Keeping up with the changing flu virus Fighting the flu/Dr Muiris Houston
It's not just children, the(1) _________ and the sick who are at (2)________. Young adults can (3)________ face the potentially(5) __________ effects of influenza. Influenza is traditionally (6)________ as an illness that (7)________ a particular risk to the very young and the very old, but young (8)_________ can also be at risk from its potentially devastating effects, as past epidemics show.
Last winter's flu was regarded as (9)____________ harmless, certainly as far as the numbers affected were concerned. The winter of 1999 produced an epidemic - officially recorded as more than 400 cases per 100,000 people. It is too early to (10)___________ what this year's (11)___________ will be like,(12) ___________ it is more than 30 years since we had a world pandemic. Many experts feel we are due another "bad one" soon.
The principal (13)___________ among doctors and scientists is that we will, (14)________ some time in the future, be (15)___________ to a strain of flu virus similar(16) ____________ the(17) ___________ one of 1918-1919. Known as Spanish flu, this highly virulent disease killed up to 40 million people in less than a year - three times the (18)__________ recorded in the four years of the first World War.
The big difference between the 1918 flu and (19)___________ before and since is the number of young (20)____________ adults who were killed by the epidemic. The first (21)_________ in a US army camp, for example, was recorded (22)____________ September 14th, 1918. By the end of October, some 17,000 of the 45,000 troops in the camp, which was based west of Boston, had (23)___________. Ninety young men died every day (24)_________ the height of the epidemic.
The (25)____________ was equally high in Europe. Flu killed 20,000 people in Ireland, which had a death rate similar to Scotland's. In Italy, 500,000 people (26)_____________. The virus infected both David Lloyd George, the British prime minister, and Woodrow Wilson, the president of the United States.
Cinemas and theatres closed. People (27)_____________ wore face masks. The streets were fumigated. And in the United States, a skipping song quickly became popular: "I have a little bird and its name is Enza. I opened the window and in flew Enza."
But that was then.(28) ____________ an outbreak could never (29)____________ again, could it? (30)____________ are not so sure, particularly since the 1997 near miss in Hong Kong - an episode that is both reassuring and worrying. If you (31)________________ flu in 1997, you were most likely to be infected with H3N2, a descendant of the last pandemic strain that had (32)______________ in Hong Kong in 1968.
On May 9th, 1977, a three-year-old boy became unwell with what seemed to be an upper-respiratory-tract infection. Five days later, he became (33)___________ more ill and was(34) ____________ to intensive care, with respiratory (35)_______________. Within two weeks, and ___________ the best medical treatment, he died. Analysis of fluid from the child's windpipe revealed a (36)____________ undetected form of influenza virus, now known as H5N1. This (37)__________ alarm bells among infectious-(38)_____________ experts around the world, and an (39)____________ team was dispatched from the Centers for Disease Control and Prevention, in Atlanta.
It soon became (40)___________ that there was a link between the human flu outbreak and the widespread death of (41)_____________ in Hong Kong's (42)____________ territories. Almost 7,000 birds had died in March 1997 of an avian flu. The virus responsible was H5N1. This was a worrying discovery. The natural (43)_____________ for the influenza virus is wildfowl: ducks, geese, chickens and turkeys. And(44) __________ the flu virus does not travel directly from birds to humans, there is a common link with swine. Both avian (45)____________ human influenza viruses can replicate in pigs. When they mix, dramatic genetic shifts can follow, bringing with them the (46)___________ for new human epidemics. The 1977 outbreak now began to look(47) ___________. South-East Asia is one of the most (48)____________ populated areas of the world - where hundreds of millions of people live and work in close (49)____________ with (50)________________ pigs and birds - so the authorities embarked on a huge cull of the chicken and duck population in Hong Kong and its New Territories.
By August 1998, no new H5N1 had shown up in Hong Kong. The 18th and final human (51)__________ of the outbreak had fallen ill on December 28th, 1997, the day the bird(52)___________ began. That there had been no more (53)___________ since then was no (54)____________: the sharp(55) ___________ by scientists had stopped the spread of a potential pandemic.
The last serious pandemic was in 1968. When a particularly(56) _________ influenza hits, it is like nothing else we have grown accustomed to labelling "flu". The normal(57) ____________ and pains become prostration; people are weakened to the point (58)______________ which they cannot (59)_____________ their heads from the (60)____________.
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A retired Irish GP(61) ____________ the rural village in which she lived and worked as being like a (62)____________ town during the 1968 outbreak. "There was no one on the streets. Entire households were (63)____________, with no one stirring out for weeks. Essential
(64)___________ were delivered by neighbours lucky enough not to be affected." The rate of house calls rocketed; she worked 18-hour days for weeks on end before succumbing herself.
The 1968 virus (65)____________ around the globe. It was a H3N2 version - coincidentally, labelled Hong Kong flu - which is still part of the flu jab that people will get this winter. It is the ability of the virus to(66) ___________ and disappear that keeps flu experts(67)____________ and uneasy. The 1933 pandemic was caused by a H1N1 that then disappeared for more than 40 years, (68)_____________ re-emerging in 1977. The possibility is strengthened by the realisation that viruses can remain inactivated in a frozen state. In August 1998, an (69)_____________ set off for Spitsbergen, an Arctic island belonging to Norway, to unearthed the bodies of coal miners who had(70) ______________ during the 1918 outbreak. The hope was that the bodies would be (71)___________ beneath permafrost, so that tissue samples might help deduce the genetic code of the Spanish flu.
Although initial analysis was (72)____________, because of poor preservation, researchers are still hopeful of (73)______________ the 1918 strain from the samples. Why (74)____________? Because of the extreme virulence of the 1918 outbreak. Not just the numbers, but also the sort of people who were killed by that flu - the majority were young fit people who died (75)____________ from pneumonia caused by the influenza virus - and because we know that it is possible, at least theoretically, for it to re-emerge 80 years later.
Admittedly, we now have antibiotics that will minimise the death rate from any secondary bacterial pneumonia. But because of the (76)___________ of antibiotics and (77)____________ scientific research in 1918, we can never be sure (78)___________ the pneumonia associated with Spanish flu was viral or bacterial. Young men died so quickly after symptoms started that it must be(79) ___________ to assume that it was the virus
(80)____________ that overwhelmed their bodies.
In the (81)_________, the likelihood, as always, is that the flu jab will protect against whatever strain is on its way. Vaccination is up to 70 per cent (82)____________, and it remains the mainstay of (83)___________ for influenza. But until the first isolates of this winter's flu are analysed and compared across Europe and the United States, a frisson of anticipation will (84)__________ through the scientific world. Could this be the next big pandemic?
The annual influenza season is (85)__________ rapidly. (86)____________ you are over 65 or suffer from a chronic illness, and you have not yet had your yearly flu jab, time is running out. A winter flu outbreak can occur any time between November and April.
Because influenza is a constantly changing virus, the organisation needs to monitor reports from laboratories around the world in order to decide which three strains to use in the vaccine. The World Health Organisation has also (87)___________ vaccination for all vulnerable groups: those aged 65 or older; adults and children of six months and older with chronic disease of the heart, lungs, (88)____________ or liver; and those whose immune systems are (89)_____________.
The Canadian province of Ontario has gone a step (90)__________ than other countries this winter. It is prepared to give free vaccine to all of its(91) ___________. Here, flu vaccine is(92) _____________ free of charge to all at-risk patients who(93) ____________ a medical card. Others, such as those in the 65-70 age bracket, are (94)___________ to free vaccine but may have to pay the doctor for (95)___________ it.
