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.



Impact of the 1918 #Influenza #Pandemic in Coastal #Kenya (Trop Med Infect Dis., abstract)

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

Trop Med Infect Dis. 2019 Jun 8;4(2). pii: E91. doi: 10.3390/tropicalmed4020091.

Impact of the 1918 Influenza Pandemic in Coastal Kenya.

Andayi F1, Chaves SS2,3, Widdowson MA4,5.

Author information: 1 Influenza Program, Centers for Disease Control and Prevention-Kenya, Nairobi 00621, Kenya. Fredandayi@gmail.com. 2 Influenza Program, Centers for Disease Control and Prevention-Kenya, Nairobi 00621, Kenya. bev8@cdc.gov. 3 Influenza Division, National Center for Immunization and Respiratory Diseases, US Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. bev8@cdc.gov. 4 Division of Global Health Protection, Centers for Disease Control and Prevention-Kenya, Nairobi 00621, Kenya. zux5@cdc.gov. 5 Division of Global Health Protection, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. zux5@cdc.gov.



The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been poorly documented in many countries especially those in Africa. We used colonial-era records to describe the impact of 1918 influenza pandemic in the Coast Province of Kenya. We gathered quantitative data on facility use and all-cause mortality from 1912 to 1925, and pandemic-specific data from active reporting from September 1918 to March 1919. We also extracted quotes from correspondence to complement the quantitative data and describe the societal impact of the pandemic. We found that crude mortality rates and healthcare utilization increased six- and three-fold, respectively, in 1918, and estimated a pandemic mortality rate of 25.3 deaths/1000 people/year. Impact to society and the health care system was dramatic as evidenced by correspondence. In conclusion, the 1918 pandemic profoundly affected Coastal Kenya. Preparation for the next pandemic requires continued improvement in surveillance, education about influenza vaccines, and efforts to prevent, detect and respond to novel influenza outbreaks.

KEYWORDS: 1918 pandemic; Africa; Kenya; Spanish flu; influenza pandemic

PMID: 31181715 DOI: 10.3390/tropicalmed4020091

Keywords: Influenza A; Pandemic Influenza; Spanish Flu; Society; Kenya.


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.