#Urbanization affects peak timing, prevalence, and bimodality of #influenza #pandemics in #Australia: Results of a census-calibrated model (Sci Adv., abstract)

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

Sci Adv. 2018 Dec 12;4(12):eaau5294. doi: 10.1126/sciadv.aau5294. eCollection 2018 Dec.

Urbanization affects peak timing, prevalence, and bimodality of influenza pandemics in Australia: Results of a census-calibrated model.

Zachreson C1, Fair KM1, Cliff OM1, Harding N1, Piraveenan M1, Prokopenko M1,2.

Author information: 1 Complex Systems Research Group, School of Civil Engineering, Faculty of Engineering and IT, The University of Sydney, Sydney, NSW 2006, Australia. 2 Marie Bashir Institute for Infectious Diseases and Biosecurity, The University of Sydney, Westmead, NSW 2145, Australia.



We examine salient trends of influenza pandemics in Australia, a rapidly urbanizing nation. To do so, we implement state-of-the-art influenza transmission and progression models within a large-scale stochastic computer simulation, generated using comprehensive Australian census datasets from 2006, 2011, and 2016. Our results offer a simulation-based investigation of a population’s sensitivity to pandemics across multiple historical time points and highlight three notable trends in pandemic patterns over the years: increased peak prevalence, faster spreading rates, and decreasing spatiotemporal bimodality. We attribute these pandemic trends to increases in two key quantities indicative of urbanization: the population fraction residing in major cities and international air traffic. In addition, we identify features of the pandemic’s geographic spread that we attribute to changes in the commuter mobility network. The generic nature of our model and the ubiquity of urbanization trends around the world make it likely for our results to be applicable in other rapidly urbanizing nations.

PMID: 30547086 PMCID: PMC6291314 DOI: 10.1126/sciadv.aau5294

Keywords: Pandemic Influenza; Australia; Society; Mathematical models.



[#NZ] New Zealand’s #experience of the 1918-19 #influenza #pandemic: a systematic review after 100 years (N Z Med J., abstract)

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

N Z Med J. 2018 Dec 14;131(1487):54-69.

New Zealand’s experience of the 1918-19 influenza pandemic: a systematic review after 100 years.

Summers JA1, Baker M2, Wilson N2.

Author information: 1 Postdoctoral Research Fellow in Medical Statistics, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom. 2 Professor of Public Health, Department of Public Health, University of Otago, Wellington.




The 1918-1919 influenza pandemic has been New Zealand’s most severe disaster event (around 9,000 deaths). We aimed to review the literature related to this pandemic in New Zealand and among New Zealanders overseas, to identify any remaining research gaps (given ongoing risks of future influenza pandemics and from new pathogens, eg, synthetic bioweapons).


Systematic literature searches and comparisons with international findings for this pandemic to facilitate identification of research gaps.


A total of 61 relevant publications were identified. The epidemiological patterns reported were largely consistent with the international literature for this pandemic. These features included the w-shaped age-distribution for mortality, and the much higher mortality rates for indigenous people (ie, seven-fold for Māori vs New Zealand European). But some novel risk factors were identified (eg, large chest size as a risk factor for death in military personnel), and there was an extremely high mortality troop ship outbreak (probably related to crowding). In contrast to some international work, there was an apparent lack of a socio-economic gradient in mortality rates in two studies using modern analytical methods. New Zealand work has clearly shown how the pandemic spread via the rail network and internal shipping routes and the rarity of successful measures to prevent spread in contrast to some other jurisdictions. It has also found a marked lack of memorials to the pandemic (in contrast to war memorials). Nevertheless, some research gaps remain, including on the apparent marked reduction in birth rates in 1918-1919 and the reasons for no socio-economic gradient despite other New Zealand evidence for occupational class variation in lifespan at this time.


This is a relatively well-studied disaster event but there remain important research questions relating to this pandemic in New Zealand. Filling these gaps may contribute to improved planning for managing future pandemics.

PMID: 30543612

Keywords: Pandemic Influenza; Spanish Flu; New Zealand.


#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.


#Antibody levels in a cohort of #pregnant women after the #influenza A #H1N1pdm09 #pandemic: waning and association with self-reported severity and duration of illness (Influenza Other Respir Viruses, abstract)

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

Influenza Other Respir Viruses. 2018 Dec 9. doi: 10.1111/irv.12623. [Epub ahead of print]

Antibody levels in a cohort of pregnant women after the 2009 influenza A(H1N1) pandemic: waning and association with self-reported severity and duration of illness.

Tunheim G1,2, Laake I1, Robertson AH1, Waalen K1, Hungnes O1, Naess LM1, Cox RJ2,3,4, Mjaaland S1,2, Trogstad L1.

Author information: 1 Division of Infection Control and Environmental Health, Norwegian Institute of Public Health, 0213, Oslo, Norway. 2 K. G. Jebsen Centre for Influenza Vaccine Research, University of Oslo, 0424, Oslo, Norway. 3 The Influenza Centre, Department of Clinical Science, University of Bergen, 5021, Bergen, Norway. 4 Department of Research and Development, Haukeland University Hospital, N5021, Bergen, Norway.




A population-based pregnancy cohort was established in Norway to study potential effects of exposure to the 2009 influenza pandemic or pandemic vaccination during pregnancy.


We studied maternal A(H1N1)pdm09-specific hemagglutination inhibition (HI)-titer levels and waning in women with influenza-like illness (ILI) in pregnancy compared to vaccinated women. Moreover, we studied the association between HI-titers and self-reported severity and duration of ILI.


HI-titers against the pandemic virus were measured in maternal blood samples obtained at birth, 3-9 months after exposure, and linked with information about pregnancy, influenza and vaccination from national registries and a cohort questionnaire.


Among 1821 pregnant women included, 43.7% were unvaccinated and 19.3% of these had ILI. HI-titers were low (geometric mean titer (GMT) 11.3) in the unvaccinated women with ILI. Higher HI-titers (GMT 37.8) were measured in the vaccinated women. Estimated HI-titer waning was similar for vaccinated women and women with ILI. Most ILI episodes were moderate and lasted 3-5 days. Women with ILI reporting specific influenza symptoms such as fever or cough had higher HI-titers than women without these symptoms. Women who reported being “very ill” or illness duration of >5 days, had higher HI-titers than women reporting less severe illness or illness of shorter duration, respectively.


Antibody waning was similar in vaccinated women and women with ILI. More severe ILI or longer duration of illness were associated with higher HI-titers. Most unvaccinated pregnant women with ILI had low HI-titers, probably due to moderate illness and HI-titer waning between exposure and sampling.

This article is protected by copyright. All rights reserved.

KEYWORDS: antibodies; influenza; pandemic H1N1pdm09; pregnancy; vaccination; waning

PMID: 30536590 DOI: 10.1111/irv.12623

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Pregnancy.


#Influenza and #Pregnancy: No Time for #Complacency (Obstet Gynecol., abstract)

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

Obstet Gynecol. 2018 Dec 4. doi: 10.1097/AOG.0000000000003040. [Epub ahead of print]

Influenza and Pregnancy: No Time for Complacency.

Rasmussen SA1, Jamieson DJ.

Author information: 1 University of Florida College of Medicine & College of Public Health and Health Professions, Departments of Pediatrics and Epidemiology, Gainesville, Florida; and Emory University, Department of Gynecology and Obstetrics, Atlanta, Georgia.



The 2009 H1N1 pandemic demonstrated the severe effects of influenza illness on pregnant women. This experience stimulated efforts to improve influenza vaccination coverage among pregnant women and resulted in a substantial increase in coverage from less than 30% before 2009 to more than 50% a few years later. As memories fade of the pandemic year, influenza vaccination coverage has stagnated at around 50%, despite considerable information becoming available on strategies to improve vaccination coverage during pregnancy. The American College of Obstetricians and Gynecologists, through its expert work groups, Committee Opinions, and other outreach efforts, has provided strong support for clinicians to implement these strategies into their practices. Influenza vaccination is the best way to safeguard pregnant women and their infants up to 6 months of age from the adverse outcomes associated with influenza. It is imperative for the obstetric community to redouble its efforts to implement strategies proven to work to improve vaccination coverage and to identify and test new strategies to increase the number of pregnant women and their infants protected from influenza.

PMID: 30531576 DOI: 10.1097/AOG.0000000000003040

Keywords: Pandemic Influenza; H1N1pdm09; Vaccines; Pregnancy.


The role of #pneumonia and secondary #bacterial infection in #fatal and serious outcomes of #pandemic #influenza A #H1N1pdm09 (BMC Infect Dis., abstract)

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

BMC Infect Dis. 2018 Dec 7;18(1):637. doi: 10.1186/s12879-018-3548-0.

The role of pneumonia and secondary bacterial infection in fatal and serious outcomes of pandemic influenza a(H1N1)pdm09.

MacIntyre CR1, Chughtai AA2, Barnes M3, Ridda I3, Seale H3, Toms R3, Heywood A3.

Author information: 1 Biosecurity Program, The Kirby Institute, UNSW Medicine, University of New South Wales, Sydney, NSW, 2052, Australia. 2 School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW, 2052, Australia. journal.health.au@gmail.com. 3 School of Public Health and Community Medicine, Faculty of Medicine, UNSW Medicine, the University of New South Wales, Samuels Building, Room 209, Sydney, NSW, 2052, Australia.




The aim of this study was to estimate the prevalence of pneumonia and secondary bacterial infections during the pandemic of influenza A(H1N1)pdm09.


A systematic review was conducted to identify relevant literature in which clinical outcomes of pandemic influenza A(H1N1)pdm09 infection were described. Published studies (between 01/01/2009 and 05/07/2012) describing cases of fatal or hospitalised A(H1N1)pdm09 and including data on bacterial testing or co-infection.


Seventy five studies met the inclusion criteria. Fatal cases with autopsy specimen testing were reported in 11 studies, in which any co-infection was identified in 23% of cases (Streptococcus pneumoniae 29%). Eleven studies reported bacterial co-infection among hospitalised cases of A(H1N1)2009pdm with confirmed pneumonia, with a mean of 19% positive for bacteria (Streptococcus pneumoniae 54%). Of 16 studies of intensive care unit (ICU) patients, bacterial co-infection identified in a mean of 19% of cases (Streptococcus pneumoniae 26%). The mean prevalence of bacterial co-infection was 12% in studies of hospitalised patients not requiring ICU (Streptococcus pneumoniae 33%) and 16% in studies of paediatric patients hospitalised in general or pediatric intensive care unit (PICU) wards (Streptococcus pneumoniae 16%).


We found that few studies of the 2009 influenza pandemic reported on bacterial complications and testing. Of studies which did report on this, secondary bacterial infection was identified in almost one in four patients, with Streptococcus pneumoniae the most common bacteria identified. Bacterial complications were associated with serious outcomes such as death and admission to intensive care. Prevention and treatment of bacterial secondary infection should be an integral part of pandemic planning, and improved uptake of routine pneumococcal vaccination in adults with an indication may reduce the impact of a pandemic.

KEYWORDS: Bacterial infection; Influenza A(H1N1)pdm09; Pneumonia; Respiratory infections hospitalization

PMID: 30526505 DOI: 10.1186/s12879-018-3548-0

Keywords: Pandemic Influenza; H1N1pdm09; Pneumonia; Streptococcus pneumoniae.


#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.