#Influenza #Cataclysm, 1918 (N Engl J Med., summary)

[Source: The New England Journal of Medicine, full page: (LINK). Summary, edited.]

Influenza Cataclysm, 1918

David M. Morens, M.D., and Jeffery K. Taubenberger, M.D., Ph.D.

December 13, 2018 / N Engl J Med 2018; 379:2285-2287 / DOI: 10.1056/NEJMp1814447


Audio Interview

Interview with Dr. David Morens on lessons from the 1918 influenza pandemic and the threat of a similar global health disaster. 

This year marks the centennial of an influenza pandemic that killed 50 million to 100 million people globally — arguably the single deadliest event in recorded human history. Evidence suggests that another pandemic at least as severe may occur one day.


Disclosure forms provided by the authors are available at NEJM.org.

Author Affiliations: From the Office of the Director (D.M.M.) and the Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases (J.K.T.), National Institute of Allergy and Infectious Diseases, Bethesda, MD.

Keywords: Pandemic Influenza; Spanish Flu; H1N1; History.



#Spanishflu in #Italy: new #data, new questions (Infez Med., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Infez Med. 2018 Mar 1;26(1):97-106.

Spanish flu in Italy: new data, new questions.

Fornasin A1, Breschi M2, Manfredini M3.

Author information: 1 Department of Economics and Statistics, University of Udine, Italy. 2 Department of Economics and Business, University of Sassari, Italy. 3 Department of Life Sciences, University of Parma, Italy.



This paper proposes a new estimate for the number of victims of Spanish flu in Italy and highlights some aspects of mortality closely linked to the First World War. The sources used are official death statistics and the Albo d’oro, a roll of honor of the Italians fallen in the First World War. The new estimate of deaths from the flu is 410,000 for 1918, which should be raised to 466,000 when the numbers are taken up to 1920. Deaths from Spanish flu among the military were about 70,000. The time sequence of deaths recognizes two distinct peaks, one in October and one in November 1918. Between these two peaks, the lowest number of deaths falls in the week of the armistice between Italy and Austria-Hungary (signed 4 November 1918). This suggests links between Spanish flu and WWI that cannot be merely explained in terms of movement of people and contagion.

PMID: 29525806[Indexed for MEDLINE] Free full text

Keywords: Pandemic Influenza; Spanish Flu; H1N1; Italy; Society; Wars.


#Natality #Decline and Spatial #Variation in Excess #Death Rates During the 1918-1920 #Influenza #Pandemic in #Arizona, #USA (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2018 Dec 1;187(12):2577-2584. doi: 10.1093/aje/kwy146.

Natality Decline and Spatial Variation in Excess Death Rates During the 1918-1920 Influenza Pandemic in Arizona, United States.

Dahal S1, Mizumoto K1,2, Bolin B3, Viboud C, Chowell G1,4.

Author information: 1 Department of Population Health Sciences, School of Public Health, Georgia State University, Atlanta, Georgia. 2 Graduate School of Medicine, Hokkaido University, Hokkaido, Japan. 3 School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona. 4 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland.



A large body of epidemiologic research has concentrated on the 1918 influenza pandemic, but more work is needed to understand spatial variation in pandemic mortality and its effects on natality. We collected and analyzed 35,151 death records from Arizona for 1915-1921 and 21,334 birth records from Maricopa county for 1915-1925. We estimated the number of excess deaths and births before, during, and after the pandemic period, and we found a significant decline in the number of births occurring 9-11 months after peak pandemic mortality. Moreover, excess mortality rates were highest in northern Arizona counties, where Native Americans were historically concentrated, suggesting a link between ethnic and/or sociodemographic factors and risk of pandemic-related death. The relationship between birth patterns and pandemic mortality risk should be further studied at different spatial scales and in different ethnic groups.

PMID: 30508194 DOI: 10.1093/aje/kwy146

Keywords: Pandemic Influenza; H1N1; Spanish Flu; Society; USA; Arizona.


#Origins of the 1918 #Pandemic: Revisiting the #Swine “Mixing Vessel” #Hypothesis (Am J Epidemiol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Epidemiol. 2018 Dec 1;187(12):2498-2502. doi: 10.1093/aje/kwy150.

Origins of the 1918 Pandemic: Revisiting the Swine “Mixing Vessel” Hypothesis.

Nelson MI1, Worobey M2.

Author information: 1 Division of International Epidemiology and Population Studies, Fogarty International Center, National Institutes of Health, Bethesda, Maryland. 2 Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, Arizona.



How influenza A viruses host-jump from animal reservoir species to humans, which can initiate global pandemics, is a central question in pathogen evolution. The zoonotic and spatial origins of the influenza virus associated with the “Spanish flu” pandemic of 1918 have been debated for decades. Outbreaks of respiratory disease in US swine occurred concurrently with disease in humans, raising the possibility that the 1918 virus originated in pigs. Swine also were proposed as “mixing vessel” intermediary hosts between birds and humans during the 1957 Asian and 1968 Hong Kong pandemics. Swine have presented an attractive explanation for how avian viruses overcome the substantial evolutionary barriers presented by different cellular environments in humans and birds. However, key assumptions underpinning the swine mixing-vessel model of pandemic emergence have been challenged in light of new evidence. Increased surveillance in swine has revealed that human-to-swine transmission actually occurs far more frequently than the reverse, and there is no empirical evidence that swine played a role in the emergence of human influenza in 1918, 1957, or 1968. Swine-to-human transmission occurs periodically and can trigger pandemics, as in 2009. But swine are not necessary to mediate the establishment of avian viruses in humans, which invites new perspectives on the evolutionary processes underlying pandemic emergence.

PMID: 30508193 DOI: 10.1093/aje/kwy150

Keywords: Avian Influenza; Swine Influenza; Influenza A; Pandemic Influenza; H1N1; Spanish Flu; Pigs; Reassortant strain.


1818, 1918, 2018: Two #Centuries of #Pandemics (Health Secur., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Health Secur. 2018 Dec 4. doi: 10.1089/hs.2018.0083. [Epub ahead of print]

1818, 1918, 2018: Two Centuries of Pandemics.

Snyder MR1,2, Ravi SJ1,2.

Author information: 1 Michael R. Snyder, MALD, is an Analyst, and Sanjana J. Ravi, MPH, is a Senior Analyst, both at the Johns Hopkins Center for Health Security. 2 Both are Research Associates at the Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.



2018 marks the centennial of the 1918 influenza pandemic, widely acknowledged as one of the deadliest infectious disease crises in human history. As public health and medical communities of practice reflect on the aftermath of the influenza pandemic and the ways in which it has altered the trajectory of history and informed current practices in health security, it is worth noting that the Spanish flu was preceded by a very different 100-year threat: the first Asiatic cholera pandemic of 1817 to 1824. In this commentary, we offer a historical analysis of the common socioeconomic, political, and environmental factors underlying both pandemics, consider the roles of cholera and Spanish flu in shaping global health norms and modern public health practices, and examine how strategic applications of soft power and broadening the focus of health security to include sustainable development could help the world prepare for pandemics of the future.

PMID: 30511884 DOI: 10.1089/hs.2018.0083

Keywords: Pandemics; Pandemic preparedness; Influenza A; Cholera; Society.


#Tissue #tropisms opt for transmissible #reassortants during #avian and #swine #influenza A virus co-infection in swine (PLoS Pathogens, abstract)

[Source: PLoS Pathogens, full page: (LINK). Abstract, edited.]


Tissue tropisms opt for transmissible reassortants during avian and swine influenza A virus co-infection in swine

Xiaojian Zhang , Hailiang Sun , Fred L. Cunningham , Lei Li , Katie Hanson-Dorr, Matthew W. Hopken, Jim Cooley, Li-Ping Long, John A. Baroch, Tao Li, Brandon S. Schmit, Xiaoxu Lin, Alicia K. Olivier,  [ … ], Xiu-Feng Wan

Published: December 3, 2018 / DOI: https://doi.org/10.1371/journal.ppat.1007417 / This is an uncorrected proof.



Genetic reassortment between influenza A viruses (IAVs) facilitate emergence of pandemic strains, and swine are proposed as a “mixing vessel” for generating reassortants of avian and mammalian IAVs that could be of risk to mammals, including humans. However, how a transmissible reassortant emerges in swine are not well understood. Genomic analyses of 571 isolates recovered from nasal wash samples and respiratory tract tissues of a group of co-housed pigs (influenza-seronegative, avian H1N1 IAV–infected, and swine H3N2 IAV–infected pigs) identified 30 distinct genotypes of reassortants. Viruses recovered from lower respiratory tract tissues had the largest genomic diversity, and those recovered from turbinates and nasal wash fluids had the least. Reassortants from lower respiratory tracts had the largest variations in growth kinetics in respiratory tract epithelial cells, and the cold temperature in swine nasal cells seemed to select the type of reassortant viruses shed by the pigs. One reassortant in nasal wash samples was consistently identified in upper, middle, and lower respiratory tract tissues, and it was confirmed to be transmitted efficiently between pigs. Study findings suggest that, during mixed infections of avian and swine IAVs, genetic reassortments are likely to occur in the lower respiratory track, and tissue tropism is an important factor selecting for a transmissible reassortant.


Author summary

Genetic reassortments between avian and swine influenza viruses are likely to occur in the swine lower respiratory track, and tissue tropism is an important factor selecting for a transmissible reassortant; determination of tissue tropisms for potential reassortants between contemporary avian and swine influenza viruses would help identify transmissible reassortants with public health risks.


Citation: Zhang X, Sun H, Cunningham FL, Li L, Hanson-Dorr K, Hopken MW, et al. (2018) Tissue tropisms opt for transmissible reassortants during avian and swine influenza A virus co-infection in swine. PLoS Pathog 14(12): e1007417. https://doi.org/10.1371/journal.ppat.1007417

Editor: Anice C. Lowen, Emory University School of Medicine, UNITED STATES

Received: July 24, 2018; Accepted: October 18, 2018; Published: December 3, 2018

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: The sequence of A/swine/Texas/A01104013/2012 (H3N2) and A/mallard/Wisconsin/A00751454/2009 (H1N1) viruses are available from Genbank under the accession numbers JX280447 to JX280454 and MH879773 to MH879780. All other relevant data are included in the main text of this paper or the Supporting Information files associated with this paper.

Funding: This study was supported by the U.S. Department of Agriculture and the National Institutes of Health (NIH) [grant number R21AI135820]. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Avian Influenza; Swine Influenza; Influenza A; H1N1; H3N2 Pigs; Reassortant strain.


Sex- and age-based #differences in #mortality during the 1918 #influenza #pandemic on the island of #Newfoundland (Am J Hum Biol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Am J Hum Biol. 2018 Nov 29:e23198. doi: 10.1002/ajhb.23198. [Epub ahead of print]

Sex- and age-based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland.

Paskoff T1, Sattenspiel L1.

Author information: 1 Department of Anthropology, University of Missouri, Columbia, Missouri.




Our aim was to understand sex- and age-based differences in mortality during the 1918 influenza pandemic on the island of Newfoundland. The pandemic’s impact on different age groups has been the focus of other research, but sex-based differences in mortality are rarely considered. Aspects of social organization, labor patterns, and social behaviors that contribute to mortality between males and females at all ages are used to explain observed mortality patterns.


Recorded pneumonia and influenza deaths on the island (n = 1871) were used to calculate cause-specific death rates and to evaluate differences in sex-based mortality. Mortality levels in 17 districts and four regions (Avalon, North, South, and West) were compared using standardized mortality ratios (SMRs). A logistic regression model was fit to determine in which regions sex-based mortality could be predicted using age and region as interactive predictors.


Differences in sex-based mortality varied across regions; they were not significant for the aggregate population. SMRs were also variable, with no significant sex-based differences. Sex-based differences were highly variable within regions. Results from a logistic regression analysis suggest that females in the South region may have experienced a higher probability of death than other island residents.


Mortality analysis for aggregate populations homogenizes important epidemiologic patterns. Men and women did not experience the 1918 influenza pandemic in the same way, and by analyzing data at the regional and district geographic levels, patterns emerge that can be explained by the economies and social organization of the people who lived there.

© 2018 Wiley Periodicals, Inc.

PMID: 30488509 DOI: 10.1002/ajhb.23198

Keywords: Pandemic Influenza; H1N1; Spanish Flu; Canada.