The effect of virus infections on the host organism and populations – viral pathogenesis, virulence, and epidemiology
Since a major motivating factor for the study of virology is that viruses cause disease of varying levels of severity in human populations and in the populations of plants and animals that support such populations, it is not particularly surprising that virus infections have historically been considered episodic interruptions of the wellbeing of a normally healthy host. This view was supported in some of the earliest studies on bacterial viruses, which were seen to cause the destruction of the host cell and general disruption of healthy, growing populations of the host bacteria. Despite this, it was seen with another type of bacterial virus that a persistent, lysogenic infection could ensue in the host population. In this case, stress to the lysogenic bacteria could release infectious virus long after the establishment of the initial infection.
These two modes of infection of host populations by viruses, which can be accurately modeled by mathematical methods developed for studying predator–prey relationships in animal and plant populations, are now understood to be general for virus–host interactions. Indeed, persistent infections with low or no levels of viral disease are universal in virus–host ecosystems that have evolved together for extended periods – it is only upon the introduction of a virus into a novel population that widespread disease and host morbidity occur.
While we can therefore consider severe virus‐induced disease to be evidence of a recent introduction of the virus into the population in question, the accommodation of the one to the other is a very slow process requiring genetic changes in both virus and host, and it is by no means certain that the accommodation can occur without severe disruption of the host population – even its extinction. For this reason, the study of the replication and propagation of a given virus in a population is of critical importance to the body politic, especially in terms of formulating and implementing health policy. This is, of course, in addition to its importance to the scientific and medical communities.
The study of viral pathogenesis is broadly defined as the study of effects of viral infection on the host. The pathogenicity of a virus is defined as the sum total of the virus‐encoded functions that contribute to virus propagation in the infected cell, in the host organism, and in the population. Pathogenicity is essentially the genetic ability of members of a given specific virus population (which can be considered to be genetically more or less equivalent) to cause a disease and spread through (propagate in) a population. Thus, a major factor in the pathogenicity of a given virus is its genetic makeup or genotype.
The basis for severity of the symptoms of a viral disease in an organism or a population is complex. It results from an intricate combination of expression of the viral genes controlling pathogenicity, physiological response of the infected individual to these pathogenic determinants, and response of the population to the presence of the virus propagating in it. Taken together, these factors determine or define the virulence of the virus and the disease it causes.
A basic factor contributing to virulence is the interaction among specific viral genes and the genetically encoded defenses of the infected individual. It is important to understand, however, that virulence is also affected by the general health and genetic makeup of the infected population, and in humans, by the societal and economic factors that affect the nature and extent of the response to the infection.
The distinction and gradation of meanings between the terms pathogenesis and virulence can be understood by considering the manifold factors involved in disease severity and spread exhibited in a human population subjected to infection with a disease‐causing virus. Consider a virus whose genotype makes it highly efficient in causing a disease, the signs and symptoms of which are important in the spread between individuals – perhaps a respiratory infection with accompanying sneezing, coughing, and so on. This ideal or optimal virus will incorporate numerous, random genetic changes during its replication cycles as it spreads in an individual and in the population. Some viruses generated during the course of a disease may, then, contain genes that are not optimally efficient in causing symptoms. Such a virus is of reduced virulence, and in the extreme case, it might be a virus that has accumulated so many mutations in pathogenic genes that it can cause no disease at all (i.e., has mutated to an avirulent or apathogenic strain). While an avirulent virus may not cause a disease, its infection may well lead to complete or partial immunity against the most virulent genotypes in an infected individual. This is the basis of vaccination, which is described in Part II, Chapter 8. But the capacity to generate an immune response and the resulting generation of herd immunity also mean that as a virus infection proceeds in a population, either its virulence must change or the virus must genetically adapt to the changing host.
Other factors not fully correlated with the genetic makeup of a virus also contribute to variations in virulence of a pathogenic genotype. The same virus genotype infecting two immunologically naive individuals (i.e., individuals who have never been exposed to any form of the virus leading to an immune response) can cause very different outcomes. One individual might only have the mildest symptoms because of exposure to a small amount of virus, or infection via a suboptimal route, or a robust set of immune and other defense factors inherent in his or her genetic makeup. Another individual might have a very severe set of symptoms or even death if he or she receives a large inoculum, or has impaired immune defenses, or happens to be physically stressed due to malnutrition or other diseases.
Also, the same virus genotype might cause significantly different levels of disease within two more‐or‐less genetically equivalent populations that differ in economic and technological resources. This could happen because of differences in the ability of one society's support net to provide for effective medical treatment, or to provide for isolation of infected individuals, or to have available the most effective treatment protocols.
Taken in whole, the study of human infectious disease caused by viruses and other pathogens defines the field of epidemiology (in animals, it is termed epizoology). This field requires a good understanding of the nature of the disease under study and the types of medical and other remedies available to treat it and counter its spread, and some appreciation for the dynamics and particular nuances and peculiarities of the society or population in which the disease occurs.
The interaction between viruses and their hosts
The interaction between viruses (and other infectious agents) and their hosts is a dynamic one. As effective physiological responses to infectious disease have evolved in the organism and (more recently) have developed in society through application of biomedical research, viruses themselves respond by exploiting their naturally occurring genetic variation to accumulate and select mutations to become wholly or partially resistant to these responses. In extreme cases, such resistance will lead to periodic or episodic reemergence of a previously controlled disease – the most obvious example of this process is the periodic appearance of human influenza viruses causing disease.
The accelerating rate of human exploitation of the physical environment and the accelerating increase in agricultural populations afford some viruses new opportunities to “break out” and spread both old and novel diseases.