Chapter One
"My God: This Is the Pandemic. It's Here!"
"I had a little bird, and its name was Enza,
I opened the window, and in-flew-Enza."
Children's rhyme during the 1918 flu pandemic
In May 1997 a three-year-old boy in Hong Kong died of influenza. His death wasn't unusual. Every year in every country in every corner of the world healthy children die of the disease. But this infection was different. Health officials couldn't figure out what type of influenza virus had killed the boy, so they sent a sample of it to the Centers for Disease Control and Prevention (CDC) in Atlanta. There, researchers found that this particular virus had never infected people before. A few months passed. The rare influenza virus infected no one else—not the boy's parents, or his relatives, or his friends, or his classmates. Later, the CDC sent a team of scientists to Hong Kong to investigate. Crowded into a wet market, where local farmers slaughtered and sold their chickens, they found what they were looking for—the source of the deadly virus. "The people here like their chickens fresh," one investigator said. "Hygiene consists of a douse with cold water. [One day] we saw a bird standing up there, pecking away at its food, and then very gently lean over, slowly fall over, to lie on its side, looking dead. Blood was trickling from [its beak]. It was a very unreal, bizarre situation. I had never seen anything like it." The disease spread to another chicken and another.
The strain of influenza virus that infected birds in Southeast Asia was particularly deadly, killing seven of every ten chickens. On December 30, 1997, Hong Kong health officials, in an effort to control the outbreak of bird flu before it spread to more people, slaughtered more than a million chickens. Still the virus spread. Bird flu attacked chickens in Japan, Vietnam, Laos, Thailand, Cambodia, China, Malaysia, and Indonesia. Then, to the horror of local physicians, the virus infected eighteen more people, killing six—a death rate of 33 percent. (Typically influenza kills fewer than 2 percent of its victims.) Soon the virus disappeared. Officials waited for an outbreak the following year, but none came. And it didn't come the year after that or the year after that. The virus lay silent, waiting.
In late 2003, six years after the initial outbreak, bird flu reappeared in Southeast Asia. This time health officials found it even harder to control. Again, the virus first infected chickens. Officials responded by slaughtering hundreds of millions of them. Despite their efforts, bird flu spread from chickens to ducks, geese, turkeys, and quail. Then the virus spread to mammals: first to mice, then to cats, then to a tiger in a Thai zoo, then to pigs, then to humans. By April 2005, bird flu had infected ninety-seven people and killed fifty-three—a death rate of 55 percent.
By September 2006 the virus had spread from birds in Asia to those in Europe, the Near East, and Africa. Two hundred fifty people living close to these birds got sick, and 146 of them died. International health officials feared that the appearance of bird flu in Southeast Asia signaled the start of a worldwide epidemic (pandemic). One later remarked, "The clock is ticking. We just don't know what time it is."
Health officials feared an influenza pandemic because they knew just how devastating pandemics could be. During the pandemic of 1918 and 1919—the one called the last great plague—influenza infected five hundred million people, half the world's population. The virus, which traveled to virtually every country and territory in the world, hit the United States particularly hard. In a single month, October 1918, four hundred thousand Americans died of influenza. Influenza typically kills the most vulnerable members of the population, the sick and the elderly. But the 1918 virus was different: it killed healthy young adults. In one year the average life span of Americans in their twenties and thirties decreased by 25 percent. When it was over, the 1918 pandemic—the most devastating outbreak of an infectious disease in medical history—had killed between fifty million- and one hundred million people worldwide, all within a single year. In comparison, since the 1970s the AIDS pandemic has killed twenty-five million people.
Pandemics of influenza are inevitable. During the past three hundred years, the world has suffered ten of them, about three per century. No century has ever avoided one. But despite their frequency and reproducibility, only one man has ever successfully predicted an influenza pandemic and done something about it.
His name was Maurice Hilleman. Born Saturday morning, August 30, 1919, during the worst influenza pandemic in history, Hilleman was the eighth child of Anna and Gustave Hillemann. (Because of intense anti-German sentiment following the First World War, Hilleman's parents deleted the second n on his birth certificate.) Devoutly religious, Anna and Gustave named him and his sister (Elsie) and all of his brothers (Walter, Howard, Victor, Harold, Richard, and Norman) after heroic characters in the Elsie Dinsmore books, stories of Christian faith popular in the late 1800s. The birth took place in the family's home on the banks of the Tongue and Yellowstone Rivers, near Miles City, Montana.
After Maurice's birth, and to the surprise of the homeopath who delivered him, a second child, Maureen, was also born, still and lifeless. The doctor tried desperately but unsuccessfully to revive her. He cupped his hands around her back and, using only his thumbs, periodically pushed down on her tiny chest. At the same time, he tried to breathe air into her lungs. It was no use. From the corner of the room, Anna Hillemann quietly watched the doctor try to save her baby daughter. When she learned that Maureen was dead, Anna closed her eyes, saying nothing. Gustave buried Maureen the following day, August 31.
Hours after the delivery, while she was holding her infant son, Anna's body stiffened, her eyes rolled up in . . .
Continues...
Excerpted from Vaccinatedby Paul Offit Copyright © 2007 by Paul Offit. Excerpted by permission.
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