New emerging viral zoonoses

New developments in the field of viral transmission from animal to man can be divided into four areas of study. First are the new viral zoonoses such as diseases caused by rotaviruses, Lassa virus and the animal orthopox viruses which will be more prevalent after the cessation of mandatory vaccination against smallpox. Secondly are the numerous ubiquitous viruses, such as adeno and herpesviruses, which in healthy animals lead only to clinically inapparent infections. A typical example of the third area is the recombination and hybridisation between animal and human influenza type A viruses. The final area is concerned with the transmission of viral zoonoses to man through food of animal origin.

Nosocomial influenza A (H1N1) infection

In late February 1979, 21 days after admission to the hospital for a diagnostic evaluation of weight loss and abdominal pain, a 25-year-old female developed nosocomial influenza. The case was presumed to be associated with an outbreak of influenza involving nursing students at the same hospital. Viral cultures obtained from the patient and two of the nursing students yielded influenza A/Brazil/11/78 (H1N)-likelike viruses. A retrospective study of the 136 nursing students indicated that 58 (43 percent) had experienced an influenza-like illness during the period mid-December 1978 to mid-March 1979 with a peak of 50 (37 percent) illnesses occurring the month of February. To the authors' knowledge, the illness involving this patient represents the first reported nosocomial case of influenza A/Brazil/78 in literature.

Animals in the influenza world

In the history of influenza there are many references, notes and comments about influenza epizootics occurring among various non-human animals, sometimes coinciding with epidemics of influenza in human beings. That the first influenza viruses were recovered from non-human animals is not so surprising, given the current knowledge of the distribution of influenza among animals. Influenza viruses are found in a wide variety of mammalian and avian species. In some species the disease that occurs as a result of the infection mimics the influenza disease of human beings, in other species there are no signs of disease, and in others there is disease specific to a species. It is clear that influenza viruses have a significant impact on the health of several animal species. In recent times it has also become clear that many species of animals are inextricably entwined in the puzzle of influenza viruses and human influenza. Our knowledge in animals has provided both questions and answers about the influenza viruses and their diseases. Certainly our understanding of human influenza has been advanced because of the animals in the influenza world.

Influenza viruses: transmission between species

The only direct evidence for transmission of influenza viruses between species comes from studies on swine influenza viruses. Antigenically and genetically identical Hsw1N1 influenza viruses were isolated from pigs and man on the same farm in Wisconsin, U.S.A. The isolation of H3N2 influenza viruses from a wide range of lower animals and birds suggests that influenza viruses of man can spread to the lower orders. Under some conditions the H3N2 viruses can persist for a number of years in some species. The isolation, from aquatic birds, of a large number of influenza A viruses that possess surface proteins antigenically similar to the viruses isolated from man, pigs and horses provides indirect evidence for inter-species transmission. There is now a considerable body of evidence which suggests that influenza viruses of lower animals and birds may play a role in the origin of some of the pandemic strains of influenza A viruses. There is no direct evidence that the influenza viruses in aquatic birds are transmitted to man, but they may serve as a genetic pool from which some genes may be introduced into humans by recombination. Preliminary evidence suggests that the molecular basis of host range and virulence may be related to the RNA segments coding for one of the polymerase proteins (P3) and for the nucleoprotein (NP).

Viral shedding patterns of children with influenza B infection

During an epidemic of influenza B, 43 ambulatory children were prospectively followed to determine the quantitative shedding patterns of influenza B viral infection, because these have not been previously described. The spectrum of illness included 74% with a typical influenzalike illness, 7% with an afebrile infection of the upper respiratory tract, and 19% with croup. Mild myositis occurred in 21%. For the first three days of illness, greater than or equal to 93% of the children shed virus, and 74% shed on day 4. The average peak quantity of virus shed in the nasal wash was 4.0 log10 50% tissue culture infective doses/ml(range, 1.5-6.0), which gradually declined over four days to 2.4 log10 50% tissue culture infective doses/ml. The quantities of virus shed correlated significantly with severity of illness and fever score, but not with sex, type of illness, or occurrence of myositis. These results suggest that the degree of clinical illness may be directly related to the cytotoxic effects of the virus and to the transmissibility of the disease.

Epidemic mechanisms of type A influenza

The antigenic varieties of influenza A virus isolated from 1968 to 1976 in a surveillance of a small, rather remote population were similar to those from England and Wales as a whole, despite frequent antigenic changes during the period. Household studies in the first two H3N2 influenza A epidemics found low attack rates within households, a high proportion (70%) of affected households with only one case of influenza, similar distributions of affected households in the two epidemics by the number of cases of influenza and similar distributions of the influenza cases by the day of their onset in the household outbreak. No serial interval could be demonstrated by cumulating household outbreaks. More than one minor variant was causing influenza contemporaneously in the same villages in several seasons, and different variants were on one occasion found on successive days in bedfellows. The regular occurrence of epidemics in winter was often accompanied by the disappearance of the epidemic variants and their replacement, after a virus-free interval, by new variants. These epidemiological findings seem best interpreted on the following tentative hypothesis. Influenza A sufferers do not transmit the virus during their illness; instead it rapidly becomes latent in their tissues so that they become symptomless carrier-hosts and develop specific immunity. Next season an extraneous seasonally mediated stimulus reactivates the latent virus residues so that the carrier-host becomes briefly infectious, though symptomless. Antigenic drift occurs because particles reconstituted to be identical with the progenitor virus cannot escape the specific immunity it has provoked in the carrier host. He can shed only mutants also determined by the progenitor virus. From the assortment of mutants shed by the carrier-host, his non-immune companions select that (those) which is best fitted to survive, and it rapidly causes influenzal illness. Epidemics consist largely or entirely of such persons sick with influenza caused by reactivated virus caught from symptomless carrier-hosts.

An outbreak of influenza aboard a commercial airliner

A jet airliner with 54 persons aboard was delayed on the ground for three hours because of engine failure during a takeoff attempt. Most passengers stayed on the airplane during the delay. Within 72 hours, 72 per cent of the passengers became ill with symptoms of cough, fever, fatigue, headache, sore throat and myalgia. One passenger, the apparent index case, was ill on the airplane, and the clinical attack rate among the others varied with the amount of time spent aboard. Virus antigenically similar to A/Texas/1/77(H3N2) was isolated from 8 of 31 passengers cultured, and 20 of 22 ill persons tested had serologic evidence of infection with this virus. The airplane ventilation system was inoperative during the delay and this may account for the high attack rate.

Reappearance of H1N1 influenza virus in man: evidence for the persistence of the virus in domestic chickens

Serological studies on domestic poultry originating from China and Hong Kong suggest that the H1N1 virus may have persisted in domestic chickens prior to its reappearance in man in 1977. Experimental infection of young, local strains of poultry provided equivocal evidence that 4-day-old chickens could be infected; virus was not recovered from infected 1-month-old chickens.

[Preliminary note on the circulation of some human respiratory viruses by wild birds]

With a view to detecting infections and carriage of human respiratory viruses in wild birds, 349 serum samples collected from 21 bird species -- sedentary ones and birds with large or limited migration areas -- were investigated. The following antigens were used: influenza virus A/Hong Kong 1/68 (H3N2)), A2 England 42/73 (H3N2), A2 Victoria 3/75 (H3N2), A/New Jersey 8/76 (HswN1), B/Hong Kong 5/72; parainfluenza virus type I Sendai and type II, coronavirus OC/43. An elevated incidence of antibodies to A2 Victoria 3/75 (H3N2) and parainfluenza type I virus was detected in herons (Ardea cinerea, Nyctycorax myctycorax). The high incidence of antibodies to B/Hong Kong 5/72 (30.7% of the samples exhibited significant titers) found in the crow (Corvus corone sardonius) is ascribed to the fact that this bird is carnivorus, feeding on corpses of mammals.

A study of acute respiratory disease in the community of Port Chalmers. II. Influenza A/Port Chalmers/1/73: intrafamilial spread and the effect of antibodies to the surface antigens

During the first year of a study of respiratory disease in the semi-isolated community of Port Chalmers, New Zealand, an epidemic of clinical influenza occurred from which the variant influenza A/Port Chalmers/1/73 (H3N2) was isolated. Within a selected group of 26 families, 59 (46%) members had clinical or laboratory evidence of infection. During intrafamilial spread the infection frequency was highest for school-aged children (77%), followed by female adults (67%), infants (64%) and male adults (41%). The index infection in each family was a school-age child on 10 occasions, suggesting the role of this age group in the transmission of influenza A in this community. The secondary attack rate (SAR) of 58.3% was higher than expected. In sera taken before the 1973 epidemic, 59% of family members had detectable HI antibody and 25% NI antibody to A/England/42/72 while 38% had detectable HI antibody and 8% NI antibody to A/Port Chalmers/1/73. The relation between pre-existing antibody and infection frequency is discussed.

Swine influenza A at Fort Dix, New Jersey (January-February 1976). II. Transmission and morbidity in units with cases

Epidemiologic study of 13 influenza A/New Jersey/76 (Hsw1N1) patients indicated that person-to-person transmission had occurred in several distinct military units. Soldiers in eight of these units (companies) were studied to determine whether they had experienced influenza A/New Jersey infections and associated acute respiratory disease. Titers of hemagglutination-inhibiting antibody to influenza A/Mayo Clinic/103/74 (Hsw1n1) antigen were determined. In seven of these eight companies, individuals with titers of greater than or equal to 1:20 were found. In these seven companies, members of platoons with cases (contact platoons) had antibody prevalences of 7%-56%, and members of platoons without cases had prevalences of 0-40%. Hospital admissions for acute respiratory disease were proportionately greater in trainees with A/Mayo Clinic antibody titers of greater than or equal to 1:20 than in trainees without antibody in five of six contact platoons studied.

Swine influenza A at Fort Dix, New Jersey (January-February 1976). IV. Summary and speculation

Influenza A/New Jersey/76 virus was detected at Fort Dix from January 19 through February 9, 1976 and infected at least 230 military personnel. Thirteen hospital admissions for acute respiratory disease were associated with influenza A/New Jersey infection, and additional members of index training companies may have been hospitalized with influenza A/New Jersey. This virus was likely introduced into the reception center by an incoming trainee. Although our studies could not eliminate the possibility that influenza A/New jersey strains are inherently less transmissible in humans than H3N2 viruses, the simultaneous transmission of influenza A/Victoria/75 virus and the unusual environment in basic combat training may explain why influenza A/New Jersey did not spread significantly outside of this training population.