Alan Sipress - The Fatal Strain

56 a baffling plague:On the connection between Hoi-ka’s case with the earlier poultry outbreak, see Eric C. J. Claas et al., “Human Influenza A H5N1 Virus Related to a Highly Pathogenic Avian Influenza Virus,” Lancet 351, no. 9101 (Feb. 14, 1998): 472-77; and David L. Suarez et al., “Comparisons of Highly Virulent H5N1 Influenza A Viruses Isolated from Humans and Chickens from Hong Kong,” Journal of Virology 72, no. 8 (Aug. 1998): 6678-88.

58 The Spanish flu:For a scientific investigation of the 1918 pandemic, see Jeffrey K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases 12, no. 1 (Jan. 2006): 15-22.

58 two subsequent pandemics:On flu pandemics of the last century, see Edwin D. Kilbourne, “Influenza Pandemics of the 20th Century,” Emerging Infectious Diseases 12, no. 1 (Jan. 2006): 9-14. WHO estimates that the 1957 pandemic killed two million and the 1968 pandemic one million.

60 If two different flu strains:For a discussion of the compatibility of genes from H5N1 and human viruses, see Li-Mei Chen et al., “Genetic compatibility and Virulence of Reassortants Derived from Contemporary Avian H5N1 and Human H3N2 Influenza A Viruses,” PLoS Pathogens 4, no. 5: e1000072.

60 the recent, seemingly improbable encounter:For early discussions of the H1N1 swine flu virus, see Rebecca J. Garten et al., “Antigenic and Genetic Characteristics of Swine-Origin 2009 A (H1N1) Influenza Viruses Circulating in Humans,” Science, published online before print May 22, 2009, doi: 10.1126/ science.1176225; Novel Swine-Origin Influenza A (H1N1) Virus Investigation Team, “Emergence of a Novel Swine-Origin Influenza A (H1N1) Virus in Humans,” NEJM , published online before print May 7, 2009, doi: 10.1056/ NEJMoa0903810; and Robert B. Belshe, “Implications of the Emergence of a Novel H1 Influenza Virus,” NEJM , published online before print May 7, 2009, doi: 10.1056/NEJMe0903995. On the triple reassortant virus, see Vivek Shinde, et al., “Triple-reassortant swine influenza A (H1) in Humans in the United States, 2005-2009,” NEJM , published online before print May 7, 2009, doi: 10.1056/NEJMoa0903812.

60 even infecting mammals:See, for example, Juthatip Keawcharoen et al., “Avian Influenza H5N1 in Tigers and Leopards,” Emerging Infectious Diseases 10, no. 12 (Dec. 2004): 2189-91; and Guus F. Rimmelzwaan et al., “Influenza A Virus (H5N1) Infection in Cats Causes Systemic Disease with Potential Novel Routes of Virus Spread Within and Between Hosts,” American Journal of Pathology 168, no. 1 (Jan. 2006): 176-83.

60 The dice were being rolled:Alice Croisier et al., “Highly Pathogenic Avian Influenza A (H5N1) and Risks to Human Health,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, June 27-29, 2007, Rome.

60 “appear out of control”:I. Capua and S. Marangon, “Control and Prevention of Avian Influenza in an Evolving Scenario,” Vaccine 25, no. 30 (July 26, 2007): 5645-52.

60 it returns:Antonio Petrini, “Global Situation: HPAI Outbreaks in Poultry—A Synthesis of Country Reports to the OIE,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, June 27-29, 2007, Rome.

60 “a distant and unlikely prospect”:Joseph Domenech et al., “Trends of Dynamics of HPAI—Epidemiological and Animal Health Risks,” Background Paper at the Technical Meeting on Highly Pathogenic Avian Influenza and Human H5N1 Infection, June 27-29, 2007, Rome.

60 not the only avian virus menacing humanity:J. S. Malik Peiris, Menno D. de Jong, and Yi Guan, “Avian Influenza Virus (H5N1): A Threat to Human Health,” Clinical Microbiology Review 20, no. 2 (April 2007): 243-67.

60 avian strain called H9N2:K. M. Xu et al., “Evolution and Molecular Epidemiology of H9N2 Influenza A Viruses from Quail in Southern China, 2000 to 2005,” Journal of Virology 81, no. 6 (Mar. 2007): 2635-45; and K. M. Xu et al., “The Genesis and Evolution of H9N2 Influenza Viruses in Poultry from Southern China, 2000 to 2005,” Journal of Virology 81 no. 19 (Oct. 2007): 10389-10401.

61 “The establishment and prevalence”:Hongquan Wan et al., “Replication and Transmission of H9N2 Influenza Viruses in Ferrets: Evaluation of Pandemic Potential,” PLoS One 3, no. 8 (Aug. 2008): e2923.

61 “continued surveillance and study”:Jessica A. Belser et al., “Contemporary North American Influenza H7 Viruses Possess Human Receptor Specificity: Implications for Virus Transmissibility,” PNAS 105 no. 21 (May 27, 2008): 7558-63.

61 Some medical scholars dissent:Dennis Normile, “Avian Influenza: Pandemic Skeptics Warn Against Crying Wolf,” Science 310, no. 5751 (Nov. 18, 2005): 1112-13; and Declan Butler, “Yes, But Will It Jump?” Nature 439, no. 12 (Jan. 2006): 124-25.

62 “Such complacency”:Robert G. Webster et al., “H5N1 Outbreaks and Enzootic Influenza,” Emerging Infectious Diseases 12, no. 1 (Jan. 2006): 3-8.

62 “The virus has evolved”:Remarks in a speech tape for Business Preparedness for Pandemic Influenza, Second Annual Summit, sponsored by the University of Minnesota Center for Infectious Disease Research and Policy, Feb. 5, 2007.

62 “If you put a burglar”:Margaret Chan, “Pandemics: Working Together for an Effective and Equitable Response,” address to the Pacific Health Summit, Seattle, June 13, 2007.

66 “There’s a possibility”:Cindy Sui, “Hospital Staff Ill After Treating Bird Flu Victims,” Hong Kong Standard, Dec. 8, 1997.

66 reached double digits:For a clinical discussion of the Hong Kong cases, see K. Y. Yuen et al., “Clinical Features and Rapid Viral Diagnosis of Human Disease Associated with Avian Influenza A H5N1 Virus,” Lancet 351, no. 9101 (Feb. 14, 1998): 467-71; and Paul K. S. Chan, “Outbreak of Avian Influenza A (H5N1) Virus Infection in Hong Kong in 1997,” Clinical Infectious Diseases 34 (2002): S58-S64.

68 The parallels were eerie:David M. Morens and Anthony S. Fauci, “The 1918 Influenza Pandemic: Insights for the 21st Century,” Journal of Infectious Diseases 195 (2007): 1018-28; Jeffrey K. Taubenberger, “The Origin and Virulence of the 1918 ‘Spanish’ Influenza Virus,” Proceedings of the American Philosophical Society 150, no. 1 (Mar. 2006); Jeffrey K. Taubenberger and David M. Morens, “1918 Influenza: The Mother of All Pandemics,” Emerging Infectious Diseases 12, no. 1 (Jan. 2006): 15-22; and L. Simonsen et al., “Pandemic Versus Epidemic Influenza Mortality: A Pattern of Changing Age Distribution,” Journal of Infectious Diseases 178, no. 1 (July 1998): 53-60.

68 this disquieting pattern:“Epidemiology of WHO-Confirmed Human Cases of Avian Influenza A (H5N1) Infection,” Weekly Epidemiological Record 81, no. 26 (June 30, 2006): 249-57; and “Update: WHO-Confirmed Human Cases of Avian Influenza A (H5N1) Infection, 25 November 2003-24 November 2006,” Weekly Epidemiological Record , 82, no. 6 (Feb. 9, 2007): 41-47.

68 “most important unsolved mystery”:David M. Morens and Anthony S. Fauci, “The 1918 Influenza Pandemic: Insights for the 21st Century,” Journal of Infectious Diseases 195 (2007): 1018-28.