FOUR RECENT INFLUENZA EPIDEMICS: AN EXPERIMENTAL STUDY

Neuraminidase inhibitors for influenza B virus infection: efficacy and resistance

Many aspects of the biology and epidemiology of influenza B viruses are far less studied than for influenza A viruses, and one of these aspects is efficacy and resistance to the clinically available antiviral drugs, the neuraminidase (NA) inhibitors (NAIs). Acute respiratory infections are one of the leading causes of death in children and adults, and influenza is among the few respiratory infections that can be prevented and treated by vaccination and antiviral treatment. Recent data has suggested that influenza B virus infections are of specific concern to pediatric patients because of the increased risk of severe disease. Treatment of influenza B is a challenging task for the following reasons: This review presents current knowledge of the efficacy of NAIs for influenza B virus and antiviral resistance in clinical, surveillance, and experimental studies.

THE SYNERGISM OF HUMAN INFLUENZA AND CANINE DISTEMPER VIRUSES IN FERRETS

The infections produced in ferrets by human influenza virus and canine distemper virus were studied. Cross immunity and cross neutralization tests showed that these two viruses were not related antigenically. Ferrets infected with influenza virus alone rapidly produced considerable quantities of neutralizing antibodies, and after the 6th day virus was not demonstrable in their lungs. Ferrets infected with both influenza and distemper viruses simultaneously produced but small amounts of neutralizing antibody, and influenza virus persisted in undiminished concentration in their lungs throughout the course of the infection.

STUDIES ON INFLUENZA VIRUS : THE COMPLEMENT-FIXING ANTIGEN OF INFLUENZA A AND SWINE INFLUENZA VIRUSES

Influenza complement fixation tests designed for use with ferret serum are described. Complement-fixing antigens derived from influenza ferret lungs were unsatisfactory due to their low content of soluble antigen; those prepared from mouse lungs or developing chick embryo membranes proved to be better antigenically and were reliable when the various reagents in the test were properly adjusted to eliminate non-specific fixation of complement. The results of cross complement fixation tests indicated that the soluble antigens of the PR8 and W.S. strains of influenza A virus were closely similar, if not identical. They indicated also that the soluble antigen of swine virus possessed components present in the antigens of the human strains of virus.

NEUTRALIZATION OF INFLUENZA A VIRUS BY HUMAN SERUM

A linear relationship exists between the quantity of human serum used and the quantity of influenza A virus neutralized. By means of this relationship it is possible to determine the maximum quantity of virus which a given human serum can neutralize. This quantity, the neutralizing capacity, is a fixed value and, unlike the serum dilution end point, is independent of the amount of virus used in the neutralization test.

A LATENT VIRUS IN NORMAL MICE CAPABLE OF PRODUCING PNEUMONIA IN ITS NATURAL HOST

1. A virus capable of producing fatal pneumonia in mice has been isolated repeatedly from the lungs of certain apparently healthy mice. Not all mice carry the virus. It was obtained only from mice supplied by three breeders although mice from eight different sources were studied. 2. The virus was avirulent as it occurred in normal mouse lungs and became virulent only after serial mouse lung passage. It was strictly pneumotropic for mice and produced pneumonia when given intranasally but showed no evidence of infection when given by other routes. The virus was non-infectious for ferrets and did not become pathogenic for this species after numerous serial passages. It was also non-pathogenic for rabbits, guinea pigs, rhesus monkeys, voles, deer mice, skunks, wood-chucks, opossums, and Syrian hamsters. 3. All strains of the virus which have been tested have been immunologically identical, as indicated both by cross immunity and cross neutralization tests in mice. 4. The virus was antigenic both in mice and in rabbits and was readily differentiated from viruses of human influenza and of swine influenza by means of either cross immunity or cross neutralization tests. 5. The virus was also neutralized by about 30 per cent of normal human sera tested. 6. The virus was extremely labile, and suspensions prepared in saline or broth became inactivated within a few hours at room temperature. The addition of normal horse serum to the virus suspensions, however, exerted a definite stabilizing effect. 7. Ultrafiltration results indicated that the virus particles have a diameter of about 100 to 150 millimicrons. 8. Evidence is presented which indicates that this virus is different from other viruses which various investigators have found in normal mouse lungs.

THE RECOVERY FROM PATIENTS WITH ACUTE PNEUMONITIS OF A VIRUS CAUSING PNEUMONIA IN THE MONGOOSE

1. A virus capable of producing pulmonary consolidation in the wild mongoose (Herpestes griseus) has been isolated from throat washings obtained from four patients with a clinical syndrome termed acute pneumonitis. 2. The virus was not pathogenic for ferrets, mice, guinea pigs, rabbits, monkeys, voles, hamsters, deer mice, skunks, opossums, or woodchucks. 3. The virus was filterable through Berkefeld V and N candles, was not inactivated by glycerin or by freezing and drying in vacuum, and was propagated for at least 30 serial passages on the chorio-allantoic membrane of the developing chick embryo. 4. Normal mongooses placed in contact with infected mongooses developed pulmonary consolidation. 5. The virus was neutralized by the serum of mongooses convalescent from the infection but was not neutralized by normal mongoose serum. 6. Serum of human beings convalescent from acute pneumonitis also neutralized the virus, but serum obtained from the same individuals during the acute phase of the disease failed to do so. 7. The evidence so far obtained strongly suggests that this virus is the cause of acute pneumonitis in human beings. It differs from other viruses known to cause infections of the respiratory tract in man.

NEUTRALIZING ANTIBODIES IN HUMAN SERUM AFTER INFLUENZA A : THE LACK OF STRAIN SPECIFICITY IN THE IMMUNOLOGICAL RESPONSE

The increased concentrations of neutralizing antibodies against influenza A virus in human serum which occur after influenza A do not differentiate between antigenically different strains of this virus or swine influenza virus but instead appear to possess equal reactivity against these agents. The decrease in antibody levels which occurs with time is also independent of the strain of virus used to measure it.

A COMPLEX VACCINE AGAINST INFLUENZA A VIRUS : QUANTITATIVE ANALYSIS OF THE ANTIBODY RESPONSE PRODUCED IN MAN

A quantitative study of the antigenicity of various vaccines containing influenza A virus has been made in human beings. A complex vaccine prepared from chick embryos inoculated with both influenza A virus and the X strain of canine distemper virus was found to be more effective than other vaccines in stimulating the production of neutralizing antibodies against the former virus. The increased antibody levels which resulted from the administration of this vaccine remained almost unaltered for at least 5 months.

EXPERIMENTAL INFECTION WITH INFLUENZA A VIRUS IN MICE : THE INCREASE IN INTRAPULMONARY VIRUS AFTER INOCULATION AND THE INFLUENCE OF VARIOUS FACTORS THEREON

Following intranasal inoculation of influenza A virus (strain PR8) there is a rapid increase of the virus in the lungs which with large doses reaches a maximum within 24 hours. With smaller doses, although the proportional increase is greater, the maximum concentration is not reached until 48 hours following inoculation. If a lethal dose is administered, the ultimate concentration of the virus in the lungs is the same, irrespective of the size of the dose. If a sublethal dose is given, the titer of the virus in the lungs does not achieve the titer reached in mice receiving a lethal dose. Within 48 hours following inoculation of a sublethal dose the lungs of a mouse may contain at least 76,000 M.L.D., yet the mouse survives. The intranasal instillation of sterile fluid (distilled water, varying concentrations of NaCl, broth, or 10 per cent normal serum) into a mouse sublethally infected produces a sharp rise in the virus content of the lung usually followed by death within 3 to 8 days. If, however, the instillate consists of 10 per cent immune serum, there is no rise in the virus titer, and no apparent harm results from the instillation. The implications of these phenomena are discussed and an hypothesis presented to explain their occurrence.

THE QUANTITATIVE DETERMINATION OF INFLUENZA VIRUS AND ANTIBODIES BY MEANS OF RED CELL AGGLUTINATION

1. The agglutination titer for chicken red cells of freshly prepared or carefully stored suspensions of PR8 influenza virus, that is to say virus of maximum pathogenicity, was found to be proportional to the mouse lethal titer of the same preparations. 2. The agglutination titer of infected allantoic fluid procured in a standard way is relatively constant, regardless of the influenza strain used and its pathogenicity for mice. 3. Virus preparations inactivated by heat or storage may retain their agglutinating power. 4. Certain animal sera contain a partially heat-labile factor which, in low dilution, inhibits the agglutination of chicken red cells by influenza A and influenza B viruses. 5. The agglutination inhibition test, using ferret and human sera, gives qualitative data regarding influenza antibodies which are similar to the information obtained on the same sera by means of the virus neutralization test. 6. There is a definite relationship between the agglutination inhibition titer and the virus neutralization titer of a serum. On a logarithmic scale of both variables, this relationship is essentially linear within the range investigated. 7. The agglutination inhibition titer of immune ferret serum is inversely proportional to the amount of virus used in the test.

Influenza antibodies in the population of the USA; an epidemiological investigation

Sera taken from persons of various ages in 1951 and collected from adults yearly from 1943 to 1951, inclusive, were tested by the haemagglutination-inhibition method with influenza viruses selected to represent the subgroups of each antigenic type. These were influenza A-WS (1933) and PR8 (1934); influenza A-prime-FM1 (1947) and FW-1-50 (1950); influenza B-Lee (1940) and IB1 (1950); influenza C-1233 (1947). The sera tested with influenza A and B viruses were treated with cholera filtrate to remove non-specific inhibitor. Since influenza C virus was not affected by the non-specific substance, the sera tested against this agent were not so treated.Children's sera showed high antibody level, attained at an early age, for FM1 and FW-1-50 viruses, and essentially no antibody for WS or PR8. By contrast, adult sera revealed high antibody content for PR8 and moderate titres for WS and the A-prime viruses. In adult sera, antibody against the PR8 virus increased significantly in 1944, after the 1943-4 epidemic, and remained at a relatively constant level for the eight succeeding years. The antibody pattern for WS was similar to that for PR8, but the values for its titres were only half as great. Antibody against the A-prime strains rose steadily from inconsequential levels in 1943 to high mean titres in 1951. These findings were consistent with virus isolation studies which suggested that the A-prime viruses, such as FM1, were introduced about 1946 and have been continuously prevalent since that time, while the WS and PR8 agents have been recovered only occasionally in recent years. Sera tested with Lee and IB1 viruses showed essentially identical titres. Antibody to these strains was low in the sera of children, indicating that there had been little previous exposure to the B agents. Adult sera showed marked elevation in titre between 1944 and 1946, and the titres have remained at a high level since that time. The increase in 1946 followed the influenza B outbreak of 1945-6; the increase in the previous year occurred in spite of the fact that there was no epidemic. Children developed significant antibody to influenza C in early life, and high antibody levels were observed in adult sera collected over the nine-year period. These observations indicate that the virus was widespread in the population and was prevalent before 1943.

Public Health Weekly Reports for SEPTEMBER 19, 1941

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