Issues in Biotechnology:

The Way We Work With Life

Dr. Albert P. Kausch

life

edu.org
OnCampus
Live
BCH 190, MIC 190, AFS 190, NRS 190, PLS 190
OnLine BCH 190
A Sweeping General Survey on Life and Biotechnology
A Public Access College Course

The University of Rhode Island

Issues in Biotechnology:
Biotechnology, Our Society and Our Future

Issues in Biotechnology:
The Way We Work With Life
Dr. Albert Kausch
Kimberly Nelson

BCH 190

Section I. The Mechanics of DNA: What is Life?

Section II. The Applications of Biotechnology

A Sweeping General Survey on Life and Biotechnology

A Public Access College Course

The University of Rhode Islandlife

Issues in Biotechnology:
The Way We Work With Life
Dr. Albert P. Kausch

life edu.org
Section II

The Applications of
Biotechnology
A Sweeping General Survey on Life and Biotechnology
The University of Rhode Island

Agricultural Biotechnology
life_edu

Lectures 13 and 14

Issues in Biotechnology:
The Way We Work With Life
Dr. Albert P. Kausch

life edu.org
Medical Biotechnology
24. Part Ia. Some Background and Historical Highlights
25 . Part Ib. Stem Cells-Therapy and Medical Research
26. Part Ic. Animal and Human Cloning and Genetic Engineering
27 . Part II. Gene Therapy, Tissue Engineering and Nanotechnology
Part III. Biotechnology Applications in Tough Times.
28. Part IIIa. Pandemic Flu
29. Part IIIb. Bioweapons
Part IV Cancer Biology and Emergent Treatments.
30. Part IVa. Cancer Basics and Socio-Economic Burdens
31. Part IVb. Applications of Biotechnology in Cancer Treatment

Issues in Biotechnology:
The Way We Work With Life
Dr. Albert P. Kausch

life edu.org
Biotechnology Applications in Tough Times
Pandemic Flu
Bioweapons
A Sweeping General Survey on Life and Biotechnology

The University of Rhode Island

Application of Biotechnology

Pandemic: A Worldwide Outbreak of Influenza

Is this
Science Fiction?
This couldnt
really happenRight???
How accurate
is this?
How worried
should I be?

Pandemic: A Worldwide Outbreak of Influenza

An influenza pandemic is a global outbreak of disease that
occurs when a new influenza A virus appears or emerges
in the human population, causes serious illness, and then
spreads easily from person to person worldwide.

Pandemic: A Worldwide Outbreak of Influenza

Pandemics are different from seasonal outbreaks or
epidemics of influenza. Seasonal outbreaks are caused
by subtypes of influenza viruses that already circulate
among people, whereas pandemic outbreaks are caused by
new subtypes, by subtypes that have never circulated
among people, or by subtypes that have not circulated
among people for a long time.
Past influenza pandemics have led to high levels of illness,
death, social disruption, and economic loss.

Appearance (Emergence) of Pandemic Influenza Viruses

There are many different subtypes of Influenza or flu
viruses of the species Influenza A virus of the
Influenzavirus A genus of the Orthomyxoviridae family. All
influenza A subtypes are RNA virues. They have a
segmented genome of eight negative sense, single-strands
of RNA, abbreviated as PB2, PB1, PA, HA, NP, NA, MP
and NS.

There are 16 known HA subtypes and 9

known NA subtypes of influenza A viruses.

Appearance (Emergence) of Pandemic Influenza Viruses

There are many different subtypes of Influenza or flu
viruses. The subtypes differ based upon certain proteins on
the surface of the virus (the hemagglutinin or HA
protein and the neuraminidase or the NA protein).
Some have been also shown to have differences in their
polymerase genes.
There are 16 known HA subtypes and 9
known NA subtypes of influenza A viruses.

Pandemic: A Worldwide Outbreak of Influenza

The different sites of infection (shown in red) of
seasonal H1N1 versus avian H5N1 influences their
lethality and ability to spread.

Appearance (Emergence) of Pandemic Influenza Viruses

Genetic structure and related subtypes The N in H5N1 stands
for "Neuraminidase, the protein depicted in this ribbon diagram.

H5N1 is a subtype of the species Influenza A virus of the

Influenzavirus A genus of the Orthomyxoviridae family. Like all other
influenza A subtypes, the H5N1 subtype is an RNA virus. It has a
segmented genome of eight negative sense, single-strands of RNA,
abbreviated as PB2, PB1, PA, HA, NP, NA, MP and NS.

Appearance (Emergence) of Pandemic Influenza Viruses

Genetic structure and related subtypes

HA codes for hemagglutinin, an antigenic glycoprotein found

on the surface of the influenza viruses and is responsible for binding
the virus to the cell that is being infected. NA codes for
neuraminidase, an antigenic glycosylated enzyme found on the
surface of the influenza viruses. It facilitates the release of progeny
viruses from infected cells.
The hemagglutinin (HA) and neuraminidase (NA) RNA strands
specify the structure of proteins that are most medically relevant as
targets for antiviral drugs and antibodies. HA and NA are also used
as the basis for the naming of the different subtypes of influenza A
viruses. This is where the H and N come from in H5N1

Pandemic: A Worldwide Outbreak of Influenza

Pandemic viruses emerge as a result of a process called
"antigenic shift, which causes an abrupt or sudden, major
change in influenza A viruses. These changes are caused by
new combinations of the HA and/or NA proteins on the
surface of the virus.

Human influenza A viruses" usually refers

to those influenza A subtypes that have
spread widely among humans.
Currently, H3N2 and H1N1 influenza A
subtypes are circulating among humans
and H2N2 influenza A circulated from
about 1957-1968

Pandemic: A Worldwide Outbreak of Influenza

Changes result in a new influenza A virus subtype. The
appearance of a new influenza A virus subtype is the first
step toward a pandemic; however, to cause a pandemic, the
new virus subtype also must have the capacity to spread
easily from person to person.

Pandemic: A Worldwide Outbreak of Influenza

Once a new pandemic influenza virus emerges and spreads, it
usually becomes established among people and moves around
or circulates for many years as seasonal epidemics of
influenza.
Who is monitoring influenza viruses?
The U.S. Centers for Disease Control and Prevention (CDC)
and the World Health Organization (WHO) have large
surveillance programs to monitor and detect influenza activity
around the world, including the emergence of possible
pandemic strains of influenza virus.

A Historical Perspective:
Influenza Pandemics during the 20th Century

During the 20th century, the emergence of several new

influenza A virus subtypes caused three pandemics, all of
which spread around the world within a year of being detected.
1918-19, "Spanish flu," [A (H1N1)]
1957-58, "Asian flu," [A (H2N2)]
1968-69, " Hong Kong flu," [A (H3N2)]
Overdue

A Historical Perspective:
Influenza Pandemics during the 20th Century

1918-19, "Spanish flu," [A (H1N1)], caused the highest

number of known influenza deaths. (However, the actual
influenza virus subtype was not detected in the 1918-19
pandemic).

More than 675,000 people died in the United States , and

up to 50 million people may have died worldwide. Many
people died within the first few days after infection, and
others died of secondary complications. Nearly half of those
who died were young, healthy adults. Influenza A (H1N1)
viruses still circulate today after being introduced again
into the human population in 1977.

A Historical Perspective:
Influenza Pandemics during the 20th Century

1957-58, "Asian flu," [A (H2N2)], caused

about 70,000 deaths in the United States .
First identified in China in late February
1957, the Asian flu spread to the United
States by June 1957.

A Historical Perspective:
Influenza Pandemics during the 20th Century

1968-69, " Hong Kong flu," [A (H3N2)],

caused about 34,000 deaths in the United
States .
This virus was first detected in Hong Kong
in early 1968 and spread to the United States
later that year. Influenza A (H3N2) viruses
still circulate today

A Historical Perspective:
Influenza Pandemics during the 20th Century
Another important clue to the current events:

Both the 1957-58 and 1968-69 pandemics

were caused by viruses containing a
combination of genes from a human influenza
virus and an avian influenza virus.
The 1918 pandemic virus appears to have an
avian origin

Stages of a Pandemic
WHO has developed a global influenza
preparedness plan, which defines the stages
of a pandemic, outlines the role of WHO,
and makes recommendations for national
measures before and during a pandemic.

Stages of a Pandemic
Phase 1 : No new influenza virus subtypes have been
detected in humans. An influenza virus subtype that
has caused human infection may be present in
animals. If present in animals, the risk of human
infection or disease is considered to be low.

Stages of a Pandemic
Phase 2 : No new influenza virus subtypes have been
detected in humans. However, a circulating animal
influenza virus subtype poses a substantial risk of
human disease.
This is called the Pandemic Alert Period

Stages of a Pandemic
Phase 3 : Human infection(s) with a new subtype, but
no human-to-human spread, or at most rare instances
of spread to a close contact.

Stages of a Pandemic
Phase 4 : Small cluster(s) with limited human-tohuman transmission but spread is highly localized,
suggesting that the virus is not yet well adapted to
humans.

Stages of a Pandemic
Phase 5 : Larger cluster(s) of human infection, but
human-to-human spread still localized, suggesting that
the virus is becoming increasingly better adapted to
humans but may not yet be fully transmissible
(substantial pandemic risk).
This is the beginning of the Pandemic Period

Stages of a Pandemic

Phase 6 : Pandemic: increased and sustained

transmission in general populationThe world is on
fire.

Stages of a Pandemic
Notes: The distinction between phases 1 and 2 is based on the risk of
human infection or disease resulting from circulating strains in
animals. The distinction is based on various factors and their relative
importance according to current scientific knowledge. Factors may
include pathogenicity in animals and humans, occurrence in
domesticated animals and livestock or only in wildlife, whether the virus
is enzootic or epizootic, geographically localized or widespread, and
other scientific parameters.
The distinction among phases 3 , 4, and is based on an assessment of
the risk of a pandemic. Various factors and their relative importance
according to current scientific knowledge may be considered. Factors
may include rate of transmission, geographical location and spread,
severity of illness, presence of genes from human strains (if derived from
an animal strain), and other scientific parameters.

Vaccines to Protect Against Pandemic Influenza Viruses

A vaccine probably would not be available in the early stages of a
pandemic. When a new vaccine against an influenza virus is being
developed, scientists around the world work together to select the virus
strain that will offer the best protection against that virus.
Manufacturers then use the selected strain to develop a vaccine.
Once a potential pandemic strain of influenza virus is identified, it
takes several months before a vaccine will be widely available. If a
pandemic occurs, the U.S. government will work with many partner
groups to make recommendations guiding the early use of available
vaccine.

Vaccine development

Antiviral Medications to Prevent and Treat

Pandemic Influenza
Four different influenza antiviral medications
(amantadine, rimantadine, oseltamivir, and zanamivir)
are approved by the U.S. Food and Drug
Administration (FDA) for the treatment and/or
prevention of influenza.
All four usually work against influenza A viruses.

Antiviral Medications to Prevent and Treat

Pandemic Influenza
The drugs may not always work, because influenza
virus strains can become resistant to one or more of
these medications.
For example, the influenza A (H5N1) viruses
identified in human in Asia in 2004 and 2005 have
been resistant to amantadine and rimantadine.
Monitoring of avian viruses for resistance to
influenza antiviral medications continues

H1N1 Swine Flu 2009

Pandemic
How dangerous?

What is the Weather Report for an emerging pandemic?

West Nile Virus

SARS
Avian Flu
Swine Flu
H5N1

West Nile Virus in Covids

Cross over viruses

SCIENCE 9 September 2005 p1680

West Nile Virus

West Nile virus was first identified in 1937 in

Uganda in eastern Africa. It was first discovered in the
United States in the summer of 1999 in New York. Sinc
then, the virus has spread throughout the United States.
West Nile is a type of virus known as a flavivirus.
Researchers believe West Nile virus is spread when a
mosquito bites an infected bird and then bites a person.
SCIENCE 9 September 2005 p1680

SARS:
Severe Acute Respiratory Disorder
How Does a Virus jump into
Humans?
SARS was the first
recognized species jumping
global epidemic
of this century.
and will not be the last

Science 16 September 2005 p1822

SARS:
Severe Acute Respiratory Disorder
How Does a Virus jump into
Humans?
8,422 cases and 916
deaths worldwide

Severe acute respiratory syndrome

(SARS) is a serious form of pneumonia. It
is caused by a virus that was first
identified in 2003.
Infection with the SARS virus causes
acute respiratory distress (severe
breathing difficulty) and sometimes death
Caused by the SARS coronavirus (SARS-CoV).
Science 16 September 2005 p1822

SARS was discovered in February 2003

The genome was sequenced by the end of March

SARS:
A Shot Over
The Bow

Science 21 October 2005 p444

The Viral Hosts of Pandemic:

Evolution and How They Move

Science 16 September 2005 p1822

Nature 2 June 2005 p542

Emerging Viral Pathogens and Their Animal Hosts

West Nile

Viral Hosts
SARS

Avian Flu

Avian Flu

Science 9 September 2005 p1680

First Responders at Risk

Science 15 September 2005 p368

How Will a Global Pandemic Move?

Science 15 September 2005 p370

How Can a Global Pandemic be Stopped?

How Will a Global Pandemic Move?

Migratory Bird Flyways

Science 21 October 2005 p427

How Will a Global Pandemic Move?

Migratory Human Flyways

The ultimate vector

How Will a Global Pandemic Move?

Migratory Human Flyways

How Will a Global Pandemic Move?

Migratory SilverBird Flyways

0 1 2

6 8 12 18 24 36 2d 3d 4d 5d 10d

Travel time to major cities (in hours and days) and shipping lane density

What can we do?

Science 21 October 2005 p429

Spanish Flu of 1918 killed 50-100 million people world wide

over 675,000 died in the United states alone

What Made the 1918 flu Virus So Deadly?

Why should we care?

Nature 6 October 2005 p794

What Made the 1918 flu Virus So Deadly?

How could we learn?

Nature 6 October 2005 p794

What Made the 1918 flu Virus So Deadly?

Did we really
need to do this?

It could help
prevent a
future disaster.

What happens if it
escapes to re-infect
the world again?

Could it be a
recipe for
bioterorrists?

It could be a
recipe for a
future disaster.
Nature 6 October 2005 p794

In the Belly of the Beast

The secrets of the 1918 flu revealed

Science 7 October 2005 p28

The Dual Use Dilemma

Science 7 October 2005 p17

The Dual Use Dilemma

Could the world stop it even it could?

Science 14 October 2005 p195

Nature 6 June 2005 p860

When it happens, will we be able to contain it?

Drugs; Will they work?

Will there be enough?
Who will get them?

Science 5 August 2005 p870

When it happens, will we be able to contain it?

Nature 8 September 2005 pxi

Nature 8 September 2005 p210

Nature 8 September 2005 p211

Preparing for the Next Pandemic

Many scientists believe it is only a matter of time
until the next lethal influenza pandemic occurs.
The severity of the next pandemic cannot be
predicted, but modeling studies suggest that the
impact of a pandemic on the United States could be
substantial.

Preparing for the Next Pandemic

In the absence of any control measures
(vaccination or drugs), it has been estimated that in
the United States a mediumlevel pandemic
could cause 89,000 to 207,000 deaths, 314,000 and
734,000 hospitalizations, 18 to 42 million
outpatient visits, and another 20 to 47 million
people being sick. Between 15% and 35% of the
U.S. population could be affected by an influenza
pandemic, and the economic impact could range
between $71.3 and $166.5 billion.

Preparing for the Next Pandemic

Influenza pandemics are different from many of the threats
for which public health and health-care systems are
currently planning:
A pandemic will last much longer than most public health
emergencies and may include waves of influenza activity
separated by months (in 20th century pandemics, a second wave of
influenza activity occurred 3 to 12 months after the first wave).
The numbers of health-care workers and first responders available
to work can be expected to be reduced. They will be at high risk of
illness through exposure in the community and in health-care
settings, and some may have to miss work to care for ill family
members.
Resources in many locations could be limited, depending on the
severity and spread of an influenza pandemic.

Preparing for the Next Pandemic

Because of these differences and the expected size of an influenza
pandemic, it is important to plan preparedness activities that
will permit a prompt and effective public health response.
The U.S. Department of Health and Human Services (HHS) supports
pandemic influenza activities in the areas of surveillance (detection),
vaccine development and production, strategic stockpiling of
antiviral medications, research, and risk communications. In May
2005, the U.S. Secretary of HHS created a multi-agency National
Influenza Pandemic Preparedness and Response Task Group. This
unified initiative involves CDC and many other agencies
(international, national, state, local and private) in planning for a
potential pandemic. Its responsibility includes revision of a U.S.
National Pandemic Influenza Response and Preparedness Plan.

Is this
Science Fiction?
This couldnt
really happenRight???
How accurate
is this?
How worried
should I be?

Pandemic: Only a Matter of Time

Surveillance of Animal
Influenza for Pandemic Preparedness
Policy Forum Public Health\

J. S. M. Peiris, L. L. M. Poon, Y. Guan

+ Author Affiliations School of Public Health, Li Ka Shing Faculty of Medicine, Sassoon Road, Pokfulam, Hong Kong Special Administrative Region (SAR), P.R.
China.

Summary
The 2009 H1N1 pandemic was not as severe as initially feared. This has led to
complacency in some quarters that future pandemics will be of comparable impact and as
readily dealt with. However, by September 2009, just 5 months after the recognition of the
novel pandemic H1N1 virus, almost 50% of children in Hong Kong were already infected
(1), which reflects the speed of spread of the virus to and within international travel hubs.
In most parts of the world, vaccines were not available in time to substantially affect the
first wave of disease. A more virulent virus, such as one comparable to the 1918 H1N1
virus or the H5N1 bird flu, spreading with such speed could be a global catastrophe

Pandemic: Only a Matter of Time

Bird Flu Controversy Does Forewarned = Forearmed With
Lab-Made Avian Influenza Strains?
Jon Cohen

The fact is,

the facts aren't clear.

Without question, H5N1 kills many of those it sickens but does not spread readily
among people. As of 8 February, the World Health Organization (WHO) says, H5N1
had killed 59% of the 584 confirmed cases in humans since 2003. If H5N1 artificially
or naturally acquired the ability to transmit easily among mammals, jumped into
humans, and remained highly pathogenic, it could trigger what Osterholm called the
worst pandemic ever seen.
Science 17 February 2012:
Vol. 335 no. 6070 pp. 785-787

Pandemic: Only a Matter of Time

Bird Flu Controversy: Dead Reckoning the Lethality of Bird Flu
Jon Cohen

Cull of duty
If surveillance detects H5N1 early, killing
flocks can contain it, as the United Kingdom did in
2007

CREDIT: COLLAGE: N. KEVITIYAGALA/SCIENCE, PHOTOS (LEFT TO RIGHT) ISTOCK

Pandemic: Only a Matter of Time

The Ferret Model

Science 3 February 2012: 512-513

H5N1 Virus Attachment to Lower Respiratory Tract
Debby van Riel, Vincent J. Munster, Emmie de Wit, Guus F. Rimmelzwaan, Ron A. M. Fouchier, SCIENCE March 12 2012

Pandemic: Only a Matter of Time

H5N1 Ron Fouchier: In the Eye of the Storm
Martin Enserink

Researchers find a limited

ofcome
mutations
render
It's number
a pity that it has
to this. RON
FOUCHIER, ERASMUS MC
H5N1 more transmissible
Spurs Controversy on
Publication and Dual-Use

The continuous threat of an influenza pandemic represents one of the biggest challenges in
public health. Influenza pandemics are known to be caused by viruses that evolve from animal
reservoirs, such as in birds and pigs, and can acquire genetic changes that increase their ability
to transmit in humans
In two independent studies conducted in two leading influenza laboratories at the University of
Wisconsin-Madison and Erasmus MC in Rotterdam, the Netherlands, investigators have
proved that viruses possessing a hemagglutinin (HA) protein from highly pathogenic avian
H5N1 influenza viruses can become transmissible in ferrets
Science 27 January 2012:
Vol. 335 no. 6067 pp. 400

Pandemic: Only a Matter of Time

The Ferret Model

Biosafety Considerations of Mammalian-Transmissible H5N1 Influenza

Michael J. Imperialea and Michael G. Hanna IIIb
- Author Affiliations
Department of Microbiology and Immunologya and
Occupational Safety and Environmental Health,b University of Michigan, Ann Arbor, Michigan, USA
Address correspondence to Michael J. Imperiale, imperial@umich.edu.

Abstract
The ability to produce an H5N1 influenza virus that can be transmitted from human to human
raises both biosecurity and biosafety concerns. After analyzing the biosafety risks of such a virus,
we propose that it be handled at biosafety level 4 (BSL4) containment until and unless it
becomes clear that the risks to humans and other mammals can be mitigated
Science 3 February 2012: 512-513

Pandemic: Only a Matter of Time

The Obligation to Prevent the Next Dual-Use Controversy
Policy Forum
Public Health and Biosecurity
Ruth R. Faden1,*,, and Ruth A. Karron2

Currently, the avian influenza virus H5N1 is not easily transmitted from human to human, but a
high mortality rate in those who have been infected with H5N1 viruses has raised fears of possible
naturally occurring mutations that would increase transmissibility

Science 17 February 2012:

Vol. 335 no. 6070 pp. 802-804

Pandemic: Only a Matter of Time

The Ferret Model

Ferret-Transmissible Influenza A(H5N1) Virus: Let Us Err on the Side of Caution

Lisa N. Murillo Amer. Soc. Microbiology Jan/Feb 2012

Science 3 February 2012

Pandemic: Only a Matter of Time

H5N1Flu Controversy Spurs Research Moratorium
David Malakoff*

Taking a break. Leading flu researchers will halt controversial studies involving
H5N1 viruses (blue) for 2 months.

Science 27 January 2012:

Vol. 335 no. 6067 pp. 387-389

Pandemic: Only a Matter of Time

Fire and Ice

Some say the world will end in fire,
Some say in ice.
From what I've tasted of desire
I hold with those who favor fire.
But if it had to perish twice,
I think I know enough of hate
To say that for destruction ice
Is also great
And would suffice.
Robert Frost

1. The film Contagion

(A) entirely depicts a situation that could never possibly happen in the
US based on and H8N14 outbreak
(B) is entirely science fiction and depicts only a Hollywood version of
pandemic
(C) is a theoretical depiction based on what might happen in a global
pandemic
(D) is based on the alien invasion of a virus that takes over the planet
that could actually happen (HxNv)
(E) is a documentary based on the 1957-58 pandemic of the Hong
Kong flue (H3N5)

2. An influenza pandemic is a global outbreak of disease that

occurs when a new influenza A virus appears or
emerges in the human population, causes serious illness,
and then spreads
(A) from plants to animals
(B) easily from person to person worldwide
(C) from birds to humans in Southeast Asia
(D) from birds to pigs
(E) out from a research laboratory

3. An influenza pandemic is a global outbreak of disease

that occurs when a new influenza A virus appears or
emerges in the human population, causes serious illness,
and then spreads easily from person to person worldwide.
An influenza pandemic
(A) is a theoretical concern of the WHO and the CDC
(B) has not occurred in the US since the famous 1918-19 Spanish Flu
(C) has occurred several time in the last 100 years with devastating
consequences
(D) will not unlikely occur in the next fifty years but is a significant
concern to the USDA
(E) None of these answers is correct

4. Pandemics:
(A) are different from seasonal outbreaks or epidemics of influenza.
(B) are outbreaks that are caused by new influenza subtypes
(C) are outbreaks that are caused by influenza subtypes that have never
circulated among people or by subtypes that have not circulated among
people for a long time
(D) in the past have led to high levels of illness, death, social disruption,
and economic loss on a global scale
(E) All of these answers is correct

5. How will the next global pandemic most likely move

most effectively?
(A) Cargo ships from southeast Asia which inadvertently may
carry infected fruit bats
(B) Infected military personnel returning from service in the
Middle East
(C) Contaminated food sources from Mexico
(D) human to human transmission facilitated by air travel
(E) As a computer virus transmitted through social media

6. There are many different subtypes of Influenza or flu

viruses. The subtypes differ based upon certain proteins on
the surface of the virus are used to classify the subtypes
are designated
(A) only for avian flu subtypes
(B) as HN based on the hemagglutinin or HA protein and the
neuraminidase or the NA protein.
(C) specifically by the WHO for seasonal flu vaccine production
(D) by their animal host reservoir whether they are avian (AV), pigs
(PG), or bats (BT)
(E) when they reach Phase 3 pandemic level as HuHu3

7. PCR is useful for use in plant genetics,

pharmacogenomics, evolutionary studies, pandemic flu,
and analysis of bioweapons.
(A) False
(B) True
(C) only when a plant geneticist thinks his collaborator stole his work
(D) only when forensic analysis involves bioweapons from a anthrax
attack
(E) This is true for everything except its use on pandemic flu.

8. Pandemic viruses emerge as a result of a process called

"antigenic shift, which causes an abrupt or sudden,
major change in influenza A viruses. These changes are
caused by
(A) people who do not practice good personal hygiene
(B) molecular biologists that study viral transmission
(C) an overuse of antibiotics
(D) new combinations of the HA and/or NA proteins on the surface of
the virus during viral evolution
(E) alternative medical therapies in Southeast Asia

9. Changes in the viral genome result in a new influenza A

virus subtype. The appearance of a new influenza A virus
subtype is the first step toward a pandemic; however, to
cause a pandemic, the new virus subtype also must
(A) escape detection by viral researchers and the CDC
(B) be transmissible through agricultural crops, such as is now feared
through genetically modified corn
(C) be able to use bats as it animal host
(D) have the capacity to spread easily from person to person
(E) be based on the genomic sequence that is the same as the 1918
Spanish flu virus

10. Who is monitoring global emergence of influenza

viruses?
(A) The US Department of Agriculture (USDA) and the Food and
Drug Administration (FDA) in the United States
(B) The U.S. Centers for Disease Control and Prevention (CDC) and
the World Health Organization (WHO)
(C) The Environmental Protection Agency (EPA) in the United States
(D) The Republican Party (GOP) related to the Personal Health Care
Act issues
(E) The Academy Awards Committee (AAC) for accuracy of the film
Contagion

11. During the 20th century, the emergence of several new

influenza A virus subtypes have caused pandemics; all of
which spread around the world within a year of being
detected. One of these is suspected of killing over 675,000
in the US and over 50 million globally. That deadly
pandemic was called the
(A) 1918-19, "Spanish flu," [A (H1N1)]
(B) 1957-58, "Asian flu," [A (H2N2)]
(C) 1968-69, " Hong Kong flu," [A (H3N2)]
(D) 2003-2004 Severe Acute Respiratory Disorder [SARS]
(E) 1972-present West Nile Virus [WNV]

12. The Stages of a Pandemic, characterized by the World

Health Organization recognizes a Phase 6 Pandemic when:
(A) an emergent influenza virus is recognized in an animal
host species
(B) human infection(s) with a new subtype have occurred, but
there is no human-to-human spread
(C) Small cluster(s) with limited human-to-human
transmission but spread is highly localized
(D) increased human to human transmission occurs and
sustained transmission in general population
(E) the virus has become sexually transmissible

13. Vaccines can be made to protect against pandemic

influenza viruses, but
(A) it would be too costly to be effective and therefore not
manufactured by major pharmaceutical companies
(B) a vaccine probably would not be available in the early stages of a
pandemic
(C) requires 12 years and would cost over $1.5 billion from bench to
bedside
(D) can only be produced using the attenuated vaccine approach in
chicken eggs
(E) could never be over 50% effective so would not interrupt a full
blown pandemic

12. Antiviral medications have been made and tested to

prevent and treat influenza
(A) of the seasonal subtypes only, and will be of little use in a
pandemic
(B) including four different influenza antiviral medications
(amantadine, rimantadine, oseltamivir, and zanamivir)
(C) but are not yet approved by the U.S. Food and Drug
Administration (FDA) for the treatment and/or prevention of
influenza
(D) but will only be available for underdeveloped countries
provided by the UN and the WHO to prevent the pandemic spread to
developed countries
(E) but cannot be commercialized because of perceived
controversies about the manufacture and possible side-effects

14. The emergence of several new influenza A virus

subtypes have caused pandemics during the 20th century;
one important clue about their origins is that
(A) the viruses contain a combination of human genes and/or
animal host species
(B) the all occurred in large urban areas in Western Europe
(C) they are not transmissible from human to human
(D) they were all genetically engineered
(E) they appeared with the onset of antibiotic use in Southeast
Asia

15. The Dual Use Dilemma refers to:

(A) The complicated situation of a train platform and whether to
sacrifice one life to save five
(B) The basic research on viral genetics and transmissibility that could
be used to combat pandemics and the use of that knowledge
for the creation of bioweapons.
(C) The use of one antibiotic to treat two separate pandemic subtypes
(D) The use of basic scientific research for profit
(E) The use of theoretical dilemmas when real lives are at high risk
through pandemics

16. Many scientists believe it is only a matter of time until

the next lethal influenza pandemic occurs. The severity of
the next pandemic cannot be predicted, but modeling
studies suggest that the impact of a pandemic on the
United States could be substantial. In the absence of any
control measures (vaccination or drugs), it has been
estimated that in the United States a mediumlevel
pandemic could cause
(A) 9,000 to 7,000 deaths, 4,000 and 5,000 hospitalizations
(B) 589,000 to 1207,000 deaths, 3,814,000 and 9,734,000
hospitalizations
(C) 89,000 to 207,000 deaths, 314,000 and 734,000 hospitalizations
(D) over 10,000 hours of missed work time
(E) a cancelation of the Academy award ceremonies