Long-term #dynamics of #measles in #London: Titrating the impact of #wars, the 1918 #pandemic, and #vaccination (PLoS Comput Biol., abstract)

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

PLoS Comput Biol. 2019 Sep 12;15(9):e1007305. doi: 10.1371/journal.pcbi.1007305. eCollection 2019 Sep.

Long-term dynamics of measles in London: Titrating the impact of wars, the 1918 pandemic, and vaccination.

Becker AD1, Wesolowski A2, Bjørnstad ON3,4, Grenfell BT1,4,5.

Author information: 1 Department of Ecology and Evolutionary Biology, Princeton, New Jersey, United States of America. 2 Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America. 3 Center for Infectious Disease Dynamics, Pennsylvania State University, University Park, Pennsylvania, United States of America. 4 Fogarty International Center, National Institutes of Health, Bethesda, Maryland, United States of America. 5 Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, New Jersey, United States of America.



A key question in ecology is the relative impact of internal nonlinear dynamics and external perturbations on the long-term trajectories of natural systems. Measles has been analyzed extensively as a paradigm for consumer-resource dynamics due to the oscillatory nature of the host-pathogen life cycle, the abundance of rich data to test theory, and public health relevance. The dynamics of measles in London, in particular, has acted as a prototypical test bed for such analysis using incidence data from the pre-vaccination era (1944-1967). However, during this timeframe there were few external large-scale perturbations, limiting an assessment of the relative impact of internal and extra demographic perturbations to the host population. Here, we extended the previous London analyses to include nearly a century of data that also contains four major demographic changes: the First and Second World Wars, the 1918 influenza pandemic, and the start of a measles mass vaccination program. By combining mortality and incidence data using particle filtering methods, we show that a simple stochastic epidemic model, with minimal historical specifications, can capture the nearly 100 years of dynamics including changes caused by each of the major perturbations. We show that the majority of dynamic changes are explainable by the internal nonlinear dynamics of the system, tuned by demographic changes. In addition, the 1918 influenza pandemic and World War II acted as extra perturbations to this basic epidemic oscillator. Our analysis underlines that long-term ecological and epidemiological dynamics can follow very simple rules, even in a non-stationary population subject to significant perturbations and major secular changes.

PMID: 31513578 DOI: 10.1371/journal.pcbi.1007305

Keywords: Pandemic Influenza; Spanish Flu; Wars; Society; Measles.



Better Prepare Than React: Reordering #PublicHealth #Priorities 100 Years After the #SpanishFlu #Epidemic (Am J Public Health, abstract)

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

Am J Public Health. 2018 Nov;108(11):1465-1468. doi: 10.2105/AJPH.2018.304682. Epub 2018 Sep 25.

Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic.

Greenberger M1.

Author information: 1 Michael Greenberger is with the Carey School of Law and the Center for Health and Homeland Security, University of Maryland, Baltimore. He is also the founder and director of the University of Maryland Center for Health and Homeland Security.



This commentary argues that 100 years after the deadly Spanish flu, the public health emergency community’s responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources. Rather than relying on nonpharmaceutical interventions, such as quarantine, the United States must reorder its health priorities to ensure adequate preparation for a large-scale pandemic.

PMID: 30252520 PMCID: PMC6187800 DOI: 10.2105/AJPH.2018.304682 [Indexed for MEDLINE] Free PMC Article

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; USA.


The #SpanishFlu, #Epidemics, and the Turn to #Biomedical #Responses (Am J Public Health, abstract)

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

Am J Public Health. 2018 Nov;108(11):1455-1458. doi: 10.2105/AJPH.2018.304581. Epub 2018 Sep 25.

The Spanish Flu, Epidemics, and the Turn to Biomedical Responses.

Schwartz JL1.

Author information: 1 The author is with the Department of Health Policy and Management, Yale School of Public Health, and Section of the History of Medicine, Yale School of Medicine, New Haven, CT.



A century ago, nonpharmaceutical interventions such as school closings, restrictions on large gatherings, and isolation and quarantine were the centerpiece of the response to the Spanish Flu. Yet, even though its cause was unknown and the science of vaccine development was in its infancy, considerable enthusiasm also existed for using vaccines to prevent its spread. This desire far exceeded the scientific knowledge and technological capabilities of the time. Beginning in the early 1930s, however, advances in virology and influenza vaccine development reshaped the relative priority given to biomedical approaches in epidemic response over traditional public health activities. Today, the large-scale implementation of nonpharmaceutical interventions akin to the response to the Spanish Flu would face enormous legal, ethical, and political challenges, but the enthusiasm for vaccines and other biomedical interventions that was emerging in 1918 has flourished. The Spanish Flu functioned as an inflection point in the history of epidemic responses, a critical moment in the long transition from approaches dominated by traditional public health activities to those in which biomedical interventions are viewed as the most potent and promising tools in the epidemic response arsenal.

PMID: 30252511 DOI: 10.2105/AJPH.2018.304581 [Indexed for MEDLINE]

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; Infectious diseases; Vaccines; Quarantine measures.


The 1918 #influenza #pandemic: 100 years of #questions answered and unanswered (Sci Transl Med., abstract)

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

Sci Transl Med. 2019 Jul 24;11(502). pii: eaau5485. doi: 10.1126/scitranslmed.aau5485.

The 1918 influenza pandemic: 100 years of questions answered and unanswered.

Taubenberger JK1, Kash JC2, Morens DM3.

Author information: 1 Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. taubenbergerj@niaid.nih.gov. 2 Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. 3 Office of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA.



The 2018-2019 period marks the centennial of the “Spanish” influenza pandemic, which caused at least 50 million deaths worldwide. The unprecedented nature of the pandemic’s sudden appearance and high fatality rate serve as a stark reminder of the threat influenza poses. Unusual features of the 1918-1919 pandemic, including age-specific mortality and the high frequency of severe pneumonias, are still not fully understood. Sequencing and reconstruction of the 1918 virus has allowed scientists to answer many questions about its origin and pathogenicity, although many questions remain. This Review summarizes key findings and still-to-be answered questions about this deadliest of human events.

Copyright © 2019 The Authors, some rights reserved; exclusive licensee American Association for the Advancement of Science. No claim to original U.S. Government Works.

PMID: 31341062 DOI: 10.1126/scitranslmed.aau5485

Keywords: Pandemic Influenza; Spanish Flu.


#Race and 1918 #Influenza #Pandemic in the #USA: A Review of the Literature (Int J Environ Res Public Health, abstract)

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

Int J Environ Res Public Health. 2019 Jul 12;16(14). pii: E2487. doi: 10.3390/ijerph16142487.

Race and 1918 Influenza Pandemic in the United States: A Review of the Literature.

Økland H1, Mamelund SE2.

Author information: 1 Department of Business, History and Social Sciences, University of South-Eastern Norway, Raveien 215, 3184 Borre, Norway. 2 Work Research Institute, OsloMet-Oslo Metropolitan University, PO. Box 4, St. Olavs Plass, 0130 Oslo, Norway. masv@oslomet.no.



During epidemics, the poorest part of the population usually suffers the most. Alfred Crosby noted that the norm changed during the 1918 influenza pandemic in the US: The black population (which were expected to have higher influenza morbidity and mortality) had lower morbidity and mortality than the white population during the autumn of 1918. Crosby’s explanation for this was that black people were more exposed to a mild spring/summer wave of influenza earlier that same year. In this paper, we review the literature from the pandemic of 1918 to better understand the crossover in the role of race on mortality. The literature has used insurance, military, survey, and routine notification data. Results show that the black population had lower morbidity, and during September, October, and November, lower mortality but higher case fatality than the white population. The results also show that the black population had lower influenza morbidity prior to 1918. The reasons for lower morbidity among the black population both at baseline and during the herald and later waves in 1918 remain unclear. Results may imply that black people had a lower risk of developing the disease given exposure, but when they did get sick, they had a higher risk of dying.

KEYWORDS: 1918; USA; case fatality; inequality; influenza; morbidity; mortality; pandemic; pneumonia; race

PMID: 31336864 DOI: 10.3390/ijerph16142487

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


The Long-Lasting #Influenza: The #Impact of #Fetal #Stress During the 1918 Influenza #Pandemic on #Socioeconomic Attainment and Health in #Sweden, 1968-2012 (Demography, abstract)

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

Demography. 2019 Jul 19. doi: 10.1007/s13524-019-00799-x. [Epub ahead of print]

The Long-Lasting Influenza: The Impact of Fetal Stress During the 1918 Influenza Pandemic on Socioeconomic Attainment and Health in Sweden, 1968-2012.

Helgertz J1,2, Bengtsson T3,4,5.

Author information: 1 Centre for Economic Demography (CED) and Department of Economic History, Lund University, Box 7083, 220 07, Lund, Sweden. Jonas.Helgertz@ekh.lu.se. 2 Minnesota Population Center, University of Minnesota, 50 Willey Hall, 225 19th Avenue South, Minneapolis, MN, 55455, USA. Jonas.Helgertz@ekh.lu.se. 3 Centre for Economic Demography (CED) and Department of Economic History, Lund University, Box 7083, 220 07, Lund, Sweden. 4 IZA, Institute of Labor Economics, Schaumburg-Lippe-Strasse 5-9, 53113, Bonn, Germany. 5 CEPR, Centre for Economic Policy Research, 33 Great Sutton Street, London, EC1V 0DX, UK.



The 1918 influenza pandemic had not only a massive instant death toll but also lasting effects on its survivors. Several studies have shown that children born in 1919, and thus exposed to the H1N1 virus in utero, experienced worse health and socioeconomic outcomes in older ages than surrounding birth cohorts. This study combines several sources of contemporary statistics with full-population individual-level data for Sweden during 1968-2012 to examine the influence of fetal exposure to the Spanish flu on health, adulthood income, and occupational attainment. For both men and women, fetal exposure resulted in higher morbidity in ages 54-87, as measured by hospitalization. For males, exposure during the second trimester also affected mortality in cancer and heart disease. Overall, the effects on all-cause mortality were modest, with about three months shorter remaining life expectancy for the cohorts exposed during the second trimester. For socioeconomic outcomes, results fail to provide consistent evidence supporting any long-term consequences of fetal exposure. We conclude that although the immediate health effects of exposure to the 1918 pandemic were huge, the long-term effects were modest in size.

KEYWORDS: Fetal origins; Health and socioeconomic outcomes; Longitudinal data; Spanish influenza pandemic; Sweden

PMID: 31325150 DOI: 10.1007/s13524-019-00799-x

Keywords: Pandemic Influenza; Spanish Flu; Sweden; Society.


A #paediatric #influenza #update 100 years after the #Skyros island #Spanishflu #outbreak (Exp Ther Med., abstract)

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

Exp Ther Med. 2019 Jun;17(6):4327-4336. doi: 10.3892/etm.2019.7515. Epub 2019 Apr 22.

A paediatric influenza update 100 years after the Skyros island Spanish flu outbreak.

Mammas IN1, Theodoridou M2, Thiagarajan P3, Melidou A4, Papaioannou G5, Korovessi P6, Koutsaftiki C7, Papatheodoropoulou A8, Calachanis M9, Dalianis T10, Spandidos DA1.

Author information: 1 Department of Clinical Virology, School of Medicine, University of Crete, 71003 Heraklion, Greece. 2 First Department of Paediatrics, ‘Aghia Sophia’ Children’s Hospital, University of Athens School of Medicine, 115 27 Athens, Greece. 3 Neonatal Unit, Division for Women’s & Children Health, Noble’s Hospital, IM4 4RJ Douglas, Isle of Man, British Isles. 4 Second Laboratory of Microbiology, School of Medicine, Aristotle University of Thessaloniki, 541 24 Thessaloniki, Greece. 5 Department of Paediatric Radiology, ‘Mitera’ Children’s Hospital, 151 23 Athens, Greece. 6 Department of Paediatrics, ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 7 Paediatric Intensive Care Unit (PICU), ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 8 Paediatric Intensive Care Unit (PICU), ‘P. and A. Kyriakou’ Children’s Hospital, 115 27 Athens, Greece. 9 Department of Paediatric Cardiology, ‘Penteli’ Children’s Hospital, 152 36 Penteli, Greece. 10 Karolinska Institutet, Karolinska University Hospital, SE-117 77 Stockholm, Sweden.



This year marks the 100th anniversary of the 1918 Spanish flu outbreak on the Greek Aegean Sea island of Skyros, which devastated its population in less than 30 days. According to Constantinos Faltaits’s annals published in 1919, the influenza attack on the island of Skyros commenced acutely ‘like a thunderbolt’ on the 27th of October, 1918 and was exceptionally severe and fatal. At that time, the viral cause of the influenza had not been detected, while the total number of victims of the Spanish flu outbreak has been estimated to have surpassed 50 million, worldwide. Almost one century after this Aegean Sea island’s tragedy, the ‘4th Workshop on Paediatric Virology’, organised on the 22nd of September, 2018 in Athens, Greece, was dedicated to the 100 years of the ‘Spanish’ flu pandemic. This review article highlights the plenary and key lectures presented at the workshop on the recent advances on the epidemiology, clinical management and prevention of influenza in childhood.

KEYWORDS: H1N1; Paediatric Intensive Care Unit; antiviral drugs; influenza; myocarditis; neurological complications; paediatric virology; probiotics; radiology; vaccination

PMID: 31186675 PMCID: PMC6507498 DOI: 10.3892/etm.2019.7515

Keywords: Pandemic Influenza; Spanish Flu; Pediatrics; History; Greece.