Don’t Smoke Don’t Smoke
National Institute of Allergy and Infectious Diseases
What’s the Difference Between Seasonal Flu, Pandemic Flu, and Avian (Bird) Flu?
Influenza, or flu, is a respiratory infection caused by several flu viruses. Flu viruses are classified as types A, B, and C; type A has a number of subtypes. The flu is not the same as the common cold, nor is it related to what is commonly called the “stomach flu.”
Seasonal flu is the term used to refer to the flu outbreaks that occur yearly, mainly in the late fall and winter. It is estimated that between 5 and 20 percent of Americans come down with the flu every flu season.
Pandemic flu refers to particularly virulent strains of flu that spread rapidly from person to person to create a world-wide epidemic (pandemic).
Avian (Bird) Flu
In nature, the flu virus also occurs in wild aquatic birds such as ducks and shore birds. It does not normally spread from birds to humans. However, pigs can be infected by bird influenza (as well as by the form of influenza that affects humans) and can pass on the flu to humans. In 1997, it was discovered that a virulent bird influenza had skipped the pig step and had infected humans directly, causing a number of deaths in Asia.
These instances of bird flu in humans have raised concerns that if this type of flu could at some point be transmitted between people, a new pandemic would occur. Thus, the term bird flu or avian flu is currently being used to refer to a possible pandemic flu.
Overview of the Flu
The flu, like the common cold, is a respiratory infection caused by viruses. But the flu differs in several ways from the common cold. For example, people with colds rarely get fevers or headaches or suffer from the extreme exhaustion that flu viruses cause. The most familiar aspect of the flu is the way it can "knock you off your feet" as it sweeps through entire communities.
The Centers for Disease Control and Prevention (CDC) estimates that 5 to 20 percent of Americans come down with the flu during each flu season, which typically lasts from November to March. Children are two to three times more likely than adults to get sick with the flu, and children frequently spread the virus to others. Although most people recover from the illness, CDC estimates that in the United States more than 200,000 people are hospitalized and about 36,000 people die from the flu and its complications every year.
Seasonal Flu Outbreaks
Seasonal flu outbreaks usually begin suddenly and occur mainly in the late fall and winter. The disease spreads through communities, creating an epidemic. During the epidemic, the number of cases peaks in about 3 weeks and subsides after another 3 or 4 weeks. Half of the population of a community may be affected. Because schools are an excellent place for flu viruses to attack and spread, families with school-age children have more infections than other families, with an average of one-third of the family members infected each year.
Importance of Flu
Besides the rapid start of the outbreaks and the large numbers of people affected, the flu is an important disease because it can cause serious complications. Most people who get the flu get better within a week (although they may have a lingering cough and tire easily for a while longer). For elderly people, newborn babies, and people with certain chronic illnesses, however, the flu and its complications can be life-threatening.
Flu Virus Characteristics
A flu virus is roughly round, but it can also be elongated or irregularly shaped. Inside are eight segments of single-strand RNA containing the genetic instructions for making new copies of the virus. Flu’s most striking feature is a layer of spikes projecting from its surface. There are two different types of spikes: one is the protein hemagglutinin (HA), which allows the virus to "stick" to a cell and initiate infection, the other is a protein called neuraminidase (NA), which enables newly formed viruses to exit the host cell.
Influenza A virus. Credit: CDC
Virus Types A, B, C
Influenza viruses are classified as type A, B, or C based upon their protein composition. Type A viruses are found in many kinds of animals, including ducks, chickens, pigs, and whales, and also humans. The type B virus widely circulates in humans. Type C has been found in humans, pigs, and dogs and causes mild respiratory infections, but does not spark epidemics.
Type A influenza is the most frightening of the three. It is believed responsible for the global outbreaks of 1918, 1957, and 1968. Type A viruses are subdivided into groups based on two surface proteins, HA and NA. Scientists have characterized 16 HA subtypes and 9 NA subtypes.
Naming Viral Strains
Type A subtypes are classified by a naming system that includes the place the strain was first found, a lab identification number, the year of discovery, and, in parentheses, the type of HA and NA it possesses, for example, A/Hong Kong/156/97 (H5N1). If the virus infects non-humans, the host species is included before the geographical site, as in A/Chicken/Hong Kong/G9/97 (H9N2). There are no type B or C subtypes.
Where Influenza Comes From
In nature, the flu virus is found in wild aquatic birds such as ducks and shore birds. It has persisted in these birds for millions of years and does not typically harm them. But the frequently mutating flu viruses can readily jump the species barrier from wild birds to domesticated ducks and then to chickens. From there, the next stop in the infectious chain is often pigs.
Pigs can be infected by both bird (avian) influenza and the form of influenza that infects humans. In a setting such as a farm where chickens, humans, and pigs live in close proximity, pigs act as an influenza virus mixing bowl. If a pig is infected with avian and human flu simultaneously, the two types of virus may exchange genes. Such a "reassorted" flu virus can sometimes spread from pigs to people.
Depending on the precise assortment of bird-type flu proteins that make it into the human population, the flu may be more or less severe.
In 1997, for the first time, scientists found that bird influenza skipped the pig step and infected humans directly. Alarmed health officials feared a worldwide epidemic (a pandemic). But, fortunately, the virus could not pass between people and thus did not spark an epidemic. Scientists speculate that chickens may now also have the receptor used by human-type viruses.
Drifting and Shifting
Influenza virus is one of the most changeable of viruses. These genetic changes may be small and continuous or large and abrupt.
Small, continuous changes happen in type A and type B influenza as the virus makes copies of itself. The process is called antigenic drift. The drifting is frequent enough to make the new strain of virus often unrecognizable to the human immune system. For this reason, a new flu vaccine must be produced each year to combat that year’s prevalent strains.
Type A influenza also undergoes infrequent and sudden changes, called antigenic shift. Antigenic shift occurs when two different flu strains infect the same cell and exchange genetic material. The novel assortment of HA or NA proteins in a shifted virus creates a new influenza A subtype. Because people have little or no immunity to such a new subtype,their appearance tends to coincide witha very severe flu epidemic or pandemic.