Current Developments in

Scientistsfrom around the world recently met at WHO Headquarters in Geneva to review current knowledge on the viral diseases and to draw up a pogram for the next decade aimed at dealing with the problems that they cause in terms of public health. It was determined that attention should be given first to working out public health procedures for those diseaseswhich affect large segments of the po#ulation andfor which immunization is practical. The next order of piority was assigned to diseases that have implications for international health butfor which vaccines are not yet available. Included in this category are diseases that have only recently appeared asprob1em.s on the public health scene. Final- ly, a third category encomfiasses those diseases that still require much basic research and on which it is urged that studies be continued. The Bulletin is publishing selections from this meeting’s short working papers in the #resent and the next two forthcoming issues. The ones transcribed below corTes#ond to some of the diseasesin the first priority group.

INFLUENZA: ITS AND ECOLOGY’

W. R. DowdleZ and G. C. S&i&

Early theories to explain & variation in human influen- za virusessuggested that they arosefrom in Previously existing strains. More recently it has been suggested that such changes may occur as a result of the int+oduction in human #o#ulations of from mammalian or avian reservoirs, or as a result of between human and animal infElrenra strains.

Influenza viruses have two surface anti- the hemagglutinin (HA) and the neu- gens of glycoprotein composition, namely raminidase (NA). Antibodies to each struc- ture are associated with immunity. Anti- body to the hemagglutinin prevents initia- 1Working paper, WHO Scientific Group on Diseases (Geneva, 1-5 September 1975): also appearing tion of virus infection. Antibody to the in Spanish in Bol Of Sat& panam. prevents virus release and ZDirector, Virology Division, Bureau of Laborato- ries. U.S. Center for Disease Control, Atlanta, spread. Internally, the virus particles Georgia, U S.A. possess two additional major , the ‘Head, Division of Viral Products, National Institute for Biological Standards and Control, nucleoprotein (NP) and the matrix (M) London NWS. United Kingdom. . These are antigenically

193 194 PAHO BULLETIN l vol. X, no. 3, I976

unvariable, and antibody to them does not obvious . In contrast, viruses confer immunity. The internal antigens are associated with pandemics in the latter years subtype-specific and provide the basis for of an interpandemic period have usually separating influenza viruses into types A, B, shown extensive antigenic drift. But anti- and C. genie drift per se does not permit prediction Both the surface antigens (HA and NA) of the epidemic potential; variants may are antigenically variable for influenza often be associated with local epidemics yet virus types A and B. A gradual antigenic fail to spread. Undoubtedly the factors change occurring with time is referred to as which contribute to a virus’ epidemic a drift. A complete or major change in potential are complex interactions between either or both surface antigens is referred to the virus and the human population. as a sh$. The latter form of variation has Antigenic drift may be only one factor; occurred only with influenza type A. The however, until all the factors are better mechanism of antigenic drift is usually understood, the antigenic character of the attributed to selection of preexisting mu- virus will continue to provide the first tants by pressure from increasing immunity warning of possible epidemic disease. in the human population. The mechanism An effective global surveillance system of is less clear. Early theories based on virus isolations and seroepidemio- suggested that it resulted from a major logic surveys is essential. Such a system of the previous . More serves two major purposes. First, it docu- recent theories suggest that such new ments the worldwide epidemiologic behav- human influenza strains may arise from ior and antigenic character of current mammalian or avian reservoirs or through viruses, a task which is essential for genetic recombination between human and understanding their ecology. Second, it animal influenza viruses. provides an early warning system for Since isolation of the first human signaling the emergence of new or altered influenza type A virus in 1933, antigenic antigenic strains and permits preparation shzyts have occurred twice, once in 1957 and and distribution of relevant influenza again in 1968. The 1957 shift involved both vaccines. the HA and the NA antigen, while that of Influenza A viruses, but not the viruses of 1968 involved only HA. Both shifts were influenza B, are commonly isolated from associated with influenza pandemics, but nonhuman hosts and often produce out- the 1968-1969 mortality rates were lower breaks of disease in swine, horses, and a than those of 1957, possibly indicating wide variety of wild and domesticated . partial protection afforded by antibody to Recent ecologic studies suggest that infec- the unchanged NA antigen. Aside from tions may also occur in other creatures (e.g. these two periods, there has been no cattle). Viruses isolated from outbreaks of occasion in recent years on which there was disease in swine constitute a single virus a clear relationship between antigenic subtype antigenically related to the classical changes and increased mortality. A single virus A/swine/Iowa/l980 antigenic subtype of (HswlNl). Also, the surface antigens (HA probably existed from the pandemic period and NA) of this virus are related to those of of 1918-1919 until 1956, and there is human influenza viruses isolated from 1933 circumstantial evidence that this virus may to 1956 (the HONl and HlNl viruses). be antigenically related to swine influenza Two distinct subtypes of influenza A A virus (see below). virus infect horses. These are represented by Viruses associated with epidemics follow- the reference strains A/equi/Prague/l/56 ing shortly after pandemics have shown no (Heql Neql) and A/equi/Miami/l/GS VIROLOGY l Dowdle and Schild l INFLUENZA 195

(Hen2 Neq2). A wide range of antigenic Genetic recombination between human varieties of influenza A virus have been and animal influenza A viruses takes place isolated from various avian . These readily in both laboratory cultures and includeviruses containing nine distinct HA experimental animals. The genetic hybrid subtypes and nine distinct NA subtypes. It is viruses so produced may contain antigenic interesting to note that influenza viruses of and biological characters (e.g. virulence) nonhuman origin include strains contain- derived from either parent. The molecular ing HA or NA antigens identical with or basis for recombination appears to be closely related to those of each of the human of the discrete RNA species influenza A subtypes isolated since 1933. In which constitute the genome of the virus addition to the instances cited above, recent and which have a specific function. The studies on the ecology of influenza in significance of these findings is that they nonhuman hosts have indicated that the provide an experimental foundation for human A/Hong Kong/1/68(HSN2) virus is the tentative hypothesis that new subtypes of capable of crossing species barriers and human influenza virus arise in nature as a producing infections in a wide variety of result of recombination between human hosts, including swine, domestic chickens, and animal influenza viruses. wild sea birds, and domestic dogs and cats.

SUMMARY

Influenza viruses have two surface antigens, antigens is termed a shzj?. The mechanism of the glycoprotein structures hemagglutinin antigenic drift is usually attributed to selection (HA) and neuraminidase (NA). Antibodies to of preexisting mutants by pressure from increas- each of these are associated with immunity, but ing immunity in the human population. The the structures themselves are antigenically mechanism of antigenic shift is less clear, but variable. one tentative hypothesis is that shifts arise from When an antigenic change is gradual over mammalian or avian reservoirs, or through time it is referred to as a drift, while a sudden genetic recombination of human and animal complete or major change in either or both influenza strains.