A Mean A/Texas Attacks

Newest flu variant on the rampage in 41 states

The medical statisticians insist that it is not yet an epidemic because not enough people have sickened and died to meet that criterion. This is no comfort to the hundreds of thousands of Americans who have been laid low with influenza. No words and no wonder drugs help to lower the initial fever, ease the aching head and bones, stop the hacking cough and make rubbery legs feel strong again. Dr. Donald O. Lyman, director of New York's Bureau of Disease Control, advises: "I'd stay in bed, let people fawn over me, drink my fruit juice, and take my tincture of time."

Last week leading flu experts met in Geneva at the World Health Organization. Their main concern was to help develop a vaccine against the reborn strain of flu now ravaging the Soviet Union. Though cases have been reported in China, Finland and Czechoslovakia, A/USSR or Russian flu is still only a threat to the rest of the world. The flu now sweeping 41 states is mostly another new variant called A/Texas.

No one knows how many cases there are or have been. Health authorities usually rely on school absenteeism as their best numerical clue, but they were foiled because this season's outbreak occurred during the Christmas holidays. One indisputable index is the number of deaths, mostly among the aged and infirm, resulting from the pneumonia that so often follows flu. In New York City alone the pneumonia deaths during three weeks rose from 70 to 97 to 104.

It was not until 1933 that a virus was identified as the cause of flu and dubbed influenza A. In 1946-47 another form of A emerged, and about this time virologists working with electron microscopes made an important discovery. They found that the outer coat of each virus particle is studded with hundreds of protein spikes. There are two types: hemagglutinin, a biochemical glue that makes red cells clump together and helps the virus get into cells, and an enzyme called neuraminidase that dissolves the glue and helps the virus get out of cells. These spikes are also the antigenic proteins that stimulate the human system to produce antibodies against future infections.

Virologists have now rechristened flu viruses, using the initials H and N for the two protein spikes and numbering their major changes. Thus the last major shift, the Hong Kong flu of 1968, becomes H3N2. But within each such shift minor changes known as drift can occur, and the last two of the five H3N2 drifts are A/Victoria and A/Texas.

In most ways they are so similar that people vaccinated within the past 12 months against A/Victoria, or who actually had that disease, have some degree of immunity against A/Texas, which first appeared in 1977. But, explains Merck & Co.'s Maurice R. Hilleman, their antibody level against A/Texas is only a fraction, perhaps a quarter or an eighth, of their level against A/Victoria.

Last week public health experts gathered at the National Institutes of Health in Bethesda, Md., to consider what could be done to fight the flu. As they all knew, it is already too late to develop a new vaccine for this winter's outbreaks. But since the first cases of Russian flu may hit the U.S. by spring, they recommended to the Surgeon General's office the development of vaccines against both Russian flu and the A/Texas and A/Victoria strains, possibly in combination. By next year, however, the adaptable virus may have developed yet another drift.

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