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There are two apparently conflicting schools of thought, when it comes to predicting which strain of influenza will eventually "go pandemic."  The first school believes that a novel strain -- usually, as we all believe, H5N1 --  will be the one to eventually explode.

But the second school rarely gets attention.  That school believes that pandemic viruses recycle themselves and reappear every so often.  There is not a lot of information available Out There on that subject, but one of its strongest proponents was the late scientist, Dr. Maurice Hilleman.

Hilleman's name should be a household word by now, but the man was not into that sort of thing.  I offer you, verbatim, and from Amazon.com, the Booklist starred review of Dr. Paul Offit's superb work Vaccinated: One Man's Quest to Defeat the World's Deadliest Diseases.

From Booklist
*Starred Review* Maurice Hilleman's name isn't well known, and according to infectious disease expert Offit's riveting biography, that is both a shame and a blessing. It's a shame because the outspoken, brilliant, yet humble scientist from Montana invented vaccines that all but wiped out a number of infectious diseases. Thanks to his genius, such diseases as mumps, rubella, measles, and hepatitis A and B no longer claim millions of lives, mostly children's. He merits greater recognition. His obscurity is a blessing because it prevents more people from using his name in vain, for Hilleman's vaccines have recently become increasingly controversial and their efficacy clouded by questions about adverse side effects. Still, Offit pulls no punches in defending Hilleman against those who would crucify him for combining measles, mumps, and rubella vaccines into one shot and for the choice to add thimerosal to extend the shelf life of all vaccines. Despite the fact that Offit's bias on behalf of public health shows, the book is a powerful examination of the kind of single-minded determination it takes to tackle diseases that threaten the world's children. And to do so without bravado—no vaccine bears Hilleman's name, no awards his mantle—is to define what it is to be simply heroic. (Chavez, Donna)

Flu aficionados who are not aware of Hilleman need to look carefully at the work he did in 1957.  Offit makes a persuasive case that it was Hilleman who first uncovered the 1957 H2N2 flu pandemic and was the first to develop a vaccine -- in four months!  Admittedly, he did this without regard to the Feds, and he took risks.  But the results of his work are indisputable.  The mortality of 1957's H2N2 was ten percent of the 1918 pandemic.  And with astonishingly little available in the literature regarding the 1957 pandemic, any time anyone devotes multiple pages to that event, it is worthwhile reading.  And since the book opens with a look back at the 1997 emergence of H5N1, and closes with a prediction of H2N2 as the next Big One, it is also required reading -- if even using the index on a cold Sunday at Borders -- for all who are interested in influenza and infectious diseases.

Before his death, Hilleman said he did not think H5N1 would produce the Next Pandemic.  But he believed he had stumbled onto a pattern of viral behavior that may be hard to shake.  He believed that pandemic influenza viruses came in 68-year intervals.  using this technique, he believed that the 1889 pandemic was an H2 virus.  He supported this with testing which (at the time and using 1957 science) purported to show that elderly people who survived the 1889 pandemic possessed antibodies to the H2 substrain.  Influenza textbooks have also adopted this view; namely, that 1889 was an H2; 1900, an H3; and so on. 

This view is hotly debated in microbiological circles.  Some researchers, such as W.R. Dowdle of the Task Force for Child Survival and Development in Decatur, Georgia, believe that an H3, not an H2, was responsible for the 1889 pandemic.  Hilleman believed an H3 was responsible for the mini-pandemic of 1900; Dowdle also believes differently.

But not too differently:  I quote from the abstract of Dowdle's research paper, H2 variants should be included in pandemic planning for a number of reasons, but not because of evidence of recycling. It is not known when the next pandemic will occur or which of the 15 (or more) haemagglutinin subtypes will be involved. Effective global surveillance remains the key to influenza preparedness.

OK, now on to today's events.  A brand new research paper has uncovered a new reassortant hybrid swine/avian H2N3 virus, previously only detected in wild birds.  Dr. Richard Webby of legendary St. Jude Childrens Research Hospital in Memphis (home of Dr. Robert Webster), along with researchers at the University of Iowa (where swine influenza was first discovered) and the University of Minnesota (also no slouches at the flu) released a major work.  The short form:  Pigs can, indeed, be the "Mixing Vessel" to produce a potential pandemic strain.

The bigger news is that H2 is now officially back on the Short List for the Next Pandemic Strain.  No doubt this will be welcome news to those who are laboring fruitlessly to persuade/convince their superiors that a flu pandemic is around the corner, if not outright imminent.  Anyone under the age of 50 is not immune to H2.  Also, no one is immune to the neuraminidase N3.  And a swine/avian H2 reassortant may not afford complete immunity to those who lived through 1957, as I did.  I recall my fever:  I was 2 at the time, and I hallucinated that a train was running up the wall of my bedroom.  The memory of that hallucination stays with me today. And no, it was not provoked by the 60s!. Wise guys.

By the way, the H2N3 was not found in Guangdong Province, China.

It was found and typed in Missouri last year, which is ironic, since it is the Show Me state.

Now, do we go back, like the Indonesians and Pakistanis have done, and try to find untyped influenza infections in farms in Missouri that were passed off as seasonal flu, no biggie?

Hmmmmm.

A huge hat-tip to Crof and FLA_MEDIC for breaking this story on H5N1 and Avian Flu Diary.