- The Washington Times - Monday, December 4, 2017

Nearly 100 years after a flu pandemic decimated the world’s population, U.S. health officials are bracing for a severe influenza season now that the annual vaccine has proved ineffective in stemming an outbreak in Australia.

All influenza viruses today are direct descendants of the deadliest outbreak in recorded human history. The 1918 Spanish flu killed 50 million people and is believed to have infected nearly every person on earth, said Dr. Jeffery Taubenberger, the foremost authority on that pandemic.

“Every single case of human influenza that’s occurred in the last 100 years, and all the millions and millions of deaths that have occurred … [are] due to a single importation of an animal virus into humans 100 years ago,” Dr. Taubenberger told The Washington Times.

Australia provides an indicator of what the U.S. can expect this flu season. Having recently emerged from their winter, Australians recorded more than 200,000 infections and 745 deaths related to influenza. It was the country’s largest flu outbreak since 2009, when it recorded 59,000 cases and nearly 200 deaths.

In an article published last week in The New England Journal of Medicine, researchers at the National Institutes of Health said Americans — even those who have been vaccinated — should prepare for a severe flu season.

“You really can’t definitively say because things change with influenza, but all the stars are aligned for that to happen,” Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, told The Times.

Confirmed cases in the U.S. are “very similar, if not identical, to the virus that was seen in Australia,” Dr. Fauci said.

Four states — Massachusetts, Georgia, Louisiana and Oklahoma — already have declared widespread infections, and at least 34 states have reported slightly lower levels of flu activity, according to reports by the Centers for Disease Control and Prevention.

Dr. Fauci and Dr. Taubenberger said the flu virus is unpredictable and rapidly mutating, which makes inoculation difficult.

Four strains of seasonal flu virus affect humans. The vaccine for the 2017-2018 season is meant to protect against the H1N1 strain, but more than half of confirmed flu cases in Australia tested positive for the H3N2 strain.

The vaccine Australians received is the same one given to Americans as part of a cyclical operation in which researchers try to predict which strain will be most damaging each year and then develop a vaccine against it.

Because flu vaccines take about six months to produce, it’s impossible to correct a mistake or “mismatch.” Medical professionals argue that some protection is better than none and encourage people to be vaccinated.

“No. 1, even though the vaccine may not be a very good match, it is still much, much better to get vaccinated than it is to not get vaccinated, no doubt about that,” Dr. Fauci said. “No. 2, if you do happen to get the flu and you’re feeling badly and it doesn’t resolve itself quickly, you should go to a doctor because we have antivirals against the flu, like Tamiflu and others.”

The World Health Organization says 300 million to 500 million people contract the flu each year and 500,000 deaths stem from complications from the disease.

In the U.S., at least 40,000 people die each year of flu-related causes, according to the CDC.

The world has had three pandemics since 1918 — 1957, 1968 and 2009 — and those were caused by an animal flu strain that mutated, adapted to humans and spread. Seasonal flu, though related, is much less severe and transfers only from human to human.

Dr. Taubenberger said medical advancements can help protect the developed world from revisiting the horrors of 1918, but people in the world’s poorest and underdeveloped areas will suffer the most.

Without a universal vaccine, the threat of a repeat of 1918 is ever-present, he said. “It’s something that happened naturally and could happen again — and we always have to be prepared for that.”

In the mid-1990s, Dr. Taubenberger and his colleague Anne Reid became the first researchers to sequence the genome of the 1918 influenza virus. The process started as a hobby but has since grown into its own division of the National Institutes of Health.

More than two-dozen researchers are doing work that ranges from basic science to clinical studies with infectious disease physicians to better understand how the flu operates.

Dr. Taubenberger’s fascination with the 1918 pandemic started when he was working as a pathologist in the Armed Forces Institute of Pathology at the old Walter Reed Army hospital in Washington. He analyzed tissue from a treasure trove of preserved samples dating as far back as the Civil War.

“I wanted to think about how we could use some of these new tools to think about old problems, and that’s how I thought of the 1918 flu,” he said.

In addition to samples kept in the Walter Reed lab, Dr. Taubenberger and colleagues also took tissue samples from nearly century-old flu victims in Alaska who had been buried in the permafrost.

“My interest in influenza started with 1918 and has expanded to encompass most aspects of influenza biology,” he said, explaining that his mission to answer key questions about that pandemic have yielded answers to benefit society today.

“I don’t know if we can ultimately defeat flu,” he said, “but it’s certainly worth the fight.”

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