It has been reported that the virus responsible for the 1918 Spanish flu pandemic, which killed an estimated 50m people worldwide, has been reconstructed by genetic engineering in a high-security US laboratory. Separately, the World Health Organization released a major report on chronic diseases.

An Emergency Hospital for US Influenza Patients - The effect of the influenza epidemic was so severe that the average life span in the US was depressed by 10 years. The influenza virus had a profound virulence, with a mortality rate at 2.5% compared to the previous influenza epidemics, which were less than 0.1%. The death rate for 15 to 34-year-olds of influenza and pneumonia were 20 times higher in 1918 than in previous years (Taubenberger). People were struck with illness on the street and died rapid deaths. One anectode shared of 1918 was of four women playing bridge together late into the night. Overnight, three of the women died from influenza (Hoagg). Others told stories of people on their way to work suddenly developing the flu and dying within hours (Henig). One physician writes that patients with seemingly ordinary influenza would rapidly "develop the most viscous type of pneumonia that has ever been seen" and later when cyanosis appeared in the patients, "it is simply a struggle for air until they suffocate," (Grist, 1979). Another physician recalls that the influenza patients "died struggling to clear their airways of a blood-tinged froth that sometimes gushed from their nose and mouth," (Starr, 1976). The physicians of the time were helpless against this powerful agent of influenza. Source: www.stanford.edu/group/virus/uda/

Preliminary studies reveal that it is an avian flu virus that mutated to spread rapidly between people just as many experts fear may happen soon with the current H5N1 strain of bird flu in Asia. Information on the project is published today in the journals Science and Nature.

The US National Institutes of Health approved the research, despite its apparent risk, because it will enable scientists find new treatments for the most dangerous types of flu.

The Centres for Disease Control laboratory in Atlanta constructed a live virus with the full genetic sequence of Spanish flu, using an engineering technique called “reverse genetics” developed at Mount Sinai Hospital in New York.

“We felt we had to recreate the virus and run these experiments to understand the biological properties that made the 1918 virus so exceptionally deadly,” said Terrence Tumpey, head of the CDC team. “We wanted to identify the specific genes responsible for its virulence, with the hope of designing antivirals or other interventions that would work against virulent influenza viruses.”

The key genetic data for the experiment came from the Armed Forces Institute of Pathology in Washington DC. Over the past eight years scientists there have put together the entire Spanish flu genome, from viral fragments isolated from preserved lung samples of patients who died in 1918 and from a female victim whose body was frozen in Alaskan permafrost.

Many of the flu viruses circulating today were related to the H1N1 strain that swept the world in 1918 so the population still had some protective immunity against it, said Jeffery Taubenberger, leader of the AFIP team. “It is unlikely that a1918-like virus would be able to cause a pandemic today.”

The research indicates that Spanish flu arose in a different way to the viruses that caused the other two 20th century pandemics. In 1957 and 1968 an existing human virus underwent genetic mixing with a bird virus to produce a new “reassorted” strain in one step.

In 1918, however, an entirely avian virus slowly adapted to function in humans through a sequence of mutations. Although the analysis is incomplete, about four to six mutations appear to have taken place in each of the eight viral genes, Dr Taubenberger said.

Ominously, the H5N1 strain currently circulating in Asia is undergoing similar humanizing mutations though it has not accumulated as many changes as Spanish flu.

Related: EU urges action in response to avian/bird flu threat

World Health Organization: "Stop the global epidemic of chronic disease"

The World Health Organization (WHO) report, 'Preventing Chronic Diseases: a vital investment' says global action to prevent chronic disease could save the lives of 36 million people who would otherwise be dead by 2015.

Dr Catherine Le Galès-Camus, Assistant Director-General for Noncommunicable Diseases and Mental Health - "Without action, almost 400 million people will die from chronic diseases in the next 10 years. Many of these deaths will occur prematurely, affecting families, communities and countries alike."

Currently, chronic diseases are by far the leading cause of death in the world and their impact is steadily growing. The report projects that approximately 17 million people die prematurely each year as a result of the global epidemic of chronic disease.

Faced with the prospect of millions of people dying prematurely and suffering needlessly from heart disease, stroke, cancer and diabetes, WHO says the global epidemic of chronic disease must be stopped. Contrary to common perception, this largely invisible epidemic is worst in low and middle income countries, where 80% of all chronic disease deaths occur. The report details the latest findings from nine countries: Brazil, Canada, China, India, Nigeria, Pakistan, the Russian Federation, the United Kingdom and the United Republic of Tanzania.

The report also provides new projections for the economic impact of chronic diseases. For example, China, India and the Russian Federation could forego billions of dollars in national income over the next ten years as a result of heart disease, stroke, cancer and diabetes. The estimated accumulated losses to China from 2005 to 2015, for example, are US$ 558 billion, for India US$ 236 billion, and US$ 303 billion for the Russian Federation.

"This is a very serious situation, both for public health and for the societies and economies affected, and the toll is projected to increase", said Dr LEE Jong-wook, WHO Director-General. "The cost of inaction is clear and unacceptable. It is vital that countries review and implement the health actions we know will reduce premature death from chronic diseases."

The global goal

In this report, WHO proposes a new global goal: to reduce the projected trend of chronic disease death rates by 2% each year until 2015. This would prevent 36 million people dying of chronic diseases in the next 10 years, nearly half of them before they turn 70.

But these problems and their solutions lie outside the control of any one sector. In order to achieve the goal, all sectors from government, private industry, civil society and communities will have to work together. "More and more people are dying too early and suffering too long from chronic diseases," said Dr. Catherine le Galès-Camus, Assistant Director-General of Noncommunicable Diseases and Mental Health, "We know what to do, and so we must do it now."

Preventable risk factors

The vast majority of cases of chronic diseases are caused by a small number of known and preventable risk factors. Three of the most important are unhealthy diet, physical inactivity and tobacco use. Globally, these risk factors are increasing as people's dietary habits change to foods high in fats and sugars, and people's work and living situations are much less physically active. Increased marketing and sales of tobacco products in low and middle income countries mean greater exposure to the risk of tobacco.

One billion people globally are overweight or obese, and WHO predicts that will rise beyond 1.5 billion by 2015 without immediate action.

The report examines the vast evidence-based knowledge about inexpensive and cost-effective measures that can produce rapid health gains and for which the benefits far outweigh the costs. Examples include: salt reduction in processed foods, improved school meals and taxation of tobacco products, which is not only cost-effective but also raises revenues for governments.

Global voices in support

'We cannot afford to say 'we must tackle other diseases first - HIV/AIDS, malaria, tuberculosis - then we will deal with chronic diseases. If we wait even 10 years, we will find that the problem is even larger and more expensive to address." President Olusegun Obasanjo, Nigeria

"Although chronic diseases are among the most common and costly health problems, they are also among the most preventable. Public health efforts on health promotion and disease prevention are critical to achieving better health outcomes for people worldwide." Ujjal Dosanjh, Minister of Health, Canada

"We can measure the loss of income to the Chinese economy alone at a staggering US$550 billion over the next 10 years. In response to these facts, the Ministry of Health of China, with the support of WHO, has been developing the first medium- and long-term high level national plan for chronic disease prevention and control." WANG Longde, Vice-Minister of Health, the People's Republic of China.

Download report (pdf format)

WHO would like to acknowledge the support of the Governments of Canada, Norway, and the United Kingdom in producing 'Preventing Chronic Diseases: a vital investment'.

Additionally, the Lancet medical journal is publishing a series of articles in support of the report, which will be available at: http://www.thelancet.com