A possible #European #origin of the #Spanish #influenza and the first attempts to reduce #mortality to combat superinfecting #bacteria: an opinion from a virologist and a military historian (Hum Vaccin Immunother., abstract)

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

Hum Vaccin Immunother. 2019 May 23:1-4. doi: 10.1080/21645515.2019.1607711. [Epub ahead of print]

A possible European origin of the Spanish influenza and the first attempts to reduce mortality to combat superinfecting bacteria: an opinion from a virologist and a military historian.

Oxford JS1, Gill D1.

Author information: 1a Blizard Institute, Queen Mary University London , Whitechapel, London.



When we reconsider the virology and history of the Spanish Influenza Pandemic, the science of 2018 provides us with tools which did not exist at the time. Two such tools come to mind. The first lies in the field of ‘gain of function’ experiments. A potential pandemic virus, such as influenza A (H5N1), can be deliberately mutated in the laboratory in order to change its virulence and spreadability. Key mutations can then be identified. A second tool lies in phylogenetics, combined with molecular clock analysis. It shows that the 1918 pandemic virus first emerged in the years 1915-1916. We have revisited the literature published in Europe and the United States, and the notes left by physicians who lived at the time. In this, we have followed the words of the late Alfred Crosby: who wrote that “contemporary documentary evidence from qualified physicians” is the key to understanding where and how the first outbreaks occurred. In our view, the scientists working in Europe fulfill Crosby’s requirement for contemporary evidence of origin. Elsewhere, Crosby also suggested that “the physicians of 1918 were participants in the greatest failure of medical science in the twentieth century”. Ours is a different approach. We point to individual pathologists in the United States and in France, who strove to construct the first universal vaccines against influenza. Their efforts were not misdirected, because the ultimate cause of death in nearly all cases flowed from superinfections with respiratory bacteria.

KEYWORDS: Etaples Administrative District; Hospital Beds in the Great War; Hygiene in the Great War; Influenza Epidemics in 1917; New Vaccines; Spanish Influenza Origin

PMID: 31121112 DOI: 10.1080/21645515.2019.1607711

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



One hundred years after the 1918 #pandemic: new concepts for #preparing for #influenza pandemics (Curr Opin Infect Dis., abstract)

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

Curr Opin Infect Dis. 2019 May 20. doi: 10.1097/QCO.0000000000000564. [Epub ahead of print]

One hundred years after the 1918 pandemic: new concepts for preparing for influenza pandemics.

Pavia A1.

Author information: 1 Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.




In the 100 years since the influenza pandemic of 1918-1919, the most deadly event in human history, we have made substantial progress yet we remain vulnerable to influenza pandemics This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system.


We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conventional infection control tools will be critical in healthcare settings. New evidence suggests that influenza virus may be present in aerosols; the contribution of airborne transmission and role of N95 respirators remains unknown. Baloxavir and pimodivir are new antivirals that may improve treatment, especially for severely ill patients. Optimal use and the risk of resistance require further study.


Despite the progress in pandemic preparedness, gaps remain including important scientific questions, adequate resources and most importantly, the ability to rapidly deliver highly effective vaccines.

PMID: 31116135 DOI: 10.1097/QCO.0000000000000564

Keywords: Pandemic Influenza; Spanish flu; Pandemic Preparedness; Antivirals; Vaccines.


What explains cross-city #variation in #mortality during the 1918 #influenza #pandemic? Evidence from 438 #US cities (Econ Hum Biol., abstract)

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

Econ Hum Biol. 2019 Apr 29;35:42-50. doi: 10.1016/j.ehb.2019.03.010. [Epub ahead of print]

What explains cross-city variation in mortality during the 1918 influenza pandemic? Evidence from 438 U.S. cities.

Clay K1, Lewis J2, Severnini E3.

Author information: 1 Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States. 2 Department of Economics, University of Montreal, C.P. 6128 succ. Centre-ville, Montreal, QC, H3C 3J7, United States. 3 Heinz College, Carnegie Mellon University, 4800 Forbes Avenue, Pittsburgh, PA, 15213, United States. Electronic address: edsons@andrew.cmu.edu.



Disparities in cross-city pandemic severity during the 1918 Influenza Pandemic remain poorly understood. This paper uses newly assembled historical data on annual mortality across 438 U.S. cities to explore the determinants of pandemic mortality. We assess the role of three broad factors: i) pre-pandemic population health and poverty, ii) air pollution, and iii) the timing of onset and proximity to military bases. Using regression analysis, we find that cities in the top tercile of the distribution of pre-pandemic infant mortality had 21 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. Similarly, cities in the top tercile of the distribution of proportion of illiterate residents had 21.3 excess deaths per 10,000 residents during the pandemic relative to cities in the bottom tercile. Cities in the top tercile of the distribution of coal-fired electricity generating capacity, an important source of urban air pollution, had 9.1 excess deaths per 10,000 residents in 1918 relative to cities in the bottom tercile. There was no statistically significant relationship between excess mortality and city proximity to World War I bases or the timing of onset. In a counterfactual analysis, the three statistically significant factors accounted for 50 percent of cross-city variation in excess mortality in 1918.

Copyright © 2019 Elsevier B.V. All rights reserved.

KEYWORDS: Air pollution; Influenza; Mortality; Pandemic

PMID: 31071595 DOI: 10.1016/j.ehb.2019.03.010

Keywords: Pandemic Influenza; Spanish Flu; USA; Society; Poverty; Environmental pollution.


A brief #history of #birdflu (Philos Transact Roy Soc B., abstract)

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

Philos Trans R Soc Lond B Biol Sci. 2019 Jun 24;374(1775):20180257. doi: 10.1098/rstb.2018.0257.

A brief history of bird flu.

Lycett SJ1, Duchatel F1, Digard P1.

Author information: 1 The Roslin Institute, University of Edinburgh , Edinburgh , UK.



In 1918, a strain of influenza A virus caused a human pandemic resulting in the deaths of 50 million people. A century later, with the advent of sequencing technology and corresponding phylogenetic methods, we know much more about the origins, evolution and epidemiology of influenza epidemics. Here we review the history of avian influenza viruses through the lens of their genetic makeup: from their relationship to human pandemic viruses, starting with the 1918 H1N1 strain, through to the highly pathogenic epidemics in birds and zoonoses up to 2018. We describe the genesis of novel influenza A virus strains by reassortment and evolution in wild and domestic bird populations, as well as the role of wild bird migration in their long-range spread. The emergence of highly pathogenic avian influenza viruses, and the zoonotic incursions of avian H5 and H7 viruses into humans over the last couple of decades are also described. The threat of a new avian influenza virus causing a human pandemic is still present today, although control in domestic avian populations can minimize the risk to human health. This article is part of the theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes’. This issue is linked with the subsequent theme issue ‘Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control’.

KEYWORDS: avian influenza virus; epidemiology; pandemic; phylogenetics; zoonotic

PMID: 31056053 DOI: 10.1098/rstb.2018.0257

Keywords: Pandemic Influenza; Avian Influenza; Spanish Flu; H1N1; Human; Poultry; Wild Birds.


The #Spanish #Influenza #Pandemic: a #lesson from #history 100 years after 1918 (J Prev Med Hyg., abstract)

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

J Prev Med Hyg. 2019 Mar 29;60(1):E64-E67. doi: 10.15167/2421-4248/jpmh2019.60.1.1205. eCollection 2019 Mar.

The Spanish Influenza Pandemic: a lesson from history 100 years after 1918.

Martini M1,2, Gazzaniga V3, Bragazzi NL4, Barberis I4.

Author information: 1 Department of Health Sciences, Section of Medical History and Ethics, University of Genoa, Italy. 2 UNESCO CHAIR Anthropology of Health, Biosphere and Healing System, University of Genoa, Italy. 3 Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Italy. 4 Department of Health Sciences, University of Genoa, Italy.



In Europe in 1918, influenza spread through Spain, France, Great Britain and Italy, causing havoc with military operations during the First World War. The influenza pandemic of 1918 killed more than 50 million people worldwide. In addition, its socioeconomic consequences were huge. “Spanish flu”, as the infection was dubbed, hit different age-groups, displaying a so-called “W-trend”, typically with two spikes in children and the elderly. However, healthy young adults were also affected. In order to avoid alarming the public, several local health authorities refused to reveal the numbers of people affected and deaths. Consequently, it was very difficult to assess the impact of the disease at the time. Although official communications issued by health authorities worldwide expressed certainty about the etiology of the infection, in laboratories it was not always possible to isolate the famous Pfeiffer’s bacillus, which was, at that time, deemed to be the cause of influenza. The first official preventive actions were implemented in August 1918; these included the obligatory notification of suspected cases and the surveillance of communities such as day-schools, boarding schools and barracks. Identifying suspected cases through surveillance, and voluntary and/or mandatory quarantine or isolation, enabled the spread of Spanish flu to be curbed. At that time, these public health measures were the only effective weapons against the disease, as no vaccines or antivirals were available. Virological and bacteriological analysis of preserved samples from infected soldiers and other young people who died during the pandemic period is a major step toward a better understanding of this pandemic and of how to prepare for future pandemics.

KEYWORDS: Flu; History of Pandemic; Mortality rate; Public Health

PMID: 31041413 PMCID: PMC6477554 DOI: 10.15167/2421-4248/jpmh2019.60.1.1205

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


#Tuberculosis as a #Risk #Factor for 1918 #Influenza #Pandemic #Outcomes (Trop Med Infect Dis., abstract)

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

Trop Med Infect Dis. 2019 Apr 29;4(2). pii: E74. doi: 10.3390/tropicalmed4020074.

Tuberculosis as a Risk Factor for 1918 Influenza Pandemic Outcomes.

Mamelund SE1, Dimka J2.

Author information: 1 Work Research Institute, OsloMet-Oslo Metropolitan University, PO. Box 4, St. Olavs Plass, 0130 Oslo, Norway. masv@oslomet.no. 2 Department of Anthropology, University of Pittsburgh, Pittsburgh, PA 15260, USA. jld199@pitt.edu.



Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts of TB on influenza-like illness (% of population sick) and case fatality (% of cases dying) by age and sex through case-control comparisons of patients (N = 201) and employees (N = 97) from two Norwegian sanatoriums. Female patients, patients at Landeskogen sanatorium, and patients aged 10-39 years had significantly lower morbidity than the controls. None of the 62 sick employees died, while 15 of 84 sick patients did. The case-control difference in case fatality by sex was only significant for females at Lyster sanatorium and females at both sanatoriums combined. Non-significant case-control differences in case fatality for males were likely due to small samples. Patients 20-29 years for both sexes combined at Lyster sanatorium and at both sanatoriums combined, as well as females 20-29 years for both sanatoriums combined, had significantly higher case fatality. We conclude that TB was associated with higher case fatality, but morbidity was lower for patients than for employees. The results add to the study of interactions between bacterial and viral diseases and are relevant in preparing for pandemics in TB endemic areas.

KEYWORDS: 1918 pandemic; Spanish flu; case fatality; case-control studies; historical epidemiology; morbidity; tuberculosis and influenza interactions

PMID: 31035651 DOI: 10.3390/tropicalmed4020074

Keywords: Pandemic Influenza; H1N1; Spanish Flu; Tuberculosis; Norway.


The #Eighteen of 1918-1919: #Black #Nurses and the Great #Flu #Pandemic in the #USA (Am J Public Health, abstract)

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

Am J Public Health. 2019 Apr 18:e1-e8. doi: 10.2105/AJPH.2019.305003. [Epub ahead of print]

The Eighteen of 1918-1919: Black Nurses and the Great Flu Pandemic in the United States.

Jones MM1, Saines M1.

Author information: 1 At the time of the study, Marian Moser Jones and Matilda Saines were with the University of Maryland School of Public Health, College Park.



This article examines the role of Black American nurses during the 1918-1919 influenza pandemic and the aftermath of World War I. The pandemic caused at least 50 million deaths worldwide and 675 000 in the United States. It occurred during a period of pervasive segregation and racial violence, in which Black Americans were routinely denied access to health, educational, and political institutions. We discuss how an unsuccessful campaign by Black leaders for admission of Black nurses to the Red Cross, the Army Nurse Corps, and the Navy Nurse Corps during World War I eventually created opportunities for 18 Black nurses to serve in the army during the pandemic and the war’s aftermath. Analyzing archival sources, news reports, and published materials, we examine these events in the context of nursing and early civil rights history. This analysis demonstrates that the pandemic incrementally advanced civil rights in the Army Nurse Corps and Red Cross, while providing ephemeral opportunities for Black nurses overall. This case study reframes the response to epidemics and other public health emergencies as potential opportunities to advance health equity.

(Am J Public Health. Published online ahead of print April 18, 2019; e1-e8. doi: 10.2105/AJPH.2019.305003).

PMID: 30998410 DOI: 10.2105/AJPH.2019.305003

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