINS
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Easter weekend 2009 in Oaxaca, Mexico was apparently ground zero for the recent outbreak of the "atypical pneumoniae" now called Influenza A H1N1.   Hundreds of cases later, and tens of thousands of frequent flyer miles, this old virus, spiffed up with a couple of new genes, has left a lasting - and unsettling - impression on an anxious and susceptible world.
   
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- U.S. PANDEMICS IN THE 2OTH CENTURY
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1. 1918 "SPANISH" FLU PANDEMIC:  Long thought to be caused by a swine strain (oops, recent research suggests the causal source was actually avian), the pandemic lasted a year and a half, killing incalculable millions (estimates vary from 20-100 million).  The unsanitary and sardine-like trench conditions of the WWI conflict made for perfect incubation and transmission.
          
Click image to view: 1918 Flu - Immunization Scarf, Necktie


 
         
2. 1957 ASIAN FLU A (H2N2)   Began in China, spread to U.S. in 4 months.  Resulted in 70,000 deaths, less than the potential due mainly to advances in scientific technology leading to early identification.  A vaccine was available within two months of outbreak in U.S., indicating lessons learned from earlier outbreaks.
         
3. 1968 HONG KONG FLU A (H3N2)  Originated in Hong Kong, struck U.S. later in the year.  34,000 deaths, the mildest of the 20th century pandemics.  Because it was similar to the previous Asian strain, parts of the population may have developed immunity, or to some degree, resistance to the more virulent strains.
 
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- RECENT HISTORY
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1995/1997 AVIAN FLU A (H5N1)   Began in Hong Kong, was characterized by its ability to jump from birds to humans.  Fortunately, it did not transmit between humans.  A 1997 strain (H9N2) led to the untimely and unroasted demise of 1.5 million chickens in Asia.  
 

 
Click image to view: Avian flu scarf, neckties







1976 SWINE FLU: THE RIPPLE EFFECT OF A PANDEMIC THAT NEVER HAPPENED
 
The 1976 influenza was thought to be a direct descendant of the 1918 strain, causing both panic and what proved to be a hasty vaccination campaign.  The pandemic never materialized, but there were some 500 cases of Guillain-Barre syndrome, a rare neurological condition, that developed after receiving the vaccine. 25 died.  Lawyers had a field day; big pharma packed it in for decades!
 
The boundaries between politics and science became critically blurred, resulting in what is now called the Swine Flu "debacle" of 1976.  The failed policy casts light on the difficult challenge faced by public health community, i.e. to err on which side of caution.  In any case, the flamed out epidemic managed to set back the development of new vaccines for decades.  
 
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"THE AGE OF THE PANDEMIC".  PERSPECTIVE and PREPARATION
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While the jury is still out on the ultimate impact of this most recent epidemic, there are important lessons to be learned about this event.   First and foremost, we were lucky.  We dodged another bacterial bullet.  Science continues to uncover many of the mysteries of disease, infection and epidemic; however, there is consensus among those that really do know that, in general, we are "under prepared" for a true pandemic or major outbreak - regardless of the source.  Genetic mutations, bioterrorism, emergence of new entities, or even a laboratory accident (see below) need only a bit of "good luck" to cause the world a really bad day.  Preparation is difficult and expensive, and direction is uncertain - but unless we are serious about prioritizing, West Nile, SARS, Ebola, HIV and cohorts, may prove to be just walks in the pathogenic park.    
 
Highly recommended: Article by Larry Brilliant, chairman of the National Biosurveillance Advisory Subcommittee  "The Age of Pandemics."  Wall Street Weekend Journal, May 2 -3, 2009.