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PANDEMICS WHAT EVERYONE NEEDS TO KNOW This page intentionally left blank PANDEMICS WHAT EVERYONE NEEDS TO KNOW PETER C. DOHERTY 1 3 Oxford University Press is a department of the University of Oxford. It furthers the University’s objective of excellence in research, scholarship, and education by publishing worldwide. Oxford New York Auckland Cape Town Dar es Salaam Hong Kong Karachi Kuala Lumpur Madrid Melbourne Mexico City Nairobi New Delhi Shanghai Taipei Toronto With offi ces in Argentina Austria Brazil Chile Czech Republic France Greece Guatemala Hungary Italy Japan Poland Portugal Singapore South Korea Switzerland Thailand Turkey Ukraine Vietnam Oxford is a registered trademark of Oxford University Press in the UK and certain other countries. Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016 © Peter C. Doherty 2013 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by license, or under terms agreed with the appropriate reproduction rights organization. Inquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above. You must not circulate this work in any other form and you must impose this same condition on any acquirer. Library of Congress Cataloging-in-Publication Data Doherty, P. C. (Peter C.) Pandemics / Peter C. Doherty. p. ; cm.—(What everyone needs to know) Includes bibliographical references. Summary: “From HIV to H1N1, pandemics pose one of the greatest threats to global health in the twenty-fi rst century. Defi ned as epidemics of infectious disease across large geographic areas, pandemics can disseminate globally with incredible speed as humans and goods move faster than ever before. While restricted travel, quarantine, vaccines, drugs, and education can reduce the severity of many outbreaks, factors such as global warming, population density, and antibiotic resistance will complicate our ability to fi ght disease. Respiratory infections like infl uenza and SARS spread quickly as a consequence of modern, mass air travel, while unsafe health practices promote the spread of viruses like HIV/AIDS and hepatitis C. In Pandemics: What Everyone Needs to Know, Nobel Prize-winning immunologist Peter Doherty addresses the history of pandemics and the ones that persist today, what promotes global spread, types of pathogens and the level of threat they pose, as well as how to combat outbreaks and mitigate their effects”—Provided by publisher. ISBN 978–0–19–989812–1 (pbk. : alk. paper) — ISBN 978–0–19–989810–7 (cloth : alk. paper) I. Title. II. Series: What everyone needs to know. [DNLM: 1. Pandemics—history. 2. Pandemics—prevention & control. 3. Disaster Planning. 4. World Health. WA 105] RA399.5 362.1028’9—dc23 2013004528 1 3 5 7 9 8 6 4 2 Printed in the United States of America on acid-free paper The deviation of man from the state in which he was originally placed by nature seems to have proved to him a prolifi c source of diseases. —Edward Jenner (1749–1823), pioneer of the smallpox vaccine, sometimes called the “father of immunology” This page intentionally left blank TABLE OF CONTENTS ACKNOWLEDGMENTS xiii ABBREVIATIONS xv INTRODUCTION xxi 1 Infection and Immunity 1 What is the difference between a virus and a bacterium? 2 What is the difference between RNA and DNA? 9 Aren’t viruses also much smaller than bacteria? 13 Why is it important to distinguish viruses from bacteria when discussing pandemics? 15 Are colds and fl u caused by hundreds of viruses? 17 What exactly is a pathogen? 19 How does infection happen? 22 What is snot? 26 What is a horizontal infection? Is there another kind? 26 Are all virus and bacterial infections bad for us? 27 If there is a bacterial and protozoal “microbiome,” is there also a “virome”? 28 What does “immunity” mean? 30 What are monoclonal antibodies? 37 viii Table of Contents Would you describe mAbs as drugs or vaccines? 39 What are vaccines? 40 2 Pandemics, Epidemics, and Outbreaks 42 What is the exact defi nition of pandemic? 42 Who declares a pandemic? 43 Was the H1N1 “swine fl u” really so mild? 44 How does the WHO operate? 45 Should the pandemic classifi cation system be refi ned? 48 How does a pandemic differ from an epidemic or an outbreak? 49 Do all pandemics involve infection? 51 What does the term “zoonosis” mean? 52 What is an endemic infection, and how does it differ from an epidemic infection? 54 Are plants also included in the world of pandemics? 55 In Summary 55 3 The SARS Warning 56 Why was SARS so scary? 56 How did SARS spread so quickly through hospitals? 57 What caused SARS and where did the pathogen come from? 59 Aside from “natural” reservoirs, are there other potential sources of SARS? 61 What steps were taken to stop the SARS outbreak? 61 Did the SARS experience have long-term effects, and what lessons were learned? 63 4 Tuberculosis and Infl uenza 66 Why should TB and infl uenza be considered together? 66 What is the current situation with TB? 66 Table of Contents ix Is multi-drug-resistant TB still an issue? 68 What is being done to combat the MDR TB threat? 70 Why might infl uenza remain the most obvious known pandemic threat? 70 What are the different kinds of infl uenza viruses? 72 What is antigenic shift and why is it so dangerous? 74 Are birds and pigs our main concern when it comes to catching the fl u? 78 What was so special about the virus that caused the 1918–1919 infl uenza pandemic? 79 Is our capacity to counter infl uenza improving? 82 Are we making progress with fl u vaccines? 83 Apart from vaccines, are there other products available to prevent infection? 86 How afraid should we be of infl uenza? 88 5 Fledermaus to Field Mouse 90 What’s a fl edermaus? 90 Is it unusual that fruit bats carry SARS? 90 Are the henipaviruses potential pandemic pathogens? 93 Is Ebola the scariest of all viruses? 94 What exactly is a hemorrhagic disease? 96 Are fi loviruses the main cause of hemorrhagic fevers? 98 6 Virus Vectors 102 What is a vector? 102 What is WNV, and has it been around for very long? 103 WNV infects birds, horses, and humans—does it also multiply in mosquitoes? 104 What exactly is yellow fever virus? 106 What do we know about the global movements of arboviruses? 109

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Pandemics. The word conjures up images of horrific diseases sweeping the globe and killing everyone in their path. But such highly lethal illnesses almost never create pandemics. The reality is deadly serious but far more subtle. In Pandemics: What Everyone Needs to Know®, Peter Doherty, who won th