I think that swine flu is still going to cause trouble, says virology professor


Experts are warning against complacency towards the H1N1 virus, saying it ‘has a sting in its tail’ and will be back this way come winter, writes CLAIRE O'CONNELL

A YEAR AGO this week the World Health Organisation teetered on the brink of calling the first flu pandemic of the 21st century. The new H1N1 “swine flu” variant was spreading around the globe and with it came a measure of unpredictability that goes with any pandemic virus.

On June 11th they declared the pandemic level to be at phase six – a full pandemic – thereby ramping up national preparation plans further and setting vaccine production in train.

A year on, more than 18,000 people have died from confirmed swine flu, and last week the WHO confirmed the pandemic status still stands.

“It is predicted that H1N1 will continue to be the primary or overwhelming virus among influenza viruses for quite a while,” said WHO spokesman Gregory Hartl. “Pandemic or no pandemic, H1N1 will still exist.”

The virus is currently active in the Caribbean and southeast Asia, and one academic who spoke at a conference in Trinity College Dublin last month reckons it will kick off again in this part of the world in the coming winter.

“I think swine flu is still going to cause trouble,” says John Oxford, professor of virology at St Bartholomew’s and the Royal London Hospital, and scientific director at Retroscreen Virology, a contract research organisation that conducts trials on anti-viral drugs and vaccines.

“Great viruses start small and go big rather quickly, so we have to be careful,” he says. “Pandemic H1N1 is a virus with a sting in its tail and I think that’s what we have to contend with. It’s too early to do a postmortem. We will see what lies ahead, but viruses don’t go easily into this dark night.”

He has studied the unfolding of previous influenza pandemics, particularly the Spanish flu around 1918, and he says we need to learn the lessons of “fewer memorials and better preparation”.

In particular, individuals need to be aware of how to limit the spread of disease, according to Oxford.

“It’s the home front that decides everything,” he says. “Anti-science doesn’t help – we don’t want to be getting into a flap, making non-scientific decisions and getting caught. Instead, on the home front we need hygiene, social distancing and knowledge, and a huge knowledge base has already been passed from one group to another, such as the importance of hand-washing to limit the spread of the virus.”

Oxford is a strong advocate of vaccination, and rubbishes the notion that governments invested unwisely in stockpiles of jabs against the new virus.

“It’s no time to be complacent and say we wasted our money on vaccines, because we haven’t. This is a virus that will be in the community for a long time.”

Vaccine immunologist Dr Anne Moore of the school of pharmacy at University College Cork agrees that vaccines have been important in the push to keep the pandemic H1N1 virus down.

“The only way to prevent the ’09 variant from becoming more virulent was to eliminate it via public-health measures. Key to this is vaccination,” she says.

“If one looks at 1918, the first wave of infection was by a non-lethal virus strain that had the opportunity to develop into a strain with very high mortality over the next nine to 12 months, some would say even longer. If we had not taken steps to control the new variant that emerged last year, it is likely that we could have experienced the same effect of a second-wave lethal variant this year. Some would argue that the WHO did cry wolf, but you don’t want to take the chance of the wolf killing your animals.”

Moore also notes that the strategy of developing mock-up vaccines ahead of the pandemic meant that once the pandemic was called it was possible to manufacture and license new vaccines against H1N1 relatively quickly, in fewer than six months.

“If anything, we are in a stronger position today than last year, as we now know that this prior preparation worked, and we can also learn lessons from how it was rolled out,” she says.