The landscape of Alan Sipress' book The Fatal Strain: On the Trail of Avian Flu and the Coming Pandemic could be considered apocalyptic if epidemiologists aren't able to put a lid on H5N1, commonly known as avian influenza. With a 60 percent mortality rate and evidence the virus has jumped from human to human, as Sipress demonstrates in this book, a pandemic is not impossible.
Among the many of Sipress' book are straightforward explanations of various forms of viruses and of avian flu and how quickly it spreads. It's a great update on epidemiology, virology and disease transmission. (It's also a remarkable job for an economics editor, who at the time he wrote The Fatal Strain was a foreign correspondent for the Washington Post.)
Sipress explains what the "H" and "N" and the numbers represent in H5N1, and the intricacies of transmission, including antigenic drift and antigenic shift. Let's start with H5N1 and what the letters and numbers mean. H is for the protein hemagglutinin, "a spiky protrusion the virus uses to break into the cells of its host," Sipress writes. The "5" indicates the fifth of several known types of hemagglutinin. N stands for the "mushroomlike neuraminidase," which the virus uses to break out of the cells of its host. The "1" refers to the first of several known types of the protein neuraminidase. Sipress explains that, so far, 16 different H subtypes and nine different N subtypes have been discovered.
H5N1 is devastating because the avian-type receptor of this virus fits better deep in our lower respiratory system, making it more deadly. Whereas in human flu, the virus nestles nicely in a type of receptor common in the nose, sinuses and upper reaches of the airway.
A major concern of epidemiologists regarding avian flu is its transmission to man. Sipress explains it could gradually undergo a series of "discrete" mutations making it more suitable to infecting humans - a process called antigenic drift. If the bird flu experiences genetic reassortment, "swapping genes with an existing human" flu virus - which by the way, can happen overnight creating an entirely new highly lethal strain that is as easy to catch as ordinary flu - that is antigenic shift. For an infectious disease specialist or an epidemiologist, how easily and how rapidly a virus spreads is important to know to stem the tide of a pandemic.
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