While awaiting the next pandemic of influenza

BMJ 1994;309:1179-1180 (5 November)

Editorials

While awaiting the next pandemic of influenza

Largely uncontrolled influenza is a potentially devastatingdisease of humans and of a limited number of domestic and wildanimals. Continued rapid evolution of the influenza A virusis responsible for the annual epidemics and occasional pandemicsthat have affected humans for centuries.¹

Epidemics can be traced to genetic drift - the accumulationof mutations in the antigenic domains of the haemagglutininand neuraminidase spike glycoproteins. These changes allow thevirus to escape immunological surveillance and spread throughhuman populations. More catastrophic are pandemics. These globaloutbreaks arise from genetic shift: the emergence of completelynew haemagglutinin or neuraminidase molecules to which mostpeople are not immune. The source of these new influenza virusgene segments is wild aquatic birds, which harbour all 14 haemagglutininsubtypes of influenza A viruses.

Five pandemics of influenza have occurred this century at irregularintervals, including the "Spanish" pandemic, which claimed over20 million . . . [Full text of this article]

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Fleming, D M, Chakraverty, P, Sadler, C, Litton, P (1995). Combined clinical and virological surveillance of influenza in winters of 1992 and 1993-4. BMJ 311: 290-291 [Full text]