Influenza Highly contagious, potentially serious viral infection of the nose, throat, and lungs. Transmissible through human-to-human contact via aerosols Seasonal influenza affects more than 60 million individuals in the US every year. High fever that begins suddenly, muscle/body aches, chills, fatigue. In some cases severe complications like pneumonia. In US annually, > 200,000 individuals are hospitalized and between 3,000-49,000 die from influenza-related complications.

Origin of influenza Most seasonal influenza originates in Asia where there is high density of animals and humans in close proximity Pigs, domestic birds are major zoonotic reservoir

CAFOs (concentrated animal feed operations) Crowding pigs or poultry, especially when they are genetically homogenous, may increase the potential for influenza viruses to infect them Once pigs in a CAFO become infected, influenza viruses may swap strands of genetic material

Influenza can travel globally and evolve in a short amount of time

How the flu virus works Virus contains RNA Virus enters thru epithelial cells in respiratory tract RNA inserted into nucleus Polymerases in nucleus used to make copies of viral RNA These copies of RNA leave the epithelial cells to infect another person Seasonal component due to closer contact among humans in winter and drying of epithelial cells due to dry warm air Vaccines can be designed for seasonal influenza

Types of seasonal influenza Three basic types of influenza viruses: A, B, and C. Influenza B and C viruses are specific to humans only (spread via human to human transmission) Influenza A viruses infect humans and nonhuman hosts like birds and pigs (spillover from nonhuman to human hosts). Can be highly pathenogenic. Epidemics of seasonal influenza occur due to influenza A or B viruses. Only A viruses are known to cause global pandemics

Naming influenza A viruses (H1N1, H3N2…) H and N refer to hemagglutinin and neuraminidase. Two main proteins on the outside of the virus Referred to as ‘antigens’ because they are the structures to which our immune system responds. Antigens are categorized according to antibodies that respond to them. There are 18 known hemagglutinin subtypes for influenza A (H1 to H18) and 11 known neuraminidase subtypes (N1 to N11).

Vaccinations for influenza Flu vaccination is a preventative stimulation of your body to produce antibodies to a particular combination of H and N subtypes predicted to be abundant during flu season flu season vaccinations designed to stimulate antibody production to respond to an A-type H1N1 virus, an A-type H3N2 virus, and a B virus.

Influenza A has a high potential to evolve In a single host, the viruses remain relatively unchanged, showing minimal evolution over extended periods. After transfer to a new type of avian or mammalian host, influenza viruses can undergo antigenic drift Vaccines may not work, no immunity among humans because virus is novel

Antigenic drift Change in single amino acid in a H or N protein These may alter the: Manner influenza is transmitted Ability of our bodies to recognize the virus and defend itself with antibodies Pathogenicity of the virus 18 x 11 = 198 possible pairings at present

Influenza A has a high potential for pandemic Under the right conditions, pathenogenic A viruses can acquire ability to pass from human- to-human

Spanish Influenza of 1918 Human-to human transmission after jumping from avian reservoir Virus is related to a influenza A (H1N1) virus

Spanish Influenza of 1918 One third of Earth’s population infected million deaths worldwide 675,000 deaths in the United States with unusually high death rate among healthy adults 15 to 34 yrs

A H1N Another human-to-human transmissible influence A virus World Health Organization declared its first ever public health emergency of international concern CDC stopped counting cases and declared the outbreak a pandemic. Joining of three previously unacquainted influenza viral strains Contained genes of swine influenza from two continents, as well as genes from strains of human and avian influenza viruses

A H1N Began in Veracruz Mexico Same virus type as Spanish Influenza Impacted young more than old who have had more influenza exposure After its first year, killed an estimated 280,000 people and sickened about 1 in 5 people worldwide 250,000 mostly in Africa and Southeast Asia

Avian influenza – H5N1 Outbreaks of H5N1 in waterfowl, poultry, and humans have been confined to Asia

Avian influenza – A H5N1 Migratory waterfowl were the main reservoir H5N1 discovered in during geese die-off and first jumps from poultry to humans 50 – 60% mortality rate, very pathogenic No human-to-human transmission (although a few cases have been suggested)

Avian influenza – A H5N1 Killed millions of poultry in Asia directly or through enforced culling. Other large financial and economic costs Vaccinating poultry against bird flu Vaccinating poultry workers against human flu Increasing farm hygiene Reducing contact between livestock and wild birds Reducing open-air wet markets

Can migratory waterfowl distribute H5N1 globally?

Emergence of H7N9 virus led to closing of poultry markets and culling No person to person transmission Not highly pathogenic A H7N9 2013

Politics of influenza Because many influenza viruses originate in China, country is under international pressure to identify, announce, and contain outbreaks China criticized for taking 27 days to announce first H7N9 cases

H5N1 has been more lethal but H7N9 is evolving rapidly Monitoring H7N9 virus difficult because poultry farmers resist testing because a positive test forces them to destroy flocks that appear healthy. A few cases of human-to- human transmission of H7N9 virus within families H7N9 could easily become global pandemic H7N9 vs H5N1

Influenza in your future: A global pandemic at some point seems likely, right now (2015), unprecedented diversification of influenza viruses in wild and domesticated birds, particularly in H7N9, which could become more pathenogenic Generic pandemic scenario: human infected by human flu virus and an avian flu virus simultaneously, allowing the pathogencity of avian flu to acquire the ability to be spread via human-to- human contacts instead of bird-to-human.

Mosquito- borne diseases Malaria, dengue, Chikungunya Of the millions of insects, only a tiny fraction of them, less than 1%, are pests. A vast majority are beneficial to humans

Plasmodium is endemic to humans yet has the potential for new spillovers Plasmodium jumped from gorillas to humans at some time in the past, estimated at 10,000 years ago Plasmodium knowlesi, primarily infect macaques but has made jump to humans and can now spread from human to humans Plasmodium gaboni identified in chimpanzees but has not yet jumped to humans

Malaria prevention 198 million cases in 2013; deaths 90% of deaths occur in Africa Children < 5 yrs account for 78% of deaths. Plasmodium falciparum malaria accounts for more than 90% of all deaths. Recent successes Areas exist where interventions have interrupted endemic transmission Since introduction of bed nets and drugs, malaria rates have fallen (30% in Africa since 2000)

Nonlocal malaria Malaria can be spread by human mobility and global travel Even in places where malaria has been eliminated, an outbreak can start when a traveler is infected in a foreign country and then returns home and bitten by a mosquito Cases in US and Florida

Eliminate mosquitoes

Nets and improved detection Free bed nets to protect sleeping children Health workers trained to find malaria cases and offer tests and treatment at no charge

Drug prevention and treatment Chloroquine (older drug) Artemisinin- based combination therapy (newer) Parasite resistance to artemisinin been detected in southeast Asia

Drug prevention and treatment Chloroquine (older) Artemisinin-based combination therapy (newer)

Mass treatment of malaria 50% rates of infection in some locations Healthy-appearing carriers Mass administration of drugs at once could have larger impact on disease reduction Difficult to fund and organize at large scale

Prophylactic seasonal malaria chemoprevention (SMC)

How will climate change impact the distribution of malaria? Climate change is not just changes in temperature, but also changes in rainfall and humidity and how these variables coincide spatially and temporally This complexity intersects with life cycle of the mosquito Warmer = more mosquitoes = more malaria is simplistic

Small shift in where malaria occurs with no large increase in cases, other studies indicate high uncertainties However, other mosquito-born diseases emerging: dengue and chikungunya