The Influenza Pandemic of 1918

AKA: “Spanish Flu”

Examples of pandemics throughout historyBelow you can see the dates of the most famous pandemics throughout history. Some may have been epidemics which crossed borders but did not go right round the world:

Antonine Plague (possibly smallpox) 165-180 A.D. Plague of Cyprian 251-266 A.D. Plague of Justinian 541 A.D. Black Death 1300s A.D. Typhus 1501-1587 A.D. InfluenzaInfluenza 1732-1733 A.D. Influenza Influenza 1775-1776 A.D. Cholera 1816-1826 A.D. Cholera 1829-1851 A.D. Influenza Influenza 1847-1848 A.D. Cholera 1852-1860 A.D. Bubonic Plague 1855 A.D. Influenza Influenza 1857-1859 A.D. Cholera 1863-1875 A.D. InfluenzaInfluenza 1889-1892 A.D. Cholera 1899-1923 A.D. Spanish Flu (avian flu)Spanish Flu (avian flu) 1918-1920 A.D.1918-1920 A.D. El Tor (Vibrio cholerae - cholera) 1960s A.D. HIV/AIDS 1980s-to date Swine InfluenzaSwine Influenza - 2009 (experts say not likely to cause many deaths)

“Worse than War”3/19

In one year, killed more people than the Great War ( somewhere between 20 and 40 million compared to 8.5 million total)

Still the most devastating pandemic in recorded world history.

More people died of flu in a single year than in four years of the “Black Death Bubonic Plague” from 1347-1351.

What is the difference between a pandemic and an epidemic? A pandemic is different from an epidemic or seasonal outbreak. Put simply, a pandemic covers a much wider geographical area, often worldwide. A pandemic

also infects many more people than an epidemic. An epidemic is specific to one city, region or country, while a pandemic goes much further than national borders.

An epidemic is when the number of people who become infected rises well beyond what is expected within a country or a part of a country. When the infection takes place in several countries at the same time it then starts turning into a pandemic.

A pandemic is usually caused by a new virus strain or subtype - a virus humans either have no immunity against, or very little immunity. If immunity is low or non-existent the virus is much more likely to spread around the world if it becomes easily human transmissible.

In the case of influenza, seasonal outbreaks (epidemics) are generally caused by subtypes of a virus that is already circulating among people. Pandemics, on the other hand, are generally caused by novel subtypes - these subtypes have not circulated among people before. Pandemics can also be caused by viruses, in the case of influenza, that perhaps have not circulated among people for a very long time.

Pandemics generally cause much higher numbers of deaths than epidemics. The social disruption, economic loss, and general hardship caused by a pandemic are much higher than what an epidemic can cause.

Pandemic5/19

In two years (1918-1919) one-fifth of the earth’s population was infected.

It was most deadly for people ages 20-40. It infected 28% of all Americans. Est. 675,000 Americans died of influenza-

ten times as many as WWI. Of U.S. Soldiers who died in Europe, half of

them died of flu, not the enemy.

The airborne virus went straight for the lungs.

A Profound Virulence… A mortality rate at 2.5X compared to the

previous influenza and pneumonia epidemics of less than 0.1%.

Death rate for 15-34 year olds of the flu were 20 times higher in 1918 than previous years.

Anecdotes:9/19

In 1918, four women playing cards (bridge) together late into the night. Overnight, three of those women had died of influenza.

Stories of people on their way to work only to become sick and die within hours.

Eeeeuuuu…. 10/19

Patients developed a pneumonia that they

“struggled for air until they suffocated to death.”

Doctors reported that patients “died struggling to clear their airways of a blood-tinged froth that gushed from their nose and mouth”

Influenza circles the globe.11/19

Spread by human carriers, along trade routes and shipping lines.

Outbreaks swept through North America, Europe, Asia, Africa, Brazil and the South Pacific.

India mortality rate was extremely high: 50 per 1,000.

WWI Aided the spread of the flu.

Origins? The name “Spanish Flu” came from an early

affliction in Spain killing 8 million. The first wave appeared in early spring 1918,

in Kansas and in Military camps throughout the US.

As the war was ending, US soldiers returning from Europe brought a second wave in September, 1918.The flu spread that winter and infected millions and killed thousands.

13/19

The virus killed 200,000 in October alone. The war’s end on November 11, 1918 brought

a resurgence with people out celebrating in the streets.

The health department distributed gauze masks to be worn in public (that didn’t work).

Stores were not allowed to hold sales. Some towns required a certificate to enter, all

railroads required them to board trains.

15/19

There was a shortage of coffins, morticians and gravediggers. Bodies began to pile up. Funerals were limited in size and to less than 15 minutes.

Could it happen again?16/19

Yes! Not a “could” it happen, but a … When WILL IT HAPPEN AGAIN? Know what to expect….

What are the Six Stages of a pandemic? The World Health Organization has a Six Stage influenza program, plus two: 17/19

Stage 1No animal influenza virus circulating among animals have been reported to cause infection in humans.

Stage 2An animal influenza virus circulating in domesticated or wild animals is known to have caused infection in humans and is therefore considered a specific potential pandemic threat.

Stage 3An animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks.

Stage 4Human-to-human transmission of an animal or human-animal influenza reassortant virus able to sustain community-level outbreaks has been verified.

Stage 5The same identified virus has caused sustained community level outbreaks in two or more countries in one WHO region.

Phase 6In addition to the criteria defined in Phase 5, the same virus has caused sustained community level outbreaks in at least one other country in another WHO region.

LOST PEAK PERIODLevels of pandemic influenza in most countries with adequate surveillance have dropped below peak levels.

POST PANDEMIC PERIODLevels of influenza activity have returned to the levels seen for seasonal influenza in most countries with adequate surveillance.

According to the WHO, if an influenza pandemic were to emerge today, we could expect:18/19

As people today are highly internationally mobile, the pandemic virus would spread rapidly around the world.

Vaccines, antiviral agents, and antibiotics to treat secondary infections would rapidly be in short supply

Several months would be needed before any vaccine became available. This is because pandemic viruses are new ones.

Medical facilities would be overwhelmed

There would be sudden and potentially considerable shortages of personnel to provide vital community services as the illness became widespread.

Flu's "first kiss": Remembered forever New research suggests elderly people may already be protected against influenza through earlier exposures to

the virus.  A new global study of a century's worth of flu pandemics gives new meaning to that "first kiss." Influenza's first

kiss, that is. "Your first kiss by the influenza virus produces original antigenic sins," the study's lead author, Dr. Thomas

Reichert of the Entropy Research Institute in Lincoln, Mass., tells CBS News. "We remember our first kiss forever."

The study, published Dec. 12 in the peer-reviewed BMC Medicine, looks at all five influenza pandemics of the past 100 years. It finds a variable but often large number of elderly individuals were immune to influenza because their bodies had been infected with a similar virus in the past. In other words, the viruses were recycled.

Reichert says that during the 2009 influenza pandemic, most people over age 62 were immune because the flu virus closely resembled viruses they'd been exposed to before 1947. In 1969, people over age 78 had immunity, the study found. In 1918, it was those over age 45-55 who were best protected.

In Reichert's view, the "immunity of past experience" has important implications. First, he says in pandemic seasons, flu shots and other resources should be diverted to younger people who aren't naturally protected and not wasted on the elderly, many of whom will already be immune. Second, he says American businesses should give serious thought to cultivating a cadre of retired, elderly to bring into the workforce in the event of a severe flu pandemic. "If your factory risks being down for a year because so many workers are stricken, the immune elderly could be a tremendous resource," says Reichert. "Any employer who motivated his retirees could bring them in and only a few would get sick." He concludes that competitors who prepared this way would have a huge advantage over those who don't.

Dr. Thomas Tallman, an emergency medicine physician at the Cleveland Clinic who was not involved in the research, tells CBS News that the study is "very intriguing." He agrees that exposure to previous flu viruses or viruses in a vaccine could build up an individual's immunity. The problem, he said, is that it is difficult to determine how much protection a person may have.

"The measure of how much immunity there is extremely unpredictable," said Tallman. He would still recommend a flu shot for older adults because they are more susceptible to repiratory diseases like COPD and pneumonia, which could make flu more dangerous.

The new research is a follow up to Reichert's study with the National Institutes of Health in the Archives of Internal Medicine in 2005, that surprisingly showed flu shots don't work well in the elderly. In fact, the results were the opposite of what the government and the researchers expected. As more and more elderly have gotten flu shots, death rates haven't gone down, they've gone up.

"We could not correlate increasing vaccination coverage after 1980 with declining mortality rates in any age group," that study concluded at the time.

With more data on more countries, Reichert adds, "We can now see that mortality rates declined in younger people -- most of whom were not vaccinated -- but not at all in the elderly (an increasing fraction of whom were vaccinated)." That was seen especially in those who were immune in the pandemic seasons, he says.

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Knowledge is power!19/19

Know the facts, get a flu shot, and stay home when you are contagiouscontagious.

Do NOT use antibacterial soaps or cleaners! Use/take antibiotics ONLY when medically essential! Do not spit on the ground. AND Wash your hands regularly.