One of the concerns appearing on the radar is the impact of a flu pandemic upon Africa, where a rudimentary infrastructure for health is combined with the largest number of individuals with HIV and AIDs. A common mistake is to view this latter group as the most vulnerable to a flu pandemic, with a potentially catastrophic death rate.
Recent comments by Dr. Robert Webster, at an avian-influenza conference, organised by the Council for Foreign Relations, in New York, theorised that HIV positive patients and those suffering from cancer could act as incubators for the virus, leading to more virulent strains. However, there is evidence to support the view that immunologically compromised individuals will not facilitate the spread of the pandemic:
Stephen Wolinsky, chief of the infectious diseases division at the Feinberg School of Medicine, concurred that prolonged shedding of the virus was a definite problem but referred to a study published earlier this week that stated that immunodeficiency may in fact be a benefit in the face of avian influenza.
The study, published in the journal Respiratory Research, indicated that the young and healthy may be those most seriously affected by avian influenza, as the body’s immuno-response was to produce a storm of cytokines that can lead to respiratory difficulties.
Wolinsky opined that, for Africa, the lack of access to doctors and hospitals may prove to be a greater concern in the fight against avian influenza than the continent’s HIV/AIDS epidemic.
This region has been identified as a potential outbreak region for the pandemic. Farming practices that bring farmers into close proximity with poultry, are compounded by non-existent public health schemes and a large proportion of the population suffering from ill-health and malnutrition.
The H5N1 virus overstimulates the immune system, and many of its powerful effects are caused by what medical expert call a “cytokine storm”, after the immune molecules excited by the disease.
It was the cytokine storm that overwhelmed so many victims of the 1918 flu pandemic. Aids patients may be spared that fate.
But equally possible, with their immune defences down, they could succumb easily to the disease.
“In that situation,” said Laurie Garrett, “vast populations of HIV positive people could be obliterated by the pandemic flu.”
Laurie Garrett, senior fellow for global health at the Council of Foreign Relations, was identifying the worst case scenario.
It’s not going to happen in Africa. The infrastructure is too shit. There’s too many areas without roads.
Malthus will be happy.
Must be why there are so many Landrovers, Landcruisers and light trucks in Africa then. Of course in South Africa, Kenya, Tanzania etc. they must have really “shit” roads for all those tourists to drive along …
Nah, that’s not the worst case scenario. The worst case would be if people with AIDS catch it, keep it, suffer no symptoms, and spread it everywhere they go.
Another thought: HIV spreads in the body by co-opting the immune system. Anything that triggers an “immune storm” would likely flip the person out of “HIV positive” and straight into full-blown AIDS.
So the really worst case is: millions of Typhoid Marys, who then themselves keel over a few months later from some unrelated infection. Now THAT’s Malthusian.
Come on, folks, let’s keep a lil bit of optimism!
AIDS-HIV? Please. No EM photos of an isolated sample of a colony of HIV yet, and they think that’s sufficient proof?
The science behind HIV is just as shitty as global warming and the ozone layer.
That article is total “whistling past the graveyard” crap.
There’s one reason, and one reason only, that AIDS exploded in the gay community in the USA. They had incurred so many immunity sapping diseases over the previous decade or two that their bodies were totally unprepared to fight off HIV/AIDS. Read the book “And The Band Played On”.
And what will happen in Africa, the one place where immunity sapping diseases have been happening since, well forever, and at a rate that is unknown anywhere in the world? Avian flu will just slaughter that poor continent. Just like HIV/AIDS is ripping that place apart right now.
Farming practices that bring farmers into close proximity with poultry[…] perhaps, but at nothing like the density or proximity of South East asia, or we’d get flu from Africa.
For all Africa’s dreadful problems this is not one it will readily produce itself because the population density of people is low and the chickens are generally outside, too, not living cheek-by-fowl with the people. Few duck and pig viruses around either.
If human-to-human transmission gets going, then of course Africans will suffer badly, but at that point chickens are irrelevant, and everybody else will have it too.
Is there anyone more qualified than me (ie, at all) who might care to speculate as to the possibilities of cross-virus mutation? It has been mooted that should enough people catch both ‘human’ ‘flu and H5N1, the cross-mutation could produce a far more transmissable form of avian ‘flu. The mind boggles at the possibilities of contact with HIV in any number.
Or am I just talking out of my hat?
So sorry.
That should have read ‘more qualified than I am…’
These things are important.
Jason, I agree. We’ve not heard of any studies, apart from the usual UK government ones designed to inspire fear and terror, that show anything about dispersion of the avian strains – can Siberian geese migrating to Norfolk carry it, for example? Other factors which certainly must not exactly help the HIV/AIDS epidemic in Africa, are surely transmission by mosquito or other insect.
Perhaps we might have some serious study done here, rather than reading banner-grabbing oneliners from government experts in tabloids, telling us to all fear for our lives.
Pretty much everyone who comments on this site is far far far more likely to die of cardiovascular disease, cancer, or accident (motor vehicle/workplace), than of avian flu, HIV/AIDS, global warming, bioterrorism, terrorist attack etc…
Keep things in perspective.
I think the same feelings that make us watch films like Deep Impact and The Day after Tomorrow make us want to believe the sky is falling.
Africa will suffer disproportionately from everything. Africans already suffer from poverty and disease and war far more than everyone else. This is not going to change in the near future (sorry Bob).
My guess is that one of the main problems is the sheer length of time it takes to conduct trials capable of producing meaningful observed data – avian ‘flu is a relatively recent emergence (I suppose it’s been a couple of years now).
But there are the related issues of funding and political will. Reluctant as I am to mention it in this place, this is one case where I think there is a solid case for public sector-funded research, and lots of it.
I just know I’m going to regret that.
“(Laurie) Garrett is to pandemics what Paul Ehrlich is to population growth”. (link). (It’s a good article. Go read it.
Jason: Eight years actually – we have known about the H5N1 strain of avian flu since 1997, and it has probably been around for much longer than that.
It is certainly possible for genes to mix between different fly strains in multiply infected people and it is certainly possible for a virulent flu strain (say H5N1) without human to human transmission to mix with a less virulent strain with human to human transmission and to ultimately give us something rather nasty and contagious (although even if they do mix it is more likely that they produce something with tepid virulence and tepid contagiousness). Something like this will inevitably happen at some point and we will definitely get another global epidemic at some point.
And, pretty much without fail, really horribly pandemics occur in populations with compromised immune systems and weakend health, which leads to deaths amongs these populations and allows the disease to spread through a pool of the weak into healthier populations. In 1918 humanity’s population was weakened horrendously by WWI. The AIDS pandemic has almost entirely killed people in weakened populations (as David Crawford points out above). In my mind the AIDS pattern (people in certain parts of the world and people in certain at risk subgroups) is likely to be repeated for a fly pandemic. It’s likely to be horrendous in Africa and other places where AIDS infection has led to weakened immune systems, nasty in places where infected people congregate and hygeine standards are low (stay out of Canadian public hospitals) but for most of us in the developed world life will just go on fairly normally, with the proviso that we stay away from infected places. We are much stronger and medicine is much better than it was in 1918.
Of course, that is all a matter of likelihoods. It is possible that a new flu strain that is vastly nastier and more easily transmissable than any before could come into being tomorrow morning and could kill every person on planet earth. It just isn’t very likely. The scenario above is what I expect the next global flu pandemic to be. As for timing, well it is somewhat more likely to be now or soon than at most times, but still a long way from certain.
Personally I don’t see the problem here – it strikes me that one of the biggest problems in Africa with regard to HIV is giving people antiretroviral drugs who then go on to give the virus to orders of magnitude more people than they would have done if they’d just dropped dead from AIDS.
Perhaps something that totally and quickly wipes out 95% of the HIV carriers in Africa is what the population needs – they die quickly so aren’t a burden on the remainder of the population and also, when dead, they can’t infect uninfected members of the population.
Handing out vast quantities of antiretroviral drugs in a location where ‘safe sex’ means making sure the girl’s father doesn’t have a spear and isn’t looking your way never did seem very future-proof to me.
Well, as has been commented in the past by so many, ‘safe sex’ generally means that the first thing you do is to remove the local missionary who tells you that AIDS is a curse from God and that the Holy Father has banned the use of condoms. Once that is done then just maybe you could start safe sex education.