
The
CDC has announced a sharp spike in cases of swine-origin
influenza, sometimes known as "swine flu." At least 224 cases have occurred
since mid-July, mostly in children living in Indiana and Ohio. This compares
with just 12 cases reported nationally in all of 2011. The threat of pandemic
influenza may not be imminent, but it is real.
To
spark a pandemic, an influenza virus in another species must evolve the ability
to infect humans and then spread quickly. So far, we believe those who
contracted swine flu this year to have been infected by pigs at agricultural
fairs; transmission between humans has not yet been reported. Several
developments have made this more likely to occur, though -- including the
serious threats introduced by the industrialization of food animal production,
which selects for genes that may allow influenza viruses to reach pandemic
proportions.
In
a country of more than 300 million people, 224 people with a mild flu may seem
unremarkable. Viruses evolve quickly, though, and one that develops the ability
to infect and spread among humans could wreak havoc. In 2009, another influenza virus infected at least 1.6 million people and
killed at least 19,000 worldwide. In 1967, the "Hong Kong flu" killed at least
one million people around the globe. The infamous 1917-18 influenza contagion
claimed at least 50 million lives.
Viral
evolution works much the same as human evolution, though faster. The replication
of viral genes is imperfect -- mistakes happen, and these mistakes (mutations)
lead to genetic variation between a virus and its progeny. Unlike humans,
viruses have no genetic "proofreading" system to catch many of these mistakes.
As a result, mutations occur much more frequently. Occasionally, a mutation
gives a virus enhanced ability to infect new host cells and reproduce more
quickly than its counterparts. An advantageous mutation quickly becomes common
throughout a viral population.
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Another
process, viral reassortment (which is unique to certain viruses) allows them to
acquire vastly different genes in just one generation. The genomes of these
viruses consist of short segments of RNA, each separate from the other. When a
virus infects a cell, these genes hijack the cellular machinery of the host to
replicate themselves. The replicated genes are then packaged into new viruses
and released to infect others. If two or more viruses infect the same cell, the
genes of all are replicated. When the new viruses are assembled, they may
receive genes from all of these viruses -- a new strain can emerge.
Our
current model of food animal production factors heavily into viral evolution and
transmission. The system -- which is vastly different than it was just a century
ago -- provides some efficiency, but it poses grave threats to public health, including increased risk
of pandemic influenza.
Beginning
in the 1940s, and intensifying recently, small farms were replaced by large,
industrial operations that confine thousands or even millions of animals at a
single site. The animals are raised in cramped quarters, in constant contact
with their waste, and fed corn and soybeans in place of the forage for which
their digestive systems evolved.
At
any given time there are about one billion poultry and swine total alive in the
U.S., and the vast majority of these animals are raised at industrial
operations. Each animal is a potential host for influenza viruses. Additionally,
the stresses induced by confinement and constant respiratory exposure to high
concentrations of ammonia, hydrogen sulfide, and other gases from concentrated
waste leave animals more susceptible to viral infections. These conditions allow
viruses to infect again and again, increasing the frequency of mutations and
viral reassortment, the raw material for evolution.
The
practices at these industrial operations can select for dangerous genes. The
plethora of potential hosts removes a barrier to increased virulence -- a virus
can kill its host quickly and still have a good chance of infecting others. The
co-location of swine and poultry operations in some states provides chicken
viruses that mutate to infect pigs with a treasure-trove of hosts just up the
road. Because humans and pigs are mammals, a swine virus may be more likely to
infect humans, given our physiologic similarities.
The
interaction between humans and food animals, and our resulting exposure to
viruses these animals carry, is now radically different from that at any
previous point in history. Earlier generations of farmers may have spent a few
hours each day with dozens of animals at most. The workers at industrial
operations work all day with hundreds or thousands of birds or pigs. The
probability of contracting influenza viruses that have mutated to infect humans
is greatly increased. Many of these workers are low-income migrants unprotected
by labor laws and without ready access to medical treatment.
A
2007 study in Iowa, the leading swine-producing state
in the U.S., determined that rural residents exposed to pigs were almost 55
times more likely than non-exposed individuals to have had contact with
influenza virus. If one of these viruses could be transmitted efficiently
between humans, an outbreak could occur. Indeed, study participants' spouses who
had no contact with pigs were still 28 times more likely than non-exposed
non-spouses to have been exposed to influenza. These results suggest that
workers may form an effective "bridge population" that spreads influenza off the
farm.
Viruses
can move in other ways too. The animals at these facilities generate massive
quantities of waste--about 335 million tons per year. This waste attracts flies
and other animals that can carry viruses far away. Food animals may also be
transported hundreds of miles in trucks and the stress of travel can lead them
to shed thousands of viruses along the way.
The
reasons for the current upswing in swine influenza cases remain unclear, but the
more general risk of influenza posed by industrial food animal production is
well established. The underlying problems of industrialization deserve our
attention for a host of reasons, not the least of which is that a stainable
system could help avert disaster.
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