Let's talk about influenza
viruses and the three different types of
influenza that there are. There are actually three
types, or three families, I think of them as. And we're going to go
through each family. And we're going to talk about
the differences between them. And so let's actually just
label the type over here. There's type A. And this
is the most common type you usually hear about. And type B and C I think
are less often talked about. But we're going to go
through them systematically. So the first thing I want to
talk about are the symptoms. If you actually get
these types of influenza, what are the symptoms
you would expect? Well, for type A you
expect the classic things that we talk about with flu. Some respiratory symptom,
like maybe a cough. And also some
constitutional symptom. I'm just going to
write constitutional. Kind of a short form. Constit. And that would be something like
a fever or a malaise or body ache. Something like that. And for type B, it's actually
pretty much the same. Sometimes people say type B is
a little bit more mild than type A. But generally
speaking, it's very hard to know whether you have
type A or type B flu. So these are the
first two, right? These are the classic
way we think about flu. Respiratory symptoms and
constitutional symptoms. Now, type C is actually
kind of different. It's actually usually
only respiratory symptoms. Now, of course I'm not
going to use the word always whenever I do this kind
of thing because everyone can find an example
of an exception. But type C is usually going to
be just a respiratory symptom. It's usually more mild. So you might have a stuffy
nose and a sore throat, but you wouldn't have
the other things. You wouldn't have any of the
fever, the malaise, body aches, none of that kind of stuff. Usually. So that's one key difference. As I go through I'm
going to kind of circle some things I think are
kind of interesting. And this is to me
very interesting because here we have an example
of influenza type C that's actually causing symptoms
that we don't classically think of as flu. And we would
actually-- if someone had a runny nose
and a sore throat-- I would think that they
had the common cold. So here I'm getting
tricked again. So initially we talked about
how you have copycat viruses. But here's an example
of the opposite. Where the influenza
virus actually isn't even causing what I would
clinically call the flu. So what's another difference
between these three types that we have listed here? Let me actually write
out the term epidemic. And you may not be totally
comfortable with what this word means. And sometimes people use
the word differently. So I'm going to
mention what I mean. But type A and type B
can both cause epidemics. And type C really doesn't. And what I mean
when I say epidemic. Let me actually just
draw out quickly the idea of an epidemic in my mind. Let's say you have one
year at the bottom. January, February,
March, April, May. I'm going to go through
the whole calendar year. This will be June and July. And then August, September,
October, November, December. This is the calendar year. Now, if I'm thinking
of type A or B, I would actually probably
expect something like this. Where you have a high level
of activity in the winter. And then in the
summer it goes down. And then as the winter
months approach again you see the activity go up. And so this would be
type A and type B. Now, with type C it's
actually really different. So type C I'm going
to do in a red color. Usually you have a
low level of activity all throughout the year. So it doesn't
really change a lot. So when I say epidemic, what
I'm really referring to, is the fact that you
can see that there's an elevation in terms
of the number of cases-- this is number of cases. You're seeing more
cases during some months of the year than the baseline. It rises away from
the baseline and then it dips down in
the summer months. So whenever you see more
cases than you would expect, we sometimes think of
that as an epidemic. And in this case you might
even call it a winter epidemic. So type A and B cause
these winter epidemics, where more people get sick. And type C doesn't
usually do that. Now we haven't talked
a whole lot about it, but what about vaccine? Which of these influenza viruses
can you find in the vaccine? Well, type A is in the vaccine. And so is type B.
But type C is not. And this actually makes sense
because with the vaccine you're really
worried about people who are going to get very sick. So these are people that
have fevers and malaise. And these are the
people that are probably going to go on to get
more sick because it's a more severe disease. And again you want to prevent
as much disease as possible. So this is the epidemics that
you're trying to prevent. So it makes sense that type A
and type B are in the vaccine, whereas type C is not. So let me circle that. Because I think that's also an
interesting and important fact about influenza. And what about the
idea of genetic drift? And this alludes to the idea
of mutations building up. And all three types, A, B,
and C, all have mutations, from time to time that
causes changes in the way the virus actually looks
to your immune system. So the proteins might
change a little bit. And all three of
them actually-- they mutate at a different rate. So interestingly, the mutation
rate is lowest for type C and highest for
type A. So type A has the highest mutation rate. So this is the mutation
rate creeping up. And it's interesting
that it's actually quite high for type
A, which is again-- that's one of the ones
that's in the vaccine. Remember? And alongside genetic drift I
want to mention the other one. Remember we talked about
genetic drift and genetic shift. And this actually is more
about shuffling bits of RNA, or pieces of that
genetic material around when two viruses
infect the same cell. And we know that this is a major
issue when we think of type A. But this doesn't really happen
in any clinically significant way for type B or
type C. It's not a major issue for those types. But it is a major
issue for type A. And next to genetic shift,
let me write pandemic. Because this is what we
always worry about, right? We don't want a virus or an
influenza virus to just rip through a population and
cause massive, massive numbers of deaths and hospitalizations. And again that is a
concern with type A. We've seen it many times
in the past 100 years or so with type A. And that's
not a concern with type B or C. And it's related of course
directly to genetic shift. And finally, the last category
I want to write up is animals. We know all three
types of influenza are going to affect humans. But which ones actually
affect animals as well? Now type A, this is
the one that affects tons and tons of animals. In fact, birds are probably
the one that jump to mind. You always hear these words like
avian flu, swine flu, right? That has to do with pigs. And there's actually also--
horses can get some of these type A's. Dogs can get them. So lots and lots of
animals are affected. And I want to point out that
all these animals I'm writing up here are animals
that humans regularly deal with or are around. So farmers might be around pigs. And if you're into horse riding
you might be around horses. Many of us have dogs. And birds are flying
above us all the time. And by comparison, there
really aren't any animals that humans are
regularly in contact with that get type B. So
that's not really an issue. Animals are not an
issue for type B. And for type C, there are
a couple of animals here I can mention. Pigs. Dogs. It's not as big a deal
as it is for type A. So really type A-- this
is an important point and it really goes together
with this idea of genetic shift and pandemics. Because you remember you
can get all this shuffling of genes that happened between
birds and pigs and humans. And that's sometimes what
sets up genetic shift. And of course if that happens
you might have a pandemic. So it all goes together.