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As we wait for this year’s influenza epidemic, keep in mind we
are also waiting for the big one, the pandemic (pan: all, demic: people).
A severe pandemic will kill many more Americans than died in the World
Trade Centers, the Iraq war, the Tsunami and Hurricane Katrina combined.
Perhaps a million or two in the USA alone. Such a
disaster would tear the fabric of our society. Our entire country would
resemble New Orleans after Katrina.
Also, it’s only a question of when it will come, not if it will
come. Pandemics come every 25 years or so, severe ones every hundred years
or so. The last pandemic, the Hong Kong flu, occurred in 1968, killing
34,000 Americans. In 1918, the Spanish flu killed more than 500,000
Americans. So many millions died in other countries, they couldn’t
bury the bodies.
The Influenza Pandemic of 1918
Young healthy adults, in the prime of their lives in the morning,
drowning in their own inflammation by noon, grossly discolored by sunset,
were dead at midnight. An overwhelming immune response to the influenza
virus - macrophages releasing large amounts of inflammatory agents called
cytokines and chemokines into the lung of the afflicted - resulted in
millions of deaths in 1918.
Nature. 2004 Oct 7;431(7009):703-7.
Keep in mind, that the Germans recently discovered that vitamin D is
intimately involved in reining in the macrophages, holding their cytokine
production back, so they don’t overshoot, and kill their owner along
with the invader.
Blood. 2005 Aug 23; [Epub ahead of print]
Your annual flu shot won’t help when the big one hits, the antigenic shift one. Once the pandemic
starts, a new vaccine, specific to the new virus must
be manufactured and that takes time. You can and should get some antiviral drugs from your doctor in
advance. Once the pandemic starts –this year, or ten years from now
- the supply of antivirals may be limited and the lines will be long.
It may surprise you that influenza remains an enigma. Current theory
holds that influenza infects like measles, one person gets it, gives it to
others, in a chain of infectious events. That theory has some problems.
For example, Dr. Carolyn Buxton Bridges, of the CDC, recently published a
review paper on the transmission of influenza. She noted, "Our review
found no human experimental studies published in the English-language
literature delineating person-to-person transmission of influenza."
Clin Infect Dis. 2003 Oct 15;37(8):1094-101
Most experts also think pandemic strains originate in birds or other
animals. Dr. Ann Reid and Dr. Jeffery Taubenberger, of the Armed Forces
Institute of Pathology recently wrote, "it is important to recognize
that the mechanisms by which pandemic strains originate have not been
explained yet." Furthermore, there is a persistent theory that
influenza lies dormant in humans, not birds or swine, where it mutates
into a killer strain.
J Gen Virol. 2003 Sep;84(Pt 9):2285-92.
Vaccine. 2002 Aug 19;20(25-26):3068-87.
So, get your flu shot for this year’s flu, stock up on some
antivirals, and let’s go looking for some ignored facts that might
improve your family’s chances when the pandemic comes. Last month we saw that aggressive treatment
of vitamin D deficiency prevented children from getting infections. Dr.
Rehman didn’t differentiate between viral and bacterial infections
but most of the illnesses vitamin D prevented were probably viral.
J Trop Pediatr. 1994 Feb;40(1):58.
When looking for ignored facts, one should always start with
epidemiology, the detective branch of medicine. Epidemiologists look for
clues, clues that lead to theories, theories that can be tested, and, if
true, save your family’s lives. One of the world’s pioneering
epidemiologists died recently, R. Edward Hope-Simpson. He used meticulous,
and solitary, detective work to discover that the chickenpox virus
was reactivated in adults, causing shingles. Dr. Hope-Simpson became
Proc R Soc Med. 1965 Jan;58:9-20.
In 1979, he turned his attention to influenza A. He studied two remote
populations, one in Wales and the other in England. He found that most
affected households had only one case of influenza. Furthermore, no serial
time intervals could be identified in cumulative household outbreaks, that
is, different families didn’t get sick one after another, but around
the same time. He discovered other facts that just didn’t fit with
the theory that influenza A is primarily spread by person-to-person
transmission of this year’s virus.
J Hyg (Lond). 1979 Aug;83(1):11-26.
Then he spent the rest of his life trying to alert us to one of the
basic facts of influenza. It is distinctly seasonal. All theories about
its transmission must take into account its seasonality. Hope-Simpson
reminded us what Davenport said, "Epidemiological hypotheses must
provide satisfactory explanations for all the known findings – not
just for a convenient subset of them."
Going back to 1945, he discovered that influenza epidemics above 30
degrees latitude in both hemispheres occurred during the six months of
least solar radiation. Outbreaks in the tropics almost always occur during
the rainy season. Hope-Simpson concluded, "Latitude alone broadly
determines the timing of the epidemics in the annual cycle, a relationship
that suggests a rather direct effect of some component of solar radiation
acting positively or negatively upon the virus, the humans host or their
interaction." That is, something may be regularly reducing our
immunity every fall and winter.
J Hyg (Lond). 1981 Feb;86(1):35-47.
In 2003, researchers confirmed that influenza epidemics in the tropics
occur, with few exceptions, during the rainy season - when vitamin D
levels should be falling.
Paediatr Respir Rev. 2003 Jun;4(2):105-11.
Furthermore, in his 1981 paper, Hope-Simpson wondered how the same
virus could cause influenza outbreaks at exactly the same time (middle of
winter) over a six-year period (1969 - 1974) in two widely separated areas
(Prague, Czechoslovakia, and Cirencester, England). Surely, during the
middle of the Cold War, infected people did not arrive at two locations
hundreds of miles apart, in the middle of winter, for five years in a row
to infect the well people. On thing Prague and Cirencester do have in
common, they are both at 50 degrees latitude.
In 1990, researchers confirmed a relative lack of country-to-country
transmission, by looking at two countries with heavy tourist traffic
J Hyg Epidemiol Microbiol Immunol. 1990;34(3):283-8
Hope-Simpson rejected the theory that this year’s virus is only
transmitted from actively infected persons to well persons, concluding
instead the facts were more consistent with transmission by symptomless
carriers who become contagious when the sun is either in the other
hemisphere or obscured by the rainy season. He theorized that annual
movement of the sun caused a "seasonal stimulus that reactivates
latent virus in the innumerable carriers who are everywhere present, so
creating the opportunity for epidemics to occur in the wake of its
passage." And thus the celebrated scientist committed heresy.
Everyone knows influenza transmission is direct; the ill people infect
the well people. The accepted theory of pandemics is that the virus first
spreads in birds, perhaps jumps to a mammal (pigs in 1918), then jumps to
humans already infected with a common influenza strain. There it combines
and mutates (reassortment) to a hybrid virus in the index case and that
single person spreads it to others who spread it to others, etc. No, said
Hope-Simpson, the epidemiology just does not fit that theory. Heresy, said
Hope-Simpson practiced medicine in a small village in southwest
England, Cirencester. He went back and looked at 16 years of his medical
records and found evidence of 20 influenza outbreaks, spaced over those 16
years. In every outbreak, he found young children were the most frequently
affected but in none of the 20 outbreaks did the children appear to be
major disseminators of the influenza virus. Furthermore, all ages seemed
to get sick around the same time. He concluded, "Such age-patterns
are not those caused by a highly infectious immunizing virus surviving by
means of direct transmissions from the sick, whose prompt development of
the disease continues endless chains of transmissions."
J Hyg (Lond). 1984 Jun;92(3):303-36.
No one listened. Everyone knew, and still knows: influenza only occurs
when sick people infect well people, who in turn infect other well people.
I don’t think so, said Hope-Simpson. In search of more evidence, he
went to all the parishes in Gloucestershire, separated by many miles. He
looked at burial records for the last 500 years and found evidence of
repeated influenza epidemics. He concluded, "In each century,
influenzal excess mortalities in Gloucestershire parishes coincided with
the date of the relevant influenza epidemic as recorded from widely
different parts of Britain." That is, long before modern rapid
transit, everyone in Britain got the flu around the same time! How could
one person come down with the flu, infect others, etc, when everyone in
Britain got sick at the same time, long before modern rapid transit?
J Hyg (Lond). 1983 Oct;91(2):293-308.
In fact, after studying influenza epidemics in schools, Hoyle and
Wickramasinghe also decided that direct spread by infected children could
not explain what was happening. They theorized that influenza viral
precursors were reaching earth from outer space!
Nature. 1987 Jun 25-Jul 1;327(6124):664.
Content to stay on earth, Hope-Simpson published a detailed theory of
influenza’s infectivity in 1987, based on the facts he observed.
Right or wrong, Hope-Simpson’s paper is wonderful reading for anyone
interested in influenza. Here is a great mind at work. He noted any theory
of influenza must explain a number of facts:
"Vast explosions of disease which may attack 15% or more of a
large community within six weeks and then cease,"
"Successive outbreaks of type A influenza in small relatively
remote communities often coincide closely season after season with those
of the country as a whole and, although the virus changes, the identical
strains of virus appear contemporaneously in the two situations,"
"Cessation of epidemics despite abundant available non-immune
household outbreaks occur all at once, not one after another,
"Low secondary attack rates within households,"
"epidemic patterns of influenza have not changed in four centuries
. . . and does not seem to have altered with the increasing speed and
complexity of human communications."
Epidemiol Infect. 1987 Aug;99(1):5-54.
Hope Simpson proposed that symptomless carriers became infective in
response to a seasonal stimulus and then infect others causing
simultaneous explosions of disease in widely different areas. Furthermore,
he concluded that those who got sick were not particularly contagious. He
proposed that the stimulus for infection "is dependent on variations
in solar radiation, an extraterrestrial influence unaffected by the
rapidity of human travel. The rapidity of influenza spread was as rapid in
previous centuries as it is at present because it does not depend on
He added, "The primary agency mediating seasonal control remains
unidentified." That is, something is weakening our immune system,
every year, as regularly as changing of the leaves and declining vitamin D
levels, but he didn’t know what it was. Hope-Simpson’s 1987
paper was his last. In 1992, he compiled all his work on influenza into a
book. He died in 2003, at the age of 95.
The Transmission of Epidemic Influenza (The Language of
I wish Hope-Simpson could have lived a while longer, to read Dr.
Colleen Hayes and her colleagues from the University of Wisconsin-Madison.
She is one of the brightest vitamin D researchers out there. In 2003, she
reviewed the profound effect vitamin D has on the immune system, including
the role vitamin D plays in fighting infections.
Cell Mol Biol (Noisy-le-grand). 2003 Mar;49(2):277-300.
Yes, as regularly as the flu season, vitamin D levels plummet in the
fall and winter. Yes, vitamin D has profound effects on the immune system.
Yes vitamin D may be involved in the epidemiology of influenza. But is
there any direct evidence?
Two animal studies showed vitamin D prevents the flu and one showed it
does not. Nothing after 1956. If you obtain and read the first citation
below, you’ll see the very first animal paper indicting vitamin D
protected rats from influenza was published in Japan during World War II,
apparently part of Japan’s biological weapons research. The CIA
confiscated the paper after the war.
Proc Soc Exp Biol Med. 1949 Dec;72(3):695-7.
Virology. 1956 Jun;2(3):415-29.
One last thing, when you give flu shots to hemodialysis patients, those
taking activated vitamin D develop significantly better immunity.
Nephron. 2000 Sep;86(1):56-61.
Will normal vitamin D levels protect your family against the flu? No
one knows. It would be nice if we had a report from a big hospital, were
some patients were on vitamin D and some who weren’t and see what
happened when the flu struck the hospital. Were the patients on vitamin D
less likely to get the flu?
In the meantime, it seems to me the smart thing to do is to take enough
real vitamin D (cholecalciferol) or get enough UVB light
to get and keep your 25-hydroxy-vitamin D level at about 50 ng/ml. Of
course, it is a good idea to keep your level around 50 ng/ml year around
even if you don’t fear the coming influenza pandemic. 50 ng/ml is
the normal human level and protects the owner from a myriad of chronic
J Nutr. 2005 Feb;135(2):317-22.
Eur J Clin Invest. 2005 May;35(5):290-304.
Also, don’t depend on high levels in the summer being stored and
used in the winter. Vieth believes that the intracellular kinetics of
vitamin D metabolism means that declining vitamin D blood levels may cause
rapidly declining intracellular levels. That is, declining levels in the
autumn may be as dangerous as low levels in the winter.
Int J Cancer. 2004 Sep 1;111(3):468
Professor Robert Heaney believes healthy blood levels may require up to
4,000 units a day for those with no sun exposure. Most people need to take
more in the winter than the summer. Big people need more than little
people. African Americans need more than whites. Sunphobes need more than
those who enjoy God’s invention.
J Steroid Biochem Mol Biol. 2005 Jul 15
Children over 50 pounds need up to 2,000 units a day. Under 50 pounds,
about 1,000 units a day. There is no way to know for sure how much you
need without a blood test, called a 25-hydroxy-vitamin D. That test should
be conducted in the late winter, when your levels are the lowest, and at
the beginning of fall, when your levels are the highest. Then you can
figure out how much you need to take to keep stable levels. Or adults can
simply take 4,000 units a day, every day, except for those late spring,
summer, and early fall days when you go into the sun.
It might be a good idea to keep pharmacological doses (50,000 units) of
vitamin D next to your antivirals and take a 50,000 unit capsule at the
first sign of the flu, although there is not one study to support such a
practice. It might help tame those unchained macrophages and save your
life or it might not help at all. You can buy 50,000 unit capsules from Bio-Tech-Pharm . Single administrations of
ten times that amount have repeatedly been found to be safe and are
routinely used in Europe as stoss therapy.
So, maybe vitamin D will help your family survive the coming influenza
pandemic, maybe not. Let’s gamble. Ever heard of the vitamin D
variation of Pascal’s wager ?
"If you erroneously believe vitamin D helps influenza, you lose
nothing, whereas if you correctly believe vitamin D helps influenza, your
family may live. But if you correctly disbelieve in vitamin D, you gain
nothing, whereas if you erroneously disbelieve in vitamin D, your family
John Cannell, MD
The Vitamin D Council
9100 San Gregorio Road
Atascadero, CA 93422
This is a periodic newsletter from the Vitamin D Council, a non-profit
trying to end the epidemic of vitamin D deficiency. If you don't want to
get the newsletter, hit reply and let us know. This newsletter is not
copyrighted. Please reproduce it and post it on Internet sites.
Not signed up for future newsletters? Sign up at Vitamin