Influenza Report 2006

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Influenza Report 2006

Influenza Report 2006

Chapter 1: Influenza 2006
Bernd Sebastian Kamps and Gustavo Reyes-Ter¡¤n
Influenza pandemics resemble major natural disasters: we know there will be an-
other one, but we ignore both time and magnitude. In most other aspects, they are
different. Earthquakes in Tokyo or San Francisco last from seconds to a couple of
minutes n pandemics spread around the world in successive waves over months or a
couple of years. And quite different are the consequences: an influenza pandemic
may be a thousand times more deadly than even the deadliest tsunami.
As unpredictable as influenza pandemics are, as unpredictable is the virus itself. We
know nothing about the pathogenic potential of the next pandemic strain. The next
pandemic may be relatively benign, as it was in 1968 and 1957, or truly malignant,
as was the 1918 episode. We don¨ªt know if the next pandemic will be caused by the
current b¨ªte noire, H5N1, or by another influenza strain. We ignore how the next
pandemic will evolve over time, how rapidly it will spread around the world, and in
how many waves. We don¨ªt know which age groups are at the highest risk of severe
outcomes. We have no idea whether the next pandemic will kill 2, 20, or 200 mil-
lion people.
Not surprisingly, healthcare professionals are becoming sensitised to the risk of a
new pandemic. The ongoing outbreak of H5N1 influenza among birds with occa-
sional transmission to human beings is of major concern because of intriguing par-
allels between the H5N1 virus and the 1918 influenza strain. Should H5N1 acquire
the capability of easy human-to-human transmissibility, even the most conservative
scenario anticipates up to several 100 million outpatient visits, more than 25 million
hospital admissions and several million deaths globally (WHO Checklist 2005).
It is wise to imagine and plan for the worst when facing an unknown threat. As the
threat is global, strategies must be global n a tricky task when our planet is divided
into more than two hundred nations. Dealing with nations and their leaders is like
dealing with children in a kindergarten. In this difficult context, the WHO is per-
forming an astonishing job.
In the following paragraphs, we shall take a look at the various facets of the war on
influenza: the global and individual impact of the disease, the virus itself, and the
individual and global management of what may one day turn out to be one of the
most challenging healthcare crises in medical history. The most important thing to
remember when talking about pandemic influenza is that its severe form has little in
common with seasonal influenza. Pandemic influenza is not business-as-usual in-
fluenza. Bear this in mind. You wouldn¨ªt call a tiger a cat.

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