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Prelude to the Fall

Andrew Pekosz/John Heuser

Prelude to the Fall: Special Flu Report

Welcome to the summer of unease. The new H1N1 influenza virus that emerged in Mexico in April quickly ignited outbreaks as far away as the U.K. and Japan. As epidemiologists accumulated data and scientists probed the novel virus, they found H1N1 was neither as virulent nor as lethal as first suspected. But the quick-mutating influenza virus should never be underestimated. To learn what might happen—and what should happen—before flu season returns this fall, we turned to three Bloomberg School experts.

5 LESSONS about H1N1

Expect change.
Andy Pekosz, PhDVirologist Andrew Pekosz, PhD, knows the eight-gene influenza virus as well as anyone. He’s familiar with its penchant for mixing and matching genetic fragments that can change its exterior coat of proteins to elude animal immune systems. H1N1’s novel gene fragments are not yet optimized to work with each other, says Pekosz, who has been studying samples of the virus since early May. Each viral protein also interacts with human proteins, so as the virus mutates, the changes that work best for the virus are more likely to survive and to be passed on as a new variant. “It could get better at causing disease or better at spreading from person to person. In either one of those situations, you should see an increase in the number of serious cases come fall,” he says.

Look south.
As summer envelops the Northern Hemisphere, H1N1 virus strains will likely retreat from here and thrive in the cooler temperatures and low humidity in southern climes, says Pekosz, an associate professor in the W. Harry Feinstone Department of Molecular Microbiology and Immunology. “It will be really important for us to look at places like Australia, New Zealand, and Argentina, which have very good public health systems and the capacity to do large-scale screening for H1N1 infections, to see if that virus emerges in the Southern Hemisphere as it has emerged in the Northern Hemisphere,” he says. “If it does, that will be a fairly strong sign that it’s here to stay, and that we should be preparing for its eventual reemergence in the fall.”

Don’t fixate on the past, but respect it.
The 1918 flu pandemic began with spring outbreaks in Europe and the U.S. That fall, it quickly went global and killed more than 50 million people. Was this spring’s H1N1 epidemic a prelude to catastrophe? Pekosz thinks not. “Everything about this virus in terms of its genes and known virulence factors … tells us this is much more similar to a seasonal influenza virus strain than it is to a 1918 virus or the H5N1 viruses, the avian influenza viruses.” At the moment, H1N1 doesn’t appear likely to become a 1918 scourge, he says, “but if it is in the human population to stay, then there will be an increase in human cases in the fall.”

Plan public health strategies now.
Although policymakers have rolled out the U.S. vaccine strategy (see related story), plenty of other public health strategies must be planned as well. H1N1 is susceptible to Tamiflu so the antiviral could be part of a strategy to limit the spread of the virus or, if necessary, for prioritized treatment of at-risk groups such as pregnant women, people who have compromised immune systems, those with pre-existing respiratory conditions, or the very old and very young, says Pekosz. Policymakers also should be setting public health policies for school closures, for example. To effectively limit transmissions, schools should be closed for up to two weeks, not mere days, because “you really need to let this epidemic pass by and settle out,” he says. “There are a lot of social and economic impacts with these type of things. The time to have this discussion is not when we have diagnosed the first H1N1 cases in the fall.”

Get personally prepared.
There are things individuals can do to limit transmission of the virus. It all comes back to basic public health: wash your hands frequently, sneeze into your sleeve or a tissue and not your hand, stay home if you’re sick, and stockpile several days of food and water at home. “Having a week’s worth of food at home means you don’t have to take that trip to the supermarket. If you ever keep track of how many people you walk within five feet of when you go to the supermarket, that’s an amazing number of people. And people can spread the flu before they have symptoms,” says Pekosz. Taking care of your individual health can also preserve public health. “If you can keep yourself from getting the flu, you probably can keep 2.1 other people you would normally infect from getting it,” he says. “And breaking that transmission cycle has profound effects on the spread of disease in a community.”

To learn more about H1N1, listen to our audio interviews.

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Tracking the Pandemic

Tracking the Pandemic

The first reported H1N1 cases in Mexico spread globally with frightening speed. This WHO timeline shows how the virus leaps borders and continents.

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