Flu viruses take one-way ticket out of Asia, then travel the world

Annual influenza epidemics are thought to result in 3 to 5 million cases of severe illness, and between 250,000 and 500,000 deaths every year, according to the World Health Organization (http://www.who.int/mediacentre/factsheets/fs211/en/index.html).

A (H3N2) is a subtype of the influenza A virus, and it is one of the three flu viruses included – in dead or in a weakened state – in the flu vaccine. The others are the influenza A (H1N1) subtype and the influenza B virus. Each year, the World Health Organization decides which strains within these three categories to include in the next vaccine, based on the recent activity of strains that are currently circulation.

The authors emphasized that the flu vaccine currently works extremely well, protecting about 300 million people from the disease each year, and that people should continue to be vaccinated annually. But, from time to time, a new strain begins infecting people after the vaccine has already been produced.

For decades, researchers haven’t known how influenza viruses migrate around the world. According to some of the scenarios that have been proposed, the viruses may migrate between the Northern and Southern hemispheres following the seasons, or they may have come out of the tropics where they were thought to circulate continuously, or they may have come out of China.

The Science study shows instead that each year since 2002, influenza A (H3N2) viruses have migrated out of what the authors call the “East and Southeast Asian circulation network,” and from there spread around the world.

Why Asia" For reasons that aren’t well-understood, flu epidemics break out during the rainy seasons in the tropics of East and Southeast Asia. On continents at higher latitudes, on the other hand, flu season simply occurs for a few months during the wintertime. Within Asia, different regions experience the rainy season at different times of year.

“Flu epidemics appear to be driven by seasonal factors such as winter, or rainy seasons. So there can be cities that are only 700 miles away from each other, such as Bangkok and Kuala Lumpur, which have epidemics six months apart. There is a lot of variability like this in East and Southeast Asia, so lots of opportunity for an epidemic in one country to seed an epidemic to another nearby country, like a baton passed by runners in a relay race,” Smith said.

“Our study is an example of the tremendous synergy between influenza science and public health,” he said. “The World Health Organization’s Global Influenza Surveillance Network tracks the evolution of influenza viruses for the primary purpose of influenza vaccine strain selection, but this also enables basic work on evolution.”