Pandemic (H1N1) 2009 Virus Viewed from an Epidemiological Triangle Model
Emmanuel A. Mpolya, Yuki Furuse, Nao Nukiwa, Akira Suzuki, Taro Kamigaki, and Hitoshi Oshitani
Department of Virology, Graduate School of Medicine, Tohoku University, 2-1 Seiryo-machi, Aoba-ku, Sendai 980-8575, Japan
The cause of atypical respiratory illness in several Mexican states in mid-March 2009 was determined to be a novel pandemic (H1N1) 2009 virus. It has since then spread to six continents, causing illness and death. We review this virus against an epidemiological triangle model for understanding and visualizing communicable diseases that describes the interaction of an agent, host, and environment. We review the agent, i.e., pandemic (H1N1) 2009 virus, hosts focusing on human beings, and the environment, suggesting from this agent-host-environment interaction measures for controlling and preventing infection spread due to pandemic (H1N1) 2009 virus and the related issues.
-  CDC, “Outbreak of Swine-Origin Influenza A (H1N1) Virus Infection - Mexico, March-April 2009,” Morb. Mort. Wkly Rept., Vol.58, No.17, pp. 467-470, 2009.
-  CDC, “Swine Influenza A (H1N1) Infection in Two Children - Southern California, March-April 2009,” Morb. Mort. Wkly Rept., Vol.58, No.15, pp. 400-402, 2009.
-  World Health Organization, “Current WHO Phase of Pandemic Alert; Current Phase of Alert in the Global Influenza Preparedness Plan,” 2009.
-  World Health Organization, “Pandemic (H1N1) 2009 - Update 58,” 2009. Updated on 2009/7/6 at 09:00GMT.
-  S.-Q. Wang et al., “Insights from investigating the interaction of oseltamivir (Tamiflu) with neuraminidase of the 2009 H1N1 Swine flu virus,” Biochem. Biophys. Res. Commun., Vol.386, No.3, pp. 432-6, 2009.
-  CDC, “Update: Drug Susceptibility of Swine-Origin Influenza A (H1N1) virus, April 2009,” Mort. Morb. Wkly. Rept, Vol.58, No.16, pp. 33-435, 2009.
-  T. Rungrotmongkol et al., “Susceptibility of antiviral drugs against 2009 influenza A (H1N1) virus,” Biochem. Biophys. Resp. Commun, Vol.385, No.3, pp. 390-4, 2009.
-  E. Rumschlag-Booms et al., “Comparative Analysis between Low Pathogenic and High Pathogenic Influenza H5 Hemagglutinin in Cell Entry,” Virol. J., Vol.6, pp. 76-80, 2009.
-  E. K. Subbarao, W. London, and B. R. Murphy, “A single amino acid in the PB2 gene of influenza A virus is a determinant of host range,” J. Virol., Vol.67, No.4, pp. 1761-4, 1993.
-  J. S. Peiris, L. L. Poon, and Y. Guan, “Emergence of a Novel Swine-origin influenza A virus (S-OIV) H1N1 virus in humans,” J. Clin. Virol., Vol.45, No.3, pp. 169-73, 2009.
-  R. A. Lamb and R. M. Krug (Eds), “Orthomyxoviridae: The viruses and their replication,” in: D. Knipe, P. M. Howley, D. E. Griffin, R. A. Lamb, and M. A. Martin (Eds.), Fields Virology, 5th Ed., Lippincott Williams & Wilkins Press, Philadelphia, PA, USA, pp. 1647-1690, 2007.
-  M. Katz, “Influenza, In: Public Health and Preventive Medicine,” 15th ed., McGrawHill. New York, pp. 120-123, 2008.
-  D. Zamarin, M. B. Ortigoza, and P. Palese, “Influenza A virus PB1-F2 Protein Contributes to Viral Pathogenesis in Mice,” J. Virol. Vol.80, pp. 7976-7983, 2006.
-  J. L. McAuley et al., “Expression of the 1918 Influenza A virus PB1-F2 Enhances the Pathogenesis of Viral and Secondary Bacterial Pneumonia,” Cell Host Microbe, Vol.2, pp. 240-249, 2007.
-  G. Neumann, T. Noda, and Y. Kawaoka, “Emergence and Pandemic Potential of Swine-origin (H1N1) Influenza Virus,” Nature, Vol.459, No.7249, pp. 931-9, 2009.
-  R. G. Webster et al., “Evolution and Ecology of Influenza A Viruses,” Microbiological Reviews, Vol.56, No.1, pp. 152-179, 1992.
-  S. Harper, A. Klimov, T. Uyeki et al., “Influenza,” Clin. Lab. Med., Vol.22, No.4, pp. 863-82, 2002.
-  R. A. Harvey, P. C. Champe, and B. D. Fisher, “Microbiology,” 2nd ed. Philadelphia, Lippincott Williams & Wilkins, pp. 315-320, 2007.
-  R. A. Fouchier, V. Munster, A. Wallensten et al., “Characterization of a novel influenza A virus hemagglutinin subtype (H16) obtained from black-headed gulls,” J. Virol., Vol.79, No.5, pp. 2814-22, 2005.
-  T. T. Wang and P. Palese, “Unraveling the Mystery of Swine Influenza Virus,” Cell, Vol.137, No.6, pp. 983-5, 2009.
-  W. R. Gallaher, “Towards a sane and rational approach to management of influenza (H1N1) 2009,” Virol. J., Vol.6, pp. 51-7, 2009.
-  J. R. Kerr, “Swine Influenza,” J. Clin. Pathol., Vol.62, No.7, pp. 577-8, 2009.
-  J. Cohen, “Swine Flu Outbreak: Flu Researchers Train Sights On Novel Tricks of Novel (H1N1),” Science, Vol.324, pp. 870-871, 2009.
-  C. Fraser et al., “Pandemic Potential of a Strain of Influenza A (H1N1): Early Findings,” Science, Vol.324, No.5934, pp. 1559-61, 2009.
-  M. A. Miller et al., “The signature features of influenza pandemics-implication for policy,” N. Engl. J. Med., Vol.360, No.25, pp. 2595-8, 2009.
-  Centers for Disease Control and Prevention, “Influenza Symptoms,” 2009.
Available at http://www.cdc.gov/flu/symptoms.htm ,
Accessed on 2009/7/9.
-  Novel Swine-origin Influenza A (H1N1) Investigation Team, “Emergence of a Novel Swine-origin Influenza A (H1N1) Virus in Human,” N. Engl. J Med., Vol.360, No.25, pp. 2605-15, 2009.
-  Health Protection Agency-London, Health Protection-Scotland, National Public Health Service-Wales and HPA Northern Ireland-Belfast, “Epidemiology of new influenza A (H1N1) virus infection, United Kingdon, April-June 2009,” Eurosurveillance, Vol.14, No.22, 2009.
-  T. Shimada et al., “Epidemiology of influenza A (H1N1) virus infection in Japan, May-June 2009,” Eurosurveillance, Vol.14, No.24, 2009.
-  G. Chowell et al., “Severe respiratory disease concurrent with the circulation of (H1N1) influenza,” N. Engl. J. Med., Vol.361, pp. 1-6, 2009.
-  S. Galwankar and A. Clem, “Swine influenza A (H1N1) strikes a potential for global disaster,” J. of Emerg, Trauma, and Shock, Vol.2, pp. 99-105, 2009.
-  Centers for Disease Control and Prevention, “H1N1 Flu,”
Available from; http://www.cdc.gov/swineflu/swineflu_you.htm ,
Updated on June 30, 2009, Accessed on 2009/7/9.
-  European Centre for Disease Prevention and Control, “Influenza A (H1N1) Pandemic 2009-10,”
Available from www.ecdc.europa.eu, accessed on 2009/7/10
-  Centers for Disease Control and Prevention, “Interim Guidance for Novel H1N1 Flu (Swine Flu): Taking Care of a Sick Person in Your Home,”
Available from: http://www.cdc.gov/swineflu/guidance_homecare.htm ,
accessed on 2009/7/6.
-  G. A. Poland, R. M. Jacobson, and I. G. Ovsyannikova, “Influenza virus resistance to antiviral agents: plea for rational use,” Clin. Infect. Dis. Vol.48, pp. 1254-1256, 2009.
-  World Health Organization, “Pandemic (H1N1) 2009 briefing note 1; Viruses resistant to oseltamivir (Tamiflu) identified,” July 8, 2009.
Available at http://www.who.int/csr/disease/swineflu/notes/h1n1_antiviral_resistance_20090708/en/index.html Accessed on 2009/7/10.
-  J. Steel, A. C. Lowen, S. Mubareka et al., “Transmission of influenza virus in a mammalian host is increased by PB2 amino acids 627K or 627E/701N,” PLoS Pathog, 5:e1000252, 2009.
-  R. J. Garten et al., “Antigenic and Genetic Characteristics of Swine-Origin 2009 A(H1N1) Influenza Viruses Circulating in Humans,” Science, Vol.325, No.5937, pp. 197-201, 2009.
-  L. P.-C. Shek and B.-W. Lee, “Epidemiology and Seasonality of Respiratory Tract Virus Infections in the Tropics,” Paediatric Respir Rev., Vol.4, No.2, pp. 105-11, 2003.
-  I. Stephenson and M. Zambon, “The Epidemiology of Influenza,” Occup Med (Lond), Vol.52, pp. 241-247, 2002.
-  L.-Y. Chang et al., “Novel Swine-origin Influenza Virus A (H1N1): The First Pandemic of the 21th Century,” J. Formos Med. Assoc., Vol.108, No.7, pp. 526-532, 2009.
-  P. K. C. Cheng et al., “Oseltamivir- and amantadine-reistant influenza A (H1N1),” Emerg. Infect. Dis., Vol.15, No.6, pp. 966-8, 2009.
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