Reflections on the epidemiology of myxovirus infections

Encephalitis lethargica and influenza. I. The role of the influenza virus in the influenza pandemic of 1918/1919

An investigation of the characteristics of influenza epidemics in the nineteenth and early twentieth centuries was undertaken, principally in order to analyze the role of the 1918/1919 influenza pandemic in the etiology of encephalitis lethargica. Expectations regarding a future influenza pandemic derive principally from experiences in the 1918 epidemic. It is proposed that this pandemic was atypical with respect to many of its features, and that these have not been appropriately regarded in mapping expectations and responses of a future pandemic. Both a longer historical viewpoint (incorporating knowledge from all major nineteenth and twentieth century epidemics) and closer examination of individual epidemics at the town level is essential for producing an accurate picture of the challenge.

Bird flu: if or when? Planning for the next pandemic

Avian influenza or "bird flu" is causing increasing concern across the world as experts prepare for the possible occurrence of the next human influenza pandemic. Only influenza A has ever been shown to have the capacity to cause pandemics. Currently A/H5N1, a highly pathogenic avian influenza virus, is of particular concern. Outbreaks of this disease in birds, especially domestic poultry, have been detected across Southeast Asia at regular intervals since 2003, and have now affected parts of Africa and Europe. Many unaffected countries across the world are preparing for the possible arrival of HPAI A/H5N1 in wild birds and poultry within their territories. All such countries need to prepare for the rare possibility of a small number of human cases of HPAI A/H5N1, imported through foreign travel. Although it is by no means certain that HPAI A/H5N1 will be the source of the next pandemic, many countries are also preparing for the inevitable occurrence of human pandemic influenza.

A new concept of the epidemic process of influenza A virus

Influenza A virus was discovered in 1933, and since then four major variants have caused all the epidemics of human influenza A. Each had an era of solo world prevalence until 1977 as follows: H0N1 (old style) strains until 1946, H1N1 (old style) strains until 1957, H2N2 strains until 1968, then H3N2 strains, which were joined in 1977 by a renewed prevalence of H1N1 (old style) strains. Serological studies show that H2N2 strains probably had had a previous era of world prevalence during the last quarter of the nineteenth century, and had then been replaced by H3N2 strains from about 1900 to 1918. From about 1907 the H3N2 strains had been joined, as now, by H1N1 (old style) strains until both had been replaced in 1918 by a fifth major variant closely related to swine influenza virus A/Hswine1N1 (old style), which had then had an era of solo world prevalence in mankind until about 1929, when it had been replaced by the H0N1 strains that were first isolated in 1933. Eras of prevalence of a major variant have usually been initiated by a severe pandemic followed at intervals of a year or two by successive epidemics in each of which the nature of the virus is usually a little changed (antigenic drift), but not enough to permit frequent recurrent infections during the same era. Changes of major variant (antigenic shift) are large enough to permit reinfection. At both major and minor changes the strains of the previous variant tend to disappear and to be replaced within a single season, worldwide in the case of a major variant, or in the area of prevalence of a previous minor variant. Pandemics, epidemics and antigenic variations all occur seasonally, and influenza and its viruses virtually disappear from the population of any locality between epidemics, an interval of many consecutive months. A global view, however, shows influenza continually present in the world population, progressing each year south and then north, thus crossing the equator twice yearly around the equinoxes, the tropical monsoon periods. Influenza arrives in the temperate latitudes in the colder months, about 6 months separating its arrival in the two hemispheres. None of this behaviour is explained by the current concept that the virus is surviving like measles virus by direct spread from the sick providing endless chains of human influenza A.(ABSTRACT TRUNCATED AT 400 WORDS)

Age and secular distributions of virus-proven influenza patients in successive epidemics 1961-1976 in Cirencester: epidemiological significance discussed

A general practice population of around 3900, under continuous clinical and laboratory surveillance, experienced 20 outbreaks of influenza between March 1960 and March 1976. Four epidemics were caused by subtype H2N2 type A viruses, seven by subtype H3N2 type A viruses and nine outbreaks by type B viruses. The age of every person proved virologically to have influenza is related to the age structure of the community and to the phase of the epidemic in which the virus-positive specimens were collected. Children 0-15 years old suffered a higher incidence rate than adults 16-90+. Pre-school children 0-4 suffered the highest rate of infection by viruses of both influenza A subtypes, whereas older schoolchildren 10-15 suffered the highest rate of type B infections. Despite these high incidence rates neither pre-school nor schoolchildren appear to have been the major disseminators of any of these influenza viruses in the community. Adults of all ages suffered a high rate of infection even into extreme old age, and the indiscriminate age distribution among adults was sustained in the successive epidemics. Such age-patterns are not those caused by a highly infectious immunizing virus surviving by means of direct transmissions from the sick, whose prompt development of the disease continues endless chains of transmissions. An alternative epidemic mechanism--whereby the virus does not spread from the sick but becomes latent in them, reactivating seasonally so that they later infect their companions--would produce age patterns similar to those recorded here for influenza patients. The suggested mechanism is illustrated by a simple conceptual model and the influenzal age patterns are discussed in relation to the recycling of influenza A subtypes.