Historical Facts About Past Flu Pandemics

Can we learn anything from past flu pandemics? How concerned should we be about the current swine flu threat.

For the past decade there has been worry about a new flu strain causing a new pandemic, the worry was avian flu, which was occurring in Asian countries. Currently there is concern about swine flu and that another major flu pandemic could occur. This current flu isn't in some far off country but right next door in Mexico and now spreading.

The Spanish flu pandemic of 1918 (H1N1)

The 1918 flu pandemic started during World War I in Europe and was not a big item in the newspapers at the time. World War I killed an estimated 9 million people; the Spanish flu sickened 500 million people and death estimates range from 25 to 50 million worldwide. By the spring of 1918 soldiers in Europe were complaining of flu symptoms but it never became severe until the summer when symptoms became much worse and soldiers started dying from the flu.

The ending of World War I and the soldiers returning home spread the disease very quickly. The first reports of this flu occurred at Fort Riley, KS with soldiers becoming sick. In September 1918 the acting Surgeon General of the US Army at Camp Devens near Boston said that every bed was filled with more soldiers coming in very ill and the dead bodies were stacked up like cordwood.

By October, Boston and many other American cities were canceling school, events of all kinds and the stock market was put on half days. In a single day in October, Boston reported 202 deaths, Philadelphia reported 289 deaths and New York reported 851 deaths. October 1918 turned out to be the deadliest month in United States history as 195,000 Americans died from the flu outbreak.

In May 1918, the first case showed up in Great Britain and in a few months had killed 228,000. By the fall of 1918, as many as 10,000 people in the United States were dying per week from the flu and by April 1919 when the flu finally abated, 500,000 Americans had died from it. Over 400,000 people died of the flu in Germany that year. India had the worst of it, first showing up in Bombay in June 1918 and in one year 16 million people had died in India.

The Spanish flu spread to all corners of the globe including the Alaskan frontier and the remote Pacific islands and one of the most unusual aspects of the Spanish flu was that it killed mostly young adults ages 20 to 50 years of age. The reason for this is uncertain but suspected that older adults had a built up immunity from a previous exposure to a flu.

The Asian flu of 1957 (H2N2)

In February 1957 the start of the Asian flu pandemic was identified in Hong Kong. Researcher Maurice Hilleman predicted that the outbreak in Hong Kong was the start of the next pandemic and he persuaded US pharmaceutical companies to make an influenza vaccine against the flu that was in Hong Kong. As he predicted, by September 1957 the flu entered the US. Immunity to this strain of the flu was rare in anyone under the age of 65 so an epidemic was predicted. Due to advances in science this virus was quickly identified and a vaccine was ready in a limited supply by August of 1957.

The flu started in the United States during the summer but like most cases of influenza quickly spread once the school season began in the fall and kids brought the flu home to parents. It seemed that the flu had passed in December, but a second wave of the illness showed up in January and February 1958. The Asian flu pandemic killed 70,000 people in the United States and nearly 2 million worldwide.

The Hong Kong flu of 1968 (H3N2)

Once again the start of another flu pandemic was in Hong Kong in early 1968. The flu didn't become widespread in the US until December 1968 and January 1969. This was the mildest of the 20th century influenza pandemics causing 33,800 deaths in the US and about 1 million people worldwide. There are a couple of reasons this pandemic was milder. The peak of this flu hit when many kids were not in school but at home during winter break. The previous two pandemics peaked in September and October. This flu also had similar properties to the Asian flu that was circulated between 1957 and 1968, which provided some immunity to people who were exposed to that flu. Antibacterial medicine were more advanced which helped many people recover from secondary infections related to the flu.

Swine flu scare of 1977 (H1N1)

If you're old enough you might remember President Ford on TV talking about the swine flu and how everyone needed to be vaccinated. This flu was first noticed at Ft. Dix, NJ and it never spread beyond. At first experts were very concerned about this flu because it was believed it was related to the 1918 Spanish flu. There was a mass vaccination program in the US with 43 million Americans being vaccinated. In the following months there were complication of Guillain-Barr' syndrome from the vaccinations and the vaccination program was abandoned. This was handled so badly by the government and when the flu never materialized it became somewhat of a joke and fiasco for the Ford administration.

Can we learn anything from past influenza pandemics? There seems to be a pattern that they start in the spring and dissipate during the summer and come back strong in the fall when children go back to school and people tend to congregate indoors more, with the exception of the 1968 flu, which didn't hit until mid winter. Good hygiene helps keep the flu away but a vaccine is needed when and if the flu becomes widespread. If and when this becomes necessary hopefully the government will have learned from the 1977 situation.

Note: The word pandemic means worldwide. The word epidemic means more regional.

© 2009 Sam Montana


National Geographic news

US Department of Health and Human Services

PBS film - The American Experience

CDC Infectious Emerging Diseases

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Sam Montana
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Posted on Apr 28, 2009