"Fasten your seatbelts — it's going to be a bumpy night."
Bette Davis's memorable quote from the cult film classic "All about Eve," may or may not apply to this year's flu season.
As Dr. Robert Norton likes to say, he would be a wealthy man if he could predict when, where and how widely the next serious flu pandemic will occur.
Even so, Norton, a veterinary bacteriologist and Auburn University professor of poultry science, says Americans are probably in for a bad flu season.
"It's not going to be a catastrophic flu season, but it's probably going to be a substantial one," says Norton.
He cites several studies that are as interesting as they are disturbing.
One study, completed in Hong Kong, focused on the three major influenza pandemics in the 20th century. It found that the viruses that ultimately sparked the pandemics were previously circulating in human and animal hosts for years.
Norton says H1N1 is undergoing a similar process — what he and other experts describe as "percolating."
Equally disturbing, the H1N1 remains active despite what Norton initially hoped would be a summer hiatus. A recent outbreak at the U.S. Air Force Academy, while mild, underscores that the flu virus remains active in the United States — that is "percolating," Norton says.
"It's not unknown, but it is unusual that a virus would be this active this far into the summer," he says.
"But it is unusual enough that some epidemiologists have been left scratching their heads."
The good news is that while the virus has caused some deaths, the strain remains comparatively mild.
Outbreaks such as these invariably raise the question: How close are we to the big one?
That remains an open question, Norton says.
"If the results of the Hong Kong study are accurate — and I see no reason that they aren't— we may be out a couple of years before the outbreak of a truly devastating pandemic," he says.
Still, Norton stresses that flu pandemics always have been notoriously difficult to predict.
"Yes, it's an educated guess, but it's still anybody's guess when this major outbreak, coupled with high pathogenicity, occurs," he says.
Whatever the case, he says such an outbreak will occur sooner or later.
"It's cyclic — we don't understand the cycles — but it will eventually happen."
Norton also is concerned about reports of drug-resistance in Asia. While this is not surprising considering the way patients sometimes are medicated in Asian countries, Norton says it's nonetheless troubling.
He also foresees some problems developing and administering vaccines.
The World Health Organization already is developing a H1N1 vaccine, which is currently undergoing human testing.
Currently, developers are beset with several challenges. For starters, the vaccine has not proven as easy to develop as other flu vaccines. There is also some confusion about how the vaccination ultimately will be administered, Norton says.
"Right now, they're talking about multiple vaccinations — perhaps as many as four — targeted primarily to children under 14," he says. Multiple vaccinations may also be recommended for adults.
Norton fears four vaccinations will prove exceptionally problematic.
"There are going to be lots of kids that don't get the four vaccinations," he says.
WHO officials also have expressed concerns about supply problems that ultimately may follow.
However, in previous medical emergencies, Norton says these challenges ultimately have been resolved.
"What initially seems inadequate at the start ultimately gets worked out," he says.
Medical authorities are also turning up some other insights into this virus. For example, obesity appears to be a major risk factor associated with H1N1.
"That's not surprising, but there is a study that now backs up that previously held opinion," Norton says.
Investigators with the Centers for Disease Control and Prevention have been especially struck by the high prevalence of severe complications associated with this virus.
The same study also revealed that males appear to be especially susceptible to the virus.