Cien años después, recordando cómo BMJ y JAMA comunicaron la pandemia de gripe de 1918-1919 / One hundred years later, recalling how BMJ and JAMA reported the 1918-1919 influenza pandemic

RESUMEN La pandemia de gripa que en 1918-1919 asoló el planeta, es sin duda el evento de enfermedad masivo de mayor virulencia y letalidad que la especie humana ha sorteado a lo largo de la historia. Este ensayo se centró en evaluar, a partir de lo publicado en la literatura médica de dos de las más importantes revistas de la época, (BMJ) The British Medical Journal y (JAMA)The Journal of the American Medical Association, la interpretación que desde la medicina se hizo de este fenómeno y de la respuesta que en términos de tecnología diagnóstica y terapéutica se dio por parte de los médicos. Se encontró que el arsenal de conocimientos, diagnóstico y terapéutica de la época ofrecía muy pocas herramientas para abordar el manejo clínico y frenar los contagios y mortalidad. No obstante, las dificultades que debieron sortear los clínicos y autoridades sanitarias de la época se constituyeron en un sólido aliciente para que en poco tiempo se avanzara significativamente en la comprensión y manejo de las enfermedades infecciosas, particularmente de etiología viral.

ABSTRACT The influenza pandemic that ravaged the planet in 1918-1919 is, undoubtedly, the most virulent and lethal infectious disease that the human species has ever overcome. This essay was to evaluate the medical interpretation of this phenomenon and the response given by doctors in terms of diagnostic and therapeutic technology based on the data published in the medical literature of two of the most important journals of the time, BMJ (The British Medical Journal) and JAMA (The Journal of the American Medical Association). It was found that the arsenal of knowledge, diagnosis and therapeutics of the time offered very few tools to address clinical management and curb contagion and mortality. However, the difficulties that clinicians and health authorities had to overcome were a solid incentive to make significant progress in the understanding and management of infectious diseases, particularly of viral etiology, in a short period of time.

A pandemia de gripe que devastou o planeta em 1918-1919 é, sem dúvida, o evento de doença maciça mais virulento e letal que a espécie humana passou ao longo da história. Este ensaio teve como objetivo avaliar, a partir do que foi publicado na literatura médica de duas das mais importantes revistas da época, (BMJ) The British Medical Journal e (JAMA) The Journal of American Medical Association,a interpretação que a medicina fez desse fenômeno e a resposta que os médicos deram em termos de tecnologia diagnóstica e terapêutica. Verificou-se que o arsenal de conhecimento, diagnóstico e terapia da época oferecia pouquíssimas ferramentas para abordar o manejo clínico e impedir infecções e mortalidade. No entanto, as dificuldades que os médicos e as autoridades de saúde da época tiveram que superar foram um sólido incentivo para que, em pouco tempo, fossem feitos progressos significativos no entendimento e tratamento de doenças infecciosas, particularmente de etiologia viral.(AU)

The history of avian influenza.

The first description of avian influenza (AI) dates back to 1878 in northern Italy, when Perroncito [Perroncito E. Epizoozia tifoide nei gallinacei. Annali Accad Agri Torino 1878;21:87-126] described a contagious disease of poultry associated with high mortality. The disease, termed "fowl plague", was initially confused with the acute septicemic form of fowl cholera. However, in 1880, soon after its first description, Rivolta and Delprato [as reported by Stubs EL. Fowl pest, In: Biester HE, Devries L, editors. Diseases of poultry. 1st ed. Ames, IO: Iowa State College Press; 1943. p. 493-502] showed it to be different from fowl cholera, based on clinical and pathological properties, and called it Typhus exudatious gallinarum. In 1901, Centanni and Savunzzi [Centanni E, Savonuzzi E, La peste aviaria I & II, Communicazione fatta all'accademia delle scienze mediche e naturali de Ferrara, 1901] determined that fowl plague was caused by a filterable virus; however, it was not until 1955 that the classical fowl plague virus was shown to be a type A influenza virus based on the presence of type A influenza virus type-specific ribonucleoprotein [Schäfer W. Vergleichender sero-immunologische Untersuchungen über die Viren der Influenza und klassischen Geflügelpest. Z Naturf 1955;10b:81-91]. The term fowl plague was substituted by the more appropriate term highly pathogenic avian influenza (HPAI) at the First International Symposium on Avian Influenza [Proceedings of the First International Symposium on Avian Influenza. Beltsville, MD. 1981, Avian Dis 47 (Special Issue) 2003.] and will be used throughout this review when referring to any previously described fowl plague virus.

As novas facetas e a ameaça da gripe aviária no mundo globalizado / New aspects and the threat of an avian flu epidemic in a globalized world

A influenza ou, como é conhecida comumente, a gripe, é uma doença infecciosa aguda causada por um grupo de vírus (com mesmo nome) que acomete várias espécies de animais, desde felinos até aves, passando por humanos. Há cerca de 10 anos têm sido descritos, inicialmente em Hong Kong, surtos de gripe causados por vírus aviários em populações humanas. A seguir, foram descritos surtos na Holanda e no Canadá. Portanto, indaga-se: o mundo corre o risco de um novo surto semelhante ao de 1918, porém com uma população mundial quatro a cinco vezes maior? Qual a velocidade de disseminação desse vírus, visto que as viagens internacionais já não são feitas em navios lentos, mas sim em jatos supersônicos que dão a volta ao mundo em algumas horas? Antes de tudo, o que torna esse vírus tão problemático? Para nós, profissionais de laboratório, é preocupante a questão do diagnóstico etiológico dessas infecções. Como ressaltamos, os quadros de gripe podem ser causados por vários agentes. Portanto, o diagnostico etiológico, básico para intervenções terapêuticas e para que se defina a ocorrência da epidemia, passa a ter relevância ainda maior.

Influenza, or as it is best known, "flu", is an acute respiratory infection caused by a virus that affects many different animal species from felines to birds, including humans.Ten years ago, initialy in Hong Kong and after that in Holand and Canada, outbreaks of avian flu have been increasingly reported in human beings. The question is innevitable: are we in the surge of a new flu pandemic like the one we had in 1918? The perspective is even worse now that we have five times the world population and the international travels are no longer made in slow-going ships but instead in super fast jet planes. For us, laboratory professionals, the question of the laboratory diagnosis is crucial. Considering that so many different viruses are associated with respiratory infections and therapeutic measures depend on this definition, this subject assumes an even greater interest.

[Christopher Columbus flu. A hypothesis for an ecological catastrophe]. / La gripe de Cristóbal Colón. Hipótesis sobre una catástrofe ecológica.

When Christopher Columbus and his men embarked on the second Colombian expedition to the New World (1493), the crew suffered from fever, respiratory symptoms and malaise. It is generally accepted that the disease was influenza. Pigs, horses and hens acquired in Gomera (Canary Islands) traveled in the same ship. The pigs may well have been the origin of the flu and the intermediary hosts for genetic recombination of other viral subtypes. The Caribbean archipelago had a large population of birds, the natural reservoir of the avian influenza virus. In this ecological scenario there was a concurrence of several biological elements that had never before coexisted in the New World: pigs, horses, the influenza virus and humans. We propose that birds are likely to have played an important role in the epidemiology of the flu occurring on the second Colombian trip, which caused a fatal demographic catastrophe, with an estimated mortality of 90% among the natives.