Biology 103
2003 Third Paper
On Serendip

This winter, media reports of early influenza (flu) deaths in American and British children sparked a panic that is spreading throughout the United States and the world. People are currently rushing to get flu shots to try to prevent this virus, which can be temporarily debilitating and even lead to death (1). With readily available flu vaccination and medication, it is a wonder that the flu is still an extant disease. In fact, in any given year, the flu kills about 15 million people world wide, more people than are killed by AIDS, lung cancer, and heart disease combined (2). With so much modern medical technology, why is it that we are still getting the flu?

Influenza, commonly known as the flu, is a virus that infects the trachea (windpipe) or bronchi (breathing tubes) (1). Strains of the flu may belong to one of three different influenza virus families, A, B, or C (3). Symptoms include high fever, chills, severe muscle aches, headache, runny nose, and cough. Complications can lead to pneumonia. Those most at risk of dying from the flu or contracting complications include asthmatics, people with sickle cell disease, people with long-term diseases of the heart, kidney, or lungs, people with diabetes, those who have weakened immunity from cancer or HIV/AIDS, children on long-term aspirin therapy, women who are on their second or third trimester of pregnancy, children under the age of nine, and adults over the age of 50 (1).

Flu shots may be a miracle of modern technology, but they are not received by everyone. The flu is a world-wide problem. While Americans spend $2 billion treating and preventing the flu every year, those countries known as the Third or Developing World simply cannot afford such a luxury (2). Even relatively wealthy countries cannot give the flu shot to everyone. Most Singaporeans are being urged to wait to get their flu shots until they have been administered to the more susceptible groups such as children and the elderly, and to health care workers and those traveling to parts of the globe where the flu season is at its worst, such as the United States and Britain (4). The United States, too, has not until recently been able to offer the flu shot to everyone. During the winters of 2001-2002 and 2002-2003, the US did not have enough influenza vaccines to administer to all of its residents, so the Centers for Disease Control and Prevention (CDC) asked healthy Americans to wait until those who were more vulnerable to the virus had a chance to get vaccinated (5).

Even those who are able to obtain flu shots often do not take advantage of them. For example, even though the flu triggers asthma attacks, studies suggest that only 8.9% of all people with asthma receive flu shots (6). In 2001, only 67% of people aged 65 years and over, another at-risk group, received the shot despite the fact that it is covered by Medicare (3). This flu season, even though many experts are recommending that most Americans receive a flu shot, a number of factors are preventing many people from doing so. Because the vaccine is made with hens' eggs (1), people who are allergic to eggs should not receive the flu vaccine. There are also some side effects of receiving the flu vaccination. Less than one-third of those who receive the vaccination experience soreness at the vaccination site, and five to ten percent suffer low-grade fevers and headaches (7). Some people are afraid of contracting the virus from the injection; however, they are misinformed as it is impossible to catch the influenza virus from the shot (8). Others are too pressed for time to receive a flu shot (5). Many people simply hate going to the doctor and getting shots, an experience that is usually physically and sometimes emotionally painful.

Even if everyone in the world got the flu shot, we still would not be eradicated of influenza. The flu shot is only about 75% effective in preventing the flu and reducing its severity. This is partly because it takes the vaccine one to two weeks to fully travel to the lungs (2), during which time the individual who has received the flu shot is just as susceptible to contracting the flu as is the individual who has not received it (7). Another reason that the flu vaccine is not always effective is that the virus that is injected into the body is never the exact same virus that is in circulation. The flu is a virus that naturally undergoes mutations from year to year, with multiple strains from three different virus families circulating somewhere in the world at any given time. This year's Fujian flu appears to have mutated from the more common Influenza A/ Panama virus (9). It is a slight "reshuffling" of existing strains of flu, a process called "antigen drift". In other years, when worldwide epidemics or "global pandemics" occur, it is often due to a major change in the flu's genetic material, an alteration into a completely different strain (4). As was the case of the 1918 Spanish Flu virus, a pandemic that killed more than 20 million people worldwide, it is also possible for genes that code for the proteins within the virus to split and recombine (10). The influenza virus can also jump from one species to another, exchanging genetic material in viruses afflicting different animals and creating new influenza strains (9).

By the time each vaccine is created, new strains of the flu are usually circulating. This is why influenza vaccines can only be made using flu varieties of the previous year, combining different strains of those flues in order to best protect against any extant strain of influenza (1). Because the strains are usually similar, these vaccines offer very good cross-protection; but they are not 100% effective (9). It is because of mutations and because the flu vaccine is made from a "killed" virus and is thus weaker than it would be if it were made from a live one that the immunity from the vaccine is short lasting, and it is recommended that people receive flu shots every year (7). If we spent a few years vaccinating the world's population as was done during the World Health Organization's smallpox eradication program (11), new strands of influenza would probably come into existence by the time everyone had been vaccinated from the old ones.

There are, at least in America, other options that help to prevent the contraction of the flu. One such option is FluMist, a nasal spray that was approved by the Food and Drug Administration in September of this year (12). It is a live but weakened form of the flu virus, and this gives it greater potential to produce a broad immune response (13). The fact that it is a nasal spray makes it much more appealing than the flu shot, which can only be administered via needle. However, because FluMist is administered through breathing, it has potential to be secreted, subjecting those who have not been vaccinated to the live virus. The fact that it is a live vaccine makes it possible for those who receive it to contract the virus from it. It is for this reason that FluMist is not recommended for people who fall in the groups most at risk of catching the flu (12).

Medications for flu are also not completely effective. Although there are currently over 100 over-the-counter flu medications, including Sudafed, Alka-Seltzer, Tylenol, Robitussin, Actifed, Dristan, Contac, TheraFlu, Dimetapp, and Nyquil, these drugs treat the flu's symptoms – they do not prevent the flu (2). One new drug, Zanamivir, can be inhaled and has been shown to reduce the symptoms of both A and B strains of influenza if taken at the onset of the disease, as has Oseltamivir, a drug taken in pill form. Oseltamivir can be used to prevent influenza, and so can the antiviral drugs, amantadine and rimantadine, although these two drugs need to be taken "as long as influenza cases continue to occur in the community," they are only useful for the prevention of Influenza A, and they can cause mild side effects. These two medications can also be used to treat influenza if taken soon after its onset (3), but again, this is not prevention, and the contagious influenza virus can still be spread.

Though it is extensive, current technology could not rid the world of the flu even if these medications and preventative measures were available to everyone. This is especially evident when we look at another kind of modern technology, the technology of travel. Today we constantly hear that the world is "getting smaller". Travel is much easier and much more frequent than it has ever been in the past. As was the case with last year's rapid spread of the SARS virus, people infected with a flu virus that is common in one area of the world constantly come into contact with those who live in areas not in contact with that particular virus, quickly spreading different strains of the flu throughout the globe. At least for now, all we can do is try to prevent ourselves from contracting and spreading influenza by receiving flu shots, inhaling FluMist, or taking medication to prevent influenza or reduce its symptoms.

References

1)Influenza Vaccine | Vaccine Education Center, an informational site on the Children's Hospital of Philadelphia website.

2)Influenza is America's #1 Killer: Flu Vaccine Found Least Effective for those Counting on it Most, an article that gives shocking flu facts.

3)American Lung Association Fact Sheet – Influenza

4)Mystery flu and its myths: Vaccination frenzy but most adults not at risk, article on a Singaporean news site.

5)MSNBC – Americas Urged to get Flu Shots, recent MSNBC news article.

6)Influenza: Serious Problem for People with Asthma, facts to do with influenza and asthma on the American Lung Association website.

7)Care Dynamix – Flu Shot Facts, facts provided by an on-site flu shot service.

8)Floyd Co., VA – Flu Vaccine

9)Fujian flu vaccine ready by next year; news article on the Star Online, a Malaysian Newspaper.

10)ScienceDaily New Release: Australian National University Scientists Find Genetic Trigger For The 1918 Spanish Flu

11)WHO 50th – Smallpox Eradication, Site Commemorating the 50th anniversary of the World Health Organization.

12)FluMist: No More Flu Shots? , On the Mayo Clinic website.

13)ScienceDaily News Release: A Better FLU Vaccine? Nasal Spray Vaccine May Give More Protection Against 'Drifted' Strains


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