Flu is a dangerous germ, having the potential to sicken and kill millions of people in a single infection season. It’s happened before as in the epidemic of 1918 and it may happen again. Experts feared that a new super flu was coming at us in 2009 when the H1N1 virus emerged in Mexico and rapidly spread across the globe. During the 2009 outbreak, attempts at isolating the patients with the virus didn’t work, antiviral medicines to treat infected patients only helped a little, and vaccines to protect the population emerged too late to really be useful. In short, we were caught off guard and couldn’t respond fast enough. Virologists and public health officials learned from this event and are planning on improving the speed and effectiveness of their response for the next novel influenza virus that may come our way.
Most of us are aware that the influenza virus is constantly changing but how does it do this? How does the influenza virus change over time? To understand this you need to become familiar with two concepts, what virologists call drift and shift. Under normal circumstances, as the flu virus moves through the population infecting us, it’s genes change very slightly causing the germ to “drift” and look slightly different at the end of the flu season than it did at the beginning. Alternatively as we experienced in 2009, the influenza germ is capable of making a major costume change and becoming a novel, very different germ from those we normally encounter each winter. When this happens we call such an event a “shift”. If this “shifted” new novel germ is capable of causing severe disease and moving from person to person, here comes a major epidemic. Maybe even a worldwide pandemic.
Experts are busy getting a rapid response plan ready to implement before the next pandemic starts to take shape. They believe the key is rapid production and delivery of an effective protective vaccine. To do this, vaccine production and distribution will need to be greatly accelerated. New ideas are being tried such as creating a synthetic virus in advance, also known as a “vaccine seed”, that can be adapted quickly into a new vaccine when it is needed. Scientists are also working on new vaccine production methods and de-centralizing the production of a new vaccine so as to hasten distribution and delivery in an emerging pandemic.
Frankly, I am thrilled that the CDC and NIH are preparing for the worst. It is very likely that history will repeat itself delivering a new worldwide serious influenza infection sometime in our children’s lifetimes; we better be ready when it does. I sleep a little better at night knowing that not only did we learn a lot form the H1N1 scare of 2009, but that we are actually acting on that knowledge.
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Written collaboratively by Catherine Wu and Paul Smolen M.D.