Arch Virol (2003) 148: 1643–1644
Potter, C. W. (ed.): Inﬂuenza. Perspectives in Medical Virology vol. 7. 280 pp, Elsevier Science,
Amsterdam, 2002. ISBN 0-444-50627-6 Hardcover $99.-, EUR 99.-.
Inﬂuenza is a clinical syndrome combining cough and fever which in the 13th century was described
in Italy as being inﬂuenced (Italian inﬂuenza) by stars and heavenly bodies. This description seems to
be the likely source of the term inﬂuenza.
Inﬂuenza epidemics can infect as many as 50% or more of a population, causing symptoms in half
the infected persons. The epidemics cause signiﬁcant morbidity; they are debilitating to patients and
are socially and economically disruptive. In the United States, inﬂuenza kills 20 000 to 40 000 people
in an average year, a ﬁgure which dwarfs the current SARS death rate of a few hundred worldwide.
Although our information on the disease and the virus that causes it is probably more detailed than
for any other virus infection, except HIV, the disease remains very much uncontrolled.
This refreshing volume, edited by C W Potter, offers personalized accounts by some of the key
players in inﬂuenza research of what has been done in the past 50 years and what the prospects are
for developing therapeutic agents and better vaccines in the future. Two chapters devoted to inﬂuenza
virus structure and replication give an overview of virus entry, assembly and release, as well as of some
aspects of host cell-virus interactions. In particular, the role of the NS1 protein of inﬂuenza virus A
in inhibiting host transcription and processing and in enhancing the synthesis of viral components is
Three chapters discuss the history of antigenic drift and shift and the appearance of new inﬂuenza
viruses from China. The spread of inﬂuenza in human populations is so rapid that populations quickly
become immune. The viruses are then able to persist mainly because of their remarkable capacity
for antigenic change. As a result, vaccines have to be updated yearly to include recent virus isolates.
Although immunity to inﬂuenza is largely mediated by antibodies directed to the haemagglutinin, there
is increasing evidence that anti-neuraminidase and anti M2 antibody may also contribute to protection
Inﬂuenza viruses transfer from aquatic birds that are infected without showing symptoms, to pigs,
horses, poultry and humans. Genetic changes in the haemagglutinin and neuraminidase genes occur
in these species but only in humans do the viruses undergo an immune selection which leads to
antigenic drift. Pigs become infected relatively easily by avian and human inﬂuenza A viruses and
serve as mixing vessels for the creation of new pandemic inﬂuenza viruses. Most pandemics start
in Southeast Asia where farming practices facilitate double infection of pigs.
One chapter in the book discusses the 1957 and 1968 inﬂuenza pandemics caused by a genetic
reassortment in which the entire haemagglutinin gene was replaced by another gene corresponding to
a different inﬂuenza subtype. As a result the new viruses did not cross-react with anti-haemagglutinin
antibodies directed to previously circulating inﬂuenza A viruses. Such an antigenic shift can occur
during the double infection of pigs with an avian inﬂuenza virus and the prevailing human inﬂuenza
virus at that moment.
One chapter is devoted to the devastating 1918 Spanish inﬂuenza pandemic which is estimated
to have killed 20 to 40 million people worldwide. This high mortality was linked to an unusually high
proportion of cases that developed pneumonia, especially in infants and young adults. Much of our
recent knowledge was obtained because the genetic material of the 1918 virus could be sequenced from
frozen lung tissue obtained from inﬂuenza victims who died in 1918.
The remaining four chapters discuss various clinical issues that are particularly relevant at a time
when there is considerable anxiety about the threat of a new pandemic. Two chapters are devoted to