WEBVTT 00:02.333 --> 00:04.033 align:left position:22.5% line:83% size:67.5% - Welcome, everyone to Wednesday Nite @ the Lab. 00:04.133 --> 00:05.300 align:left position:32.5% line:89% size:57.5% I'm Tom Zinnen. 00:05.400 --> 00:07.433 align:left position:15% line:83% size:75% I work here at the UW-Madison Biotechnology Center. 00:07.533 --> 00:11.733 align:left position:15% line:83% size:75% I also work for the Division of Extension and Wisconsin 4-H, 00:11.833 --> 00:14.100 align:left position:15% line:71% size:75% and on behalf of those folks and our other co-organizers, 00:14.200 --> 00:17.633 align:left position:15% line:71% size:75% PBS Wisconsin, the Wisconsin Alumni Association, 00:17.733 --> 00:20.100 align:left position:27.5% line:71% size:62.5% and the UW-Madison Science Alliance, 00:20.200 --> 00:22.966 align:left position:17.5% line:71% size:72.5% thanks again for coming to Wednesday Nite @ the Lab. 00:23.066 --> 00:26.566 align:left position:17.5% line:71% size:72.5% We do this every Wednesday night, 50 times a year. 00:26.666 --> 00:29.433 align:left position:15% line:71% size:75% Tonight, it's my pleasure to introduce to you Katie Schmit. 00:29.533 --> 00:32.766 align:left position:20% line:71% size:70% She's a physician in the Department of Pediatrics here. 00:33.966 --> 00:36.500 align:left position:27.5% line:71% size:62.5% She was born in St. Charles, Illinois, 00:36.600 --> 00:39.833 align:left position:15% line:71% size:75% which is right down Illinois 38 from Dixon, Illinois. 00:41.100 --> 00:43.366 align:left position:22.5% line:71% size:67.5% She went to St. Charles North High School, 00:43.466 --> 00:47.066 align:left position:10% line:71% size:80% and then came here to UW-Madison to study biochemistry. 00:47.166 --> 00:49.800 align:left position:30% line:71% size:60% Then she went to St. George's University 00:49.900 --> 00:53.033 align:left position:20% line:71% size:70% to get her medical degree on the island of Grenada, 00:53.133 --> 00:55.466 align:left position:30% line:71% size:60% then she did her clinical work in Brooklyn 00:55.566 --> 00:58.600 align:left position:10% line:71% size:80% and lived in Bedford-Stuyvesant. 01:00.233 --> 01:03.500 align:left position:25% line:71% size:65% Then she came here to UW-Madison to do her residency. 01:03.600 --> 01:05.533 align:left position:25% line:71% size:65% She's currently here doing a fellowship 01:05.633 --> 01:08.033 align:left position:10% line:71% size:80% in pediatric infectious disease, 01:08.133 --> 01:12.166 align:left position:12.5% line:71% size:77.5% and she's also doing a primary care research fellowship 01:12.266 --> 01:14.266 align:left position:27.5% line:71% size:62.5% with the Department of Family Medicine. 01:14.366 --> 01:16.466 align:left position:22.5% line:71% size:67.5% Tonight, she's going to talk to us about something 01:16.566 --> 01:18.066 align:left position:32.5% line:71% size:57.5% that's near and dear to all of us 01:18.166 --> 01:19.566 align:left position:17.5% line:71% size:72.5% who have ever had children, 01:19.666 --> 01:22.900 align:left position:22.5% line:71% size:67.5% respiratory viruses of children and adults. 01:23.000 --> 01:24.966 align:left position:17.5% line:71% size:72.5% The focus is on influenza. 01:25.066 --> 01:27.566 align:left position:15% line:71% size:75% It's gonna be interesting to see how the numbers stack up 01:27.666 --> 01:31.500 align:left position:15% line:71% size:75% to this competing virus that we have going around right now. 01:31.600 --> 01:34.100 align:left position:17.5% line:71% size:72.5% I think influenza may win. 01:34.200 --> 01:36.133 align:left position:30% line:71% size:60% Please join me in welcoming Dr. Katie Schmit 01:36.233 --> 01:37.466 align:left position:15% line:71% size:75% to Wednesday Nite @ the Lab. 01:37.566 --> 01:40.266 align:left position:25% line:71% size:65% [audience applauding] 01:45.200 --> 01:46.366 align:left position:35% line:71% size:55% - All right. 01:49.233 --> 01:51.266 align:left position:27.5% line:71% size:62.5% Thank you, Tom, for that introduction. 01:51.366 --> 01:54.466 align:left position:20% line:71% size:70% Today, I'll be discussing influenza, like Tom mentioned. 01:54.566 --> 01:57.500 align:left position:20% line:71% size:70% I will focus on three key concepts that will help us 01:57.600 --> 02:00.500 align:left position:30% line:71% size:60% follow influenza from the virus itself 02:00.600 --> 02:02.833 align:left position:10% line:71% size:80% to the infection that it causes. 02:02.933 --> 02:06.033 align:left position:20% line:71% size:70% So my goal is to help you guys enhance your knowledge 02:06.133 --> 02:08.500 align:left position:27.5% line:71% size:62.5% about influenza you hear so much about, 02:08.600 --> 02:10.966 align:left position:25% line:71% size:65% and the flu virus you hear so much about. 02:11.066 --> 02:12.600 align:left position:30% line:71% size:60% I recognize that everyone in this room 02:12.700 --> 02:14.833 align:left position:30% line:71% size:60% is starting from different backgrounds. 02:14.933 --> 02:17.633 align:left position:30% line:71% size:60% There may be some virologists in the audience, 02:17.733 --> 02:19.666 align:left position:30% line:71% size:60% but I'm trying to keep it quite basic 02:19.766 --> 02:22.966 align:left position:22.5% line:71% size:67.5% with talking about key concepts about influenza 02:23.066 --> 02:27.100 align:left position:22.5% line:71% size:67.5% that transfers over to different respiratory viruses. 02:28.533 --> 02:30.600 align:left position:17.5% line:71% size:72.5% So before I get started, I have no financial disclosures. 02:30.700 --> 02:33.333 align:left position:25% line:71% size:65% [audience chuckling] I will not be addressing 02:33.433 --> 02:36.233 align:left position:22.5% line:71% size:67.5% any non-FDA medications during this talk. 02:38.233 --> 02:39.966 align:left position:22.5% line:71% size:67.5%   So these are the three key concepts 02:40.066 --> 02:42.033 align:left position:17.5% line:83% size:72.5% that I'll be going through today to talk about 02:42.133 --> 02:43.966 align:left position:20% line:89% size:70% in addressing influenza. 02:44.066 --> 02:46.700 align:left position:15% line:83% size:75% So even though some of these are very specific and unique 02:46.800 --> 02:49.900 align:left position:20% line:83% size:70% to influenza, overarching respiratory viruses, 02:50.000 --> 02:53.400 align:left position:20% line:83% size:70% a lot of this is the same in regards to transmission 02:53.500 --> 02:56.100 align:left position:30% line:83% size:60% and immunity, and within transmission, 02:56.200 --> 02:57.833 align:left position:15% line:89% size:75% animal to human transmission 02:57.933 --> 03:01.400 align:left position:27.5% line:83% size:62.5% as well as human to human transmission. 03:01.500 --> 03:05.400 align:left position:20% line:83% size:70% So the first concept I'll go over is viral properties 03:05.500 --> 03:07.233 align:left position:15% line:89% size:75% that are unique to influenza, 03:07.333 --> 03:10.000 align:left position:20% line:83% size:70% dealing with some surface antigens called hemagglutinin 03:10.100 --> 03:13.233 align:left position:17.5% line:83% size:72.5% and neuraminidase, and then going to antigenic drift 03:13.333 --> 03:16.300 align:left position:22.5% line:83% size:67.5% and shift, which really helps us understand epidemics 03:16.400 --> 03:18.700 align:left position:30% line:83% size:60% and pandemics and how they occur. 03:18.800 --> 03:21.333 align:left position:27.5% line:71% size:62.5% Second concept I'll go to is transmission. 03:21.433 --> 03:24.066 align:left position:17.5% line:71% size:72.5% So this is focusing more on the human to human transmission 03:24.166 --> 03:27.200 align:left position:20% line:71% size:70% that occurs with droplets transmission mainly, 03:27.300 --> 03:29.766 align:left position:15% line:71% size:75% and then also discussing some of the environmental changes 03:29.866 --> 03:32.033 align:left position:25% line:71% size:65% that allow influenza to replicate. 03:33.233 --> 03:35.000 align:left position:30% line:71% size:60% The third concept that I'll go through 03:35.100 --> 03:36.500 align:left position:20% line:71% size:70% has to do with immunity. 03:36.600 --> 03:38.233 align:left position:10% line:71% size:80% So not only population immunity, 03:38.333 --> 03:41.066 align:left position:25% line:71% size:65% but I will talk about influenza vaccine overall. 03:43.466 --> 03:46.500 align:left position:17.5% line:71% size:72.5% So I know I listed a whole bunch of things on that slide. 03:46.600 --> 03:47.933 align:left position:17.5% line:71% size:72.5%   Some things may be familiar to you, 03:48.033 --> 03:50.233 align:left position:27.5% line:83% size:62.5% some things may be completely foreign, 03:50.333 --> 03:52.233 align:left position:17.5% line:83% size:72.5% so I really don't want you guys thinking like this 03:52.333 --> 03:53.466 align:left position:32.5% line:89% size:57.5% at this point. 03:53.566 --> 03:56.166 align:left position:20% line:83% size:70% I really want us to take this journey together 03:56.266 --> 03:57.700 align:left position:30% line:83% size:60% and have a better understanding idea 03:57.800 --> 04:00.066 align:left position:20% line:83% size:70% of some of these concepts that come through 04:00.166 --> 04:01.700 align:left position:15% line:89% size:75% when we talk about influenza. 04:01.800 --> 04:06.700 align:left position:25% line:83% size:65% So my goal is to put you more in this realm. 04:06.800 --> 04:09.600 align:left position:15% line:83% size:75% Being able to talk to family and friends about influenza, 04:09.700 --> 04:11.000 align:left position:25% line:83% size:65% being more informed, yourself, about influenza 04:11.100 --> 04:13.366 align:left position:32.5% line:83% size:57.5% and some other respiratory viruses. 04:13.466 --> 04:16.533 align:left position:17.5% line:83% size:72.5% Realistically, I know that you may feel more like this 04:16.633 --> 04:20.600 align:left position:12.5% line:83% size:77.5% after my talk, and that's okay, but I'm hoping that we land 04:20.700 --> 04:23.133 align:left position:22.5% line:83% size:67.5% more on this, where we just really understand 04:23.233 --> 04:25.366 align:left position:22.5% line:83% size:67.5% the importance of hand washing and the key things 04:25.466 --> 04:27.900 align:left position:20% line:83% size:70% with influenza and other respiratory viruses 04:28.000 --> 04:30.233 align:left position:12.5% line:89% size:77.5% to reduce transmission overall. 04:32.900 --> 04:36.200 align:left position:15% line:83% size:75% So before I go into those key concepts that I talked about, 04:36.300 --> 04:38.800 align:left position:25% line:83% size:65% I'm gonna start with the burden of influenza. 04:38.900 --> 04:40.033 align:left position:25% line:89% size:65% So this is important, 04:40.133 --> 04:41.933 align:left position:27.5% line:83% size:62.5% and why I'm talking about influenza today 04:42.033 --> 04:44.366 align:left position:20% line:71% size:70% has to do with the burden of disease that we see 04:44.466 --> 04:46.400 align:left position:20% line:71% size:70% in the United States and throughout the world. 04:48.600 --> 04:50.866 align:left position:20% line:71% size:70% So these statistics here, I'll try not to bore you 04:50.966 --> 04:53.500 align:left position:20% line:71% size:70% with a ton of statistics, but these statistics here 04:53.600 --> 04:56.066 align:left position:27.5% line:71% size:62.5% are just from this influenza season. 04:56.166 --> 04:59.266 align:left position:27.5% line:71% size:62.5%   So starting from September to this is the most recent one 04:59.366 --> 05:02.166 align:left position:12.5% line:89% size:77.5% on the CDC from February 22nd. 05:02.266 --> 05:04.733 align:left position:25% line:83% size:65% These are the numbers that we're dealing with. 05:04.833 --> 05:07.766 align:left position:25% line:83% size:65% So when we talk about flu illnesses overall, 05:07.866 --> 05:12.766 align:left position:22.5% line:83% size:67.5% we're at 45 million flu illnesses in the United States. 05:12.866 --> 05:14.366 align:left position:45% line:89% size:45% Okay. 05:14.466 --> 05:16.600 align:left position:15% line:83% size:75% So this isn't world, this is in the United States, here. 05:16.700 --> 05:20.866 align:left position:17.5% line:83% size:72.5% We're talking about 500,000 influenza hospitalizations. 05:20.966 --> 05:22.433 align:left position:12.5% line:89% size:77.5% So to put that in perspective, 05:22.533 --> 05:25.600 align:left position:30% line:83% size:60% that's about the size of Milwaukee. 05:25.700 --> 05:27.966 align:left position:17.5% line:83% size:72.5% A little bit less than the size of Milwaukee, overall. 05:28.066 --> 05:32.000 align:left position:12.5% line:89% size:77.5% So the entire city of Milwaukee 05:32.100 --> 05:33.966 align:left position:25% line:83% size:65% would be hospitalized with influenza. 05:35.366 --> 05:37.433 align:left position:20% line:83% size:70% In addition to that, when we look at flu deaths 05:37.533 --> 05:39.400 align:left position:20% line:89% size:70% so far this season alone, 05:39.500 --> 05:43.133 align:left position:27.5% line:83% size:62.5% we're at 18,000 to 46,000 influenza deaths, 05:44.266 --> 05:46.366 align:left position:25% line:83% size:65% which is quite a lot when we're comparing it 05:46.466 --> 05:48.966 align:left position:20% line:83% size:70% to some other things that are going on at this time. 05:50.400 --> 05:54.100 align:left position:12.5% line:83% size:77.5% Overall, the CDC tracks all of the leading causes of death, 05:54.200 --> 05:56.500 align:left position:25% line:83% size:65% and in 2017, which is the most updated ones 05:56.600 --> 05:59.566 align:left position:20% line:83% size:70% that they have, it is the eighth leading cause of death. 05:59.666 --> 06:01.433 align:left position:30% line:83% size:60% So influenza and pneumonia combined 06:01.533 --> 06:03.800 align:left position:22.5% line:83% size:67.5% are the eighth leading cause of death overall. 06:03.900 --> 06:06.066 align:left position:15% line:83% size:75% So this is really important, and something I think 06:06.166 --> 06:09.100 align:left position:15% line:83% size:75% a lot of us forget about, is how big of a burden this is. 06:10.533 --> 06:13.633 align:left position:12.5% line:5% size:77.5% This is also from the CDC, the Center for Disease Control. 06:13.733 --> 06:16.733 align:left position:25% line:5% size:65% I'll abbreviate it as the CDC going forward. 06:16.833 --> 06:18.900 align:left position:27.5% line:5% size:62.5% This has to do with the median incidence 06:19.000 --> 06:23.500 align:left position:20% line:5% size:70% of symptomatic influenza throughout the influenza years 06:23.600 --> 06:27.200 align:left position:30% line:5% size:60% from 2010 to 2015 influenza seasons. 06:27.300 --> 06:29.266 align:left position:20% line:5% size:70% So the seasons' severity change quite a bit 06:29.366 --> 06:33.366 align:left position:12.5% line:5% size:77.5% from moderate, to low, to high depending on certain types 06:33.466 --> 06:35.633 align:left position:27.5% line:5% size:62.5% of viruses that are circulating that year, 06:35.733 --> 06:38.900 align:left position:17.5% line:5% size:72.5% but overall, with all ages, this is the amount of people 06:39.000 --> 06:40.900 align:left position:27.5% line:5% size:62.5% that have symptoms because of influenza. 06:41.000 --> 06:47.033 align:left position:12.5% line:5% size:77.5% So 8.3% of the total population has influenza symptoms 06:47.133 --> 06:48.933 align:left position:10% line:5% size:80% throughout the influenza season. 06:49.033 --> 06:52.933 align:left position:25% line:5% size:65% Then, when we look at specific age groups overall, 06:53.033 --> 06:56.400 align:left position:17.5% line:5% size:72.5% we notice that the children less than five years of age 06:56.500 --> 07:01.266 align:left position:20% line:5% size:70% have a higher percentage, and also adults age 50 to 64 07:01.366 --> 07:03.333 align:left position:12.5% line:5% size:77.5% also have a higher percentage. 07:03.433 --> 07:05.466 align:left position:22.5% line:5% size:67.5% Again, every season it changes a little bit, 07:05.566 --> 07:07.766 align:left position:25% line:5% size:65% there's some certain seasons that it shifts, 07:07.866 --> 07:10.700 align:left position:15% line:5% size:75% but really these are the ages that are affected the most. 07:12.333 --> 07:14.466 align:left position:27.5% line:71% size:62.5% The deaths per year in the United States, 07:14.566 --> 07:15.966 align:left position:22.5% line:71% size:67.5% it's 12,000 to 61,000. 07:16.066 --> 07:18.433 align:left position:15% line:71% size:75% Again, that changes depending on the circulating viruses 07:18.533 --> 07:21.766 align:left position:15% line:71% size:75% and some of the other things I'll talk about moving forward. 07:21.866 --> 07:28.566 align:left position:12.5% line:71% size:77.5% But worldwide, there is 290,000 to 646,000 deaths per year. 07:28.666 --> 07:29.833 align:left position:30% line:71% size:60% The entire world. 07:31.033 --> 07:33.766 align:left position:22.5% line:71% size:67.5% Okay, so that addresses just some of the burden, 07:33.866 --> 07:36.166 align:left position:12.5% line:71% size:77.5% and why I think it's important to talk about influenza, 07:36.266 --> 07:39.466 align:left position:15% line:71% size:75% and why we should be educated about influenza overall. 07:39.566 --> 07:41.100 align:left position:27.5% line:71% size:62.5% So now I'll go into the viral properties 07:41.200 --> 07:42.266 align:left position:25% line:71% size:65% I was talking about. 07:42.366 --> 07:44.066 align:left position:25% line:71% size:65% So these are specific to influenza 07:44.166 --> 07:46.733 align:left position:22.5% line:71% size:67.5% and help with influenza being virulent, 07:46.833 --> 07:49.633 align:left position:17.5% line:71% size:72.5% and how it gets transmitted to others. 07:49.733 --> 07:52.533 align:left position:20% line:71% size:70% So first, I'm gonna talk about the two surface proteins 07:52.633 --> 07:55.433 align:left position:27.5% line:71% size:62.5% that are important, hemagglutinin and neuraminidase. 07:57.233 --> 08:00.500 align:left position:22.5% line:71% size:67.5% So this is a depiction of the influenza virus 08:00.600 --> 08:02.166 align:left position:12.5% line:71% size:77.5% that really graphically helps. 08:02.266 --> 08:04.766 align:left position:27.5% line:5% size:62.5% So influenza virus is an RNA virus. 08:04.866 --> 08:07.900 align:left position:20% line:5% size:70% This is important when we talk about some of the changes 08:08.000 --> 08:10.200 align:left position:27.5% line:5% size:62.5% that the virus can have moving forward. 08:10.300 --> 08:13.300 align:left position:25% line:5% size:65% So its genome, so the genetic makeup of this virus 08:13.400 --> 08:17.533 align:left position:15% line:5% size:75% is RNA instead of DNA, which our genetic makeup is made of. 08:19.933 --> 08:22.800 align:left position:27.5% line:83% size:62.5% So now, moving onto some surface proteins. 08:22.900 --> 08:25.866 align:left position:20% line:83% size:70% So the first one I wanna talk about is hemagglutinin, 08:25.966 --> 08:27.700 align:left position:25% line:83% size:65% which is, really how you think about it 08:27.800 --> 08:32.366 align:left position:22.5% line:83% size:67.5% is this the virus here, and how it sticks to cells, 08:32.466 --> 08:34.100 align:left position:15% line:89% size:75% and how it's glued to a cell 08:34.200 --> 08:37.033 align:left position:32.5% line:83% size:57.5% is the protein called hemagglutinin. 08:37.133 --> 08:40.500 align:left position:25% line:83% size:65% So this is the reason that the influenza viruses 08:40.600 --> 08:42.500 align:left position:27.5% line:89% size:62.5% attaches to cells. 08:42.600 --> 08:46.966 align:left position:25% line:83% size:65% Moving forward, it's abbreviated as HA or H. 08:47.066 --> 08:50.600 align:left position:20% line:83% size:70% I'll come into influenza naming in a little bit. 08:51.966 --> 08:55.166 align:left position:27.5% line:83% size:62.5% The second surface protein that you can see 08:55.266 --> 08:58.333 align:left position:22.5% line:83% size:67.5% on this picture here is something called neuraminidase, 08:58.433 --> 09:01.133 align:left position:22.5% line:83% size:67.5% which helps release the virus from the cell. 09:01.233 --> 09:03.300 align:left position:12.5% line:89% size:77.5% So after the virus is attached, 09:03.400 --> 09:06.566 align:left position:20% line:83% size:70% it gets engulfed into the cell, it makes new virus, 09:06.666 --> 09:08.833 align:left position:25% line:83% size:65% and then prior to it getting out of the cell, 09:08.933 --> 09:10.566 align:left position:32.5% line:83% size:57.5% it needs to be released by something. 09:10.666 --> 09:13.533 align:left position:15% line:83% size:75% And this is what is releasing it, the neuraminidase. 09:13.633 --> 09:15.533 align:left position:22.5% line:83% size:67.5% So you can think about the neuraminidase 09:15.633 --> 09:17.166 align:left position:27.5% line:89% size:62.5% as a scissor, okay? 09:17.266 --> 09:21.066 align:left position:25% line:83% size:65% So the hemagglutinin glues it to the cell, 09:21.166 --> 09:24.966 align:left position:22.5% line:83% size:67.5% the neuraminidase cuts it off from the cell. 09:25.066 --> 09:28.633 align:left position:20% line:71% size:70% Moving forward, this will be abbreviated as NA or N. 09:28.733 --> 09:30.833 align:left position:17.5% line:71% size:72.5% And so, these are important when we talk about 09:30.933 --> 09:32.900 align:left position:27.5% line:71% size:62.5% some of the naming of influenza viruses. 09:33.000 --> 09:35.233 align:left position:20% line:71% size:70% So if you guys have heard of influenza viruses 09:35.333 --> 09:41.033 align:left position:22.5% line:71% size:67.5% named H1N1, H3N2, H2N2, 09:41.133 --> 09:42.733 align:left position:25% line:71% size:65% those are why they're named that way 09:42.833 --> 09:44.733 align:left position:30% line:71% size:60% is based on these surface proteins. 09:44.833 --> 09:47.100 align:left position:32.5% line:71% size:57.5% So the H refers to hemagglutinin, 09:47.200 --> 09:49.666 align:left position:12.5% line:71% size:77.5% the N refers to neuraminidase. 09:52.933 --> 09:55.466 align:left position:20% line:71% size:70% So now, we'll go through the life cycle of influenza. 09:55.566 --> 09:58.533 align:left position:27.5% line:71% size:62.5% So once it attaches to the epithelial cell 09:58.633 --> 10:03.000 align:left position:15% line:71% size:75% of either humans or animals, what it does is that virus 10:03.100 --> 10:06.800 align:left position:20% line:71% size:70% goes into the cell, over on the second portion here, 10:07.966 --> 10:10.300 align:left position:20% line:71% size:70% and that is facilitated, the actual attachment 10:10.400 --> 10:12.233 align:left position:25% line:71% size:65% like we talked about, is the hemagglutinin, 10:12.333 --> 10:16.066 align:left position:15% line:71% size:75% goes into the cell, and then it releases its viral contents 10:16.166 --> 10:18.733 align:left position:22.5% line:71% size:67.5% in that third stage, in the uncoating stage. 10:20.633 --> 10:23.533 align:left position:22.5% line:5% size:67.5% Once its viral contents are in the human cell 10:23.633 --> 10:27.466 align:left position:22.5% line:5% size:67.5% or animal cell, it then transfers its RNA material 10:27.566 --> 10:29.800 align:left position:12.5% line:5% size:77.5% into the nucleus of that cell, 10:29.900 --> 10:31.933 align:left position:25% line:5% size:65% and then what it does is it replicates it. 10:32.033 --> 10:33.966 align:left position:17.5% line:5% size:72.5% So it makes more of itself, 10:34.066 --> 10:36.600 align:left position:25% line:5% size:65% making more of these infectious viral particles 10:36.700 --> 10:39.566 align:left position:30% line:5% size:60% that you can see within the cell, here. 10:39.666 --> 10:43.500 align:left position:17.5% line:5% size:72.5% And then, once it's ready, it goes to the cell's surface 10:43.600 --> 10:44.733 align:left position:17.5% line:5% size:72.5% and then it gets released, 10:44.833 --> 10:46.300 align:left position:25% line:5% size:65% and that's where the neuraminidase comes in 10:46.400 --> 10:48.066 align:left position:12.5% line:5% size:77.5% and it helps with the process. 10:52.033 --> 10:54.833 align:left position:15% line:83% size:75% So there are three different types of influenza, 10:56.000 --> 10:58.066 align:left position:17.5% line:89% size:72.5% type A, type B, and type C. 10:59.066 --> 11:00.766 align:left position:15% line:89% size:75% So first I'll mention type C. 11:00.866 --> 11:03.733 align:left position:22.5% line:83% size:67.5% Type C is not something we hear about very often, 11:03.833 --> 11:06.900 align:left position:27.5% line:83% size:62.5% but it is a subtype of influenza. 11:07.000 --> 11:09.366 align:left position:20% line:83% size:70% It typically causes very mild respiratory illnesses 11:09.466 --> 11:10.533 align:left position:35% line:89% size:55% in children. 11:10.633 --> 11:12.033 align:left position:15% line:89% size:75% We don't focus on it as much 11:12.133 --> 11:14.333 align:left position:22.5% line:71% size:67.5% because it doesn't lead to pandemics or epidemics, 11:14.433 --> 11:17.433 align:left position:17.5% line:71% size:72.5% so it doesn't lead to mass people having infections 11:17.533 --> 11:19.800 align:left position:22.5% line:71% size:67.5% because of it, and the symptoms are quite mild 11:19.900 --> 11:22.466 align:left position:22.5% line:71% size:67.5% so we don't see deaths associated with it. 11:22.566 --> 11:24.466 align:left position:25% line:71% size:65% This is the last time I'll talk about type C, 11:24.566 --> 11:26.566 align:left position:27.5% line:71% size:62.5% 'cause really, the importance of the influenza 11:26.666 --> 11:28.766 align:left position:15% line:71% size:75% has to do with type A and B. 11:30.400 --> 11:34.266 align:left position:17.5% line:71% size:72.5% So now, talking about type A, as I mentioned previously, 11:34.366 --> 11:38.300 align:left position:17.5% line:71% size:72.5% type A is named by the H#*N#* 11:38.400 --> 11:42.133 align:left position:30% line:89% size:60% or H#N# subtypes. 11:42.233 --> 11:45.800 align:left position:20% line:83% size:70% When we look at different subtypes like I had mentioned, 11:45.900 --> 11:49.333 align:left position:17.5% line:83% size:72.5% there are certain subtypes that infect different types 11:49.433 --> 11:51.700 align:left position:20% line:83% size:70% of animals and different types of humans. 11:52.700 --> 11:55.166 align:left position:12.5% line:89% size:77.5% So influenza A is quite unique 11:55.266 --> 11:58.566 align:left position:25% line:83% size:65% because it can infect birds, can infect pigs, 11:58.666 --> 12:00.800 align:left position:20% line:89% size:70% and it can infect humans. 12:00.900 --> 12:03.066 align:left position:12.5% line:83% size:77.5% So this becomes important when we talk a little bit later 12:03.166 --> 12:05.833 align:left position:17.5% line:83% size:72.5% about some of the pandemics that have happened in the past. 12:05.933 --> 12:08.733 align:left position:20% line:83% size:70% And concern for pandemics happening in the future 12:08.833 --> 12:11.266 align:left position:30% line:83% size:60% really has to do with multiple species 12:11.366 --> 12:14.700 align:left position:20% line:83% size:70% being able to be infected with influenza A virus. 12:15.866 --> 12:18.466 align:left position:25% line:83% size:65% Humans, at this time, have only been known 12:18.566 --> 12:23.266 align:left position:15% line:89% size:75% to have H1N1, H2N2, and H3N2, 12:23.366 --> 12:24.666 align:left position:30% line:83% size:60% so those are the most common ones 12:24.766 --> 12:26.200 align:left position:30% line:83% size:60% that you'll hear over and over again. 12:26.300 --> 12:28.066 align:left position:22.5% line:71% size:67.5% They're the most common ones that are covered 12:28.166 --> 12:29.800 align:left position:20% line:71% size:70% in our vaccines as well. 12:33.266 --> 12:34.333 align:left position:35% line:71% size:55% Now, type B. 12:34.433 --> 12:36.666 align:left position:12.5% line:71% size:77.5% So type B infects humans only, 12:36.766 --> 12:39.466 align:left position:25% line:71% size:65% so it does not infect animals at all. 12:39.566 --> 12:42.933 align:left position:20% line:71% size:70% There are two lineages of circulating influenza B 12:43.033 --> 12:44.500 align:left position:22.5% line:71% size:67.5% for the past 20 years, 12:44.600 --> 12:47.533 align:left position:25% line:71% size:65% and those are called Victoria and Yamagata. 12:51.866 --> 12:54.733 align:left position:30% line:71% size:60% So I talked about the viral properties 12:54.833 --> 12:57.533 align:left position:17.5% line:71% size:72.5% in regards to hemagglutinin and neuraminidase. 12:57.633 --> 13:01.766 align:left position:15% line:71% size:75% Now, I will go on and change to talk about antigenic drift 13:01.866 --> 13:03.666 align:left position:25% line:71% size:65% and antigenic shift. 13:03.766 --> 13:06.000 align:left position:25% line:71% size:65% So these words sound very similar, 13:06.100 --> 13:07.633 align:left position:20% line:71% size:70% and as a medical student, 13:07.733 --> 13:11.033 align:left position:20% line:71% size:70% and learning all of this, they jumble up in your mind, 13:11.133 --> 13:14.400 align:left position:15% line:71% size:75% so I'll try and make them as different as possible as I can 13:14.500 --> 13:16.933 align:left position:22.5% line:71% size:67.5% in using some analogies moving forward. 13:17.033 --> 13:18.933 align:left position:25% line:71% size:65% But really, these are important to understand 13:19.033 --> 13:21.533 align:left position:25% line:71% size:65% why we get outbreaks of influenza 13:21.633 --> 13:25.033 align:left position:20% line:71% size:70% and why we get outbreaks between continents of influenza. 13:27.600 --> 13:29.500 align:left position:27.5% line:71% size:62.5% So I'll first start with antigenic drift. 13:29.600 --> 13:32.400 align:left position:12.5% line:71% size:77.5% So this is a similar influenza virus that we saw before. 13:32.500 --> 13:35.366 align:left position:20% line:71% size:70% Instead, it's not opened, it's actually closed. 13:35.466 --> 13:37.466 align:left position:15% line:71% size:75% So you have the hemagglutinin and the neuraminidase 13:37.566 --> 13:38.733 align:left position:32.5% line:71% size:57.5% on the surface. 13:41.666 --> 13:43.200 align:left position:35% line:83% size:55% So like I had mentioned previously, 13:43.300 --> 13:45.200 align:left position:17.5% line:89% size:72.5% influenza is an RNA virus. 13:45.300 --> 13:48.033 align:left position:27.5% line:83% size:62.5% With an RNA virus, that virus is at risk 13:48.133 --> 13:50.200 align:left position:27.5% line:83% size:62.5% for having certain types of mutations. 13:50.300 --> 13:52.566 align:left position:25% line:83% size:65% It doesn't do a good job of proofreading 13:53.700 --> 13:56.666 align:left position:27.5% line:83% size:62.5% through any of the viruses that it makes. 13:56.766 --> 13:59.966 align:left position:30% line:83% size:60% It does not do a great job about it, 14:00.066 --> 14:02.433 align:left position:27.5% line:83% size:62.5% and so it can have certain mutations. 14:02.533 --> 14:04.100 align:left position:30% line:83% size:60% It can result in point mutations, 14:04.200 --> 14:05.933 align:left position:12.5% line:89% size:77.5% which is just a minor mutation 14:06.033 --> 14:08.366 align:left position:12.5% line:89% size:77.5% or a minor change that happens. 14:08.466 --> 14:10.833 align:left position:22.5% line:83% size:67.5% So when this happens on those surface proteins, 14:10.933 --> 14:13.733 align:left position:27.5% line:83% size:62.5% with hemagglutinin or neuraminidase, 14:13.833 --> 14:17.433 align:left position:22.5% line:83% size:67.5% what you get is a virus that is closely related 14:17.533 --> 14:20.566 align:left position:20% line:83% size:70% but not exactly the same as the initial virus. 14:20.666 --> 14:23.100 align:left position:30% line:83% size:60% So as you can see here, the neuraminidase 14:23.200 --> 14:26.333 align:left position:17.5% line:83% size:72.5% changed from this circular sort of flower structure 14:26.433 --> 14:29.166 align:left position:12.5% line:89% size:77.5% over to these squares overall. 14:29.266 --> 14:33.200 align:left position:20% line:83% size:70% So it's somewhat similar, but definitely has changed. 14:33.300 --> 14:35.366 align:left position:12.5% line:5% size:77.5% This can occur with influenza A 14:35.466 --> 14:38.233 align:left position:25% line:5% size:65% and it can occur with influenza B as well. 14:40.100 --> 14:42.666 align:left position:25% line:5% size:65% This is what leads to seasonal epidemics. 14:42.766 --> 14:45.933 align:left position:22.5% line:5% size:67.5% So you have your virus, it changes slightly, 14:46.033 --> 14:49.800 align:left position:25% line:5% size:65% but people still have some immunity to it, 14:49.900 --> 14:51.833 align:left position:30% line:5% size:60% then that's when you get your changes 14:51.933 --> 14:54.433 align:left position:27.5% line:5% size:62.5% and why the vaccine may not be the best fit 14:54.533 --> 14:57.200 align:left position:20% line:5% size:70% or why certain people are getting sick because of it. 14:58.700 --> 15:01.433 align:left position:20% line:5% size:70% So because it is closely related, like I had mentioned, 15:01.533 --> 15:02.700 align:left position:22.5% line:71% size:67.5% there is some immunity 15:02.800 --> 15:06.400 align:left position:25% line:71% size:65% and so people do have some cross-protection. 15:06.500 --> 15:07.833 align:left position:32.5% line:71% size:57.5% So there is... 15:07.933 --> 15:09.666 align:left position:30% line:71% size:60% Depending on how big the change is 15:09.766 --> 15:12.766 align:left position:17.5% line:71% size:72.5% really depends on how much protection you have circulating. 15:17.533 --> 15:19.933 align:left position:22.5% line:71% size:67.5% So we talked about the drift, minor change 15:20.033 --> 15:23.966 align:left position:15% line:71% size:75% leads to seasonal epidemics, occurs with influenza A, 15:24.066 --> 15:26.466 align:left position:12.5% line:71% size:77.5% and can occur with influenza B. 15:26.566 --> 15:28.966 align:left position:25% line:71% size:65% Now, we'll move onto antigenic shifts. 15:29.066 --> 15:30.466 align:left position:25% line:71% size:65% So antigenic shifts, 15:30.566 --> 15:32.833 align:left position:25% line:71% size:65% we'll start with the same influenza virus, 15:32.933 --> 15:35.833 align:left position:22.5% line:71% size:67.5% but now there's a major change in the virus. 15:35.933 --> 15:38.600 align:left position:20% line:71% size:70% So it's not just a small minor point mutation change, 15:38.700 --> 15:40.233 align:left position:27.5% line:71% size:62.5% it's a big change. 15:40.333 --> 15:41.933 align:left position:30% line:71% size:60% So really, you're completely changing 15:42.033 --> 15:43.666 align:left position:17.5% line:71% size:72.5% what the virus looks like. 15:43.766 --> 15:46.533 align:left position:25% line:5% size:65% So in this case, the hemagglutinin changes 15:46.633 --> 15:48.633 align:left position:25% line:5% size:65% from that blue color to a yellow color 15:48.733 --> 15:50.966 align:left position:10% line:5% size:80% and it's a completely new virus. 15:52.666 --> 15:55.133 align:left position:30% line:5% size:60% This occurs only with influenza A. 15:57.500 --> 16:00.433 align:left position:22.5% line:5% size:67.5% And this is what leads to novel or new viruses 16:00.533 --> 16:02.266 align:left position:20% line:5% size:70% that can cause pandemics. 16:03.666 --> 16:05.833 align:left position:22.5% line:5% size:67.5% The other part of this that is important to know 16:05.933 --> 16:08.966 align:left position:15% line:5% size:75% that, in order for these new viruses to cause pandemics, 16:09.066 --> 16:10.433 align:left position:15% line:71% size:75% it has to be really distinct 16:10.533 --> 16:14.100 align:left position:20% line:71% size:70% from any other previously circulating influenza viruses. 16:14.200 --> 16:17.333 align:left position:17.5% line:71% size:72.5% So the immunity to this new virus has to be very low 16:17.433 --> 16:20.800 align:left position:20% line:71% size:70% or none at all for it to actually cause a pandemic. 16:23.933 --> 16:26.366 align:left position:10% line:71% size:80% So how exactly does this happen? 16:26.466 --> 16:29.766 align:left position:17.5% line:83% size:72.5% How does an antigenic shift or those major changes happen? 16:29.866 --> 16:32.000 align:left position:30% line:83% size:60% There's two ways that have happened, 16:32.100 --> 16:34.533 align:left position:25% line:83% size:65% and I'll go over the history of some of this 16:34.633 --> 16:36.733 align:left position:20% line:83% size:70% and some of the pandemics that we've had in the past, 16:36.833 --> 16:38.733 align:left position:12.5% line:89% size:77.5% and which one fits into where. 16:38.833 --> 16:40.600 align:left position:32.5% line:83% size:57.5% But as I talked about with influenza A 16:40.700 --> 16:44.000 align:left position:22.5% line:83% size:67.5% on the previous slides, influenza A can infect animals 16:44.100 --> 16:46.100 align:left position:20% line:89% size:70% and it can infect humans, 16:46.200 --> 16:48.900 align:left position:25% line:83% size:65% so this is where the shifts become important. 16:49.000 --> 16:52.200 align:left position:17.5% line:83% size:72.5% So I'll start off and say I just made up these virus names. 16:52.300 --> 16:55.533 align:left position:20% line:83% size:70% They aren't actual names, but we'll start with the pig. 16:55.633 --> 17:02.666 align:left position:17.5% line:83% size:72.5% So he has HpNp, the chicken has HcNc, the duck has HdNd, 17:02.766 --> 17:05.966 align:left position:15% line:89% size:75% and then the human has HhNh. 17:06.066 --> 17:09.733 align:left position:20% line:83% size:70% So what happens is these viruses normally circulate. 17:09.833 --> 17:13.033 align:left position:15% line:83% size:75% Some of the animals may have symptoms, most of them don't, 17:13.133 --> 17:15.833 align:left position:20% line:83% size:70% so no one knows that they actually have these viruses. 17:15.933 --> 17:19.033 align:left position:20% line:83% size:70% And then, somehow there's a change in transmission 17:19.133 --> 17:22.200 align:left position:25% line:83% size:65% and it goes from the animals to the human. 17:23.800 --> 17:26.033 align:left position:17.5% line:83% size:72.5% Okay, so this is not like, let's use for an example, 17:26.133 --> 17:28.533 align:left position:25% line:83% size:65% the pig one, so HpNp, is not something 17:28.633 --> 17:31.033 align:left position:20% line:83% size:70% that normally circulates in humans but somehow, 17:31.133 --> 17:33.333 align:left position:27.5% line:83% size:62.5% someone was working closely with pigs 17:33.433 --> 17:36.300 align:left position:17.5% line:83% size:72.5% or was exposed to the virus when working with pigs 17:36.400 --> 17:39.300 align:left position:20% line:83% size:70% or eating pigs, and then the human gets the virus. 17:40.433 --> 17:42.133 align:left position:30% line:83% size:60% This is something that's called spillover, 17:42.233 --> 17:44.333 align:left position:25% line:83% size:65% so it's spilling over from the animal population 17:44.433 --> 17:46.166 align:left position:17.5% line:89% size:72.5% into the human population. 17:46.266 --> 17:48.166 align:left position:27.5% line:83% size:62.5% So you may see that word over and over again 17:48.266 --> 17:51.366 align:left position:10% line:83% size:80% when people talk about outbreaks of respiratory viruses. 17:53.666 --> 17:57.133 align:left position:27.5% line:83% size:62.5% In order for these viruses to go from the pig 17:57.233 --> 17:59.733 align:left position:27.5% line:83% size:62.5% to the human and to actually infect the humans, 17:59.833 --> 18:02.300 align:left position:25% line:83% size:65% there's other things that need to happen 18:02.400 --> 18:04.966 align:left position:22.5% line:83% size:67.5% in order for that virus to cause pandemics 18:05.066 --> 18:07.500 align:left position:27.5% line:83% size:62.5% or to cause massive outbreaks of them. 18:08.500 --> 18:10.233 align:left position:22.5% line:83% size:67.5% The virus itself needs to be able to survive 18:10.333 --> 18:11.633 align:left position:17.5% line:89% size:72.5% and replicate in the human. 18:11.733 --> 18:13.533 align:left position:22.5% line:83% size:67.5% So it did a really good job about surviving 18:13.633 --> 18:15.233 align:left position:15% line:89% size:75% and replicating in that pig, 18:15.333 --> 18:17.066 align:left position:30% line:83% size:60% but now it's in a completely different host 18:17.166 --> 18:19.533 align:left position:20% line:83% size:70% with completely different receptors for things. 18:19.633 --> 18:22.933 align:left position:12.5% line:71% size:77.5% And so that's really important is if that virus can adapt 18:23.033 --> 18:26.533 align:left position:25% line:71% size:65% or change to actually have that survival. 18:26.633 --> 18:28.166 align:left position:10% line:71% size:80% Like I had mentioned previously, 18:28.266 --> 18:32.000 align:left position:20% line:71% size:70% the human has to have no previous or very low immunity 18:32.100 --> 18:35.666 align:left position:20% line:71% size:70% to this virus, otherwise their body would take over 18:35.766 --> 18:38.266 align:left position:30% line:71% size:60% and get protected with antibodies. 18:38.366 --> 18:40.633 align:left position:22.5% line:71% size:67.5% And then, in addition, in order for it to pass 18:40.733 --> 18:43.033 align:left position:15% line:71% size:75% from one person to the next, you need to have the virus 18:43.133 --> 18:46.200 align:left position:20% line:71% size:70% be able to be transmitted from humans to humans. 18:46.300 --> 18:48.633 align:left position:20% line:71% size:70% So not only does it have to be a spillover event, 18:48.733 --> 18:50.966 align:left position:22.5% line:71% size:67.5% there's all these other factors that need to happen 18:51.066 --> 18:52.700 align:left position:15% line:71% size:75% in order to cause pandemics. 18:54.633 --> 18:57.033 align:left position:22.5% line:71% size:67.5% The pig is very unique in this situation 18:57.133 --> 19:00.166 align:left position:32.5% line:71% size:57.5% because it has respiratory receptors 19:00.266 --> 19:03.233 align:left position:32.5% line:71% size:57.5%   for both the avian influenza, so the bird influenza, 19:03.333 --> 19:06.666 align:left position:12.5% line:89% size:77.5% as well as the human influenza, 19:06.766 --> 19:09.933 align:left position:20% line:89% size:70% so it really facilitates 19:10.033 --> 19:12.700 align:left position:17.5% line:83% size:72.5% some of these interspecies transmissions. 19:14.033 --> 19:17.466 align:left position:22.5% line:5% size:67.5% And where that becomes important is this second method 19:17.566 --> 19:20.200 align:left position:30% line:5% size:60% of how antigenic shift can happen. 19:20.300 --> 19:22.400 align:left position:32.5% line:5% size:57.5% It's something called reassortment. 19:22.500 --> 19:25.900 align:left position:20% line:5% size:70% So reassortment means, if we look in the middle here, 19:26.000 --> 19:29.766 align:left position:20% line:5% size:70% that the pig was infected with multiple viruses, 19:29.866 --> 19:35.033 align:left position:20% line:5% size:70% so from the human, from a previous pig, from a bird, 19:36.033 --> 19:38.266 align:left position:27.5% line:5% size:62.5% and then within the genome of the pig, 19:38.366 --> 19:40.600 align:left position:25% line:5% size:65% it recombines all of these genetic material 19:40.700 --> 19:42.600 align:left position:22.5% line:5% size:67.5% and makes a new virus. 19:43.600 --> 19:45.333 align:left position:17.5% line:5% size:72.5% Then that new virus can go 19:45.433 --> 19:48.066 align:left position:27.5% line:5% size:62.5% and combined again with another virus, 19:48.166 --> 19:50.300 align:left position:32.5% line:5% size:57.5% and then create another new virus, 19:50.400 --> 19:53.733 align:left position:32.5% line:5% size:57.5% and then it can switch over to humans. 19:53.833 --> 19:57.666 align:left position:15% line:5% size:75% So this example here is what caused the 2009 outbreak 19:58.800 --> 20:01.866 align:left position:27.5% line:5% size:62.5% with H1N1, referred to as swine flu, 20:01.966 --> 20:04.033 align:left position:25% line:5% size:65% and so what happened in this situation 20:04.133 --> 20:07.133 align:left position:22.5% line:5% size:67.5% is that there were two different swine species 20:07.233 --> 20:09.833 align:left position:17.5% line:5% size:72.5% that were involved, so you have the Eurasian swine, 20:09.933 --> 20:12.533 align:left position:30% line:5% size:60% which are located in Europe and Asia, 20:12.633 --> 20:14.233 align:left position:27.5% line:5% size:62.5% you have your North American swine, 20:14.333 --> 20:16.000 align:left position:30% line:5% size:60% which are located in North America, 20:16.100 --> 20:18.700 align:left position:22.5% line:5% size:67.5% and then you have this previous combination with human 20:18.800 --> 20:20.933 align:left position:27.5% line:71% size:62.5% and avian species. 20:21.033 --> 20:24.633 align:left position:17.5% line:71% size:72.5% So overall, there were four different species involved 20:24.733 --> 20:29.700 align:left position:15% line:71% size:75% with it that really produced this novel or new H1N1 virus. 20:31.666 --> 20:33.466 align:left position:12.5% line:71% size:77.5% So this is called reassortment. 20:33.566 --> 20:34.900 align:left position:15% line:71% size:75% The thing about reassortment 20:35.000 --> 20:37.433 align:left position:27.5% line:71% size:62.5% is that it doesn't always lead to pandemics. 20:37.533 --> 20:39.633 align:left position:27.5% line:71% size:62.5% So reassortment can happen, we may not know 20:39.733 --> 20:41.400 align:left position:25% line:71% size:65% that it's happening, and as long as people 20:41.500 --> 20:44.233 align:left position:25% line:71% size:65% are not getting sick or not dying from it, 20:44.333 --> 20:45.866 align:left position:22.5% line:71% size:67.5% we still wouldn't know. 20:45.966 --> 20:48.266 align:left position:30% line:71% size:60% So a lot of this happens within animals 20:48.366 --> 20:49.966 align:left position:20% line:71% size:70% and we are unaware of it. 20:54.033 --> 20:56.633 align:left position:12.5% line:83% size:77.5% So this looks at the different pandemics throughout history. 20:56.733 --> 20:59.533 align:left position:12.5% line:89% size:77.5% So we've had four total so far, 21:01.000 --> 21:04.933 align:left position:17.5% line:83% size:72.5% the first one starting with the 1918 Spanish influenza. 21:05.033 --> 21:07.933 align:left position:25% line:83% size:65% So what is predicted happened in that situation 21:08.033 --> 21:10.300 align:left position:25% line:83% size:65% was that first method I had talked about. 21:10.400 --> 21:12.766 align:left position:22.5% line:83% size:67.5% So all of these are big shifts that happened 21:12.866 --> 21:16.466 align:left position:25% line:83% size:65% that causes the major mutations to cause a new virus 21:16.566 --> 21:18.700 align:left position:25% line:89% size:65% and cause pandemics. 21:18.800 --> 21:21.233 align:left position:25% line:83% size:65% With the 1918 Spanish influenza, what happened 21:21.333 --> 21:25.000 align:left position:15% line:83% size:75% is that there were birds that then transmitted their virus 21:25.100 --> 21:28.266 align:left position:25% line:83% size:65% that humans had never seen before, to humans. 21:29.466 --> 21:32.066 align:left position:27.5% line:83% size:62.5% And then, it caused a massive outbreak 21:32.166 --> 21:34.033 align:left position:15% line:89% size:75% where 50 million people died 21:34.133 --> 21:36.266 align:left position:10% line:89% size:80% with the 1918 Spanish influenza. 21:37.966 --> 21:41.200 align:left position:25% line:83% size:65% Then, with the second outbreak in 1957, 21:41.300 --> 21:43.566 align:left position:27.5% line:83% size:62.5% referred to as the Asian influenza, 21:43.666 --> 21:45.133 align:left position:10% line:89% size:80% this involved that reassortment, 21:45.233 --> 21:46.966 align:left position:32.5% line:83% size:57.5% so that second method I talked about 21:47.066 --> 21:49.300 align:left position:25% line:83% size:65% where there is mixing of the genetic material 21:49.400 --> 21:51.366 align:left position:17.5% line:89% size:72.5% to make these new viruses. 21:51.466 --> 21:54.100 align:left position:25% line:83% size:65% But this involved an avian influenza strain 21:54.200 --> 21:56.866 align:left position:27.5% line:83% size:62.5% as well as a human influenza strain 21:56.966 --> 21:59.866 align:left position:22.5% line:89% size:67.5% to cause H2N2 pandemic. 22:01.400 --> 22:02.866 align:left position:20% line:89% size:70% The third outbreak, here, 22:02.966 --> 22:07.600 align:left position:25% line:83% size:65% is the 1968 Hong Kong influenza pandemic. 22:07.700 --> 22:10.000 align:left position:30% line:83% size:60% And this one also had reassortment 22:10.100 --> 22:12.000 align:left position:22.5% line:89% size:67.5% of the avian influenza 22:12.100 --> 22:15.333 align:left position:22.5% line:83% size:67.5% and the human influenza that exchanged material, 22:15.433 --> 22:17.533 align:left position:27.5% line:89% size:62.5% resulting in H3N2. 22:19.133 --> 22:20.333 align:left position:27.5% line:83% size:62.5% The last pandemic, and the reason 22:20.433 --> 22:23.133 align:left position:25% line:83% size:65% why it's not on this particular article 22:23.233 --> 22:25.666 align:left position:25% line:83% size:65% is that this article was written in 2005, 22:25.766 --> 22:29.000 align:left position:20% line:83% size:70% and so the 2009 pandemic was not on that one, 22:29.100 --> 22:30.633 align:left position:25% line:83% size:65% so we had previously talked about that, 22:30.733 --> 22:32.966 align:left position:35% line:83% size:55% that was that quadruple reassortment 22:33.066 --> 22:36.133 align:left position:17.5% line:83% size:72.5% with two different swines, an avian, and a human 22:36.233 --> 22:39.066 align:left position:27.5% line:83% size:62.5% that then resulted in this new H1N1. 22:44.366 --> 22:47.900 align:left position:15% line:83% size:75% For now, your next question, I assume, is gonna be, 22:48.000 --> 22:49.500 align:left position:10% line:89% size:80% "Okay, well, what does this mean 22:49.600 --> 22:53.133 align:left position:15% line:83% size:75% "and can we predict when the next pandemic is gonna happen?" 22:54.366 --> 22:56.500 align:left position:17.5% line:71% size:72.5% There are a lot of experts that are trying to do 22:56.600 --> 22:57.866 align:left position:22.5% line:71% size:67.5% that exact same thing, 22:57.966 --> 23:00.733 align:left position:22.5% line:71% size:67.5% to try and predict what exactly is gonna happen 23:00.833 --> 23:04.766 align:left position:22.5% line:71% size:67.5% and to try and come up with antiviral medications, 23:04.866 --> 23:06.566 align:left position:10% line:71% size:80% to try and come up with vaccines 23:06.666 --> 23:09.400 align:left position:20% line:71% size:70% that can actually protect against some of this. 23:09.500 --> 23:13.000 align:left position:17.5% line:71% size:72.5% Overall, experts are really focusing on the avian influenza 23:13.100 --> 23:15.866 align:left position:22.5% line:71% size:67.5% and their concern about the avian influenza 23:15.966 --> 23:18.200 align:left position:30% line:71% size:60% actually causing the next pandemic. 23:18.300 --> 23:20.733 align:left position:27.5% line:71% size:62.5% And the reason for this has to do with, 23:20.833 --> 23:23.500 align:left position:27.5% line:71% size:62.5% there's two current strains of avian influenza 23:23.600 --> 23:27.166 align:left position:22.5% line:71% size:67.5% that have actually gone to humans at this point. 23:27.266 --> 23:31.333 align:left position:30% line:71% size:60% The first one is something called H5N1. 23:31.433 --> 23:36.133 align:left position:30% line:71% size:60%   So H5N1 started to become present in 1994 23:36.233 --> 23:38.500 align:left position:22.5% line:83% size:67.5% when they first noticed that there was a new strain 23:38.600 --> 23:41.466 align:left position:32.5% line:83% size:57.5% in humans when someone got very sick, 23:41.566 --> 23:42.866 align:left position:15% line:89% size:75% and they've been tracking it. 23:42.966 --> 23:44.933 align:left position:12.5% line:83% size:77.5% It's kind of spread throughout different continents. 23:45.033 --> 23:47.366 align:left position:15% line:83% size:75% It's been present in Europe, it's been present in Asia, 23:47.466 --> 23:49.300 align:left position:30% line:83% size:60% it's been present in North America. 23:50.766 --> 23:54.200 align:left position:12.5% line:83% size:77.5% The thing about this one is it causes very severe infection, 23:54.300 --> 23:56.466 align:left position:25% line:83% size:65% and the case fatality rates are quite high. 23:56.566 --> 23:58.566 align:left position:25% line:83% size:65% So the case vitality rates are 53%, 23:58.666 --> 24:02.133 align:left position:15% line:83% size:75% which means 53% of the people that get this infection 24:02.233 --> 24:04.066 align:left position:15% line:89% size:75% are dying from the infection. 24:05.500 --> 24:09.100 align:left position:15% line:83% size:75% So for perspective-wise, the normal seasonal influenza, 24:09.200 --> 24:12.933 align:left position:22.5% line:83% size:67.5% it varies a little bit by year, but it's 0.1%. 24:13.033 --> 24:17.933 align:left position:15% line:83% size:75% Okay, coronavirus right now, the novel coronavirus COVID-19, 24:18.033 --> 24:21.500 align:left position:32.5% line:83% size:57.5% is predicted to be about 3 to 4%. 24:21.600 --> 24:24.666 align:left position:17.5% line:83% size:72.5% So when we're talking about 53% case fatality rate, 24:24.766 --> 24:28.466 align:left position:20% line:89% size:70% that is incredibly high. 24:28.566 --> 24:31.300 align:left position:25% line:71% size:65% The other interesting thing about this H5N1 24:31.400 --> 24:35.200 align:left position:20% line:71% size:70% is that the median age is very young at 20 years of age, 24:36.466 --> 24:37.700 align:left position:27.5% line:71% size:62.5% which is something that has happened 24:37.800 --> 24:39.533 align:left position:20% line:71% size:70% with previous pandemics, and I'll go into that 24:39.633 --> 24:41.366 align:left position:22.5% line:71% size:67.5% a little bit more when we talk about immunity 24:41.466 --> 24:43.133 align:left position:27.5% line:71% size:62.5% moving forward, but it's really hitting 24:43.233 --> 24:46.800 align:left position:22.5% line:71% size:67.5% the younger populations with this type of virus. 24:48.166 --> 24:50.233 align:left position:17.5% line:71% size:72.5% The thing about this virus, though, is that people 24:50.333 --> 24:53.133 align:left position:20% line:71% size:70% that have been infected, they've been able to track 24:53.233 --> 24:58.466 align:left position:30% line:71% size:60% that they've had exposure to ill poultry 24:58.566 --> 25:01.400 align:left position:25% line:71% size:65% about one week prior to their onset. 25:01.500 --> 25:04.666 align:left position:22.5% line:71% size:67.5% So really, the control of this virus has been 25:04.766 --> 25:07.833 align:left position:22.5% line:71% size:67.5% monitoring poultry and mass killing of poultry 25:07.933 --> 25:11.233 align:left position:25% line:71% size:65% when they demonstrate any symptoms. 25:11.333 --> 25:13.366 align:left position:25% line:71% size:65% In addition to that, farmers are testing 25:13.466 --> 25:17.766 align:left position:17.5% line:71% size:72.5% a lot of their chickens or poultry for this type of virus, 25:17.866 --> 25:22.866 align:left position:15% line:71% size:75% and then will proceed to kill that whole area of chickens. 25:26.066 --> 25:28.633 align:left position:27.5% line:71% size:62.5% The second one that also is concerning 25:28.733 --> 25:34.233 align:left position:20% line:71% size:70% is something called H7N9, and this has caused outbreaks 25:34.333 --> 25:35.500 align:left position:35% line:89% size:55% within China. 25:37.400 --> 25:39.333 align:left position:22.5% line:83% size:67.5% The case fatality with this one, as well, 25:39.433 --> 25:40.866 align:left position:25% line:89% size:65% is quite high at 30%. 25:40.966 --> 25:44.666 align:left position:20% line:83% size:70% The median age is older, about 60 years of age. 25:44.766 --> 25:47.800 align:left position:22.5% line:83% size:67.5% But the reason why this one is such a concern, 25:47.900 --> 25:50.500 align:left position:27.5% line:83% size:62.5% in addition to the case fatality rates, 25:50.600 --> 25:54.233 align:left position:35% line:83% size:55% is that it is resistant to Tamiflu. 25:54.333 --> 25:57.966 align:left position:22.5% line:83% size:67.5% So Tamiflu is the main antiviral medication 25:58.066 --> 26:02.400 align:left position:17.5% line:83% size:72.5% we use to treat and to use as prophylaxis for influenza, 26:02.500 --> 26:04.033 align:left position:12.5% line:89% size:77.5% and a lot of the other viruses 26:04.133 --> 26:06.633 align:left position:32.5% line:83% size:57.5% have not shown resistance to Tamiflu. 26:06.733 --> 26:08.566 align:left position:32.5% line:83% size:57.5% That's why it's so routinely used, 26:08.666 --> 26:10.900 align:left position:17.5% line:83% size:72.5% but this one in particular has shown resistance, 26:11.000 --> 26:12.833 align:left position:17.5% line:89% size:72.5% which is really concerning 26:12.933 --> 26:14.733 align:left position:25% line:83% size:65% when you don't have a lot of other options 26:14.833 --> 26:17.300 align:left position:25% line:83% size:65% to treat people with for their influenza. 26:17.400 --> 26:21.633 align:left position:12.5% line:83% size:77.5% And so the CDC and the WHO have actually labeled this virus 26:21.733 --> 26:25.066 align:left position:15% line:83% size:75% as the highest potential for pandemic risk in the future. 26:26.266 --> 26:29.500 align:left position:27.5% line:83% size:62.5% Luckily, this virus has incredibly poor 26:29.600 --> 26:31.800 align:left position:15% line:89% size:75% human to human transmission. 26:31.900 --> 26:36.800 align:left position:20% line:83% size:70% So people can get it from interactions with a poultry 26:36.900 --> 26:41.033 align:left position:25% line:83% size:65% or a chicken that has this type of virus, 26:41.133 --> 26:43.133 align:left position:25% line:83% size:65% but really, it's not transmitting from one person 26:43.233 --> 26:46.800 align:left position:17.5% line:83% size:72.5% to the next, so there's no further spread that's happening, 26:46.900 --> 26:48.033 align:left position:17.5% line:89% size:72.5% which is really important. 26:48.133 --> 26:50.200 align:left position:27.5% line:83% size:62.5% - Attendee: Is that true of H5N1 as well? 26:50.300 --> 26:53.466 align:left position:20% line:83% size:70% - H5N1 has a lower human to human transmission. 26:53.566 --> 26:55.066 align:left position:30% line:89% size:60% It's not as much. 26:55.166 --> 27:00.066 align:left position:22.5% line:83% size:67.5% There's about 860 cases total from 2013 to 2018 27:00.166 --> 27:01.400 align:left position:25% line:89% size:65% that have been there, 27:01.500 --> 27:04.033 align:left position:17.5% line:83% size:72.5% so it's a pretty poor human to human transmission. 27:05.766 --> 27:08.366 align:left position:20% line:83% size:70% But the concerning thing with these avian influenza 27:08.466 --> 27:10.533 align:left position:20% line:83% size:70% is, like I talked about, if they go through 27:10.633 --> 27:13.600 align:left position:17.5% line:89% size:72.5% any major antigenic shifts, 27:13.700 --> 27:16.600 align:left position:30% line:83% size:60% that can increase their transmissibility 27:16.700 --> 27:20.266 align:left position:17.5% line:83% size:72.5% or make their transmission from humans to humans better, 27:20.366 --> 27:22.933 align:left position:22.5% line:83% size:67.5% then that's where this gets really concerning. 27:23.033 --> 27:26.033 align:left position:17.5% line:71% size:72.5% A lot of these patients end up in intensive care units, 27:26.133 --> 27:28.166 align:left position:30% line:71% size:60% have very severe pulmonary problems, 27:28.266 --> 27:30.500 align:left position:30% line:71% size:60% and then the high case fatality rates. 27:30.600 --> 27:33.533 align:left position:25% line:71% size:65% So that's why this is a very concerning area 27:33.633 --> 27:35.033 align:left position:20% line:71% size:70% in regards to influenza. 27:37.400 --> 27:40.066 align:left position:20% line:71% size:70% So I know I told you that these words sound the same 27:40.166 --> 27:43.066 align:left position:17.5% line:71% size:72.5% and you may have heard me, and they kind of blur together 27:43.166 --> 27:45.166 align:left position:30% line:71% size:60% when I talk about drift and shift, 27:46.166 --> 27:47.866 align:left position:25% line:71% size:65% so I thought I would give you an example 27:47.966 --> 27:51.066 align:left position:17.5% line:71% size:72.5% to take it home to try and really give you a better idea 27:51.166 --> 27:52.566 align:left position:20% line:71% size:70% about remembering these. 27:52.666 --> 27:55.966 align:left position:17.5% line:71% size:72.5% So antigenic drift, imagine you're on a lazy river, right? 27:56.066 --> 27:58.200 align:left position:22.5% line:5% size:67.5% So you're on the tube, you're just drifting along, 27:58.300 --> 28:00.966 align:left position:17.5% line:5% size:72.5% you're drifting along, and then you get stuck on the side 28:01.066 --> 28:03.666 align:left position:17.5% line:5% size:72.5% because there's a big bunch of people that are coming by 28:03.766 --> 28:05.966 align:left position:27.5% line:5% size:62.5% and you get pushed out of the way. 28:06.066 --> 28:09.600 align:left position:15% line:5% size:75% So your tube goes in a little bit, shifts a little bit, 28:09.700 --> 28:12.133 align:left position:17.5% line:5% size:72.5% but in the end, you end up in the same spot, right? 28:12.233 --> 28:14.833 align:left position:25% line:5% size:65% So you have a little bit of a drift, 28:14.933 --> 28:17.866 align:left position:25% line:5% size:65% but you still end up where you wanted to be. 28:17.966 --> 28:20.733 align:left position:12.5% line:5% size:77.5% This happens with influenza A, and it happens with B, 28:20.833 --> 28:23.100 align:left position:20% line:5% size:70% and this is what leads to your seasonal epidemics. 28:23.200 --> 28:26.433 align:left position:12.5% line:5% size:77.5% So if you think about it, when you got stuck in that area, 28:26.533 --> 28:28.400 align:left position:27.5% line:5% size:62.5% you're close to the people that you're around 28:28.500 --> 28:30.066 align:left position:17.5% line:5% size:72.5% in that local environment. 28:30.166 --> 28:32.433 align:left position:25% line:5% size:65% You can transmit that virus in that point, 28:32.533 --> 28:34.533 align:left position:22.5% line:5% size:67.5% but then you go back to your normal lazy river 28:34.633 --> 28:36.200 align:left position:15% line:5% size:75% once the crowding goes away. 28:38.533 --> 28:41.933 align:left position:12.5% line:5% size:77.5% Antigenic shift, you can think about it as a gear shift. 28:42.033 --> 28:43.933 align:left position:27.5% line:5% size:62.5% So as you shift the gear, you're ending up 28:44.033 --> 28:45.333 align:left position:20% line:5% size:70% in a different location, 28:45.433 --> 28:47.066 align:left position:25% line:5% size:65% or you're going in a different direction. 28:47.166 --> 28:49.566 align:left position:27.5% line:5% size:62.5% So this is a major change from your endpoint 28:49.666 --> 28:50.933 align:left position:22.5% line:5% size:67.5% that you initially had, 28:51.033 --> 28:52.633 align:left position:30% line:5% size:60% or your starting point, I should say. 28:52.733 --> 28:54.800 align:left position:10% line:5% size:80% And this occurs with influenza A 28:54.900 --> 28:57.000 align:left position:30% line:5% size:60% and this is what leads to pandemics. 29:01.066 --> 29:04.233 align:left position:17.5% line:71% size:72.5% All right, we talked about the viral properties, 29:04.333 --> 29:06.233 align:left position:25% line:71% size:65% the surface antigens, the neuraminidase, 29:06.333 --> 29:07.633 align:left position:27.5% line:71% size:62.5% the hemagglutinin. 29:07.733 --> 29:11.033 align:left position:15% line:71% size:75% We talked about the antigenic shift and antigenic drift. 29:11.133 --> 29:12.400 align:left position:10% line:71% size:80% Now, we'll go onto transmission. 29:12.500 --> 29:14.333 align:left position:22.5% line:71% size:67.5% So I already previously talked about the animal 29:14.433 --> 29:16.966 align:left position:25% line:71% size:65% to human transmission and why that's important 29:17.066 --> 29:18.933 align:left position:20% line:71% size:70% in regards to influenza, 29:19.033 --> 29:22.466 align:left position:20% line:71% size:70% and now I'll focus on the human to human transmission. 29:22.566 --> 29:25.033 align:left position:15% line:71% size:75% So I'll start with droplets. 29:26.566 --> 29:28.900 align:left position:25% line:71% size:65% So let's say you have your infected person 29:29.000 --> 29:32.066 align:left position:20% line:71% size:70% that has influenza here, and they're coughing, 29:32.166 --> 29:33.866 align:left position:20% line:71% size:70%   and they're sneezing, and everything is going 29:33.966 --> 29:36.433 align:left position:20% line:83% size:70% all over the place 'cause they try to control it, 29:36.533 --> 29:39.133 align:left position:17.5% line:83% size:72.5% but as you know and you've seen in some of those videos, 29:39.233 --> 29:41.933 align:left position:20% line:83% size:70% the snot goes everywhere, and it's quite disturbing. 29:43.300 --> 29:46.533 align:left position:12.5% line:83% size:77.5% And with that, they're carrying influenza virus particles. 29:46.633 --> 29:49.266 align:left position:22.5% line:83% size:67.5% So the influenza virus particles get into the air, 29:49.366 --> 29:52.133 align:left position:17.5% line:83% size:72.5% and these are all different ways that infectious disease 29:52.233 --> 29:54.033 align:left position:27.5% line:89% size:62.5% can be transmitted. 29:54.133 --> 29:58.733 align:left position:15% line:83% size:75% So with influenza itself, it tends to be larger droplets. 29:58.833 --> 30:01.066 align:left position:27.5% line:83% size:62.5% So instead of these smaller droplet nuclei 30:01.166 --> 30:04.566 align:left position:12.5% line:83% size:77.5% that you can see here, they're really larger droplets. 30:04.666 --> 30:08.000 align:left position:15% line:83% size:75% So what that means is larger droplets can't stay in the air 30:08.100 --> 30:10.900 align:left position:17.5% line:83% size:72.5% for a long period of time, so you have to be quite close 30:11.000 --> 30:15.100 align:left position:22.5% line:83% size:67.5% to a person in order to actually transmit influenza. 30:15.200 --> 30:17.400 align:left position:20% line:83% size:70% Some of the other things, like tuberculosis, 30:17.500 --> 30:21.133 align:left position:27.5% line:83% size:62.5% which is airborne, so these tiny nuclei, 30:21.233 --> 30:23.533 align:left position:20% line:83% size:70% they can stay in the air for a longer period of time 30:23.633 --> 30:25.333 align:left position:20% line:89% size:70% and go further distances. 30:28.400 --> 30:30.600 align:left position:27.5% line:83% size:62.5% So let's put these two people in a bubble 30:30.700 --> 30:33.066 align:left position:17.5% line:83% size:72.5% and let's say, "Okay, what does that mean, really, 30:33.166 --> 30:34.300 align:left position:32.5% line:89% size:57.5% "in real time?" 30:34.400 --> 30:36.666 align:left position:10% line:89% size:80% The infected individual sneezes. 30:36.766 --> 30:39.733 align:left position:12.5% line:83% size:77.5% How close does the susceptible individual need to be 30:39.833 --> 30:41.866 align:left position:25% line:83% size:65% in order to actually transmit the virus? 30:41.966 --> 30:44.666 align:left position:20% line:83% size:70% And a lot of studies have been done about this, 30:44.766 --> 30:47.000 align:left position:15% line:89% size:75% and what they have found out 30:47.100 --> 30:49.833 align:left position:25% line:83% size:65% is that it's between three to six feet, 30:49.933 --> 30:51.666 align:left position:15% line:89% size:75% so it has to be quite close. 30:51.766 --> 30:55.833 align:left position:15% line:83% size:75% It's not always super close, but it's a pretty close contact 30:55.933 --> 30:57.433 align:left position:12.5% line:89% size:77.5% within that three to six feet. 30:59.233 --> 31:02.133 align:left position:25% line:83% size:65% The other areas that influenza has been shown, 31:02.233 --> 31:05.166 align:left position:25% line:83% size:65% although they're very lower on the list 31:05.266 --> 31:08.300 align:left position:25% line:83% size:65% of being transmitted, is direct contact. 31:08.400 --> 31:11.500 align:left position:22.5% line:83% size:67.5% So direct contact means that you have direct contact 31:11.600 --> 31:14.966 align:left position:12.5% line:83% size:77.5% with that infectious particle, so if you're sitting close 31:15.066 --> 31:19.466 align:left position:17.5% line:71% size:72.5% to that person within that distance, and they sneeze, 31:19.566 --> 31:22.466 align:left position:22.5% line:71% size:67.5% and then you grab their Kleenex, and now you have, 31:22.566 --> 31:24.466 align:left position:17.5% line:71% size:72.5% I don't know why you would grab their Kleenex but, 31:24.566 --> 31:26.500 align:left position:32.5% line:71% size:57.5% [all chuckling] you, 31:26.600 --> 31:28.700 align:left position:15% line:71% size:75% if it's a family member, you don't think about these things, 31:28.800 --> 31:31.766 align:left position:17.5% line:71% size:72.5% so you grab their Kleenex, now you have influenza virus, 31:31.866 --> 31:34.566 align:left position:17.5% line:71% size:72.5% potentially, on your hand, and then we touch our faces 31:34.666 --> 31:36.833 align:left position:22.5% line:71% size:67.5% a lot, I don't know if you guys have ever done 31:36.933 --> 31:39.700 align:left position:20% line:71% size:70% the experiments about how many times you touch your face 31:39.800 --> 31:42.000 align:left position:22.5% line:71% size:67.5% within a day or within a short period of time. 31:42.100 --> 31:43.200 align:left position:37.5% line:71% size:52.5% It's a lot. 31:43.300 --> 31:45.000 align:left position:30% line:71% size:60% And so, what you would do is you have 31:45.100 --> 31:46.600 align:left position:30% line:71% size:60% those infectious particles on your hand, 31:46.700 --> 31:48.400 align:left position:20% line:71% size:70% you then touch your nose, you touch your mouth, 31:48.500 --> 31:51.300 align:left position:15% line:71% size:75% you touch your eye, and then the virus particles are there. 31:51.400 --> 31:54.700 align:left position:22.5% line:71% size:67.5% Again, this is a lower risk of transmission, 31:54.800 --> 31:56.400 align:left position:20% line:71% size:70% but it's still possible. 31:57.400 --> 31:59.166 align:left position:27.5% line:71% size:62.5% Indirect contact is what we deal with a lot 31:59.266 --> 32:01.866 align:left position:27.5% line:71% size:62.5% in the hospital, so indirect contact has to do 32:01.966 --> 32:06.666 align:left position:22.5% line:71% size:67.5% with the person that's infected sneezes on their hand, 32:06.766 --> 32:11.600 align:left position:17.5% line:71% size:72.5% they touch an object, they walk away, you would come up, 32:11.700 --> 32:14.866 align:left position:25% line:71% size:65% you touch that object within a shorter time frame, 32:14.966 --> 32:17.433 align:left position:22.5% line:71% size:67.5% and you would then have influenza on your hand, 32:17.533 --> 32:19.733 align:left position:20% line:71% size:70% and then touch your nose, or your eye, or your mouth 32:19.833 --> 32:21.000 align:left position:25% line:71% size:65% in those situations. 32:22.866 --> 32:25.200 align:left position:30% line:71% size:60% So these are all important to understand, 32:25.300 --> 32:28.600 align:left position:25% line:71% size:65% and a lot of studies have gone into this 32:28.700 --> 32:31.566 align:left position:27.5% line:71% size:62.5% because of hospital situations and precautions 32:31.666 --> 32:34.133 align:left position:17.5% line:71% size:72.5% that need to be preventing hospital outbreak. 32:34.233 --> 32:35.766 align:left position:17.5% line:71% size:72.5%   So I had to show one gross picture 32:35.866 --> 32:37.000 align:left position:47.5% line:83% size:42.5% of, [audience chuckling] 32:37.100 --> 32:38.633 align:left position:30% line:83% size:60% there's a lot of 'em on the internet, 32:38.733 --> 32:42.066 align:left position:17.5% line:83% size:72.5% but I had to show one gross picture of someone snotty. 32:42.166 --> 32:44.833 align:left position:20% line:83% size:70% So now let's go through, now that we talked about 32:44.933 --> 32:48.600 align:left position:15% line:71% size:75% how you can get transmission, we have these infected people 32:48.700 --> 32:52.633 align:left position:20% line:71% size:70% with influenza, they can transmit influenza virus 32:52.733 --> 32:55.366 align:left position:25% line:71% size:65% anywhere from one day before their symptoms 32:55.466 --> 32:58.600 align:left position:27.5% line:71% size:62.5% to seven days after their symptoms, okay? 32:58.700 --> 33:00.866 align:left position:20% line:71% size:70% So the one day before the symptoms is something important 33:00.966 --> 33:04.033 align:left position:15% line:71% size:75% to keep in mind, because they don't know that they're sick 33:04.133 --> 33:06.866 align:left position:25% line:71% size:65% at that point, and so they can transmit it. 33:06.966 --> 33:09.933 align:left position:15% line:71% size:75% The highest transmission rate is really three to four days 33:10.033 --> 33:11.533 align:left position:20% line:71% size:70% after the symptom onset. 33:13.133 --> 33:16.766 align:left position:17.5% line:5% size:72.5% So they cough or sneeze and a susceptible individual 33:16.866 --> 33:19.333 align:left position:17.5% line:5% size:72.5% is within six feet of that. 33:19.433 --> 33:20.533 align:left position:25% line:5% size:65% So then what happens? 33:20.633 --> 33:22.166 align:left position:32.5% line:5% size:57.5% So once it gets coughed and sneeze, 33:22.266 --> 33:25.033 align:left position:17.5% line:5% size:72.5% the susceptible individual then gets that viral particle 33:25.133 --> 33:27.900 align:left position:22.5% line:5% size:67.5% in their nose, in their mouth, in their eyes, 33:29.000 --> 33:30.166 align:left position:22.5% line:5% size:67.5% and then this happens. 33:30.266 --> 33:32.533 align:left position:25% line:5% size:65% So this is a picture of influenza virus, 33:32.633 --> 33:35.233 align:left position:22.5% line:5% size:67.5% and you have epithelial cells, which are right here. 33:35.333 --> 33:38.233 align:left position:12.5% line:5% size:77.5% Epithelial cells are cells that line your respiratory tract, 33:38.333 --> 33:41.166 align:left position:22.5% line:5% size:67.5% so all throughout from your nose to your pharynx, 33:41.266 --> 33:44.400 align:left position:20% line:5% size:70% so your throat, and then into your respiratory system. 33:44.500 --> 33:47.633 align:left position:25% line:5% size:65% So influenza, what it does is it attaches 33:47.733 --> 33:49.200 align:left position:17.5% line:5% size:72.5% to these epithelial cells. 33:49.300 --> 33:51.800 align:left position:22.5% line:5% size:67.5% So remember that glue I was talking about before? 33:51.900 --> 33:53.266 align:left position:27.5% line:5% size:62.5% That's where these become important. 33:53.366 --> 33:56.666 align:left position:25% line:5% size:65% So the hemagglutinin, or that glue, 33:56.766 --> 34:01.733 align:left position:17.5% line:5% size:72.5% attaches to the sialic acid receptors that are present 34:01.833 --> 34:03.200 align:left position:25% line:5% size:65% on epithelial cells. 34:03.300 --> 34:05.833 align:left position:22.5% line:5% size:67.5% So once it attaches to those, then the virus 34:05.933 --> 34:08.533 align:left position:20% line:5% size:70% can then enter into your system, and then replicate, 34:08.633 --> 34:09.766 align:left position:15% line:5% size:75% and go through the life cycle 34:09.866 --> 34:11.266 align:left position:12.5% line:5% size:77.5% that I talked about previously. 34:14.366 --> 34:17.200 align:left position:20% line:5% size:70% So we have these people, the susceptible individual 34:17.300 --> 34:21.033 align:left position:20% line:5% size:70% gets the virus, the virus attaches to the sialic acid, 34:21.133 --> 34:24.500 align:left position:22.5% line:5% size:67.5% it goes into the cell, then about one to four days 34:24.600 --> 34:29.166 align:left position:17.5% line:5% size:72.5% after being exposed to the virus, they develop symptoms. 34:29.266 --> 34:32.333 align:left position:22.5% line:5% size:67.5% So the one to four days is when the virus enters, 34:32.433 --> 34:33.866 align:left position:22.5% line:5% size:67.5% and then symptom onset, 34:33.966 --> 34:35.833 align:left position:20% line:5% size:70% and so that's referred to as your incubation period. 34:35.933 --> 34:37.533 align:left position:32.5% line:5% size:57.5% So how long it takes for a person 34:37.633 --> 34:39.533 align:left position:27.5% line:5% size:62.5% after they've been introduced with the virus 34:39.633 --> 34:41.233 align:left position:17.5% line:5% size:72.5% to actually have symptoms. 34:42.700 --> 34:46.466 align:left position:17.5% line:5% size:72.5% So relatively to some other viruses, this is quite short, 34:46.566 --> 34:51.000 align:left position:12.5% line:5% size:77.5% and so people typically present with symptoms earlier on. 34:53.766 --> 34:55.333 align:left position:27.5% line:71% size:62.5% So we talked about droplet, now we'll go 34:55.433 --> 34:58.533 align:left position:12.5% line:71% size:77.5% onto some of the environmental things that are important. 34:59.933 --> 35:04.666 align:left position:17.5% line:5% size:72.5% So here is a picture of the world, and so what is important 35:04.766 --> 35:08.066 align:left position:22.5% line:5% size:67.5% in this picture is that it's a study that was done 35:08.166 --> 35:11.333 align:left position:22.5% line:5% size:67.5% that looked at the peak month of influenza, 35:11.433 --> 35:14.666 align:left position:15% line:5% size:75% so when influenza, during the season, their peak month is, 35:14.766 --> 35:17.166 align:left position:10% line:5% size:80% and then how long it lasted for. 35:17.266 --> 35:21.300 align:left position:15% line:5% size:75% So we're very used to having a set period of influenza. 35:21.400 --> 35:23.766 align:left position:15% line:5% size:75% It changes a little bit each year, but most of the time 35:23.866 --> 35:26.633 align:left position:32.5% line:5% size:57.5% it'll last from September to about March. 35:26.733 --> 35:28.766 align:left position:27.5% line:5% size:62.5% Some years it will last a little bit later 35:28.866 --> 35:31.466 align:left position:12.5% line:5% size:77.5% depending on what's circulating and what's going on. 35:32.633 --> 35:34.833 align:left position:27.5% line:5% size:62.5% With our peak time, around January or February 35:34.933 --> 35:36.600 align:left position:25% line:5% size:65% in the United States. 35:36.700 --> 35:39.200 align:left position:22.5% line:5% size:67.5% But other areas of the world don't have that, 35:39.300 --> 35:43.500 align:left position:30% line:5% size:60% or have different environments that have it peak 35:43.600 --> 35:46.166 align:left position:12.5% line:5% size:77.5% at different times of the year. 35:46.266 --> 35:48.466 align:left position:22.5% line:5% size:67.5% So when we look at some of these other places, 35:48.566 --> 35:52.666 align:left position:15% line:5% size:75% this is when their influenza epidemics or pandemics peak, 35:52.766 --> 35:56.933 align:left position:32.5% line:5% size:57.5% is that in the tropical environments, 35:57.033 --> 35:59.333 align:left position:30% line:5% size:60% they are peaking around June or July, 35:59.433 --> 36:03.733 align:left position:12.5% line:5% size:77.5% lasting about the same duration as our influenza season. 36:03.833 --> 36:07.200 align:left position:20% line:5% size:70% But the interesting thing is over here in Asia, 36:07.300 --> 36:09.233 align:left position:32.5% line:5% size:57.5% they have these semiannual peaks. 36:09.333 --> 36:11.800 align:left position:22.5% line:5% size:67.5% So they have two peaks a year of influenza 36:11.900 --> 36:14.733 align:left position:30% line:5% size:60% instead of having one peak like we do. 36:15.866 --> 36:17.200 align:left position:27.5% line:5% size:62.5% That has to do with the environment. 36:17.300 --> 36:19.966 align:left position:27.5% line:5% size:62.5% So influenza really likes colder temperatures 36:20.066 --> 36:21.700 align:left position:30% line:5% size:60% and low humidity. 36:21.800 --> 36:24.933 align:left position:25% line:5% size:65% So any time you alter that or change that, 36:25.033 --> 36:27.166 align:left position:32.5% line:5% size:57.5% then influenza doesn't do as well 36:27.266 --> 36:29.400 align:left position:15% line:5% size:75% with circulating in the air. 36:29.500 --> 36:33.133 align:left position:20% line:71% size:70% This is from 2013, so it would be interesting to see 36:33.233 --> 36:36.066 align:left position:20% line:71% size:70% how this has changed, and what will change in the future 36:36.166 --> 36:38.333 align:left position:17.5% line:71% size:72.5% with some of these climate changes and global warming, 36:38.433 --> 36:41.766 align:left position:20% line:71% size:70% and what that will do for influenza, both the seasons, 36:41.866 --> 36:44.733 align:left position:15% line:71% size:75% the duration of the seasons, and when they actually peak. 36:48.666 --> 36:50.666 align:left position:15% line:71% size:75% So now I'll go onto immunity. 36:50.766 --> 36:54.000 align:left position:15% line:71% size:75% So I'll talk about population immunity and vaccines. 36:54.100 --> 36:56.033 align:left position:32.5% line:71% size:57.5% So this is our third concept here. 36:58.733 --> 37:01.266 align:left position:27.5% line:5% size:62.5% So we'll start with this diagram here, 37:01.366 --> 37:02.633 align:left position:27.5% line:5% size:62.5% and the importance of this diagram 37:02.733 --> 37:04.300 align:left position:12.5% line:5% size:77.5% really has to do with immunity, 37:04.400 --> 37:06.833 align:left position:22.5% line:5% size:67.5% and what the population immunity is doing, 37:06.933 --> 37:10.366 align:left position:22.5% line:5% size:67.5% and how that relates to outbreaks or pandemics. 37:10.466 --> 37:14.933 align:left position:22.5% line:5% size:67.5% So we'll start all the way on the left here. 37:15.033 --> 37:17.633 align:left position:17.5% line:5% size:72.5% So we have an introduction of a new virus. 37:17.733 --> 37:22.633 align:left position:17.5% line:5% size:72.5% So influenza A, HxNx, which we've never seen before. 37:22.733 --> 37:24.333 align:left position:45% line:5% size:45% Okay. 37:24.433 --> 37:26.233 align:left position:25% line:5% size:65% So what happens after that's introduction 37:26.333 --> 37:27.733 align:left position:12.5% line:5% size:77.5% is that it leads to a pandemic. 37:27.833 --> 37:29.766 align:left position:32.5% line:5% size:57.5% So you see your disease incidence here, 37:29.866 --> 37:34.766 align:left position:12.5% line:5% size:77.5% so you get high disease rates, and then those will fall 37:34.866 --> 37:38.666 align:left position:22.5% line:5% size:67.5% over time, and as those fall, you see this antibody, 37:38.766 --> 37:41.200 align:left position:27.5% line:5% size:62.5% or the immunity to that virus, go up. 37:42.666 --> 37:44.966 align:left position:30% line:5% size:60% And then you get your next season, 37:45.066 --> 37:46.566 align:left position:15% line:5% size:75% which there is some immunity, 37:46.666 --> 37:48.600 align:left position:27.5% line:5% size:62.5% so some people have created these antibodies 37:48.700 --> 37:51.333 align:left position:30% line:5% size:60% and can fight off these infections, 37:51.433 --> 37:54.000 align:left position:17.5% line:5% size:72.5% and so, then you get lower amounts of incidence. 37:54.100 --> 37:57.566 align:left position:20% line:5% size:70% And then as more of your population is exposed 37:57.666 --> 38:01.466 align:left position:22.5% line:5% size:67.5% to this virus, you see that your antibodies go up, 38:02.900 --> 38:06.433 align:left position:17.5% line:5% size:72.5% and then you see the rates of disease go down overall. 38:08.166 --> 38:10.233 align:left position:25% line:5% size:65% So this middle range is where we see 38:10.333 --> 38:11.633 align:left position:15% line:5% size:75% some of those drifts happen. 38:11.733 --> 38:13.700 align:left position:10% line:5% size:80% So those are those minor changes 38:13.800 --> 38:16.200 align:left position:27.5% line:5% size:62.5% that can affect and still cause disease, 38:16.300 --> 38:18.400 align:left position:22.5% line:5% size:67.5% but really, people are protecting themselves 38:18.500 --> 38:21.100 align:left position:12.5% line:5% size:77.5% with the antibodies they've had from the previous infection. 38:22.200 --> 38:24.266 align:left position:25% line:5% size:65% So then what happens again is that, 38:24.366 --> 38:26.700 align:left position:27.5% line:5% size:62.5% all the way on your right-hand side, 38:26.800 --> 38:28.566 align:left position:22.5% line:5% size:67.5% there's an introduction of a new virus. 38:28.666 --> 38:31.766 align:left position:12.5% line:5% size:77.5% So now we're introducing HyNy. 38:33.066 --> 38:36.800 align:left position:25% line:71% size:65% So even though we had great immunity to HxNx, 38:36.900 --> 38:39.833 align:left position:17.5% line:71% size:72.5% that really doesn't help us for this new virus that comes. 38:39.933 --> 38:41.566 align:left position:30% line:5% size:60% So with this new virus that it comes, 38:41.666 --> 38:45.200 align:left position:17.5% line:5% size:72.5% you see a huge peak in your incidence rates of disease, 38:45.300 --> 38:47.166 align:left position:20% line:5% size:70% causing another pandemic. 38:47.266 --> 38:50.366 align:left position:15% line:5% size:75% And then, over time, what you see is the antibodies here 38:51.366 --> 38:53.666 align:left position:15% line:5% size:75% go along and start to go up, 38:53.766 --> 38:55.566 align:left position:25% line:5% size:65% and you see the same sorts of cycles happen 38:55.666 --> 38:57.166 align:left position:25% line:5% size:65% over and over again. 38:57.266 --> 38:59.700 align:left position:22.5% line:5% size:67.5% So this is what you see when you look at pandemics 38:59.800 --> 39:03.233 align:left position:22.5% line:5% size:67.5% throughout history and that interpandemic era, 39:03.333 --> 39:05.666 align:left position:17.5% line:5% size:72.5% where you're seeing little spikes but they're not as big. 39:05.766 --> 39:08.300 align:left position:17.5% line:5% size:72.5% It's because the population has developed some immunity 39:08.400 --> 39:09.566 align:left position:42.5% line:5% size:47.5% to it. 39:13.566 --> 39:15.733 align:left position:27.5% line:83% size:62.5% I'm just gonna show this in a different way 39:16.900 --> 39:19.033 align:left position:25% line:83% size:65% using our history to help follow along. 39:19.133 --> 39:22.933 align:left position:15% line:83% size:75% So first I'll start with the 1918 pandemic, or outbreak, 39:23.033 --> 39:25.033 align:left position:25% line:83% size:65% the Spanish influenza that happened. 39:26.366 --> 39:30.000 align:left position:22.5% line:83% size:67.5% So up top you have the circulating influenza viruses. 39:30.100 --> 39:32.200 align:left position:22.5% line:83% size:67.5% Down below you have the timeline of pandemics 39:32.300 --> 39:34.700 align:left position:27.5% line:83% size:62.5% or important things in influenza history. 39:35.866 --> 39:40.533 align:left position:27.5% line:83% size:62.5% So in 1918, you see that H1N1 arises. 39:40.633 --> 39:43.333 align:left position:22.5% line:83% size:67.5% It results in about 50 million deaths worldwide, 39:43.433 --> 39:47.066 align:left position:22.5% line:83% size:67.5% then H1N1 continues to circulate throughout that time. 39:47.166 --> 39:48.666 align:left position:30% line:83% size:60% So as you follow along the timeline, 39:48.766 --> 39:51.833 align:left position:15% line:83% size:75% you have your 1918 pandemic, and then it circulates 39:51.933 --> 39:54.166 align:left position:30% line:89% size:60% until about 1947. 39:55.600 --> 39:58.000 align:left position:20% line:83% size:70% And then it has a slight drift that makes it 39:58.100 --> 40:01.333 align:left position:22.5% line:83% size:67.5% a little bit different, but still protected. 40:01.433 --> 40:03.700 align:left position:25% line:89% size:65% Then we get to 1957. 40:03.800 --> 40:06.133 align:left position:27.5% line:83% size:62.5% 1957 is when we had our second outbreak, 40:06.233 --> 40:09.766 align:left position:27.5% line:83% size:62.5% and that's when you notice that H2N2 arises. 40:09.866 --> 40:13.733 align:left position:20% line:83% size:70% So you have your big peak with no immunity previously, 40:14.900 --> 40:17.933 align:left position:20% line:83% size:70% and then H2N2 circulates for a period of time. 40:18.033 --> 40:20.933 align:left position:27.5% line:83% size:62.5% Then you have your 1968 outbreak, 40:21.033 --> 40:24.533 align:left position:30% line:83% size:60% which you notice that H3N2 now arises. 40:25.966 --> 40:29.000 align:left position:17.5% line:83% size:72.5% And then we get all the way to 2009, where we notice 40:29.100 --> 40:34.433 align:left position:22.5% line:83% size:67.5% that there's this novel H1N1, or the swine flu H1N1, 40:34.533 --> 40:39.433 align:left position:17.5% line:83% size:72.5% that came up that resulted in 150,000 to 580,000 deaths 40:39.533 --> 40:40.733 align:left position:35% line:89% size:55% in the world. 40:42.200 --> 40:45.033 align:left position:27.5% line:83% size:62.5% What's interesting about the 2009 outbreak 40:45.133 --> 40:48.366 align:left position:30% line:83% size:60% is that it really affected people 40:48.466 --> 40:51.266 align:left position:27.5% line:83% size:62.5% that were less than 24 years of age. 40:51.366 --> 40:53.733 align:left position:12.5% line:83% size:77.5% And there was a lot of thought when this initially happened, 40:53.833 --> 40:57.733 align:left position:20% line:83% size:70% like, "Why are all these adolescents or college students 40:57.833 --> 41:01.500 align:left position:27.5% line:83% size:62.5% "that are healthy, for college students, 41:01.600 --> 41:04.433 align:left position:25% line:83% size:65% "getting really sick and not doing well?" 41:04.533 --> 41:05.933 align:left position:25% line:89% size:65% And what they noticed 41:06.033 --> 41:08.366 align:left position:22.5% line:83% size:67.5% is that there actually was some similarity 41:08.466 --> 41:11.200 align:left position:30% line:83% size:60% between the H1N1 that circulated here 41:11.300 --> 41:13.500 align:left position:30% line:83% size:60% and the H1N1 that circulated here. 41:13.600 --> 41:15.066 align:left position:12.5% line:89% size:77.5% That's why this arrow is there. 41:15.166 --> 41:18.633 align:left position:25% line:83% size:65% And so it seems like the older adults 41:18.733 --> 41:23.166 align:left position:25% line:83% size:65% actually had partial immunity to the new H1N1 41:23.266 --> 41:26.833 align:left position:17.5% line:83% size:72.5% 'cause they had previously been exposed to a similar H1N1 41:26.933 --> 41:30.466 align:left position:12.5% line:83% size:77.5% that provided cross-protection or cross-immunity. 41:30.566 --> 41:32.833 align:left position:35% line:71% size:55% So with these pandemics, you can see 41:32.933 --> 41:35.600 align:left position:27.5% line:71% size:62.5% there's certain age groups that get affected 41:35.700 --> 41:37.866 align:left position:22.5% line:71% size:67.5% that aren't the typical age group that you think of 41:37.966 --> 41:40.866 align:left position:20% line:71% size:70% with the highest rates of incidence of influenza. 41:44.333 --> 41:46.033 align:left position:27.5% line:71% size:62.5% So we talked about population immunity, 41:46.133 --> 41:48.333 align:left position:32.5% line:71% size:57.5% we talked about antibodies circulating, 41:48.433 --> 41:52.466 align:left position:30% line:5% size:60% now we'll go onto influenza vaccine. 41:54.500 --> 41:56.466 align:left position:27.5% line:83% size:62.5% So we'll start with our virus here. 41:58.133 --> 42:00.900 align:left position:20% line:83% size:70% What some of you may have noticed on the previous slides 42:01.000 --> 42:04.433 align:left position:15% line:83% size:75% is there are these areas that are called antigenic sites 42:04.533 --> 42:06.733 align:left position:22.5% line:83% size:67.5% on this hemagglutinin, and these become important 42:06.833 --> 42:09.700 align:left position:27.5% line:83% size:62.5% when we talk about influenza vaccine. 42:10.766 --> 42:12.200 align:left position:25% line:83% size:65% So how does influenza vaccine work? 42:12.300 --> 42:14.833 align:left position:32.5% line:83% size:57.5% What it does is your body is exposed 42:14.933 --> 42:18.400 align:left position:22.5% line:83% size:67.5% to either a weakened or killed form of the disease, 42:18.500 --> 42:20.633 align:left position:27.5% line:83% size:62.5% and then your body creates these antibodies, 42:20.733 --> 42:23.866 align:left position:22.5% line:83% size:67.5% which are present here after being exposed to it, 42:25.233 --> 42:29.700 align:left position:17.5% line:83% size:72.5% and then these antibodies, let's say you got your flu shot, 42:29.800 --> 42:31.233 align:left position:12.5% line:89% size:77.5% you developed your antibodies, 42:31.333 --> 42:34.033 align:left position:17.5% line:83% size:72.5% and then you got exposed to influenza, unfortunately. 42:34.133 --> 42:37.400 align:left position:30% line:83% size:60% And what happens is these antibodies 42:37.500 --> 42:41.533 align:left position:17.5% line:83% size:72.5% go to these antigenic sites and actually clamp onto them. 42:41.633 --> 42:43.200 align:left position:30% line:83% size:60% So we're talking about these antibodies 42:43.300 --> 42:45.833 align:left position:30% line:83% size:60% that were in your system go to the virus, 42:45.933 --> 42:48.733 align:left position:20% line:83% size:70% the outer portion of the virus, and go on top of them. 42:49.900 --> 42:53.300 align:left position:22.5% line:71% size:67.5% And so what that does, is our previous picture, 42:53.400 --> 42:56.733 align:left position:22.5% line:71% size:67.5% is it blocks the virus actually being able to attach 42:56.833 --> 42:58.200 align:left position:32.5% line:71% size:57.5% to those sites. 42:58.300 --> 43:01.933 align:left position:20% line:5% size:70% So the virus is unable to attach the sites of the cells, 43:02.033 --> 43:04.033 align:left position:30% line:5% size:60% and so they can't enter into the cells, 43:04.133 --> 43:06.433 align:left position:27.5% line:5% size:62.5% and then your body mops up this virus 43:06.533 --> 43:08.800 align:left position:35% line:5% size:55% through other immune system cells, 43:08.900 --> 43:11.500 align:left position:20% line:5% size:70% and is able to get rid of it so you don't get sick. 43:12.833 --> 43:15.100 align:left position:17.5% line:5% size:72.5% So that's how the influenza virus actually works, 43:15.200 --> 43:17.600 align:left position:27.5% line:5% size:62.5% is it really blocks this attachment part. 43:21.766 --> 43:23.466 align:left position:20% line:89% size:70% So the influenza vaccine, 43:23.566 --> 43:27.300 align:left position:30% line:83% size:60% we'll talk about the 2019, 2020 one, 43:27.400 --> 43:28.533 align:left position:10% line:89% size:80% these are the different viruses. 43:28.633 --> 43:30.166 align:left position:30% line:83% size:60% You don't have to read all of them, 43:30.266 --> 43:33.300 align:left position:22.5% line:83% size:67.5% just know that there's two influenza A viruses 43:33.400 --> 43:36.500 align:left position:20% line:83% size:70% on there, and there's two influenza B viruses on there. 43:36.600 --> 43:37.766 align:left position:22.5% line:89% size:67.5% All of the other stuff 43:37.866 --> 43:40.266 align:left position:25% line:83% size:65% really is just really specific virology names 43:40.366 --> 43:43.166 align:left position:22.5% line:83% size:67.5% and what specific virus they put into the influenza. 43:44.466 --> 43:46.633 align:left position:25% line:83% size:65% But you can see here that the first one 43:46.733 --> 43:50.100 align:left position:22.5% line:83% size:67.5% was an H1N1-like virus, the second was an H3N2, 43:50.200 --> 43:52.766 align:left position:22.5% line:83% size:67.5% and then you have your Victoria and your Yamagata. 43:54.266 --> 43:56.933 align:left position:30% line:83% size:60% The stars next to those first two ones 43:57.033 --> 44:00.700 align:left position:20% line:83% size:70% is what changed from the previous year's vaccines. 44:00.800 --> 44:04.666 align:left position:20% line:83% size:70% So every year, at the end of the influenza season, 44:04.766 --> 44:07.133 align:left position:25% line:71% size:65% a ton of experts get together and try to predict 44:07.233 --> 44:10.666 align:left position:17.5% line:71% size:72.5% what they think is gonna be circulating the following year. 44:10.766 --> 44:14.300 align:left position:17.5% line:71% size:72.5% And what they predicted for this year are these four. 44:15.533 --> 44:16.800 align:left position:15% line:71% size:75% It's still too early to know 44:16.900 --> 44:19.166 align:left position:12.5% line:71% size:77.5% exactly how effective this is. 44:19.266 --> 44:22.766 align:left position:25% line:71% size:65% There's varying rates between the virus strains. 44:22.866 --> 44:26.966 align:left position:15% line:71% size:75% It's probably about 30 to 50% vaccine effectiveness this year, 44:27.066 --> 44:31.200 align:left position:22.5% line:71% size:67.5% which is pretty typical of the influenza vaccine. 44:31.300 --> 44:33.466 align:left position:27.5% line:71% size:62.5% But these first two are new ones this year. 44:37.133 --> 44:39.033 align:left position:20% line:71% size:70% So the important thing to know and the important thing 44:39.133 --> 44:40.766 align:left position:15% line:71% size:75% that I like to tell patients 44:40.866 --> 44:42.533 align:left position:27.5% line:5% size:62.5% when we're talking about influenza vaccine 44:42.633 --> 44:45.766 align:left position:27.5% line:5% size:62.5% is you're 50 times less likely to get sick 44:45.866 --> 44:48.033 align:left position:32.5% line:5% size:57.5% from influenza compared to someone 44:48.133 --> 44:49.766 align:left position:15% line:5% size:75% who doesn't get the vaccine. 44:50.933 --> 44:52.633 align:left position:22.5% line:5% size:67.5% So I feel like this is an important concept 44:52.733 --> 44:54.800 align:left position:27.5% line:5% size:62.5% that we don't talk about very much. 44:56.233 --> 44:59.400 align:left position:17.5% line:5% size:72.5% And, in addition, not only do you have 50% less likely, 44:59.500 --> 45:01.533 align:left position:30% line:5% size:60% if you do get an influenza strain 45:01.633 --> 45:03.633 align:left position:30% line:5% size:60% that's not one of the ones listed, 45:03.733 --> 45:05.466 align:left position:12.5% line:5% size:77.5% there is some cross-protection. 45:05.566 --> 45:08.700 align:left position:17.5% line:5% size:72.5% So you can have less severe disease even if you get exposed 45:08.800 --> 45:11.100 align:left position:17.5% line:5% size:72.5% to an influenza virus that isn't covered by the vaccine 45:11.200 --> 45:12.366 align:left position:37.5% line:5% size:52.5% that year. 45:18.200 --> 45:20.533 align:left position:27.5% line:5% size:62.5% So now the vaccine impacts on influenza. 45:20.633 --> 45:24.433 align:left position:17.5% line:5% size:72.5% So this is the most recent updated that the CDC has 45:24.533 --> 45:28.933 align:left position:15% line:5% size:75% about what the actual vaccine is helping to prevent. 45:29.033 --> 45:33.933 align:left position:12.5% line:5% size:77.5% So in the year of 2017 to 2018 in the United States alone, 45:34.033 --> 45:36.800 align:left position:17.5% line:5% size:72.5% it prevented 5,700 deaths. 45:37.966 --> 45:40.700 align:left position:27.5% line:5% size:62.5% It prevented 91,000 hospitalizations. 45:41.866 --> 45:43.600 align:left position:25% line:5% size:65% Does anyone what this is, the picture of? 45:45.666 --> 45:47.866 align:left position:17.5% line:5% size:72.5% Some stadium, it's Lambeau. 45:47.966 --> 45:50.600 align:left position:25% line:5% size:65% So Lambeau Field can hold about 81,000, 45:50.700 --> 45:54.266 align:left position:17.5% line:5% size:72.5% so we're protecting 10,000 more than what Lambeau Field 45:54.366 --> 45:56.533 align:left position:15% line:5% size:75% can hold in hospitalizations. 45:58.000 --> 46:02.033 align:left position:20% line:5% size:70% In addition, we protected 3.2 million medical visits 46:02.133 --> 46:05.433 align:left position:32.5% line:5% size:57.5% and 6.2 million illnesses overall. 46:05.533 --> 46:10.766 align:left position:12.5% line:5% size:77.5% So we protected over an entire state of Wisconsin population 46:10.866 --> 46:13.033 align:left position:10% line:5% size:80% with illnesses with the vaccine. 46:14.466 --> 46:16.466 align:left position:17.5% line:5% size:72.5% So that's quite impressive of something that we can do 46:16.566 --> 46:19.733 align:left position:20% line:5% size:70% and why a lot of medical providers really push 46:19.833 --> 46:21.233 align:left position:22.5% line:5% size:67.5% for influenza vaccine. 46:22.700 --> 46:24.966 align:left position:12.5% line:5% size:77.5% And this is just in the United States, it's not worldwide. 46:25.066 --> 46:28.033 align:left position:12.5% line:5% size:77.5% The rates are much higher when you look at the whole world. 46:30.666 --> 46:32.233 align:left position:25% line:83% size:65% So we talked through these three concepts, 46:32.333 --> 46:34.766 align:left position:30% line:83% size:60% which I think are important in influenza, 46:34.866 --> 46:37.166 align:left position:17.5% line:71% size:72.5% and to help you understand some of the other things 46:37.266 --> 46:38.933 align:left position:20% line:71% size:70% that can happen in other respiratory viruses 46:39.033 --> 46:42.133 align:left position:12.5% line:71% size:77.5% that are important, why we see these pandemics or outbreaks. 46:42.233 --> 46:44.566 align:left position:15% line:71% size:75% So with influenza, we talked about those viral properties 46:44.666 --> 46:47.000 align:left position:17.5% line:71% size:72.5% that are important for the structure of influenza, 46:47.100 --> 46:48.400 align:left position:15% line:71% size:75% how it gets into your cells, 46:48.500 --> 46:51.600 align:left position:22.5% line:71% size:67.5% and then why it causes epidemics and pandemics. 46:51.700 --> 46:54.666 align:left position:15% line:71% size:75% And then we talked about the transmission with droplets, 46:54.766 --> 46:57.500 align:left position:17.5% line:71% size:72.5% and some other transmission that can happen 46:57.600 --> 46:59.900 align:left position:17.5% line:71% size:72.5% as well as the environment and any climate changes 47:00.000 --> 47:01.566 align:left position:25% line:71% size:65% that may affect that. 47:01.666 --> 47:04.233 align:left position:20% line:71% size:70% And then the last concept had to do with immunity, 47:04.333 --> 47:07.633 align:left position:17.5% line:71% size:72.5% which is important overall, about your population immunity, 47:07.733 --> 47:09.533 align:left position:10% line:71% size:80% so overall, who's being covered, 47:09.633 --> 47:11.666 align:left position:30% line:71% size:60% and then also the vaccine itself. 47:14.233 --> 47:16.966 align:left position:17.5% line:71% size:72.5% So these are the important things to take away, 47:17.066 --> 47:19.766 align:left position:20% line:71% size:70% and why pandemics happen 47:19.866 --> 47:21.966 align:left position:27.5% line:71% size:62.5% is a change in each one of these concepts 47:22.066 --> 47:25.100 align:left position:27.5% line:71% size:62.5%   can really lead to a big outbreak of things. 47:25.200 --> 47:27.933 align:left position:25% line:83% size:65% So viral properties, when we get new virus, 47:28.033 --> 47:32.933 align:left position:12.5% line:83% size:77.5% or a novel virus, and then that virus is easily transmitted, 47:33.033 --> 47:36.066 align:left position:22.5% line:83% size:67.5% and then the population has no previous immunity, 47:36.166 --> 47:38.900 align:left position:20% line:83% size:70% that's when we get really big outbreaks with viruses. 47:42.400 --> 47:45.500 align:left position:20% line:83% size:70% So I'm gonna talk briefly about my specific research. 47:45.600 --> 47:48.100 align:left position:22.5% line:83% size:67.5% I was just giving you a rundown about influenza. 47:48.200 --> 47:50.166 align:left position:25% line:83% size:65% So my research really has to do with the impact 47:50.266 --> 47:52.366 align:left position:32.5% line:83% size:57.5% of respiratory infections in children, 47:53.533 --> 47:55.566 align:left position:25% line:83% size:65% and why I care about that, and why I think 47:55.666 --> 47:57.833 align:left position:20% line:83% size:70% that that's important is a lot of these numbers. 47:57.933 --> 48:02.366 align:left position:22.5% line:83% size:67.5% So overall, $40 billion is spent per year 48:02.466 --> 48:05.900 align:left position:15% line:83% size:75% on non-influenza respiratory infections in children. 48:06.000 --> 48:07.366 align:left position:20% line:89% size:70% So those rates skyrocket 48:07.466 --> 48:10.800 align:left position:20% line:83% size:70% when you actually include influenza into those accounts. 48:10.900 --> 48:13.600 align:left position:15% line:83% size:75% It also accounts for greater than 45 million missed days 48:13.700 --> 48:15.900 align:left position:22.5% line:83% size:67.5% of work and 22 million missed days of school 48:16.000 --> 48:18.466 align:left position:17.5% line:83% size:72.5% because of kids being sick, parents needing to leave work, 48:18.566 --> 48:21.300 align:left position:17.5% line:83% size:72.5% or parents themselves being sick, adults being sick. 48:22.466 --> 48:24.366 align:left position:25% line:83% size:65% The other interesting thing is down here. 48:24.466 --> 48:28.466 align:left position:17.5% line:83% size:72.5% So the $2 billion per year is spent on cold remedies. 48:28.566 --> 48:30.000 align:left position:12.5% line:89% size:77.5% So this is out-of-pocket money 48:30.100 --> 48:33.700 align:left position:22.5% line:83% size:67.5% that we are spending on cold remedies, overall. 48:37.033 --> 48:38.533 align:left position:10% line:89% size:80% So really where I found this gap 48:38.633 --> 48:40.600 align:left position:15% line:83% size:75% in the respiratory infection research in children 48:40.700 --> 48:42.733 align:left position:27.5% line:83% size:62.5% has to do with, we have clinical trials 48:42.833 --> 48:44.966 align:left position:30% line:83% size:60% for some of these symptomatic treatments, 48:45.066 --> 48:46.966 align:left position:30% line:83% size:60% we have clinical trials trying to use 48:47.066 --> 48:48.833 align:left position:20% line:83% size:70% some of these antivirals in certain type 48:48.933 --> 48:51.333 align:left position:10% line:89% size:80% of respiratory viral infections, 48:51.433 --> 48:53.433 align:left position:32.5% line:83% size:57.5% but really, the measures that they use 48:53.533 --> 48:55.633 align:left position:27.5% line:83% size:62.5% are not consistent between the trials, 48:55.733 --> 48:57.100 align:left position:17.5% line:89% size:72.5% and they're not validated. 48:57.200 --> 49:00.300 align:left position:17.5% line:83% size:72.5% So they previously haven't been shown to be valid 49:00.400 --> 49:04.266 align:left position:17.5% line:83% size:72.5% in pediatric patients with acute respiratory infections. 49:04.366 --> 49:06.400 align:left position:25% line:83% size:65% So what this means is that it's really hard 49:06.500 --> 49:09.600 align:left position:27.5% line:83% size:62.5% to compare clinical trials in children 49:09.700 --> 49:11.700 align:left position:27.5% line:83% size:62.5% when they're trying to see what helps 49:11.800 --> 49:13.700 align:left position:35% line:83% size:55% improve their respiratory infections 49:13.800 --> 49:16.566 align:left position:22.5% line:83% size:67.5% or helps to cure their respiratory infections. 49:16.666 --> 49:19.166 align:left position:12.5% line:83% size:77.5% Then, it's also challenging to interpret what this data means 49:19.266 --> 49:22.000 align:left position:22.5% line:83% size:67.5% when they use measures that haven't been validated 49:22.100 --> 49:24.233 align:left position:32.5% line:83% size:57.5% or haven't been researched previously. 49:28.500 --> 49:31.000 align:left position:27.5% line:5% size:62.5% So Wisconsin Upper Respiratory Symptom Survey 49:31.100 --> 49:33.366 align:left position:25% line:5% size:65% is something that was developed by Dr. Bruce Barrett, 49:33.466 --> 49:35.600 align:left position:25% line:5% size:65% who is a part of the Department of Family Medicine 49:35.700 --> 49:37.533 align:left position:25% line:5% size:65% and Community Health. 49:37.633 --> 49:41.433 align:left position:15% line:5% size:75% He developed it in the 2000s and it was focusing on adults. 49:41.533 --> 49:44.066 align:left position:17.5% line:5% size:72.5% So it's an illness-specific quality of life instrument 49:44.166 --> 49:46.566 align:left position:22.5% line:5% size:67.5% that was used to assess the negative impact 49:46.666 --> 49:49.466 align:left position:17.5% line:5% size:72.5% of acute upper respiratory infections in adults. 49:49.566 --> 49:52.133 align:left position:20% line:5% size:70% It's been used in various different clinical trials, 49:52.233 --> 49:55.233 align:left position:17.5% line:5% size:72.5% and really, what's happened with it is it's really exploded. 49:55.333 --> 49:57.333 align:left position:27.5% line:5% size:62.5% So 150 institutions around the world 49:57.433 --> 50:01.633 align:left position:32.5% line:5% size:57.5% in 35 different countries use this survey 50:01.733 --> 50:03.300 align:left position:27.5% line:5% size:62.5% to help with their clinical trials, 50:03.400 --> 50:07.000 align:left position:12.5% line:5% size:77.5% their observational trials, and any pharmaceutical companies 50:07.100 --> 50:08.900 align:left position:30% line:5% size:60% that have picked this up as well. 50:09.000 --> 50:11.266 align:left position:17.5% line:5% size:72.5% It's translated to multiple different languages 50:11.366 --> 50:13.466 align:left position:27.5% line:5% size:62.5% to be used in these different countries. 50:16.133 --> 50:20.333 align:left position:20% line:83% size:70% So what I am doing right now is taking that framework 50:20.433 --> 50:23.000 align:left position:22.5% line:83% size:67.5% of the Wisconsin Upper Respiratory Symptom Survey 50:23.100 --> 50:26.333 align:left position:22.5% line:83% size:67.5% and trying to validate it in pediatric patients. 50:26.433 --> 50:30.366 align:left position:12.5% line:83% size:77.5% So it was validated and proven to work in adult patients, 50:30.466 --> 50:32.633 align:left position:27.5% line:83% size:62.5% but as we all know, children are very different 50:32.733 --> 50:35.633 align:left position:27.5% line:71% size:62.5% than adults in many different aspects. 50:35.733 --> 50:37.733 align:left position:25% line:71% size:65% So what I'm trying to do is really assess 50:37.833 --> 50:39.700 align:left position:27.5% line:71% size:62.5% their symptoms and their quality of life, 50:39.800 --> 50:41.733 align:left position:25% line:71% size:65% and how that impacts their scores overall, 50:41.833 --> 50:45.266 align:left position:20% line:71% size:70% and what that means with the overarching structure 50:45.366 --> 50:46.766 align:left position:27.5% line:71% size:62.5% of the actual form. 50:47.933 --> 50:50.166 align:left position:25% line:71% size:65% My goal is to use it in future clinical 50:50.266 --> 50:52.866 align:left position:22.5% line:71% size:67.5% or observational trials focusing on children 50:52.966 --> 50:55.933 align:left position:15% line:71% size:75% in an outpatient setting with acute respiratory infections. 50:56.033 --> 50:58.466 align:left position:17.5% line:71% size:72.5% There is a lot of research being done about children 50:58.566 --> 51:01.133 align:left position:22.5% line:71% size:67.5% that are hospitalized, children that have asthma, 51:01.233 --> 51:03.900 align:left position:25% line:71% size:65% or infants with acute respiratory infections, 51:04.000 --> 51:07.300 align:left position:27.5% line:71% size:62.5% but this part with the outpatient setting 51:07.400 --> 51:08.566 align:left position:22.5% line:71% size:67.5% with acute respiratory infections, 51:08.666 --> 51:10.533 align:left position:30% line:71% size:60% there hasn't been as much research. 51:12.433 --> 51:14.166 align:left position:10% line:71% size:80% So where I am now with things is 51:14.266 --> 51:16.600 align:left position:12.5% line:71% size:77.5% I completed the administration to all the participants 51:16.700 --> 51:18.133 align:left position:35% line:71% size:55% in my study. 51:18.233 --> 51:20.400 align:left position:17.5% line:71% size:72.5% The analysis shows that it holds together quite well, 51:20.500 --> 51:22.333 align:left position:15% line:71% size:75% and it's valid and reliable, 51:22.433 --> 51:24.700 align:left position:20% line:71% size:70% so now I'm thinking about where do I fit this in 51:24.800 --> 51:27.533 align:left position:12.5% line:71% size:77.5% with different clinical trials and where do I go with this 51:27.633 --> 51:28.800 align:left position:32.5% line:71% size:57.5% at this point? 51:30.800 --> 51:33.500 align:left position:17.5% line:5% size:72.5% These are all of the people I would like to thank. 51:33.600 --> 51:35.800 align:left position:22.5% line:5% size:67.5% So as you know, there's a lot of people involved 51:35.900 --> 51:37.366 align:left position:22.5% line:5% size:67.5% in a lot of this work. 51:37.466 --> 51:39.500 align:left position:25% line:5% size:65% With the WURSS Kids, these are all the people 51:39.600 --> 51:41.566 align:left position:27.5% line:5% size:62.5% that have helped me get to where I am, 51:41.666 --> 51:44.066 align:left position:15% line:5% size:75% and then my mentors as well. 51:44.166 --> 51:45.866 align:left position:25% line:5% size:65% So I'm a part of two different departments 51:45.966 --> 51:47.033 align:left position:12.5% line:5% size:77.5% at the University of Wisconsin, 51:47.133 --> 51:48.866 align:left position:20% line:5% size:70% so I'd like to thank the University of Wisconsin 51:48.966 --> 51:50.266 align:left position:20% line:5% size:70% Department of Pediatrics 51:50.366 --> 51:52.100 align:left position:15% line:5% size:75% and the Department of Family Medicine and Community Health, 51:52.200 --> 51:53.733 align:left position:22.5% line:5% size:67.5% and then the Wisconsin Survey Center 51:53.833 --> 51:56.333 align:left position:17.5% line:5% size:72.5% helped to put together the WURSS Kid Symptom Survey 51:56.433 --> 51:58.266 align:left position:15% line:5% size:75% that was used and validated. 52:00.200 --> 52:01.433 align:left position:35% line:5% size:55% So thank you, guys, for listening 52:01.533 --> 52:03.433 align:left position:27.5% line:5% size:62.5% and taking the time out of your night. 52:03.533 --> 52:05.566 align:left position:25% line:5% size:65% [audience applauding]