The northern hemisphere is bracing itself for a severe influenza season this winter, with reported deaths in Europe and North America surpassing the early seasonal figures from recent years and a new strain of the virus circulating in the population.
Type A Fujian flu made headlines in Australia during that country's winter, when about 3000 people succumbed to flu and its complications. In Britain, two English and three Scottish children died from the Fujian flu in November. That is considered a high toll so early in the season.
France, Spain, Norway, and Portugal are reporting high infection rates among children. The southwestern United States has also seen an early onset, with vaccine demand outstripping production. “People wishing to be vaccinated may need to be persistent to find vaccine,” said Dr Julie Gerberding, director of the Centers for Disease Control and Prevention.
A spokeswoman for the United Kingdom's Department of Health said: “We have vaccines for everybody in the at-risk groups, but not much more than that. If a lot of other people sought immunisation, there could be a shortage.”
One cause for concern about Fujian flu is that this year's flu vaccine is based on a different strain. The Fujian virus was detected before the annual meeting of the World Health Organization's Global Influenza Surveillance Network, but materials were lacking to make sufficient vaccine, so they chose instead to include the A Panama strain, which has been prevalent for the past three years. Experts are confident, however, that the vaccine will provide some cross protection against the closely related Fujian strain.
Dr John Watson, a respiratory expert at the Health Protection Agency, said: “For the last three years, we have seen very low levels of flu in the UK, but flu activity has started earlier than normal this year so we are expecting to see more cases. Over the winter period we usually see around three deaths in children from respiratory illness in England each week. When flu strains change over time, they are more likely to affect the young, who will have less immunity to them.”
John Oxford, professor of virology at Queen Mary's School of Medicine, London, says that although Fujian flu was clearly not going to cause a pandemic, it highlighted weaknesses in Britain's flu prevention strategy. “We're definitely seeing increased infection and death rates among children, whereas the elderly seem to be coping quite well. This is probably because we've had some mild years, and young children have been less exposed. Clearly we have to pay more attention to flu in the young.”
He criticised the guidelines on antiviral drugs issued by the National Institute for Clinical Excellence: “Here we have this whole new armoury of drugs effectively sitting on the shelf, because the guidelines say they should only be prescribed to people from the at-risk groups.” Professor Oxford said that Britain should build up a stockpile of vaccines and anti-virals. “If we can do it for smallpox we should certainly do it for flu.”
He said experts were unanimous that another great pandemic was inevitable, describing flu as the most dangerous disease facing humanity. “We had three pandemics in the last century, in 1918, 1957, and 1968. Flu killed 50 million people in the 20th century.” He said that many researchers nowadays believe the Black Death of the 14th century was not a bacterial disease at all but a virus, possibly flu.
Figure 1.
Hazel Guinn, aged 3, from Buckinghamshire, who died of flu in November. Because Britain has had some mild years with little flu circulating, young children have been less exposed
Credit: PA PHOTO
Professor Oxford worried that patients would consider the mismatched vaccine as an excuse to avoid immunisation. “That would be a very bad idea. It still offers protection, though obviously it won't be perfect.”