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The 1918 flu pandemic (commonly referred to as the Spanish flu) was an influenza pandemic that was first found in the United States, appeared in Sierra Leone and France, and then spread to nearly every part of the world. The United States of America —commonly referred to as the Sierra Leone, officially the Republic of Sierra Leone, is a country in West Africa. This article is about the country For a topic outline on this subject see List of basic France topics. It was caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. Influenzavirus A is a Genus of the Orthomyxoviridae family of Viruses Influenzavirus A includes only one Species: Influenza A virus In biology strain is a low-level Taxonomic rank used in three related ways H1[[Neuraminidase N1]] is a subtype of the species Influenza A virus. Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The Spanish flu lasted from March 1918 to June 1920,[1] spreading even to the Arctic and remote Pacific islands. The Arctic is the Region around the Earth 's North Pole, opposite the Antarctic region around the South Pole. It is estimated that anywhere from 20 to 100 million people were killed worldwide, or the approximate equivalent of one third of the population of Europe,[2][3][4] more than double the number killed in World War I. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All [5] This extraordinary toll resulted from the extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. A cytokine storm is a potentially fatal immune reaction consisting of a Positive feedback loop between Cytokines and Immune cells with highly elevated

The disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918,[6] and Queens, New York, on March 11, 1918. Fort Riley is a United States Army installation located in Northeast Kansas, on the Kansas River, between Junction City The United States of America —commonly referred to as the Events 51 - Nero, later to become Roman Emperor, is given the title Princeps iuventutis (head of the youth Year 1918 ( MCMXVIII) was a Common year starting on Tuesday (link will display the full calendar of the Gregorian calendar (or a Common New York ( is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous Events 1425 BC - Thutmose III, Pharaoh of Egypt, dies (according to the Low Chronology of the 18th Dynasty Year 1918 ( MCMXVIII) was a Common year starting on Tuesday (link will display the full calendar of the Gregorian calendar (or a Common In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U. Brest (bʁɛst in French, in Breton) is a city in the Finistère department in Bretagne in northwestern France. Freetown is the Capital and largest City of Sierra Leone, and a major Port on the Atlantic Ocean. S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. The Entente Powers (from Triple Entente) were the countries at war with the Central Powers during World War I. Spain was not involved in the war and had not imposed wartime censorship. Spain () or the Kingdom of Spain (Reino de España is a country located mostly in southwestern Europe on the Iberian Peninsula. Censorship is the suppression of speech or deletion of communicative material which may be considered objectionable harmful or sensitive as determined by a censor [7]

Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm, which explains its unusually severe nature and the unusual age profile of its victims (the virus caused an overreaction of the body's immune system—the strong immune systems of young adults ravaged the body, while the weaker immune systems of children and middle-aged adults caused less morbidity and mortality). A cytokine storm is a potentially fatal immune reaction consisting of a Positive feedback loop between Cytokines and Immune cells with highly elevated

Contents

Mortality

The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).
The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line). [8]
Chart of deaths in major cities
Chart of deaths in major cities

The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time 5 to 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25 million in its first 25 weeks (in contrast, AIDS killed 25 million in its first 25 years). Older estimates say it killed 40–50 million people[9] while current estimates say 50 million to 100 million people worldwide were killed. [10] This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death. The Black Death, or the Black Plague, was one of the deadliest Pandemics in human history widely thought to have been caused by a bacterium named Yersinia [11]

An estimated 7 million died in India, about 2. India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country 78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it. In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. The United States of America —commonly referred to as the In Britain as many as 250,000 died; in France more than 400,000. The United Kingdom of Great Britain and Ireland was the formal name of the United Kingdom from 1 January 1801 until 12 April 1927 This article is about the country For a topic outline on this subject see List of basic France topics. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa. Alaska ( Аляска Alyaska) is a state in the United States of America, in the northwest of the North American continent Southern Africa is the Southernmost Region of the African Continent, variably defined by Geography or Geopolitics. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%. For a topic outline on this subject see List of basic Australia topics. Fiji (Matanitu ko Viti फ़िजी officially the Republic of the Fiji Islands (Matanitu Tu-Vaka-i-koya ko Viti फ़िजी द्वीप समूह गणराज्य Samoa, officially the Independent State of Samoa, is a country governing the western part of the Samoan Islands Archipelago in the South Pacific Ocean

This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. [9] Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. Cholera, sometimes known as Asiatic cholera or epidemic cholera, is an infectious Gastroenteritis caused by the Bacterium Typhoid fever, also known as enteric fever, bilious fever, Yellow Jack or commonly just typhoid, is an illness caused by the Bacterium One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred. A petechia (pɨˈtiːkiə plural petechiae (pɨˈtiːkɪiː is a small (1-2mm red or purple spot on the body caused by a minor Hemorrhage (broken Capillary "[10] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung. See Pneumonia for a general overview of pneumonia and its other causes An infection is the detrimental Colonization of a host Organism by a foreign Species. Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from Oedema (or Edema in American English formerly known as dropsy or hydropsy, is the increase of Interstitial fluid in any organ &mdash swelling [8]

The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0. Mortality rate is a measure of the number of Deaths (in general or due to a specific cause in some population scaled to the size of that population per unit time 1%. [8][10] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old. [12] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70).

History

While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All Researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease.

A large factor of worldwide flu prevalence was increased travel. The modern transportation systems made it easier for soldiers, sailors, and travelers to spread the disease quickly and to communities worldwide.

American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918
American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918

Two poems, dedicated to the Spanish flu, were popular in those days:

I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza. The American Red Cross (also known as the American National Red Cross) is a humanitarian organization that provides emergency assistance disaster relief and education inside Oakland (ˈoʊklənd founded in 1852 is the eighth-largest city in the U
-American Skipping Rhyme circa 1918

Obey the laws
And wear the gauze.
Protect your jaws
From septic paws.

Patterns of fatality

The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims – typical influenzas kill mostly infants (aged 0-2 years), the elderly, and the immunocompromised. In biology strain is a low-level Taxonomic rank used in three related ways In Medicine, immunodeficiency (or immune deficiency) is a state in which the Immune system 's ability to fight Infectious disease is compromised Another oddity was that this influenza outbreak was widespread in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months.

People without symptoms could be stricken suddenly and within hours be too weak to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids (pneumonia). Bleeding, technically known as hemorrhaging / haemorrhaging (see American and British spelling differences) is the loss of Blood from lung is the essential Respiration organ in air-breathing Animals including most Tetrapods a few Fish and a few Snails The most primitive Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal In others, the flu caused frequent loss of bowel control and the victim would die from losing critical intestinal lining and blood loss.

In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced consolidation. Pneumonia is an inflammatory illness of the Lung. Frequently it is described as lung Parenchyma / alveolar inflammation and abnormal Consolidation is a clinical term for solidification into a firm dense mass Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. The nervous system is a Network of specialized cells that communicate information about an animal's surroundings and itself Mental disorder or mental illness is a psychological or behavioral pattern that occurs in an individual and is thought to cause distress or disability that is not expected as Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.

Devastated communities

Street car conductor in Seattle not allowing passengers aboard without a mask in 1918.
Street car conductor in Seattle not allowing passengers aboard without a mask in 1918. A mask is an artefact normally worn on the face typically for protection concealment performance or amusement

While in most places less than one-third of the population was infected, only a small percentage of whom died, in a number of towns in several countries entire populations were wiped out.

Even in areas where mortality 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 not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places. A steam shovel is a large steam-powered excavating machine designed for lifting and moving material such as rock and Soil.

Unaffected locales

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0. For a topic outline on this subject see List of basic Japan topics. 425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck. The only sizeable inhabited place with no documented outbreak of the flu in 1918–1919 was the island of Marajó at the mouth of the Amazon River in Brazil . Marajó is an Island located at the mouth of the Amazon River in Brazil. The Amazon River (Rio Amazonas Río Amazonas of South America is the largest river in the world by volume with a total river flow greater than the next top ten largest rivers |utc_offset = -2 to -4 |time_zone_DST = BRST |utc_offset_DST = -2 to -5 |cctld In the Pacific, American Samoa[13] and the French colony of New Caledonia [14] also succeeded in preventing even a single death from influenza through effective quarantines. American Samoa (Amerika Sāmoa or sm ''Sāmoa Amelika'' is an unincorporated territory of the United States located in the South Pacific Ocean, southeast For the former North American fur-trading district see New Caledonia (Canada, and for the Scottish colony in Panama see Darien scheme. For other uses see Quarantine (disambiguation Quarantine is voluntary or compulsory isolation typically to contain the spread of something In Australia, only 12,000 perished compared to higher rates in other countries.

Government Response

The Great Influenza was the source of much fear in citizens around the world. Further inflaming that fear was the fact that governments and health officials were downplaying the influenza. While the panic from WWI was dwindling, governments attempted to keep morale up by spreading lies and dismissing the influenza. On Sept. 11, 1918, Washington officials reported that the Spanish Influenza had arrived in the city. The following day, roughly thirteen million men across the country lined up to register for the war draft, providing the influenza with an efficient way to spread. However, the influenza had little impact upon institutions and organizations. While medical scientists did rapidly attempt to discover a cure or vaccine, there were virtually no changes in the government or corporations. Additionally, the political and military events were fairly unaffected due to the impartiality of the disease, affecting either side likewise. [15]

Cultural Impact

In the United States, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918-1919, the Spanish flu remained a relatively obscure event until the rise in public awareness of bird flu and other pandemics in the 1990s and 2000s. The United States of America —commonly referred to as the In Medicine, Epidemiology and Actuarial science, the term morbidity can refer to the state of poor health (from Latin This has led some historians to label the Spanish flu a “forgotten pandemic. ” [16] Indeed, one of the only major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. Katherine Anne Porter ( 15 May 1890 – 18 September 1980) was a Pulitzer Prize -winning American Journalist, Pale Horse Pale Rider (ISBN 0-15-170755-3 is a collection of three short novels by American author Katherine Anne Porter published in 1939 More recently (2006), author Thomas Mullen wrote a novel called The Last Town on Earth, about the impact of the Spanish flu on a fictional mill town in Washington.

Several theories have been offered as to why the Spanish flu may have been “forgotten” by historians and the public over so many years, including the rapid pace of the pandemic (it killed most of its victims in the United States in a period of less than nine months), Americans' familiarity with pandemic disease in the late 19th and early 20th centuries, and the distraction of the First World War. World War I (abbreviated WWI; also known as the First World War, the Great War, and the War to End All [17] Another explanation is shown when observing the age group affected by the disease. The majority of fatalities, in both World War One and by the Spanish Flu, were young adults. The deaths caused by the flu were overlooked due to the deaths from the war. When people would read the obituaries they would see the deaths from war and the deaths from the influenza side by side. Seeing the figures right next to each other lessened the impact the influenza had on individual people. [18] The fact that the disease would usually only affect a certain area for a month before leaving, left little time for the disease to have a significant impact on the economy. During this time period pandemic out breaks were not uncommon, the terror of typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks lessened the impact the Influenza pandemic had on Americans. [19]

Spanish flu research

Main article: Spanish flu research

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms – genetic drift and antigenic shift – in viruses in poultry and swine which the fort bred for local consumption. Spanish flu research has long included many theories about the origins and progress of the Spanish flu, but it wasn't until 2005 when various samples recovered from American Fort Riley is a United States Army installation located in Northeast Kansas, on the Kansas River, between Junction City Kansas ( is a Midwestern state in the central region of the United States of America, an area often referred to as the American " Genetics (from Ancient Greek grc-Latn genetikos, “genitive” and that from grc-Latn genesis, “origin” a discipline of Biology, is In Population genetics, genetic drift is the accumulation of random events that change the makeup of a gene pool slightly but often compound over time Antigenic shift is the process by which at least two different strains of a virus (or different viruses especially Influenza, combine to form a new subtype But evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine. [20] On October 5, 2005, researchers announced that the genetic sequence of the 1918 flu strain, a subtype of avian strain H1N1, had been reconstructed using historic tissue samples. Events 869 - The Fourth Council of Constantinople is convened to decide about what to do about Patriarch Photius of Constantinople Year 2005 ( MMV) was a Common year starting on Saturday (link displays full calendar of the Gregorian calendar. [21] [22] On 18 January 2007, Kobasa et al. Events 350 - Generallus Magnentius deposes Roman Emperor Constans and proclaims himself Emperor Year 2007 ( MMVII) was a Common year starting on Monday of the Gregorian calendar in the 21st century. reported that infected monkeys (Macaca fascicularis) exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm. The Crab-eating Macaque ( Macaca fascicularis) is a primarily Arboreal Macaque native to Southeast Asia. A cytokine storm is a potentially fatal immune reaction consisting of a Positive feedback loop between Cytokines and Immune cells with highly elevated [23]

Victims

Alberta farmers wearing masks to protect themselves from the flu.
Alberta farmers wearing masks to protect themselves from the flu. Alberta (ælˈbɝtə is one of Canada's prairie provinces. It became a province on September 1 1905

Famous

Fictional

References

  1. ^ Institut Pasteur. La Grippe Espagnole de 1918 (Powerpoint presentation in French)
  2. ^ America: A Narrative History by Tindall, George Brown & Shi, David Emory 7th ed. Year 1918 ( MCMXVIII) was a Common year starting on Tuesday (link will display the full calendar of the Gregorian calendar (or a Common Upstairs Downstairs is a BAFTA and Emmy award-winning British Drama set in a large Townhouse in Edwardian Year 1918 ( MCMXVIII) was a Common year starting on Tuesday (link will display the full calendar of the Gregorian calendar (or a Common Jean Little is a Canadian author born in 1932 Her work has mainly consisted of Children's literature, but she has also written two Autobiographies: copyright 2007 by W. W Norton & Company, Inc.
  3. ^ The 1918 Influenza Pandemic
  4. ^ www.ncbi.nlm.nih.gov. NCBI. PubMed. Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 "Spanish" influenza pandemic. (2002)
  5. ^ Hakim, Joy (1995). War, Peace, and all that Jazz. New York: Oxford University Press, 21–24.  
  6. ^ Avian Bird Flu. 1918 Flu (Spanish flu epidemic)
  7. ^ See: Talk:Spanish flu#Origin of the name "spanish flu"
  8. ^ a b c Taubenberger, J; Morens D (2006). "1918 Influenza: the mother of all pandemics.". Emerg Infect Dis 12 (1): 15–22. PMID 16494711.  
  9. ^ a b Patterson, KD; Pyle GF (Spring 1991). "The geography and mortality of the 1918 influenza pandemic. ". Bull Hist Med. 65 (1): 4–21. PMID 2021692.  
  10. ^ a b c "1: The Story of Influenza", in Knobler S, Mack A, Mahmoud A, Lemon S: The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005). Washington, D. C. : The National Academies Press, 60–61.  
  11. ^ Potter, CW (Oct 2006). "A History of Influenza". J Appl Microbiol. 91 (4): 572–579. doi:10.1046/j.1365-2672.2001.01492.x. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document. PMID 11576290.  
  12. ^ Simonsen, L; Clarke M, Schonberger L, Arden N, Cox N, Fukuda K (Jul 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. ". J Infect Dis 178 (1): 53–60. PMID 9652423.  
  13. ^ Influenza of 1918 (Spanish Flu) and the US Navy
  14. ^ World Health Organization Writing Group (2006). "Nonpharmaceutical interventions for pandemic influenza, international measures.". Centers for Disease Control and Prevention (CDC) Emerging Infectious Diseases (EID) Journal 12 (1): 189.  
  15. ^ Graham, Rod. "Author Brings "The Great Influenza" to the School. . " John Hopkins Bloomberg School of Public Health. 4 Mar 2005. John Hopkins Bloomberg School of Public Health. 6 Jun 2008 http://www.jhsph.edu/publichealthnews/articles/2005/great_influenza.html
  16. ^ Crosby, Alfred. America's Forgotten Pandemic. New York: Cambridge University Press, 2003.
  17. ^ Crosby, America's Forgotten Pandemic, pp. 320–322.
  18. ^ Simonsen, L; Clarke M, Schonberger L, Arden N, Cox N, Fukuda K (Jul 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. "
  19. ^ Morrisey, Carla R. "The Influenza Epidemic of 1918. " Navy Medicine 77, no. 3 (May-June 1986): 11-17.
  20. ^ Sometimes a virus contains both avian adapted genes and human adapted genes. Both the H2N2 and H3N2 pandemic strains contained avian flu virus RNA segments. H2N2 is a subtype of the species Influenza A virus (sometimes called bird flu virus H3N2 is a subtype of the influenza A virus. Its name derives from the forms of the two kinds of Proteins on the surface of its coat Hemagglutinin (H and Ribonucleic acid ( RNA) is a Nucleic acid that consists of a long chain of Nucleotide units "While the pandemic human influenza viruses of 1957 (H2N2) and 1968 (H3N2) clearly arose through reassortment between human and avian viruses, the influenza virus causing the 'Spanish flu' in 1918 appears to be entirely derived from an avian source (Belshe 2005). " (from Chapter Two : Avian Influenza by Timm C. Harder and Ortrud Werner, an excellent free on-line Book called Influenza Report 2006 which is a medical textbook that provides a comprehensive overview of epidemic and pandemic influenza. )
  21. ^ Taubenberger, Jeffery K. ; et al. (2005). "Characterization of the 1918 influenza virus polymerase genes". Nature 437: 889–893. Nature is a prominent Scientific journal, first published on 4 November 1869 doi:10.1038/nature04230. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  22. ^ Tumpey, Terrence M. ; et al. (2005). "Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus". Science 310: 77–80. Science is the Academic journal of the American Association for the Advancement of Science and is considered one of the world's most prestigious Scientific doi:10.1126/science.1119392. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  23. ^ Kobasa, Darwyn; et al. (2007). "Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus". Nature 445: 319–323. doi:10.1038/nature05495. A digital object identifier ( DOI) is a permanent identifier given to an Electronic document.  
  24. ^ Duncan, Kirsty (2003). Hunting the 1918 Flu: One Scientist's Search for a Killer Virus. University of Toronto Press, 304. ISBN 0802087485.  
  25. ^ Duncan, Kirsty (2003). Hunting the 1918 Flu: One Scientist's Search for a Killer Virus. University of Toronto Press, 304. ISBN 0802087485.  
  26. ^ PBS. Influenza 1918. Victims
  27. ^ PBS. Influenza 1918. Victims
  28. ^ PBS. Influenza 1918. Victims

Further reading

External links

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Dictionary

Spanish flu

-noun

  1. Short of Spanish influenza.
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