Helen L. Regnery,

       Just when you think, “Gosh, I can take a breather today and catch up on the papers that are stacking up on my desk–especially correspondence,” you find you have no such luck. But I will make time for correspondence tomorrow, especially to the young master’s degree student from Mexico who is excited about organizing surveillance for influenza in the Yucatán.
       In the mornings my routine at work is to always boot up the computer and quickly check my e-mail for urgent messages. If there are none, there is time for a cup of tea while I get ready for any meetings of the day. It there are any such e-mails, I forget the tea until later–don’t really need it anyway–it’s a habit. Today there was one such e-mail. Since 1995, we have been watching an addition to the family of viruses–a twig that has decided to branch far from its siblings. This virus belongs to the influenza A(H1N1) family. It is really dramatically different, but the severity of illness it may cause is unknown. Typically, the family of H1N1 viruses does not cause as much increased mortality among high-risk groups as the worrisome family of H3N2 (the Sydney virus that is circulating now is H3N2; sadly, mortality is up). We identified this new member in Wuhan, China. In 1989 our group organized a surveillance program in China that has been extremely successful in the identification of new family members. This is why there are so many vaccine strains with Chinese names.
       Contrary to what you would expect, this virus, for some unknown reason, either does not spread at all or spreads very slowly through the population. It is a plot to keep us on our toes. The Wuhan virus we identified in China remained confined to Asia, mainly in China and Hong Kong, but occasionally would be identified in Singapore and Taiwan. Until recently. Last August, the first indication of spread appeared in Senegal and then, in November, in Johannesburg. This morning we learned of the first isolation in Europe. With the vaccine meeting coming up in about 10 days, there must be serious thought and data analysis to make a decision for the 1998-99 vaccine. An event such as this one is why our U.S. advisory panel tries to give us as much time as possible after the FDA meeting in January. With flu, the direction can change with the wind.
       The questions that must be considered and decided within the month include: 1) Should this strain replace the old H1 strain currently in the vaccine, now that it is apparent that the new Wuhan H1 virus is beginning to spread? Unlike the H3 family, the H1 family does not replace its members rapidly. The anxiety is that the H1 family would keep its older member active as well as the new youngster. 2) If both H1 members are circulating and each is very different, which one do we choose? The influenza vaccine is licensed for three components and we cannot add a fourth. 4) How much protection would there be against the old strain if the new strain was chosen as the third component of the vaccine? This is a key question, and we are fortunate that people around the globe are working together in the interest of global health rather than in competition for publications. Personally, this is one aspect of my work that I appreciate. We are all working toward a common goal and we each need the others to be successful. A group of our colleagues in Europe designed an experimental vaccine using Wuhan as one of the components. A small clinical trial was done to evaluate the antibody response. We appreciate these data, which will be analyzed carefully and a decision made.
       Many times I have been asked by reporters, “What do you predict will happen?” There is no way you can predict events with influenza, just as you can’t predict the winner of the Superbowl or the World Series. The best we can do is keep working to understand the influenza virus family and use all our ammunition to outsmart this “sly character.”