Spanish flu
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http://en.wikipedia.org/wiki/Spanish_Flu
The Spanish Flu Pandemic,
also known as the Great Influenza Pandemic, the 1918 Flu
Epidemic, and La Grippe, was an unusually severe and deadly
strain of avian influenza, a viral infectious disease, that killed some
25 million to 50 million people worldwide in 1918 and 1919. It is
thought to have been one of the most deadly pandemics so far in human
history.
The nations of the Allied
side of World War I frequently called it the "Spanish Flu." This
was mainly because the pandemic received greater press attention in
Spain than in the rest of the world, because Spain was not involved in
the war and there was no wartime censorship. In Spain it was called "The
French Flu". Spain did have one of the worst early outbreaks of the
disease, with some 8 million people infected in May 1918. It was also
known as "only the flu" or "the grippe" by public health officials
seeking to prevent panic.
Geographic origin
Many infections with similar
but milder symptoms were recorded in the spring of 1918, with sore
throat, headaches, dizziness, and loss of appetite. It has been proposed
that the earliest known cases were in Haskell County, Kansas, in January
1918. Several local men were inducted into the army at Fort Riley,
Kansas, where on March 4, 1918, company cook Albert Gitchell reported to
the infirmary with a temperature of 103°F (39.5°C). He was soon followed
by Corporal Lee Drake and Sergeant Adolph Hurby. Within two days 522 men
at the camp had reported sick. In the summer, infections became much
more severe. In August 1918 the more deadly version broke out
simultaneously in three disparate locations — Brest, France; Boston,
Massachusetts; and Freetown, Sierra Leone. Many of the worst outbreaks
of the "Flu" were among soldiers, both at the front lines and in camps
far away which soon spread into civilian populations. Severe outbreaks
often required hospitalization and even with the best of care often
killed one third of those infected. The strain was unusual in
commonly killing many young and healthy victims, as opposed to more
common influenzas which caused the bulk of their mortality among
newborns and the old and infirm. People without symptoms could be struck
suddenly and be rendered too feeble to walk within hours; many would die
the next day. Symptoms included a blue tint to the face and coughing up
blood caused by severe obstruction of the lungs.
Mortality in the
fast-progressing cases was primarily from pneumonia, by virus-induced
consolidation. Slower progressing cases featured secondary bacterial
pneumonias while some suspect neural involvement led to psychiatric
disorders in a minority of cases. Some deaths resulted from
malnourishment and even animal attacks in overwhelmed communities.
Global mortality rate from
the influenza was estimated at 2.5%–5% of the population, with some 20%
of the world population suffering from the disease to some extent. The
disease spread across the world killing twenty-five million in the
course of six months; some estimates put the total of those killed
worldwide at over twice that number, possibly as high as 100 million. An
estimated 17 million died in India alone, with a mortality rate of about
5% of the population. In the Indian Army, almost 22% of troops who
caught the disease died of it. About 28% of the population of the U.S.
suffered from the disease, and some 500,000–675,000 died from it. Some
200,000 were killed in Britain and more than 400,000 in France. The
death rate was especially high in indigenous peoples where some entire
villages perished in Alaska and southern Africa. Fourteen percent of the
population of the Fiji Islands died in a period of only two weeks while
22% of the population of Western Samoa died. By July of 1919, 257,363
deaths in Japan were attributed to influenza, giving an estimated
Japanese mortality rate of 0.425%, much lower than nearly all other
Asian countries for which data are available.
Social facts
While it usually only
infected less than one-third of the population in most places and killed
only a fraction of those infected, there were a number of towns in
several countries where the entire population was wiped out. The only
sizeable inhabited place with no documented outbreak of the flu in
1918–1919 was the island of Marajo at the mouth of the Amazon River in
Brazil.
Many cities, states, and
countries enforced restrictions on public gatherings and travel to try
to stay the epidemic. In many places theaters, dance halls, churches and
other public gathering places were shut down for over a year.
Quarantines were enforced with little success. Some communities placed
armed guards at the borders and turned back or quarantined any
travellers. One U.S. town even outlawed shaking hands.
Even in areas where morbidity
was low, those incapacitated by the illness were often so numerous as to
bring much of everyday life to a stop. Some communities closed all
stores or required customers to not enter the store but place their
orders outside the store for filling. There were many reports of places
with no healthy health care workers to tend the sick and no able bodied
grave diggers to inter the dead. Mass graves were dug by steam shovel
and bodies buried without coffins in many places.
The social effects were
intense due to the speed of the epidemic. AIDS killed 25 million in its
first 25 years, but the Spanish flu may have killed as many in only 25
weeks beginning in September 1918.
The Spanish Flu vanished
within eighteen months, and the actual cause was not determined at the
time. It appears to have been an H1 virus type. (The outbreaks of bird
flu in Hong Kong in 1997 and other parts of Asia since then are an H5
type.) The influenza virus was not understood by medical science at the
time, and most contemporary effort was spent in an unsuccessful quest to
find a vaccine to the supposed bacterial cause of the disease,
Bacillus influenza, which was in fact only one of several causes of
secondary pneumonia associated with the epidemic. Two much milder
influenza pandemics followed the Spanish Flu: the Asian Flu in 1957, and
the Hong Kong Flu in 1968.
It has been suggested that
the stresses of combat, possibly combined with the effects of chemical
warfare, may have weakened soldiers' immune systems thereby increasing
their vulnerability to the disease and accelerating its spread.
Certainly the close quarters and mass movement of troops accelerated the
process.
Recent research
In September 2000, Noymer and
Garenne published a study that poses an ætiological theory explaining
the unusual W-shaped mortality age profile of the virus. This profile is
characterized by a mode in the 25–34-year age group. Usually, influenza
has a U-shaped profile, being most deadly to the young and the old.
Additionally, after the pandemic the difference in life expectancy
between men and women decreased (women had a historically longer life
expectancy). Noymer and Garenne have causally linked these two anomalies
with the predominantly-male mortality of tuberculosis.
In October 2002, the Armed
Forces Institute of Pathology teamed up with a microbiologist from the
Mount Sinai School of Medicine in New York. Together, they started to
reconstruct the Spanish Flu. In an experiment, published in October
2002, they were successful in creating a virus with two 1918 genes. This
virus was much more deadly to mice than other constructs containing
genes from contemporary influenza virus. The experiments were conducted
under high biosafety conditions at a laboratory of the US Department of
Agriculture in Athens, Georgia.
In the February 6, 2004,
edition of Science magazine it was reported that two teams of
researchers, one led by Sir John Skehel, director of the National
Institute for Medical Research in London and another by Professor Ian
Wilson of the Scripps Research Institute in San Diego had managed to
synthesize the hemagglutinin protein responsible for the 1918 outbreak
of Spanish Flu by piecing together DNA procured from a lung sample taken
from the body of an Inuit woman buried in the Alaskan tundra and a
number of preserved samples taken from American soldiers of the First
World War. The two teams had analyzed the structure of the gene and
discovered how subtle alterations to the shape of a protein molecule had
allowed it to move from birds to humans with such devastating effects.
In October 5, 2005
researchers announced that the genetic sequence of the 1918 flu strain
had been reconstructed using historic tissue samples. The 2005 bird flu
strain spreading through Asia has some features of the 1918 strain but
is so far not able to pass easily from human to human. [1]
Sources
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Terrence M. Tumpey,
Adolfo García-Sastre, Andrea Mikulasova, Jeffery K. Taubenberger,
David E. Swayne, Peter Palese, and Christopher F. Basler (2002)
"Existing antivirals are effective against influenza viruses with
genes from the 1918 pandemic virus". Proceedings of the National
Academy of Sciences 99, 13849–13854.
-
Alfred W. Crosby (1990).
America's Forgotten Pandemic: The Influenza of 1918.
Cambridge University Press. ISBN 0521386950.
-
John M. Barry, (2004).
The Great Influenza: The Epic Story of the Greatest Plague in
History. Viking Penguin. ISBN 0670894737.
-
Leonard Crane, (2000).
Ninth Day of Creation. Connection Books. ISBN 0967571294.
-
Andrew Noymer and Michel
Garenne (2000). "The 1918 Influenza Epidemic's Effects on Sex
Differentials in Mortality in the United States". Population and
Development Review, 26(3):565–581.
-
Geoffrey W. Rice and
Edwina Palmer (1993). "Pandemic Influenza in Japan, 1918–19:
Mortality Patterns and Official Responses". Journal of Japanese
Studies, 19(2):389–420.
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