![]() These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. Army camp to a colleague puts a more human face on those numbers: By comparison, at this writing AIDS has killed approximately 24 million, and an estimated 40 million more people are infected with the virus.Ī letter from a physician at one U.S. Adjusting for population, a comparable toll today would be 175 to 350 million. The world population in 1918 was only 28 percent of today's population. A 2002 epidemiologic study also estimates the deaths at between 50 and 100 million ( Johnson and Mueller, 2002). Frank Macfarlane Burnet, who won his Nobel Prize for immunology but who spent most of his life studying influenza, estimated the death toll as probably 50 million, and possibly as high as 100 million. Epidemiologists and scientists have revised that figure several times since then. ![]() A contemporary estimate put the death toll at 21 million, a figure that persists in the media today, but understates the real number. The 1918–1919 influenza pandemic killed more people in absolute numbers than any other disease outbreak in history. If such a shift could be recognized in incipient pandemics, it might allow sufficient time for the production and distribution of vaccine and antiviral drugs before the worst pandemic impact occurs.ġ918 REVISITED: LESSONS AND SUGGESTIONS FOR FURTHER INQUIRYĬenter for Bioenvironmental Research at Tulane and Xavier Universities In particular, these studies reveal a signature change in excess mortality from the elderly to younger age groups, a “pandemic age shift,” that occurred with each of the three pandemics of the 20th century. Such findings could inform planning for public health interventions to reduce the incidence of severe outcomes in future pandemics. In a parallel effort, subsequently described, epidemiologists are analyzing death records and serological data to better understand patterns of transmission, morbidity, and mortality in past influenza pandemics. Characterization of five of the eight RNA segments of the 1918 influenza virus indicates that it was the common ancestor of both subsequent human and swine H1N1 lineages, and experiments testing models of virulence using reverse genetics approaches with 1918 influenza genes have begun in hopes of identifying genetic features that confer virulence in humans. Clues are being sought by examining viruses preserved in frozen and fixed tissues of victims of the 1918 flu. The chapter continues with an account of molecular studies underway to determine the origin of the 1918 virus and the source(s) of its exceptional virulence. It describes the epidemiology and symptomology of that deadly viral strain, limited efforts toward prevention and treatment, and the resulting social disruption and its exacerbation by the actions of public officials and the media. The chapter begins with a review of the events of 1918, the lessons they offer, and the historical and scientific questions they raise. As the contributors to this chapter demonstrate, there is still much to be learned from past pandemics that can strengthen defenses against future threats. Yet the world is vulnerable to the next pandemic, perhaps even more than in 1918, when the pace and frequency of global travel was considerably less than today. Since then, mankind has gained several advantages against the disease: experience of three better characterized pandemics (1918, 1957, and 1968) knowledge of influenza viruses capacity to design and manufacture vaccines and antiviral drugs to forestall (if not prevent) infection and molecular technology that may one day pinpoint the viral components that produce virulence, and thereby identify targets for more effective vaccines and drugs. In the early 20th century, science was sufficiently sophisticated to anticipate that influenza, which had twice reached pandemic proportions in the late 19th century, would recur, but was largely powerless to blunt the devastating impact of the 1918 (H1N1) pandemic.
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