The Current Position

Multiple Sclerosis is the most common of the neurological disabilities, striking about 160 in every 100,000, and it has a high impact on those affected with a long progress from diagnosis in early adulthood often leading to loss of ability to work and earn an income and ultimately serious disability several decades later. We can recognise it, and to some extent relieve the symptoms and perhaps slow the progress, but we otherwise do not know what causes it, we do not know the mechanism that leads to inflammation and damage in the nervous system and for any individual we cannot predict the progress of the disease, of how relapses will affect the patient, because the episodes of inflammation can crop up anywhere in the nervous system.

There are many puzzles. Twin studies show that there are genetic factors contributing to the likelihood of MS, but that is not the whole story because only a few twins of sufferers progress to MS themselves. Furthermore, there are multiple genetic markers associated with MS: no single gene is predictive. It is an autoimmune disease and MS sufferers are more likely than average to have other autoimmune diseases and vice versa. Presumably there are environmental triggers, but we do not know what they are - though smoking appears to impair the immune system and raise the risk of contracting MS. Recent research also suggests that gut microbiomes may have some influence - but it is too early to be sure how this will develop. For some reason it is also more common in females than males and also among those living in high latitudes - perhaps there is a connection with vitamin D levels?

The Future

In spite of our lack of understanding of causes and mechanisms, there has been steady progress on treating symptoms, mainly through improvements in anti-inflammatory drugs, which can reduce the rate at which permanent damage occurs in the nervous system. Unfortunately, the more effective drugs also have the most serious side effects (such as immunological suppression raising the risk of other infections - and even cancer). Doctors and patients therefore still have difficult choices to make: does one go for the more aggressive treatment as early as possible, hoping to stave off the progressive phase of the disease for as long as possible (accepting the risks) or start with gentler and safer treatments, reserving the more effective but riskier drugs for a time when the disease gets worse?

Dr Harding provided us with a fascinating and information packed lecture, and the audience showed their involvement with the topic through many interesting questions.

Flu, it seems, will always be with us, and even in non-epidemic years is likely to lead to 15,000 UK deaths - with many more in epidemic or pandemic years.
So far, at least, hopes of a “universal” flu vaccine, proof against all strains over long periods of time, are just that. The parts of the virus which the current vaccines attack are highly variable year-to-year, so new vaccines are needed every year. And sometimes we get it wrong: the manufacturers have to start producing vaccines six months before they are needed and rely on predictions about which strains are likely to be in wide circulation. Unfortunately, the 2014/15 vaccine was based on the wrong choices and gave reduced protection. Furthermore, influenza circulates between humans and other animal species, such as birds and pigs, so reducing the rate of transmission in people makes only a minor impact on the evolution of the virus.
Not all is gloom, however. Although vaccines that target other parts of the virus are so far ineffective at preventing infection, it seems that they may well be able to reduce the severity of illnesses. That is important: it can reduce death rates, and more rapid recovery reduces lost working time (not to say the considerable discomfort of full-blown flu). We can also reduce infection rates by widening the vaccination programme, particularly amongst young school age children, who may not suffer severely from the virus, but act as effective agents for infecting their parents and grandparents.
Dr Lambkin Williams explained that more progress relies on “human challenge” experiments: deliberately giving people flu. Animal models (ferrets are the best apparently) are too far away to give a good representation of the full complexity of the human immune system in realistic circumstances.
The take home message is: get vaccinated - and make sure it is the four-strain vaccine.