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H5N1: The Next Pandemic ?

Midwest Tech Journal | March 19, 2005
By Steven A. Turner MD

When the great influenza pandemic started in Haskell County, Kansas, in January 1918 people lived in relatively geographically isolated regions. It was a rural community with farmers tending to raising chickens, pigs and cattle. There wasn’t the prevalence of mass transportation in the form of cars, planes, and buses that exist today. Rarely did a farmer travel to the city. There simply was no incentive for frivolous travel; transportation over long distances was difficult and tedious, Roads were unpaved muddy obstacle courses and the horsepower one relied for locomotion was from the real thing.

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The influenza epidemic that struck Haskell County that January was unusually virulent. Adults who were normally safe from morbidity of the flu suddenly succumbed to the virus-- often dying from pneumonia within days of its onset. By March, the rash of deaths had petered out and would have gone unnoticed if it hadn’t been for the intervention of a little conflict that spilled from the furthest reaches of the Austrian Empire to the rest of the earth: World War One.

Suddenly, entire communities of farmers joined up for the patriotic war, traveling for training in massive, tented army camps. The destination for the men of Haskell County was the Fort Riley complex in Kansas. There, in camp Funston, the fist cases of this new influenza strain appeared in the first weeks of March. The virus spread rapidly. First, it struck the closely quartered men in the gigantic tent cities of army training camps. Within weeks it appeared in the surrounding towns and cities. As the soldiers were shipped overseas to the French port of Brest, the virus accompanied the soldiers, rapidly infecting entire cities in its wake, striking down their healthiest inhabitants.

The symptoms started like a bad cold: first a cough, runny nose and a headache. Then, a fever ensued followed by upper respiratory congestion, a racing heartbeat and difficulty breathing. If one was unlucky, (and 50 million people were), the disease progressed to fatal pneumonia. This pneumonia was particularly vicious: people literally would drown in their own fluids as lungs rapidly lost the ability to exchange oxygen while the victim would turn a cyanotic blue. The brevity of the time from the first sniffle to the writhing death rattles was horrendously short. There were eyewitness accounts of people taking the New York Subway seemingly in good health upon boarding and then dying in a congested suffocating fury with blood pouring from every orifice by the time their car had reached the end of the line.

It was truly a dangerous time to be out in public. People who did venture outside would cover their faces with handkerchiefs in the futile hope that they were somehow protected from this vile plague. They were not. Instead, entire communities were decimated. For example, the hamlet of Brevig Mission, Alaska lost 85% of its population over the age of 16. Isolation of the population was the only affective measure to slow down the progression of spread. This rarely happened. In India alone, 12 million people died. In the city of Philadelphia, against the better judgement of protesting physicians, politics prevailed when the public health director allowed a half a million strong rally for war bonds took place. Within days, more than 500,000 Philadelphians succumbed to the virus.

What made the influenza virus of 1918 so Virulent? For a long time no one knew. It wasn’t until the late 1990's, under the strictest of secrecy, that a genetic sequence of the virus was reconstructed. Using PCR technology, the virus’ RNA fragments were retrieved from the Alaskan victim’s lungs. It was the geography that played an important role in preserving the residual evidence of this modern day plague. The victims were buried in permafrost which retarded the decomposition of the virus’ genetic material.

In comparison with the genetic material of current avian flu viruses, it was found that there had been a mutation of the Hemagglutinin protein. It is this protein that allows the virus to attach to the cells of the infected host in order to invade the cells and begin replicating. Normally, through eons of exposures to similar proteins, humans are able to have a selective immune response to fight the virus. However, in the case of the 1918 pandemic, the virus’ hemagglutinins along with other proteins were so foreign and at the same time so effective in invading cells, the human body simply could not cope with an infection.

Once infected, a generalized defense would be mounted by the victim’s body. An inflammatory protein called cytokines would be produced by the host’s body which is normal in any inflammatory response to infection. However, in this case, a massive storm of cytokines would be evoked by the virus’ unique amino acid sequence. People would drown from the fluid caused by this cytokine onslaught, which in turn generated leakage of the weeping endothelial cells that line the lung. In other words, there would be a situation akin to Cholera of the Lungs.

We are faced with same type of virus today. It is termed the H5N1 virus. Remember that name because you are going to be hearing it repeatedly. It is only a matter of time before some Asian who lives with livestock in their abode will be simultaneously infected with human influenza and avian H5N1 flu. Then the virus will incorporate the genes (from the human influenza) necessary to make transmission from human to human. This new hybrid virus will be particularly contagious. Then all hell will break loose.

The H5N1 strain has already killed millions of chickens in Asia. It is particularly virulent in humans as well. It kills at least 33% of the people who are infected it. What is worse is the fact that it has a long incubation period in water fowl. In ducks, who apparently can carry the virus without getting sick, the virus is spread through its digestive system, polluting the water for up to 17 days after being infected.

When this outbreak occurs -it’s not a question of “if” only ”when”- it will spread much more rapidly than the 1918 pandemic. It is estimated that more than 150 million people will die. This is due to the fact that during the human latency period a person can circle the globe while shedding the virus from one unsuspecting victim to another. It will spread exponentially like nuclear fission reaction. There will be no sanctuary.

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