Could we see one fifth of the pop­u­la­tion struck down with in­fluenza ever again?

The Irish Times - Tuesday - Health - - Front Page - Muiris Hous­ton

“Yes­ter­day, from early morn­ing till well af­ter mid­day, cortege af­ter cortege reached Glas­nevin Ceme­tery, some­times as many as three corpse-laden hearses be­ing seen pro­ceed­ing up Sackville Street at the same time. Close on 40 or­ders for in­ter­ment were issued at the Ceme­ter­ies’ Of­fice yes­ter­day, and, in­clu­sive of the re­mains brought for burial on the pre­vi­ous day, which had been tem­po­rar­ily placed in the vaults overnight, there were close on one hun­dred bod­ies for sepul­chre.”

This is how the The Ir­ish Times of Oc­to­ber 31st, 1918, de­scribed the ef­fects of the Span­ish flu epi­demic – 100 years ago this month.

Glob­ally the in­fluenza virus killed an es­ti­mated 50 mil­lion peo­ple. And yet the dis­ease was not con­sid­ered es­pe­cially lethal. As Ida Milne, in her re­cently pub­lished book Stack­ing Coffins notes: “In­ter­na­tional statis­ti­cians and his­to­ri­ans of­ten use a death rate of 2.5 per cent of those who ac­tu­ally caught the dis­ease (case fa­tal­ity rate) to es­ti­mate mor­bid­ity. Ap­ply­ing this rate to the of­fi­cial es­ti­ma­tion of Ir­ish in­fluenza dead, 20,057 would give a mor­bid­ity of ap­prox­i­mately 800,000, or about one fifth of the is­land’s pop­u­la­tion at the time.”

What­ever it may have lacked in lethal­ity, the 1918 flu made up for in vir­u­lence. Could we see one fifth of the pop­u­la­tion struck down with in­fluenza ever again?

Dr Michael Oster­holm, di­rec­tor of the Cen­tre for In­fec­tious Dis­ease Re­search and Pol­icy at the Uni­ver­sity of Min­nesota, thinks so. In a re­cent con­ver­sa­tion piece in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion, he was asked if im­prove­ments in vac­cine de­vel­op­ment and san­i­ta­tion mean an­other pan­demic on the scale of the 1918 flu is avoid­able?

Vac­cines

“I would say that we are much more vul­ner­a­ble to­day to a cat­a­strophic in­fluenza pan­demic than we were in 1918. That may seem coun­ter­in­tu­itive, but to­day there are about 7.6 bil­lion peo­ple on Earth, more than 3 times the pop­u­la­tion in 1918. When we talk about less crowded liv­ing con­di­tions to­day, that is true for part of the world. But for the vast ma­jor­ity of the world it’s worse.”

“We now have in­fluenza vac­cines that we didn’t have in 1918, but their ef­fec­tive­ness is lim­ited. In the 2009 in­fluenza pan­demic, which for­tu­nately was mild, that vac­cine was roughly 50 to 55 per cent ef­fec­tive. More im­por­tantly, less than one per cent of the world’s pop­u­la­tion had ac­cess to the vac­cine in the first six to 12 months of the pan­demic be­cause of our in­abil­ity to quickly make a largely egg-based prod­uct. In the fu­ture, vac­cines still are go­ing to have only a lim­ited im­pact.”

With a uni­ver­sal flu vac­cine that could be given every 10 years in the pipe­line, surely Oster­holm is be­ing overly pes­simistic?

Erad­i­ca­tion

“Un­for­tu­nately we’re a long way away even though there’s a lot of hype to­day that it’s just around the cor­ner . . . We think there’s rea­sons to be­lieve we can find a com­bi­na­tion vac­cine that would be much more ef­fec­tive. But I would say we’re at least five to eight years off . . .”

He thinks more money and ef­fort is re­quired – a uni­ver­sal flu vac­cine “could do more for the world’s pub­lic health than we even did with the

What­ever it may have lacked in lethal­ity, the 1918 flu made up for in vir­u­lence. Could we see one fifth of the pop­u­la­tion struck down with in­fluenza again?

erad­i­ca­tion of small­pox, and it would surely have a ma­jor im­pact eco­nom­i­cally in terms of tak­ing off the ta­ble fu­ture pan­demics”.

Mean­while, it’s the an­nual in­fluenza vac­cine sea­son. The World Health Or­gan­i­sa­tion has cho­sen its three strains of virus for this year’s shot. It has up­dated the in­fluenza B com­po­nent to take ac­count of last year’s prom­i­nent strain. The two in­fluenza A el­e­ments re­main the same. Sever­ity A cal­cu­lated gam­ble by WHO every year, the lead in time to man­u­fac­ture means we will al­ways be vul­ner­a­ble, as hap­pened last year, to the emer­gence of a dif­fer­ent strain of the virus as the flu sea­son pro­gresses. But even if this hap­pens, hav­ing the vac­cine will lessen the sever­ity of flu in­fec­tion.

It’s avail­able now from your GP or phar­macy.

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