Kilbourne in 1976 (Kilbourne, 1976) noted that pandemics of influenza occur every 11 years. Since the latest prediction in the New York Times (Editorial, 2005) suggests that after 39 years we may be overdue for a pandemic, and since 2 US senators have recently headlined the possibility (Obama and Lugar, 2005), that observation may become a political fact. Whether it becomes a scientific fact and a policy fact is yet to be seen. Some reflections on 1976 from 2 insiders’ viewpoints may identify some of the pitfalls that public health policymakers will face in addressing potential influenza pandemics.
On February 3, 1976, the New Jersey State Health Department sent the Center for Disease Control (CDC) in Atlanta isolates of virus from recruits at Fort Dix, New Jersey, who had influenzalike illnesses. Most of the isolates were identified as A/Victoria/75 (H3N2), the contemporary epidemic strain. Two of the isolates, however, were not typeable in that laboratory. On February 10, additional isolates were sent and identified in CDC laboratories as A/New Jersey/76 (Hsw1N1), similar to the virus of the 1918 pandemic and better known as “swine flu.”
A meeting of representatives of the military, the National Institute of Health, the Food and Drug Administration (FDA), and the State of New Jersey Department of Health was quickly convened on Saturday, February 14, 1976. Plans of action included heightened surveillance in and around Fort Dix, investigation of the ill recruits to determine if contact with pigs had occurred, and serologic testing of recruits to determine if spread had occurred at Fort Dix.
Surveillance activities at Fort Dix gave no indication that recruits had contact with pigs. Surveillance in the surrounding communities found influenza caused by the current strain of influenza, A/Victoria, but no additional cases of swine flu. Serologic testing at Fort Dix indicated that person-to-person transmission had occurred in >200 recruits (Hodder et al., 1977).
In 1974 and 1975, 2 instances of humans infected with swine influenza viruses had been documented in the United States. Both persons involved had close contact with pigs, and no evidence for spread of the virus beyond family members with pig contact could be found (Dowdle and Hattwick, 1977).
On March 10, 1976, the Advisory Committee on Immunization Practices of the United States Public Health Service (ACIP) reviewed the findings. The committee concluded that with a new strain (the H1N1 New Jersey strain) that could be transmitted from person to person, a pandemic was a possibility. Specifically, the following facts were of concern: 1) persons <50 years of age had