Influenza: A Century of Science and Public Health Response

Chapter 6:"Chance Favors the Prepared Mind"

110 In January 1976 influenza researchers and public health officials around the globe coordinated their efforts to speed up their responses to pandemic influenza . At Rougemont, Switzerland, public health experts met to evaluate the current status of influenza surveillance and vaccine manufacturing and to discuss methods of improving both. The predictive eleven-year-cycle and recycling theories added impetus to influenza research, providing an almost audible ticking sound to preparations for the next pandemic. When Martin Goldfield, an epidemiologist for New Jersey, sent his unidentified influenza samples to the CDC headquarters in Atlanta, he had no idea that he was initiating the first step in a decision chain that would end in the creation of the National Influenza Immunization Program (or Swine Flu Program). The novel influenza samples were received by an organization that had been preparing— in both national and international terms—for the next pandemic strain.1 January 1976 was cold in south-central New Jersey, and the crowded conditions and stress of training made the base at Fort Dix an ideal amplifier of respiratory diseases.2 As influenza researchers and public health experts were meeting in places such as the National Institutes of Health offices outside Washington, D.C. (on 12 Jan. 1976), and at the Swiss resort town of Rougemont (26–28 Jan.), a minor epidemic of respiratory disease was circulating at chapter 6 “Chance Favors the Prepared Mind” • “chance favors the prepared mind” 111 Fort Dix. The epidemic resulted in an unexpectedly high hospitalization rate, predominantly among recent trainees. On Thursday, 29 January 1976, the post’s medical officer, Colonel Bartley, sent eight samples to Dr. Goldfield’s laboratory to settle their friendly wager. Lab technicians at Goldfield’s laboratory injected the material into fertilized chicken eggs and left them to incubate over the weekend. On Monday, 2 February, Goldfield harvested the material and tested it to determine whether the specimens contained influenza virus. Goldfield quickly typed four of the eight samples as A/Victoria, an H3N2 Hong-Kong-drifted descendant recently detected in Hawaii. Two of the other viral packages responded to tests indicating they were influenza strains but did not react to any of the reagents that Goldfield had on hand. Colonel Bartley later shipped an additional eleven samples, which turned up two more unidentified influenza strains. Of the nineteen units tested by Goldfield’s laboratory, seven were typed A/Victoria and four revealed unidentified influenza strains. Goldfield dutifully shipped these mystery items to the CDC in Atlanta for typing on 6 February. When Goldfield’s samples arrived in Atlanta, they were delivered to the laboratory where two virologists—Gary Noble and Alan Kendal—were charged with identifying influenza. Unlike Goldfield’s lab in New Jersey, which possessed only a limited number of reagents, the CDC laboratory contained freeze-dried reagents extending all the way back to 1931 (the 1931 sample , coincidentally, was collected by Shope from midwestern pigs). Goldfield’s jest that the strains were probably swine aside, the unidentified subjects were likely to be some drifted relative of Hong Kong flu that Goldfield’s laboratory had been unable to detect; growing influenza virus can be a fickle business. But swine influenza was on the minds of the two virologists. Gary Noble had identified two mystery strains that other researchers had been unable to type just a few weeks before. One strain came from a sixteen-year-old boy afflicted with Hodgkin’s disease who had died in September 1974; the other came from an eight-year-old Wisconsin boy who had recovered from a severe illness in October 1975. The identity of the material was unknown until Noble thought to try samples against swine flu reagents. Both results came back positive. But those two cases were seen as anomalies. Both children had been in contact with pigs on their farms, and there was no evidence of spread beyond those two isolated cases. In addition, it was presumed that the sixteen-year-old’s fatality was hastened by his immunocompromised state due to Hodgkin’s disease. The Fort Dix samples were viewed like any other unidentified test result: interesting , but not of immediate concern. This blasé view was about to change. On Wednesday, 4 February 1976, Private Lewis began his doomed final day of training at Fort Dix, collapsing and dying on the return march that 112 “chance favors the prepared mind” evening. On autopsy, tracheal swabs were collected from...