Re: What happened in 1957 and 1968?
1957: Asian Influenza (H2N2) <hr style="color: rgb(209, 209, 225);" size="1"> <!-- / icon and title --> <!-- message -->
History
[FONT=Arial, Helvetica, sans-serif]Influenza Pandemics of the 20th Century[/FONT]
Edwin D. Kilbourne*<sup>

</sup>
*New York Medical College, Valhalla, New York, USA
[FONT=Arial, Helvetica, sans-serif]1957: Asian Influenza (H2N2)[/FONT]
After the influenza pandemic of 1918, influenza went back to its usual pattern of regional epidemics of lesser virulence in the 1930s, 1940s, and early 1950s. With the first isolation of a virus from humans in 1933 (
5), speculation began about the possible role of a similar virus in 1918. However, believing that this could have been the case was difficult until the pandemic of 1957. This was the first time the rapid global spread of a modern influenza virus was available for laboratory investigation. With the exception of persons >70 years of age, the public was confronted by a virus with which it had had no experience, and it was shown that the virus alone, without bacterial coinvaders, was lethal (
6).
[FONT=Arial, Helvetica, sans-serif]First Recognition of the Pandemic[/FONT]
In 1957, worldwide surveillance for influenza was less extensive than it is today. However, attentive investigators in Melbourne, London, and Washington, DC soon had the virus in their laboratories (
7) after the initial recognition of a severe epidemic, followed by the publication in The New York Times of an article in 1957 describing an epidemic in Hong Kong that involved 250,000 people in a short period (
8). Three weeks later, a virus was recovered from the outbreak and sent to Walter Reed Army Institute for Research in Washington, DC for study.
[FONT=Arial, Helvetica, sans-serif]Nature of the Virus[/FONT]
The virus was quickly recognized as an influenza A virus by complement fixation tests. However, tests defining the HA antigen of the virus showed it to be unlike any previously found in humans. This was also true for the neuraminidase (NA) antigen. The definitive subtype of the Asian virus was later established as H2N2. The new virus had high sialidase/neuraminidase activity, and this activity was more stable than that of earlier strains. Different strains of the Asian virus also differed markedly with respect to sensitivity to either antibody neutralization or nonspecific inhibitors of hemagglutination (
9). In animal studies, the new H2N2 viruses did not differ in their virulence characteristics from earlier influenza A subtypes. Viral isolates from the lungs of patients with fatal cases showed no discernible differences from those from throat washing isolates of patients without pulmonary involvement within a small circumscribed hospital outbreak (
10).
[FONT=Arial, Helvetica, sans-serif]Primary Influenza Virus Pneumonia[/FONT]
Although secondary or concomitant bacterial infections of the lung were found to be a prominent feature of fatal cases in 1918 when a specific etiologic agent was sought (
4), many cases of rapid death and lung consolidation or pulmonary edema occurred in which bacterial infection could not be demonstrated. As influenza persisted as an endemic disease with regional recurrences after the pandemic, lives continued to be occasionally claimed by abacterial pneumonia.
With the arrival of Asian influenza in 1957, the sheer number of cases associated with pandemicity again brought the phenomenon of primary influenza virus pneumonia to the attention of physicians in teaching hospitals. In contrast to the observations in 1918, underlying chronic disease of the heart or lungs was found in most of these patients, although deaths of previously healthy persons were not uncommon. In the case of carefully studied patients at the New York Hospital, rheumatic heart disease was the most common antecedent factor, and women in the third trimester of pregnancy were among those vulnerable (
11).
[FONT=Arial, Helvetica, sans-serif]Response to Vaccination in an Unprimed Population[/FONT]
The pandemic of 1957 provided the first opportunity to observe vaccination response in that large part of the population that had not previously been primed by novel HA and NA antigens not cross-reactive with earlier influenza A virus antigens. As summarized by Meiklejohn (
12) at an international conference on Asian influenza held 3 years after the 1957 onslaught of H2N2, more vaccine was required to initiate a primary antibody response than with the earlier H1 vaccines (almost always observed in heterovariant primed subjects). In 1958, 1959, and 1960 (as recurrent infections occurred), mean initial antibody levels in the population increased (i.e., subjects were primed) and response to vaccination was more readily demonstrated. Divided doses given at intervals of
<4 weeks were more beneficial than a single injection. Less benefit was derived from this strategy as years passed. Intradermal administration of vaccine provided no special advantage over the conventional subcutaneous/intramuscular route, even when the same small dose was given (
13).
[FONT=Arial, Helvetica, sans-serif]Nature of Endemic H2N2 Postpandemic Infection[/FONT]
The Asian influenza experience provided the first opportunity to study how the postpandemic infection and disease into an endemic phase subsided. In studies conducted in separate and disparate populations (
14), the populations compared were Navajo school children and New York City medical students. In both groups, subclinical infections occurred each year during the 3-year study period, and clinically manifested infections decreased in conjunction with an increasing level of H2N2-specific hemagglutination inhibition antibody.
A decreasing incidence of clinically manifested cases can be ascribed either to the increase in antibody levels in the community or to a change in the intrinsic virulence of the virus. Therefore, the nature of the disease during the endemic period is important to define. A study (
15) in 1960 of hospitalized patients with laboratory-confirmed infections demonstrated a spectrum of disease from uncomplicated 3-day illnesses to fatal pneumonia, all in the absence of discernible epidemic influenza in the community (
15). Asian (H2N2) virus was destined for short survival in the human population and disappeared only 11 years after its arrival. It was supplanted by the Hong Kong (H3N2) subtype.
http://www.cdc.gov/ncidod/EID/vol12no01/05-1254.htm#asi