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February 17, 2006

Influenza: What If We Had a Sept. 11th Every Month and Nobody Cared?

A think tank in Australia released a report claiming that an influenza pandemic might kill over 140 million people. So, after spending most of my professional career examining the evolution of infectious disease, I think...I don't have any idea if a pandemic influenza strain will evolve. Ultimately, we're trying to anticipate a unique historically contingent event: placing a probability on the likelihood that this would happen is foolish.

Personally, I think a pandemic is a low probability event, but likely enough to worry about. Why? There is one little datum that scares the hell out of me: amantadine resistance. Amantadines are powerful antivirals that were widely used (or misused–don't get me started) in agriculture, particularly in China. Today, most influenza viruses are resistant to amantadine. Now that these antivirals aren't suppressing influenza in the massive Asian chicken flocks (China alone has ~12 billion chickens), the total amount of virus has increased. I hope it's just a coincidence that the spread of the virus into migratory birds and pets began when amantadine essentially became ineffective. To my knowledge, no one has addressed the effects of amantadine resistance.

But like I said, there are too many unknowns to make any robust predictions. However, I can make one confident prediction: by May 2006, ~37,000 U.S. residents will have died from 'ordinary' influenza during the previous twelve months. Yes, 37,000.  If these deaths were spaced evenly throughout the year, that would be the equivalent of a Sept. 11 massacre every month.

By comparision, HIV/AIDS killed ~18,000 people in the U.S. last year, and breast cancer killed 40,000 (of course, hospital acquired infections 'win', killing roughly 90,000 people per year in the U.S.). Unlike many other causes, influenza doesn't have the likes of Brad and Angelina (or even Jennifer Anniston) to promote awareness. No one wears ribbons, or walks for a cure. It's just not a 'sexy' disease.  What is infuriating is that dramatically lowering influenza deaths is within our power:  increasing the scope and extent of annual influenza vaccination would dramatically lower influenza deaths.

And one of the best ways to prepare for an influenza pandemic is to increase the production capacity of 'ordinary' influenza vaccines–the exact same technology can be 'repurposed' for avian influenza vaccines (a national handwashing education campaign would save many lives too). Another important step would be increasing the level of vaccination against bacterial pneumonia–about half of all influenza-related deaths are due to secondary bacterial pneumonia infections. There's nothing magical or pie-in-the-sky about any of this: we simply need the political will to do this. Otherwise, next year, I'll still be Mad about another unnecessary 37,000 deaths...

And if you're freaked out now, I might just decide to blog about Acinetobacter...

an aside:  if you want to know what the American Society of Microbiologists thinks about our influenza preparedness, click here.

(crossposted at Mike the Mad Biologist)

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Comments

Acinetobacter?.. sounds like a chain-smoking bug that won't go near a movie theater. Hey- maybe Paris Hilton would LIKE one of these things... is there maybe a subspecies Acinetobacter tomcruzii? hmmm
^..^

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