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Pandemics:
The history of influenza pandemics in the last century and lessons we can learn from them. (Part 1)
Just how
do influenza pandemics break out and what can we expect from the H5N1 or avian
flu version? What might the short and long term consequences look like?
The
following pages are here to help you understand what has happened and what might
happen. You will also find the complete details of how the World Health
Organization (WHO) rates our current pandemic phase.
Be aware and prepare.
"Pandemics are global in nature, but their impact
is local. When the next pandemic strikes, as it surely will, it is likely to
touch the lives of every individual, family, and community. Our task is to make
sure that when this happens, we will be a Nation prepared."
Michael O. Leavitt, Secretary
U.S. Department of Health and Human Services
Historical Perspective
In the last century there were three influenza pandemics. All of them were called pandemics because of their worldwide spread and because they were caused by a new influenza virus. The 1918 pandemic was especially severe.
- 1918-1919 "Spanish" Virus Type A (H1N1): Most severe, caused at least 675,000 U.S. deaths and up
to 50
million deaths worldwide.
- 1957-1958 "Asian" Virus Type A (H2N2): Moderately severe, caused at least 70,000 U.S. deaths and 1-2
million deaths worldwide.
- 1968-1969 "Hong Kong" Virus Type A (H3N2): Least severe, caused at least 34,000 U.S. deaths and 700,000 deaths worldwide.
The 1918 Pandemic in Asia and Africa: Influenza-Associated Deaths
• Asia
–India: 8.5 million deaths (higher than bubonic plague).
–Japan: 257,000 deaths.
–Rest of Asia: 3,000,000 deaths.
• Africa
–Union of South Africa: 139,471 deaths/6,100,00 population.
–Madagascar: 114,000 deaths/3,250,000 population.
The influenza pandemic of 1918 first appeared at Fort Riley, Kansas when an Army cook reported to the infirmary with head and muscle aches, a sore throat, and fever. Later that same day over 100 soldiers were complaining of similar symptoms. Within a week over 500 soldiers at Fort Riley had come down with the flu.
The medical histories of those who have already died from H5N1 influenza are disturbingly similar to accounts of sufferers of the Spanish flu in 1918-19.
4 reasons to be concerned
1. History of pandemic influenza suggests a devastating
pandemic is due
2. It is in the nature of the influenza A virus—virology and epidemiology—to
mutate often
3. The history of this virus A (H5N1) and other avian flu epidemics is not
reassuring
4. We lack the tools we need to prevent and mitigate a pandemic if it were to
begin today
History of avian influenza
•1959 -2005: 21 outbreaks of highly pathogenic avian
influenza (HPAI) reported worldwide; five outbreaks with significant spread
•1983: Pennsylvania (H5N2). 17 million birds culled
•1997: Hong Kong (H5N1). 1.5 million birds culled, 18 human cases, 6 deaths
•2003: Netherlands (H7N7). 30 million birds culled, 89 human cases, one death
•2003-now: Asia (H5N1). Avian outbreaks ongoing in domestic poultry and wild
birds, 150 human cases, CFR approximately 50%
• 2006-to date: Multiple avian outbreaks of H5N1, in Turkey; at least 15
cases, 3 deaths
In Short
In the absence of an effective vaccine, a novel influenza virus and begins human to human transmittion would infect an estimated 650 million to 2.8 billion, and kill an estimated 25 million to 165 million and create social disruption on a scale unprecedented in the modern era. This is why so many experts so worried.
A pandemic would touch every aspect of society, so every part of society must begin to prepare. All have roles in the event of a pandemic. Federal, state, tribal, and local governments are developing, improving, and testing their plans for an influenza pandemic. Businesses, schools, universities, and other faith-based and community organizations are also preparing plans.
Article Sources:
USGlezen WP. Epidemiol Rev. 1996;18:65.CDC. Influenza Prevention and Control.
Influenza. Available at: http://www.cdc.gov/ncidod/diseases/flu/fluinfo.htm.
Jordan, ED. Epidemic Influenza, AMA, Chicago, 1927.
Video Presentation: Hospitals "Full-Up": The 1918 Influenza Pandemic Video - By John Hopkins Centre (7 min.) (requires free flash software).
Poll Results: Our
Quick Poll for April asked, "Is a flu pandemic likely in the next 3 years?
Yes : 73%
No : 27%
Some 800 people polled.
Next: » Defending ourselves against the next influenza pandemic
Related Articles:
» The Influenza Pandemics of the 20th Century.
» Defending ourselves against the next influenza
pandemic.
» Outcomes and Social Reshaping following a 21st Century Pandemic.
» The six phases and three periods defined by WHO for Pandemics.
» The Ethics of Pandemics - who gets the medicine and who decides.
» Scenario - how the next influenza pandemic is likely to start.
Video Presentation:
(Requires free Google video software) (57 min)
A candid conversation with Google.org director Dr. Larry Brilliant about
pandemic bird flu, the risks we face, the uncertainties, and to talk about the
accuracy ... and inaccuracies in the mass media. (Opens in a new window on the
Google Video site.)