The 1918 Influenza Pandemic: Insights for the 21st Century

Abstract

The 1918-1919 H1N1 influenza pandemic was among the most deadly events in recorded human history, killing an estimated 50-100 million persons. Because recent H5N1 avian epizootics have been associated with sporadic human fatalities, concern has been raised that a new pandemic, as fatal as the pandemic of 1918, or more so, could be developing. Understanding the events and experiences of 1918 is thus of great importance. However, despite the genetic sequencing of the entire genome of the 1918 virus, many questions about the 1918 pandemic remain. In this review we address several of these questions, concerning pandemic-virus origin, unusual epidemiologic features, and the causes and demographic patterns of fatality. That none of these questions can yet be fully answered points to the need for continued pandemic vigilance, basic and applied research, and pandemic preparedness planning that emphasizes prevention, containment, and treatment with antiviral medications and hospital-based intensive care.

Parapneumonic Empyema Deaths during Past Century, Utah

“…Bacterial pneumonia is a serious complication of infl uenza infection and was likely a major cause of the excess deaths seen during the 1918 infl uenza pandemic (4)(5)(6)(7)(8). Even today, though the overall disease mortality rate due to infectious diseases is declining in the United States, death from pneumonia and infl uenza remains one of the top 10 causes of death overall (9,10).…”

Human influenza pandemics: Myth and reality

“…These strains are associated with high case fatality rates due to respiratory distress. A highly aggressive bronchopneumonia as well as rapidly evolving acute respiratory distress were characteristics of the 1918 clinical picture (Morens and Fauci 2007). Of note a pandemic may have a greater impact on vulnerable populations, such as children (H5N1 being the best example of a current strain) and pregnant women as was the case with 1918 pandemic.…”

Pandemic influenza and socioeconomic disparities: Lessons from 1918 Chicago

“…The 1918 "Spanish" influenza pandemic holds a particular place in medical history; it wiped out an estimated ∼1% of the global population, or ∼20-50 million deaths worldwide, and earned the dubious honor of being coined the "mother of all pandemics" (1). Fortunately, important strides have been made in elucidating the emergence of novel pandemic influenza viruses and their impact on human populations since the 1918 pandemic.…”