A novel H1N1 virus of swine origin (H1N1v ) is currently spreading in humans, giving rise to the first pandemic in 40 years. The disease is of moderate severity but has notable differences from seasonal influenza. In contrast to seasonal influenza, those over 60 years are relatively spared, a likely consequence of the presence of H1N1v crossneutralizing antibody in this age group. Most patients appear to have mild influenza-like illness and many of the complications leading to hospitalization and mortality occur in those with underlying disease conditions or pregnancy. Studies in animal models suggest that the novel H1N1v pandemic virus causes a more severe illness and appears to have a greater predilection for the alveolar epithelium than seasonal influenza viruses. As there are as yet little data on the pathogenesis and immunology of H1N1v infection in humans, we have reviewed relevant data from past pandemics, from seasonal influenza and avian influenza H5N1 to highlight key issues pertaining to pathogenesis and immunology.Key words: H1N1 . Immunology . Influenza . Pandemic . Pathogenesis Introduction A novel H1N1 virus originating in swine recently emerged as the first influenza pandemic of the 21 st century [1]. As the 20 th century saw three influenza pandemics, in 1918 (H1N1), 1957 (H2N2) and 1968 (H3N2), and the historical record indicates that there were approximately three to four influenza-like pandemics every century, going back to 1500 AD [2], the emergence of a pandemic 40 years after the last in 1968 was hardly a surprise. Its nature and origins however, were unexpected. This review summarizes the emergence of this pandemic, clinical features of the disease and its pathogenesis, and also highlights the key questions for immunological research.
The virus and the birth of pandemicsPandemic influenza is caused by type A influenza viruses and these are single-stranded RNA viruses with an eight-segmented genome. Type A influenza viruses are subtyped on the basis of antigenic relationships of the virus surface glycoproteins, the HA and neuraminidase (NA), into 16 HA and 9 NA subtypes. The HA and NA are the key antigens to which protective antibody responses are directed and there is minimal serological crossprotection across HA subtypes. All 16 HA and 9 NA subtypes are present in the aquatic avian reservoir while a more restricted range of subtypes are endemic in other species such as pigs (H1, H3) and horses (H3, H7). Pandemics were believed to arise when a virus with a novel HA subtype (sometimes together with a novel NA) adapts to efficient transmission in humans [3]. The recent H1N1 pandemic arose from a swine H1N1 virus adapting to human transmission without genetic reassortment with current
2946Review human influenza viruses, i.e. all eight gene segments of the animal virus adapted to human transmission [4,5]. Aspects of the evolution of viruses in pigs and how these contributed to the genesis of the current pandemic virus have been reviewed elsewhere [6].Since previous pandemics arose from a su...