The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic Global Challenges, Global Solutions: Workshop Summary (2010) / Chapter Skim
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A12 Southern Hemisphere, Northern Hemisphere: A Global Influenza World
A12 Southern Hemisphere, Northern Hemisphere: A Global Influenza World
Pages 306-326
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Swine influenza virus infections in humans. J Infect Dis.
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This informal designation followed the hypothesis that southern China is an epicenter for the emergence of pandemic influenza viruses (Shortridge and Stuart-Harris, 1982) , a hypothesis that was the anchor for subsequent thinking and goals considered here.
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South June, outbreaks in pigs following northward human spread North-east October, pigs infected at same time as humans South Hong Kong, June, human deaths 2009-H1N1 influenza A human cases virologically confirmed (publicly available data) b Mainland 5,592 September 9 Hong Kong 15,357 September 9 1st case May 1 Taiwan 94 September 9 Macao 1,435 September 9 Porcine infection not known to this time.
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. BOX A12-1 Brief Overview of the Origin of the 1918 Pandemic H1N1 Virus and the Classical H1N1 Swine Flu Virus Origin of the 1918 Pandemic Virus Differing times of yearly influenza occurrence in temperate and tropical zones may be a key factor, something not appreciated until the late 1980s (see later discus sion)
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It clearly occurs in temperate zones with a recognizable disease burden, but in the tropics and subtropics? A meeting was convened in Singapore in late 1988 with influenza colleagues from around the Pacific Basin with an emphasis on those from Asia.
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. The ability of seemingly the same influenza viruses to manifest in a cold, dry, or damp winter and year-round in a hot, humid climate is more than a little curious.
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Ideally, as many isolates of the three categories of variants as practicable from the Northern Hemisphere winter should be sequenced for evidence of reassortment, as should those obtained from tropical East Asia throughout the year. Recycling of H Subtypes The appearance of the 2009-H1N1 influenza A virus has rekindled the notion that there is a limited range of H subtypes that can cause pandemics, namely H1, H2, and H3.
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. The virus appears to be endemic in poultry in southern China (Chen et al., 2006)
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International human and animal health authorities now face exceedingly complex influenza issues. Food, Flu, and the Future With the big increase in global population in the past 60 or so years has come the need to supply dietary meat protein on an unprecedented scale, bringing with it infectious agents arising from intensified animal production (Greger, 2006)
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Suffice it to ask whether the acquisition of Eurasian "avian-like" swine genes through reassortment in the pig could have facilitated the transition of a virus of North American geographical lineage into a pandemic virus? The Eurasian genetic composition of the pandemic viruses of the past century prompts this question.
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The interpretation of serological studies for the detection of presumptive antibody to avian influenza viruses in mammalian sera by widely used hemagglutination inhibition is more complex than the simple test belies. Whatever the diagnostic approach, it is suggested that investigation be carried out through an international collaborative effort using standardized reagents and techniques.
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Might it be possible to distinguish among events that take place in, say, the nasal turbinates following infection by a seasonal flu virus, a precursor pandemic virus, and the earliest detected pandemic virus? Whatever the situation, it would be beneficial to know
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No More Pandemics Having observed the changing tide of progress in influenza over the years from the Hong Kong influenza sentinel post, I feel the time is appropriate in the early phase of the 2009-H1N1 influenza A pandemic to rethink our view of pandemics. There is now better understanding of influenza virus ecology, the zoonotic dimension of pandemics, reaction to threats and outbreaks in incipient and pandemic phases, and special features of the virus and its disease to allow transition from a reactive or defensive position to a more positive one, namely, no more pandemics (Figure A12-2)
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A recognition of these properties provides the type and level of preventative action appropriate for birds and mammals to break the chain of zoonotic transmission. There is still a long way to go; it will require inter alia global mapping of avian influenza viruses and the influenza viruses of other hosts bearing in mind that pandemic influenza by its very nature is a zoonosis that is noneradicable.
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It is not often appreciated that dangerous or potentially dangerous influenza viruses can be carried by subclinically infected birds and mammals and be spread from population to population and across different populations. One might reasonably ask if, in hindsight, long-term systematic virus surveillance of pig populations, on the one hand, and concerted action on the part of farm operators and civil authorities, on the other, would have averted the 2009-H1N1 influenza A pandemic.
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. PANDEMIC INFLUENZA QUESTION EXCEEDINGLY COMPLEX GLOBAL PROBLEM REQUIRING GLOBAL EFFORT SMALLPOX POLIOMYELITIS ACHIEVABILITY AND AFFORDABILITY FOR ALL NATIONS GLOBAL STRATEGY AND GLOBAL PREVENTION PROGRAMME INTERNATIONAL DECISION MAKING OF UNITED NATIONS FIGURE A12-4 Toward a unified, global effort for the prevention of pandemic influenza.
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Jude Children's Research Hospital, Memphis; the Centers for Disease Control and Prevention, Atlanta, for studies in moving the animal-human influenza link forward and, later The Wellcome Trust, London and the Li Ka Shing SCIENCE AND CIVILIZATION IN CHINA Joseph Needham & Lu Gwei Djen ■ The Best Medicine is Preventive Medicine Warring States Period 472-221 BC ■ A Skillful Doctor Cures Illness when there is No Sign of Disease, and thus the Disease Never Comes Han Dynasty 206 BC-220 AD CHINESE HIPPOCRATIC CORPUS FIGURE A12-5 Fundamental principles still apply. SOURCE: Adapted from Needham (1980)
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2006. Establishment of multiple sublineages of H5N1 influenza viruses in Asia: implications for pandemic control.
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. Transmission of influenza viruses in temperate zones is predominantly by aerosol, in the tropics by contact.
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In The origin of pandemic influenza viruses, edited by W
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1990. Antigenic stability of H3 influenza viruses in the domestic duck population of southern China.
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