Spatiotemporal patterns of pandemic influenza-related deaths in Allied naval forces during 1918

Shanks, G. Dennis; Waller, Michael; Smallman–Raynor, Matthew

doi:10.1017/s0950268812003032

Cited by 6 publications

(3 citation statements)

References 22 publications

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“…The findings are consistent with that described in the French Army, where the early wave began in the soldiers at the front in April and then moved into the general population [18]. This was reversed during the later wave which began in August in sailor recruits in the Mediterranean ports in the south and then moved north [19]. Therefore, the current study does appear to describe what was reported to have occurred in 1918 in terms of the direction of influenza mortality movement [20].…”

Section: Discussionsupporting

confidence: 91%

Spatio-temporal investigation of the 1918 influenza pandemic in military populations indicates two different viruses

et al. 2014

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There were multiple waves of influenza-like illness in 1918, the last of which resulted in a highly lethal pandemic killing 50 million people. It is difficult to study the initial waves of influenza-like illness in early 1918 because few deaths resulted and few morbidity records exist. Using extant military mortality records, we constructed mortality maps based on location of burial in France and Belgium in the British Army, and on home town in Vermont and New York in the USA Army. Differences between early and more lethal later waves in late 1918 were consistent with historical descriptions in France. The maps of Vermont and New York support the hypothesis that previous exposure may have conferred a degree of protection against subsequent infections; soldiers from rural areas, which were likely to have experienced less mixing than soldiers from urban areas, were at higher risk of mortality. Differences between combat and disease mortality in 1918 were consistent with limited influenza virus circulation during the early 1918 wave. We suggest that it is likely that more than one influenza virus was circulating in 1918, which might help explain the higher mortality rates in those unlikely to have been infected in early 1918.

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Section: Discussionsupporting

confidence: 91%

Spatio-temporal investigation of the 1918 influenza pandemic in military populations indicates two different viruses

et al. 2014

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“…It is widely recognized that infectious outbreaks show extreme spatiotemporal variation (space–time variation) both between countries and within a country [ 86 , 87 , 88 , 89 , 90 , 91 ]. As an example, the winter of 2014/15 saw high international excess winter mortality, partly due to the emergence of new influenza A/H1N1 clade(s) [ 3 ].…”

Section: A Wider Context To Pathogen Interferencementioning

confidence: 99%

Roles for Pathogen Interference in Influenza Vaccination, with Implications to Vaccine Effectiveness (VE) and Attribution of Influenza Deaths

Jones¹,

Ponomarenko

2022

Infectious Disease Reports

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Pathogen interference is the ability of one pathogen to alter the course and clinical outcomes of infection by another. With up to 3000 species of human pathogens the potential combinations are vast. These combinations operate within further immune complexity induced by infection with multiple persistent pathogens, and by the role which the human microbiome plays in maintaining health, immune function, and resistance to infection. All the above are further complicated by malnutrition in children and the elderly. Influenza vaccination offers a measure of protection for elderly individuals subsequently infected with influenza. However, all vaccines induce both specific and non-specific effects. The specific effects involve stimulation of humoral and cellular immunity, while the nonspecific effects are far more nuanced including changes in gene expression patterns and production of small RNAs which contribute to pathogen interference. Little is known about the outcomes of vaccinated elderly not subsequently infected with influenza but infected with multiple other non-influenza winter pathogens. In this review we propose that in certain years the specific antigen mix in the seasonal influenza vaccine inadvertently increases the risk of infection from other non-influenza pathogens. The possibility that vaccination could upset the pathogen balance, and that the timing of vaccination relative to the pathogen balance was critical to success, was proposed in 2010 but was seemingly ignored. Persons vaccinated early in the winter are more likely to experience higher pathogen interference. Implications to the estimation of vaccine effectiveness and influenza deaths are discussed.

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“…The Commonwealth Serum Laboratories in Australia produced a special vaccine mixture of chemically killed bacteria as a mélange of Haemophilus influenzae, Streptococcus pneumoniae, Streptococcus pyogenes , and Neisseria species ( Figure 3 ) [ 4 , 5 , 13 , 14 , 15 , 16 ]. This vaccine was effectively a large injection of endotoxin-like material and other toll-like receptor (TLR) agonists, which was repeatedly given to the 450 crew members of HMAS Encounter [ 10 , 17 ]. HMAS Encounter had previously experienced influenza while the ship was off Western Australia in October 1918, when 16% of the sailors developed an influenza-like illness without any serious consequences.…”

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confidence: 99%

The ‘Influenza’ Vaccine Used during the Samoan Pandemic of 1918

Shanks

2018

TropicalMed

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In 1918, a crude influenza vaccine made from chemically inactivated, mixed cultures of respiratory bacteria was widely used prior to the understanding that influenza was caused by a virus. Such vaccines contained no viral material and probably consisted largely of bacterial endotoxin. The Australian military used such a vaccine on Samoa in December 1918 and thought it was valuable. Post hoc analyses suggest that the mixed respiratory bacteria vaccine may have actually been of some benefit, but the mechanism of such protection is unknown. Although such a crude vaccine would not be considered in a modern setting, the rapid use of problematic vaccines still remains a risk when new influenza types suddenly appear, as in 1976 and 2009.

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Spatiotemporal patterns of pandemic influenza-related deaths in Allied naval forces during 1918

Cited by 6 publications

References 22 publications

Spatio-temporal investigation of the 1918 influenza pandemic in military populations indicates two different viruses

Spatio-temporal investigation of the 1918 influenza pandemic in military populations indicates two different viruses

Roles for Pathogen Interference in Influenza Vaccination, with Implications to Vaccine Effectiveness (VE) and Attribution of Influenza Deaths

The ‘Influenza’ Vaccine Used during the Samoan Pandemic of 1918

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