October 9, 2005
October 4-8: The 100-Hour “Tipping Point” in US Pandemic Flu Awareness
This past week marked the tipping point in public awareness of pandemic influenza preparedness in the United States of America.
In his press conference Tuesday, October 4, President Bush mentioned a book he had read recently on the devastating 1918 pandemic flu, and discussions he has had with Dr. Anthony Fauci at the National Institutes of Health about influenza. He also referred to the need for discussion about potential use of the military if the current potential threat of a severe flu pandemic were to occur. Media interest in pandemic influenza was accelerated as this story was reported Tuesday and Wednesday, October 4-5.
On Thursday, October 6, the renowned basic science journal, Nature, published online a landmark medical paper regarding the sequence of the final three genes (polymerase) of the 1918 pandemic influenza virus. Notably, it appeared that this 1918 pandemic flu virus may have originated entirely from an avian source (“bird flu”) without having exchanged genes (“reassorted”) with another virus as occurred in the less devastating pandemics of 1957-58 and 1968-69. The actual avian source of such a flu virus that gave rise to the 1918 human pandemic, however, was not identified.
The media noted the potential similarity between this H1N1 influenza A “avian flu” virus that caused the human pandemic in 1918-1919, and the current H5N1 influenza A “avian flu” virus that President Bush, HHS Secretary Michael Leavitt, and many in the global medical and scientific community emphasized may cause the next human flu pandemic. The Secretary of the Department of Health and Human Service, Michael Leavitt, was shown on CBS Evening News Thursday evening clearly stating that the US was not adequately prepared for a human flu pandemic.
This work on the 1918 flu virus marked the culmination of ten years of sustained effort by a team of researchers lead by the first author of this publication, Dr. Jeffery Taubenberger of the Armed Forces Institute of Pathology (AFIP) in Rockville, Maryland.
By Friday, October 7, the equally renowned journal, Science, published another landmark paper in which the 1918 pandemic influenza virus had been reconstructed and studied in a high biosecurity containment laboratory at the CDC in Atlanta. This virus was shown to be highly lethal in mice (Balb/c) after only 3-4 days, and in embryonated chicken eggs. It caused swelling and hemorrhage in the lungs of the mice, and also produced very high amounts of virus in tissue culture of human lung (bronchial) epithelial cells.
These experiments were done only at the CDC under strict safety conditions primarily by the first author of the paper Dr. Terrence Tumpey of the CDC. At the same time, many collaborators from other institutions contributed significantly and were co-authors on the paper, including Dr. Peter Palese from Mt. Sinai School of Medicine in NY City, David Swayne from the US Department of Agriculture, and Dr. Taubenberger.
In addition, on Friday, October 7, the US hosted a meeting on avian influenza and the human pandemic threat for 80 nations in Washington, DC, and President Bush met with vaccine manufacturers regarding ways to increase influenza vaccine production. By Saturday, October 8th, HHS Secretary Leavitt was leading a high-level delegation to SE Asia from the USA, with key partners from the WHO and other global organizations in the new international alliance against avian and pandemic influenza. The delegation will visit four nations affected by bird flu since 2004: Thailand, Vietnam, Laos, and Cambodia.
In the course of 100 hours, between October 4 and October 8, the tipping point had been reached in the US media and the US Public’s awareness of H5N1 avian influenza and its potential human pandemic threat.
Although the current H5N1 avian flu has not spread in a sustained manner from person-to-person, this virus has infected 117 people, killing 60 (51%). If this avian flu virus ever does mutate and acquire the ability to spread in a sustained manner from person-to-person, then a human pandemic will begin. The policy and actions of national and international planners now should be “Preparedness not Panic”.
Daniel R. Lucey, MD, MPH
Director, Center for Biologic Counterterrorism and Emerging Diseases
ER One Institutes, Washington Hospital Center
Adjunct Professor, Department of Microbiology and Immunology
Georgetown University School of Medicine, Washington, DC