 Good afternoon and welcome to another episode of likable science here on think tech Hawaii We have with us today a very special guest dr. Virginia Hinshaw. Welcome Virginia. Hello Good to have her. She is a chancellor emeritus from Jabson the John A. Byrne School of Medicine and has Been a researcher for many years on flu and vaccines and so that's what we're gonna talk about here towards the end this year's flu season But it's being a pretty heavy flu season in a lot of parts of the country I don't think too bad here, right right now yet now So I think we should just start by Sort of explain what is flu, you know, okay influenza is a virus and it causes flu By infecting people and it spreads really quickly and it's a global disease. It's not just a local disease The whole world shares it viruses don't need visas. They just come on in So it's and it's in humans long mammals and birds So it has a wide distribution in nature and so that's and it also changes a lot So that's one of the challenges with it, right? And it can be relatively mild in some cases for some people just almost like a little cold Although we will have some fever or something associated with it more aches But it can also be very very dangerous certain strains at least right most definitely 1918 Spanish flu epidemic 1918 killed 20 to 40 million people Wow, and actually more people died of influenza than more related injuries Wow, and so that one was a particularly interesting strain and they've actually reconstituted it by digging up bodies in the tundra in Alaska and we and looking at the genetic material That was still there from the virus and then we making it and it was still what we call hot or highly virulent Yeah, yeah, hopefully not all of them are like that Those are nasty cousins. You don't ever ask for dinner Exactly, exactly. Yeah But that's and they've been a few since there was an Asian flu epidemic Years after that and we've had several pandemic. Yeah, when the whole world experience It's called a pandemic a world flu local epidemics or something like in Hawaii or something but we've had many Pandemics and those are because the virus has changed significantly, right? And you hit on a very interesting point early on when you commented that Influenced virus lives in mammals birds and we are a man, of course But it crosses species lines fairly easily sometimes, right? Yeah It's rather striking at times and probably one of the examples that people have heard the most about lately is the h5n1 And chickens and poultry birds. Yeah bird flu and that one is very hot in the fact It kills 100% of the birds in three or four days and unfortunately it has transmitted to people and that required very close contact Particularly if they're killing the birds or processing them in bird markets and things Thankfully, it never acquired the ability to go person to person and that is a characteristic We look for for pandemic strains, right because those are the ones that'll take off Right thing is then they test this in like a fair up model and watch out how easily the ferrets transmit it from one to another Right. Yeah, and that gives them a clue as to how contagious that's going to be, right? Yeah And so we there's these two sort of separate issues right there's the how contagious it is and how sort of strong or Lethal it is or right and and then the one h5n1 and the one from the birds as a 50% death rate in people So it's very dramatic. Yeah, so we certainly don't want that and So how does it how does flu virus manages when we have very sophisticated scientists working on what yourself and many others? We've beaten back a lot of viral diseases. I'll use kept them down if not only eliminated them but flu seems Endlessly resurgent. Yes, it is at two major reasons and I can can illustrate that for you One is the ability to change it mutates regularly and also the large animal reservoir that occurs in nature That's probably been there for a millennium many different species. Okay, particularly birds and particularly migratory birds like ducks And it doesn't necessarily bother them, right? Let's them spreader goes around. Yeah, excellent. Excellent. But so You hit that the fact that it changes it mutates it evolves very rapidly I was reading a little bit about because the the Vaccine for this year's flu was really a little more attuned to a different strain of what has actually ended up sort of at the later In the season actually going around now, right? And what happens is it goes through people and we're usually on the tail end of the epidemics in the u.s It mutates and sometimes it mutates where it's less of a problem sometimes more of a problem But the vaccine is still a very good idea, right? Absolutely even even with only moderate effectiveness back always a good idea, but Despite all the anti-vaxxer campaigns People are doing no in any favor So can you can you illustrate the This business of the mutation. Oh, yeah, I love to do that Well, first of all, you have to use your imagination I know you've got that and our viewers do too you have to imagine that my head is a virus Okay, in this case. I'm an influenza virus. Okay, and I have a hemagglutinin H, you know the number H3 And that's my ear. Okay, and my hair is the neuraminidase the end Okay, the hemagglutinin is what attaches to a cell and the neuraminidase the end is what helps the virus get out of the Cell to go to other cells. It's got to do both. That's great But a virus is whole goal in life is to get into a cell because it can't reproduce itself Right, it has to have the cells machinery So what I do is I come along and I attach and I enter and I make thousands of virus particles Which then go on and infect you and everybody else So now a lot of people don't love viruses like I do they want to prevent them and so do I so you go take vaccines And when you get a vaccine I Can reach down here and get this What's your body produces is antibodies and this is structurally correct slightly enlarged So what happens is now when I come along if I had this antibody In my body and I come along I can't attach right the virus can't and that means the vaccine worked Right, and that's where we got rid of smallpox with a great vaccine, but the virus doesn't change And so that's how a conceptually of our vaccine works as you induce antibodies that protect you And now flu does something that makes it very difficult and that it changes I'm coming back It mutates I'm still recognizable as Virginia Hinchall like that I was originally, but I'm slightly different or altered Okay, external code there. Yes. So what I've mutated right and so what happens now is antibodies don't fit so well And so I can now still infect and spread to other people. Okay, okay And this is actually what happens with HIV, but it does it over and over again in the same person Right, and that's one of the reasons it's so difficult to control the flu now does something No, the virus does it changes dramatically. Wow, okay, right. So now I'm not recognized Exactly as Virginia Hinchall, right and what happened is I acquired a new hat a new age or a new in or both right and The way this happens is because the virus there are viruses and other species that have genes influence of viruses that those genes can get Interchange with the one that was in the human virus, right? And so this one This is called Anagenic shift and this is drift. This happens each year and that's the reason we have to often change the vaccine every year This is what causes pandemics or worldwide epidemics because nobody has any protection And the mechanism that it uses It's called genetically assortment. I've got two viruses here This one's a human influenza virus This is an alien bird influenza virus if they get into the same host and the same cell which doesn't happen real often And they have eight genes eight RNA segments other is the genome for these viruses and they get in the same one What happens? I can create 256 different influenza viruses Yeah, new new different strains right and that's where those new hats come from and then they go out and spread and cause Worldwide problems because you don't have any antibodies against these right like this hat, right? That's an h5 that that that is an example of that But we have 18 different h's and 11 different ends out there Right, so there's a wealth of them and almost all of them exist in avian species Yeah, we generally only deal with a few a very limited number with with us, right? They're usually only about two in people at any one time There's an influenza B, but it's a totally separate virus But they're usually to at least to influence a virus is circulating Right and but then the the sort of the big fear is that yeah, we got one of these new Radical one around yeah, and it happens to be a hot or a highly virulent strain That's what they worry about based on the 1918 right epidemic or panzerotic And that if that happened then people would not have any protection and we could lose a lot of people's lives, right, right? And indeed at 1918 epidemic was interesting in that Most of the time the people who are most at risk from the flu are the elderly and the very young, right? But that one actually had a very funny almost reverse distribution Although it did take up the elderly on it took a big chunk of normal healthy people. Yeah, I did and I did it rapidly Yeah, even though we didn't have antibiotics at that point But this was much faster than normal within three days people were dying and you're right It hit a lot of young people and there is a reason for that some of the avian Some of the viruses not in Burden people induce what we call a cytokine storm and cytokines are normal products that we produce in our bodies and we need them for lots of different things but if you overproduce then it can cause damage particularly to the lungs and These are young people right so they have more robust immune responses than those of us who might be older Right and so they they're susceptible in that case, right? The better immune system actually worked against them because they basically got triggered Too strongly in some sense. Yeah, and the people basically Or their own immune systems essentially kill them, right? Yeah, the virus but you put that virus that can induce that together and it can really harm young people now Most of the older people are susceptible because they have other issues And taxes the heart the lungs all the body functions But they also developed a vaccine specifically for older people It's called flu zone and it has four times the amount of virus in it Because our immune responses have slowed or waned somewhat and so they give us more to boost a little bit better And they give it every year. Hopefully you should So that in case we don't respond one year, we'll get it the next year and we'll be better and better Excellent. Excellent. Well, it's good to see the people are working on these these sorts of issues and The medical profession understands actually great deal about what what what goes on and what what their challenges are, right? Well influenza is a is a killer. Yeah, I mean it kills between 20 and 40,000 people in the US each year Even the milder strains and if you had one that was like a highly hot strain and people The toll would be much higher. So we do want to prevent it, right? Absolutely. Absolutely And we're gonna talk a little more about how the prevention and the things go After we come back from a little break here, I've got Virginia Hinshaw here the Chancellor from the John A. Burns School of Medicine at UH Manila talking about flu and vaccines and we'll be back in about one minute Hi, I'm Rusty Komori host of Beyond the Lines on Think Tech, Hawaii My show is based on my book also titled Beyond the Lines and it's about creating a superior culture of excellence Leadership and finding greatness. I interview guests who are successful in business sports and life Which is sure to inspire you in finding your greatness Join me every Monday as we go beyond the lines at 11 a.m. Aloha Aloha and my boo. Hi. My name is Emmy or Tega Anderson Inviting you to join us every Tuesday here on Pinoy Power, Hawaii with Think Tech, Hawaii We come to your home at 12 noon every Tuesday. We invite you to listen watch For our mission of empowerment. We aim to enrich and lighten, educate, entertain and we hope to empower again Maraming, Salamatpo, Mabuhay, and Aloha And you're back here on likable science. I'm your host Ethan Allen here on Think Tech, Hawaii With me today in the Think Tech studios is Dr. Virginia Hinshaw Chancellor Emeritus from the from Jabson and thank you for being here again We've been talking about flu and vaccines and and how she was giving us a vivid demonstration I've just had a sort of mechanics of the whole thing of vaccines work against flu Want to dig a little more about this business of vaccines though You know it often seems that we're we're making vaccines for one strain of flu and then the flu is That's around is actually a slightly different strain or it's already evolving away What's reason for that sort of lag that exists? Why is it that we can't make start cranking out a lot of vaccine really quickly? Well, it's how it's made is quite a problem and first meeting safety standards It takes a long time to get them through that process. It takes about six months and each year WHO and CDC and all the labs that cooperate with them health organizations that are for disease control Okay, they could they compare their viruses and they see which they have to they have to determine which one has the most likely Risk of being the one for the next ball So it's an educated. It's very educated guess, but it has to be a guess And then everybody in the world uses the same vaccine And so when you make it you grow it in ember-nated chicken eggs typically And so that is it and then you purify it and inactivate it the flu virus isn't inactive It's dead the virus is dead and then you distribute it and so that's about a six month process Now some companies now are making it in what we call tissue culture Which is particularly for people who are allergic to eggs Because even if you you know when a virus comes out of a cell it takes a little bit of a cell with it so it's there's egg Right and so people are allergic to eggs or not to take the normal one. They take that that special one And there's a lot of research going on on what we call getting an universal flu vaccine Because to get around all these to make an antibody that would work against any flu virus You have to find something on the virus and never changes right and that's important to its own yes And that has been very difficult with flu Yeah, and also with the animal reservoir You've always got the possibility of new hats coming in that the antibody that you might you wouldn't have this antibody that would work Right So again you got this this sort of processing bottleneck because that you've got it You've got incubate this and grow it in eggs Which must be I mean a sort of tedious technical process involving lots and lots of eggs when presumes well And one really interesting aspect that people need to consider is if you get a hot influenza virus in birds in your country or Wherever the vaccine is being made, you don't have any eggs Because it kills the birds and Actually, the viruses the hot viruses don't grow as well And so you have to grow more to get what you need for the people because they have to have a certain level of The virus in it to be effective Certainly now researchers must be working on some better newer methods to try to get around this to bottleneck, right? I mean with the new genetic engineering techniques who thinks they could start slicing and dicing viruses and Get bacteria for instance start cranking cranking vaccines out They've tried a lot of different things, but flu is so good at changing It's a it's a virus that can mutate fairly readily and still function and that is a huge challenge and also Animal reservoir we will never eradicate flu. Right. We hope to control the disease better But because we have the animal reservoir and the virus is so good at changing Right, and you know a lot of viruses I gather are found in one or two or a very small number of species But the flu virus you say lives in lots and lots of different species, so it's when it crosses species I get like the bird flew in and people and I had an interesting Situation number years ago we had an outbreak in seals and it was an avian influenza virus that infected seals in New England and there were a lot of deaths and then we were doing some experiments in Greenland with seals and this young man an infected seal spitting his eye And he developed conjunctivitis and it was the flu virus from the seal that had caused the conjunctivitis So here you have an avian virus that gotten into seals or mammals and into people and We went back and talked to the people that worked on infected the seals in the wild and they also had a problem with conjunctivitis So flu is an interesting virus and that can change species We've had many many examples of that pigs to people and people to pigs, right? It's not just one way Since feeding the loop we are part of the part of the reservoir right and and you know that we have it in horses We have it in all kinds of different species dogs cat they can pick up flu So it is one of those viruses that is able to move around And so that's why we do a lot of surveillance to see where is it and what's it doing? The hallmark that we're looking for is did it go from person to person, right? If it stops with this one host Then we realize it probably doesn't have the potential to cause a pandemic, right? Even if it's a nasty virus and hurts or it kills a lot of people it's still I can't spread that rapidly So ultimately not that big a threat that way, right? But if it acquires that ability to transmit between people then We have the potential you say for a pandemic and we've had many examples of where we thought maybe it'd take off like the swine flu right and We vaccinated millions of people it didn't take off thankfully But you know there's always that risk with influenza because of all the different host Right and the biggest reservoir probably is migratory ducks But it doesn't typically bother them, right and in mammals. It's respiratory disease, right? And in ducks, it's intestinal. It replicates an intestinal tract and then is excreted in the feces If anybody there's no such thing as stomach flu literally Flu does not replicate there So people are calling you a bird if they But that's that's an interesting point about about it's It's spreading through through the birds to two people so we can get it through Any reasonable light contact that is if birds are pooping everywhere, of course And that's not blows in the dust and we inhale that and start that whole cycle again It depends on the virus right, you know Some of them are more infectious like the H5N1 obviously was more infectious than most viruses And that one actually killed a lot of different species They actually killed some tigers in a zoo because they fed them some infected birds But now I love the ducks and the wildlife and so I've interacted with it for many years These are rare occasions. These are not common events. That's the reason you only periodically have pandemics You have epidemics all the time because it's continuing to grow and spread in people, right? But on occasion if it swaps genes you can get them runs of a new strain, right? this is why again though the Issue of vaccination is so important right we've we've seen with another viral disease chicken pox now What happens when you stop vaccinating a population? Yeah, when the vaccination rate drops below a critical Point something like 92 95 percent of the population Suddenly there are enough unvaccinated individuals around the virus can Yeah, yeah, well we're looking for in most cases with viruses that we can't eradicate and flu is one of those is We're looking for herd immunity, right? So that enough people are vaccinated so the virus doesn't have many susceptible hosts and kind of gets stalled out, right? Yeah, you stop the epidemic or the pandemic before it can really take up get going right and this is I mean That's a good argument. Why you should pay attention to the public health authorities when they say hey We're having we're entering a flu season go get your flu shot, right? Oh, yeah, I'm an advocate and certainly I believe that it reduces the Mobility and mortality to do that plus you don't serve as a source Right other people and you know at universities we have lots of young people and they're going all different directions during the holidays And they all come back together Which is a big risk factor for transmission and bringing new ones in so yeah And a lot of students do it because they don't miss two weeks for their studies or their athletics or whatever it is Right, it's a good idea. Yeah, and you know people say oh, I don't want to get my children vaccine vaccinated You know against measles because I think it's a bad idea. I think it's dangerous or whatever But they're not just impacting their own children. They're impacting the other kids and the adults actually around to right? Yeah, the best response I ever heard to that was a fellow that was talking to an anti-vaxxer They call them and she said I don't want to hurt my child I love my child and he says well, I love my children too, but the difference is I love your child as well Because you have to have a concern for the other people in the population All right, and that's what you're trying to do is protect not only your own child or yourself But protect everybody else right that's why you need those high rates of vaccination among a population For the vaccine real really to truly achieve its aims, right? Well particularly for measles measles is the most contagious viral disease we have okay It infects a lot of people really quickly And so you really need a very high level of herd immunity so to speak okay to protect the population, right? Well, we are having great success in some some viruses. We're getting down to the very last of the polio, right? Exciting yeah, we may get it off the face of the earth in the next few years polio and measles should be eradicated Huh, they have every potential they don't change. They're only in mammals and people They have a really good vaccine Everything is right for those two in the case of polio It's been primarily because of war and strife in areas right Afghanistan and Pakistan still have last pockets Right there the last pockets and and suspicion is a problem with measles It's really having so many people that aren't vaccinated and there is a good vaccine for it And it does work and there is no connection with autism. That's been shown time and time again And it's a shame when we see that coming back because it has increased dramatically right there There's sort of no excuse for it. I mean it's a result of various or anti science thinking well the other day Somebody a child had tetanus, which is a deadly disease and there should never be a tense case now Because vaccines great and you really should have that and keep it up to date people forget that every ten years All right supposed to get a little boost right and that's really important particularly in where we live where we're walking barefoot or whatever Yeah, yeah, yeah It's it's really important to stay sort of tuned into what is happening in the vaccine world to pay attention to what what your Doctor recommends about getting a given vaccine getting your boosters regularly staying thoroughly Protected here because it's it's an ongoing struggle, right? I mean, oh, yeah, and flu is the champion of change that has been a challenge with it and The fascinating virus is very old virus apocrates described influenza symptoms 400 BC so it's been around a long time and We but we can make progress on reducing the disease for people and for animals We work a lot on animals too because if people lose their animal source because that's their protein or their income Then they have a major problem as well So it's it's both all populations turn again. You're working on a reservoir trying to Slow reservoir as possible basically now. Yeah, I keep them healthy to exactly and I said and with influenza It's not just keeping your next door neighbor healthy. It's keeping your global now neighbor healthy Yeah, more and more. I think that actually that's a beautiful example of how we need more and more to be thinking globally Realizing that what we do impacts not just us not just the people around us But literally it can blow around the globe if the viruses can and particularly where we are we have people coming from all different directions Here Hawaii, which is lovely, right? We do have to stay attuned to the fact that My club's rule Absolutely Well, thank you so much Virginia. It's been a real pleasure having you here. Well, I've learned a lot I thought you each time you're on my show So I thank you very much for sharing your knowledge and wisdom with us here And I hope you'll come back and Is it us next week or another episode of likeable science here on think tech Hawaii?