Viral tropism and the pathogenesis of influenza in the Mammalian host.

Influenza viruses, single-stranded negative-sense RNA viruses within the family Orthomyxoviridae, remain an important cause of human morbidity and mortality worldwide. Despite effective vaccines, more than 200,000 individuals in the United States are hospitalized each year for influenza, and approximately 35,000 succumb to disease.1 Seasonal epidemics arise through antigenic variation and recombination events from existing and currently circulating human strains, which initially target the upper respiratory tract with extension to a bronchointerstitial pneumonia in a subset of affected individuals. Disease is often more severe in older and debilitated patients, producing a characteristic distribution in age-related mortality within the affected population.2 In contrast to seasonal epidemics, pandemics arise when antigenically novel viruses emerge and are readily transmissible within the naive human population. Such events are rare and occur after zoonotic transmission of viruses through recombination events between established human and avian strains or possibly through direct adaptation of avian strains for efficient human to human transmission.3 Concerns over an avian influenza pandemic have risen since 1997 with the recognition of H5N1 as a cause of fulminant disease in humans.4,5 Pathologically fatal H5N1 causes diffuse alveolar damage and progression to multiple organ dysfunction with a case fatality rate estimated at more than 50%. Although H5N1 disease is severe, transmission rates have been low, and viral adaptation to efficient human to human transmission has not occurred. Understanding viral and host barriers that prevent transmission may be critical in establishing rational control measures as well as predicting and stratifying risk for individual strains of influenza. In this issue of The American Journal of Pathology, van Riel et al6 examine the viral binding distribution in pulmonary tissue of a number of avian and human influenza strains to elucidate the role of tropism in transmission and pathogenesis.