Influneza Swine Flu and H1N1 Pandemic of 1918 ,Osteopathy,and more Info than You wanna Know

So,

My Alma Mater , C.C.O.M. realy got it's boost about 1918. We osteopaths, with No antibiotics, had a Bit better Track record thatn the Allopaths, (M.D.s) ( No Antiobiotics back then), due to our ability and Willingness,To TOuch, to look for the Health in a Patient and Work with it, to Attend at the Beside with OMT(ostepathic Manipulation Treatment)and thus improve the respiratory mechanics of the many who would of and did succumb to pneumonia. Many of Our Patients Survived!.  When antibiotics came along, the allopaths,embraced them , and rightfully so,Pneumonia No Longer was the "Old Man's Best Friend"( Osler). But, finding the Health, Touching and treating the Patient, It doesn't hurt, Mostly,and Often helps. 
I use Mindfullness Based Stress Reduction (MBSR) ,Heart Math, QiQong,Oregano Oil, Rest, Rest,Love!If I need them for Discolured Sputum and recurring Fever!

Get Your Flu Shot! and The Above, Good Luck!  Bill / swanndo!
What is 2009 H1N1 (swine flu)?

2009 H1N1 (referred to as “swine flu” early on) is a new influenza virus causing illness in people. This new virus was first detected in people in the United States in April 2009. This virus is spreading from person-to-person worldwide, probably in much the same way that regular seasonal influenza viruses spread. On June 11, 2009, the World Health Organization (WHO) signaled that a pandemic of 2009 H1N1 flu was underway.



Why is 2009 H1N1 virus sometimes called “swine flu”?

This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America. But further study has shown that this new virus is very different from what normally circulates in North American pigs. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. Scientists call this a "quadruple reassortant" virus.


2009 H1N1 Flu in Humans
Are there human infections with 2009 H1N1 virus in the U.S.?

Yes. Human infections with the new H1N1 virus are ongoing in the United States. Most people who have become ill with this new virus have recovered without requiring medical treatment.

CDC routinely works with states to collect, compile and analyze information about influenza, and has done the same for the new H1N1 virus since the beginning of the outbreak. This information is presented in a weekly report, called FluView.
Is 2009 H1N1 virus contagious?

CDC has determined that 2009 H1N1 virus is contagious and is spreading from human to human.
How does 2009 H1N1 virus spread?

Spread of 2009 H1N1 virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing by people with influenza. Sometimes people may become infected by touching something – such as a surface or object – with flu viruses on it and then touching their mouth or nose.
What are the signs and symptoms of this virus in people?

The symptoms of 2009 H1N1 flu virus in people include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue. A significant number of people who have been infected with this virus also have reported diarrhea and vomiting. Severe illnesses and death has occurred as a result of illness associated with this virus.

How severe is illness associated with 2009 H1N1 flu virus?

Illness with the new H1N1 virus has ranged from mild to severe. While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.



In seasonal flu, certain people are at “high risk” of serious complications. This includes people 65 years and older, children younger than five years old, pregnant women, and people of any age with certain chronic medical conditions. About 70 percent of people who have been hospitalized with this 2009 H1N1 virus have had one or more medical conditions previously recognized as placing people at “high risk” of serious seasonal flu-related complications. This includes pregnancy, diabetes, heart disease, asthma and kidney disease.



One thing that appears to be different from seasonal influenza is that adults older than 64 years do not yet appear to be at increased risk of 2009 H1N1-related complications thus far. CDC laboratory studies have shown that no children and very few adults younger than 60 years old have existing antibody to 2009 H1N1 flu virus; however, about one-third of adults older than 60 may have antibodies against this virus. It is unknown how much, if any, protection may be afforded against 2009 H1N1 flu by any existing antibody.



How does 2009 H1N1 flu compare to seasonal flu in terms of its severity and infection rates?

With seasonal flu, we know that seasons vary in terms of timing, duration and severity. Seasonal influenza can cause mild to severe illness, and at times can lead to death. Each year, in the United States, on average 36,000 people die from flu-related complications and more than 200,000 people are hospitalized from flu-related causes. Of those hospitalized, 20,000 are children younger than 5 years old. Over 90% of deaths and about 60 percent of hospitalization occur in people older than 65.



When the 2009 H1N1 outbreak was first detected in mid-April 2009, CDC began working with states to collect, compile and analyze information regarding the 2009 H1N1 flu outbreak, including the numbers of confirmed and probable cases and the ages of these people. The information analyzed by CDC supports the conclusion that 2009 H1N1 flu has caused greater disease burden in people younger than 25 years of age than older people. At this time, there are few cases and few deaths reported in people older than 64 years old, which is unusual when compared with seasonal flu. However, pregnancy and other previously recognized high risk medical conditions from seasonal influenza appear to be associated with increased risk of complications from this 2009 H1N1. These underlying conditions include asthma, diabetes, suppressed immune systems, heart disease, kidney disease, neurocognitive and neuromuscular disorders and pregnancy.



How long can an infected person spread this virus to others?

People infected with seasonal and 2009 H1N1 flu shed virus and may be able to infect others from 1 day before getting sick to 5 to 7 days after. This can be longer in some people, especially children and people with weakened immune systems and in people infected with the new H1N1 virus.



Prevention & Treatment


What can I do to protect myself from getting sick?

There is no vaccine available right now to protect against 2009 H1N1 virus. However, a 2009 H1N1 vaccine is currently in production and may be ready for the public in the fall. As always, a vaccine will be available to protect against seasonal influenza

There are everyday actions that can help prevent the spread of germs that cause respiratory illnesses like influenza.
Take these everyday steps to protect your health:

•Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.

•Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.*

•Avoid touching your eyes, nose or mouth. Germs spread this way.

•Try to avoid close contact with sick people.

•If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Keep away from others as much as possible to keep from making others sick.

Other important actions that you can take are:



•Follow public health advice regarding school closures, avoiding crowds and other social distancing measures.

•Be prepared in case you get sick and need to stay home for a week or so; a supply of over-the-counter medicines, alcohol-based hand rubs,* tissues and other related items might could be useful and help avoid the need to make trips out in public while you are sick and contagious

What is the best way to keep from spreading the virus through coughing or sneezing?

If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.)

Keep away from others as much as possible. Cover your mouth and nose with a tissue when coughing or sneezing. Put your used tissue in the waste basket. Then, clean your hands, and do so every time you cough or sneeze.



If I have a family member at home who is sick with 2009 H1N1 flu, should I go to work?

Employees who are well but who have an ill family member at home with 2009 H1N1 flu can go to work as usual. These employees should monitor their health every day, and take everyday precautions including washing their hands often with soap and water, especially after they cough or sneeze. Alcohol-based hand cleaners are also effective.* If they become ill, they should notify their supervisor and stay home. Employees who have an underlying medical condition or who are pregnant should call their health care provider for advice, because they might need to receive influenza antiviral drugs to prevent illness. For more information please see General Business and Workplace Guidance for the Prevention of Novel Influenza A (H1N1) Flu in Workers.



What is the best technique for washing my hands to avoid getting the flu?

Washing your hands often will help protect you from germs. Wash with soap and water or clean with alcohol-based hand cleaner*. CDC recommends that when you wash your hands -- with soap and warm water -- that you wash for 15 to 20 seconds. When soap and water are not available, alcohol-based disposable hand wipes or gel sanitizers may be used. You can find them in most supermarkets and drugstores. If using gel, rub your hands until the gel is dry. The gel doesn't need water to work; the alcohol in it kills the germs on your hands.



What should I do if I get sick?

If you live in areas where people have been identified with 2009 H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people. CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.Staying at home means that you should not leave your home except to seek medical care. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings.



If you have severe illness or you are at high risk for flu complications, contact your health care provider or seek medical care. Your health care provider will determine whether flu testing or treatment is needed.



If you become ill and experience any of the following warning signs, seek emergency medical care.



In children, emergency warning signs that need urgent medical attention include:



•Fast breathing or trouble breathing

•Bluish or gray skin color

•Not drinking enough fluids

•Severe or persistent vomiting

•Not waking up or not interacting

•Being so irritable that the child does not want to be held

•Flu-like symptoms improve but then return with fever and worse cough

In adults, emergency warning signs that need urgent medical attention include:



•Difficulty breathing or shortness of breath

•Pain or pressure in the chest or abdomen

•Sudden dizziness

•Confusion

•Severe or persistent vomiting

•Flu-like symptoms improve but then return with fever and worse cough

Are there medicines to treat 2009 H1N1 infection?

Yes. CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with 2009 H1N1 flu virus. Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. If you get sick, antiviral drugs can make your illness milder and make you feel better faster. They may also prevent serious flu complications. During the current pandemic, the priority use for influenza antiviral drugs is to treat severe influenza illness (for example hospitalized patients) and people who are sick who have a condition that places them at high risk for serious flu-related complications.



What is CDC’s recommendation regarding "swine flu parties"?

"Swine flu parties" are gatherings during which people have close contact with a person who has 2009 H1N1 flu in order to become infected with the virus. The intent of these parties is for a person to become infected with what for many people has been a mild disease, in the hope of having natural immunity 2009 H1N1 flu virus that might circulate later and cause more severe disease.



CDC does not recommend "swine flu parties" as a way to protect against 2009 H1N1 flu in the future. While the disease seen in the current 2009 H1N1 flu outbreak has been mild for many people, it has been severe and even fatal for others. There is no way to predict with certainty what the outcome will be for an individual or, equally important, for others to whom the intentionally infected person may spread the virus.



CDC recommends that people with 2009 H1N1 flu avoid contact with others as much as possible. If you are sick with flu-like illness, CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) Stay away from others as much as possible to keep from making others sick.



Contamination & Cleaning





How long can influenza virus remain viable on objects (such as books and doorknobs)?

Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface.



What kills influenza virus?

Influenza virus is destroyed by heat (167-212°F [75-100°C]). In addition, several chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols are effective against human influenza viruses if used in proper concentration for a sufficient length of time. For example, wipes or gels with alcohol in them can be used to clean hands. The gels should be rubbed into hands until they are dry.



*What if soap and water are not available and alcohol-based products are not allowed in my facility? Updated on Sept 14

If soap and water are not available and alcohol-based products are not allowed, other hand sanitizers that do not contain alcohol may be useful.



What surfaces are most likely to be sources of contamination?

Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth. Droplets from a cough or sneeze of an infected person move through the air. Germs can be spread when a person touches respiratory droplets from another person on a surface like a desk, for example, and then touches their own eyes, mouth or nose before washing their hands.



How should waste disposal be handled to prevent the spread of influenza virus?

To prevent the spread of influenza virus, it is recommended that tissues and other disposable items used by an infected person be thrown in the trash. Additionally, persons should wash their hands with soap and water after touching used tissues and similar waste.



What household cleaning should be done to prevent the spread of influenza virus?

To prevent the spread of influenza virus it is important to keep surfaces (especially bedside tables, surfaces in the bathroom, kitchen counters and toys for children) clean by wiping them down with a household disinfectant according to directions on the product label.



How should linens, eating utensils and dishes of persons infected with influenza virus be handled?

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but importantly these items should not be shared without washing thoroughly first.

Linens (such as bed sheets and towels) should be washed by using household laundry soap and tumbled dry on a hot setting. Individuals should avoid "hugging" laundry prior to washing it to prevent contaminating themselves. Individuals should wash their hands with soap and water or alcohol-based hand rub immediately after handling dirty laundry.



Eating utensils should be washed either in a dishwasher or by hand with water and soap.



Exposures Not Thought to Spread 2009 H1N1 Flu





Can I get infected with 2009 H1N1 virus from eating or preparing pork?

No. 2009 H1N1 viruses are not spread by food. You cannot get infected with novel HIN1 virus from eating pork or pork products. Eating properly handled and cooked pork products is safe.



Is there a risk from drinking water?

Tap water that has been treated by conventional disinfection processes does not likely pose a risk for transmission of influenza viruses. Current drinking water treatment regulations provide a high degree of protection from viruses. No research has been completed on the susceptibility of 2009 H1N1 flu virus to conventional drinking water treatment processes. However, recent studies have demonstrated that free chlorine levels typically used in drinking water treatment are adequate to inactivate highly pathogenic H5N1 avian influenza. It is likely that other influenza viruses such as 2009 H1N1 would also be similarly inactivated by chlorination. To date, there have been no documented human cases of influenza caused by exposure to influenza-contaminated drinking water.



Can 2009 H1N1 flu virus be spread through water in swimming pools, spas, water parks, interactive fountains, and other treated recreational water venues?

Influenza viruses infect the human upper respiratory tract. There has never been a documented case of influenza virus infection associated with water exposure. Recreational water that has been treated at CDC recommended disinfectant levels does not likely pose a risk for transmission of influenza viruses. No research has been completed on the susceptibility of 2009 H1N1 influenza virus to chlorine and other disinfectants used in swimming pools, spas, water parks, interactive fountains, and other treated recreational venues. However, recent studies have demonstrated that free chlorine levels recommended by CDC (1–3 parts per million [ppm or mg/L] for pools and 2–5 ppm for spas) are adequate to disinfect avian influenza A (H5N1) virus. It is likely that other influenza viruses such as 2009 H1N1 virus would also be similarly disinfected by chlorine.



Can 2009 H1N1 influenza virus be spread at recreational water venues outside of the water?



Yes, recreational water venues are no different than any other group setting. The spread of this 2009 H1N1 flu is thought to be happening in the same way that seasonal flu spreads. Flu viruses are spread mainly from person to person through coughing or sneezing of people with influenza. Sometimes people may become infected by touching something with flu viruses on it and then touching their mouth or nose.



Note: Much of the information in this document is based on studies and past experience with seasonal (human) influenza. CDC believes the information applies to 2009 H1N1 (swine) viruses as well, but studies on this virus are ongoing to learn more about its characteristics. This document will be updated as new information becomes available.



For general information about influenza in pigs (not 2009 H1N1 flu) see Background Information on Influenza in Pigs.

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1918 flu pandemic

Two American Red Cross nurses demonstrate treatment practices during the influenza pandemic of 1918.The 1918 flu pandemic (commonly referred to as the Spanish Flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly influenza A virus strain of subtype H1N1. Historical and epidemiological data are inadequate to identify the geographic origin of the virus.[1] Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The flu pandemic has also been implicated in the sudden outbreak of encephalitis lethargica in the 1920s.[2]



The pandemic lasted from March 1918 to June 1920,[3] spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 50 to 100 million people were killed worldwide.[4][5][6][7][8] An estimated 500 million people, one third of the world's population (approximately 1.6 billion at the time), became infected.[5]



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 (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.[9]



Contents [hide]


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).[10]

Three pandemic waves: weekly combined influenza and pneumonia mortality, United Kingdom, 1918–1919[11]The global mortality rate from the 1918/1919 pandemic is not known, but it is estimated that 10% to 20% of those who were infected died. With about a third of the world population infected, this case-fatality ratio means that 3% to 6% of the entire global population died.[12] Influenza may have killed as many as 25 million in its first 25 weeks. Older estimates say it killed 40–50 million people[4] while current estimates say 50 million to 100 million people worldwide were killed.[13] This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.[14]



As many as 17 million died in India, about 5% of India's population at the time.[15] In Japan, 23 million people were affected, and 390,000 died.[16] In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died.[17] In Britain as many as 250,000 died; in France more than 400,000.[18] In Canada approximately 50,000 died.[19] Entire villages perished in Alaska[20] and southern Africa.[which?] Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived,[21] although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher,[22] while in British Somaliland one official there estimated that 7% of the native population died from influenza.[23] 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%.



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.[4] Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. 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."[13] 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.[10]



The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[10][13] 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.[24] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.[25]



[edit] Origins of name

Although the first cases of the disease were registered in the continental U.S, and the rest of Europe long before getting to Spain, the 1918 Flu received its nickname "Spanish flu" because Spain, a neutral country in WWI, had no special censorship for news against the disease and its consequences. Hence the most reliable news on the disease came from Spain, giving the false impression that Spain was the most—if not the only—affected zone.[26]



[edit] History

While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic and probably increased transmission, augmented mutation and may have increased the lethality of the virus. Some researchers speculate that the soldiers' immune systems were weakened by malnourishment as well as the stresses of combat and chemical attacks, increasing their susceptibility to the disease.[27] Price-Smith has made the controversial argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. Specifically, he provides data that the viral waves hit the Central Powers before they hit the Allied powers, and that both morbidity and mortality in Germany and Austria were considerably higher than in Britain and France.[28]



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



[edit] Geographic sources

Some scholars have theorized that the flu probably originated in the Far East.[29] Dr. C. Hannoun, leading expert of the 1918 flu for the Institut Pasteur noticed that the former virus was likely to have come from China, mutated in the United States near Boston, and spread to Brest (France), Europe's battlefields, Europe, and the world using Allied soldiers and sailors as main spreaders.[30] C. Hannoun also designated several other theories, such as Spain, Kansas, and Brest, as being possible but not likely.



Historian Alfred W. Crosby observed that the flu seems to have originated in Kansas.[31] Political scientist Andrew Price-Smith published data from the Austrian archives suggesting that the influenza had earlier origins, beginning in Austria in the spring of 1917.[32] Popular writer John Barry echoed Crosby in proposing that Haskell County, Kansas was the location of the first outbreak of flu.[33] In the United States the disease was first observed at Fort Riley, Kansas, United States, on March 4, 1918,[34] and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.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. Spain was not involved in the war and had not imposed wartime censorship.[35]



Investigative work by a British team, led by virologist John Oxford[36] of St Bartholomew's Hospital and the Royal London Hospital, has suggested that a principal British troop staging camp in Étaples, France was at the center of the 1918 flu pandemic, or was the location of a significant precursor virus.[37]



[edit] Patterns of fatality

The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly weak individuals, such as infants (aged 0–2 years), the elderly, and the immunocompromised. Older adults may have had some immunity from the earlier Russian flu pandemic of 1889.[25] Another oddity was that the outbreak was widespread in the summer and autumn (in the Northern Hemisphere); influenza is usually worse in winter.[38]



In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced pulmonary consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in some cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.[39]



[edit] Deadly second wave

The second wave of the 1918 pandemic was much deadlier than the first. During the first wave, which began in early March, the epidemic resembled typical flu epidemics. Those at the most risk were the sick and elderly, and younger, healthier people recovered easily. But in August, when the second wave began in France, Sierra Leone and the United States,[40] the virus had mutated to a much more deadly form. This has been attributed to the circumstances of the First World War.[41] In civilian life evolutionary pressures favour a mild strain: those who get really sick stay home, but those mildly ill continue with their lives, go to work and go shopping, preferentially spreading the mild strain. In the trenches the evolutionary pressures were reversed: soldiers with a mild strain remained where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus. So the second wave began and flu quickly spread around the world again.[42] It was the same flu, in that most of those who recovered from first-wave infections were immune, but it was now far more deadly and the most vulnerable people were those who were like the soldiers in the trenches - young, otherwise healthy, adults.[43] Consequently, during modern pandemics, health officials pay attention when the virus reaches places with social upheaval, looking for deadlier strains of the virus.[42]



[edit] Devastated communities



Chart of deaths in major citiesEven in areas where mortality was low, so many people were incapacitated that much of everyday life stopped. Some communities closed all stores or required customers to leave their orders outside the store. There were many reports of places where the health-care workers could not tend the sick nor the grave-diggers bury the dead because they too were ill. Mass graves were dug by steam shovel and bodies buried without coffins in many places.[44] Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent ships carrying the flu from leaving its ports. From New Zealand the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9000 people). Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed. By contrast, the flu was kept away from American Samoa by a commander who imposed a blockade.[45] In New Zealand itself 8,573 deaths were attributed to the 1918 pandemic influenza, resulting in a total population fatality rate of 7.4 per thousand (0.74%) .[46]



[edit] Less affected areas

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% 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.



In the Pacific, American Samoa[47] and the French colony of New Caledonia[48] also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.[49]



[edit] End of the pandemic

After the lethal second wave struck in the autumn of 1918, the disease died down abruptly. New cases almost dropped to nothing after the peak in the second wave.[9] In Philadelphia for example, 4,597 people died in the week ending October 16, but by November 11 influenza had almost disappeared from the city. One explanation for the rapid decline of the lethality of the disease is that doctors simply got better at preventing and treating the pneumonia which developed after the victims had contracted the virus, although John Barry states in his book that researchers have found no evidence to support this. Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a general tendency for pathogenic viruses to become less lethal as time goes by, providing more living hosts. According to this theory, this happened very quickly for the 1918 virus.[9]



[edit] Cultural impact

The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.





American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918In the United States, Great Britain and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 1918–1919, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s.[50] This has led some historians to label the Spanish flu a “forgotten pandemic.”[31] One of the few major works of American literature written after 1918 that deals directly with the Spanish flu is Katherine Anne Porter’s Pale Horse, Pale Rider. In 1935 John O'Hara wrote a long short story, "The Doctor's Son," about the experience of his fictional alter ego during the flu epidemic in a Pennsylvania coal mining town. In 1937 American novelist William Keepers Maxwell, Jr. wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, wrote about her parents' deaths in Memories of a Catholic Girlhood. In 1992 Bodie and Brock Thoene's "Shiloh Legacy" series leads off with an account of the Spanish Flu in New York and Arkansas in their fictional novel In My Father's House. In 1997 David Morrell's short story If I Die Before I Wake - dealing with a small American town during the second wave - was published in the anthology REVELATIONS, which was framed by Clive Barker. In 2006 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. These include the rapid pace of the pandemic (it killed most of its victims in the United States, for example, within a period of less than nine months), previous familiarity with pandemic disease in the late 19th and early 20th centuries, and the distraction of the First World War.[51]



Another explanation involves the age group affected by the disease. The majority of fatalities, in both World War I and in the Spanish Flu epidemic, were young adults. The deaths caused by the flu may have been overlooked due to the large numbers of deaths of young men in the war or as a result of injuries. When people read the obituaries of the era, they saw the war or post-war deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was extremely high, the flu may not have had a great, separate, psychological impact, or may have seemed a mere "extension" of the war's tragedies.[52] The duration of the pandemic and the war could also play a role: the disease would usually only affect a certain area for a month before leaving, while the war, which most expected to end quickly, had lasted for four years by the time the pandemic struck. This left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.[53]



[edit] Spanish flu research

Main article: Spanish flu research



Centers for Disease Control and Prevention’s Dr. Terrence Tumpey examining a reconstructed version of the 1918 flu.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 food; the soldiers were then sent from Fort Riley to different places around the world, where they spread the disease. However, evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine.[54][55] This suggestion is slightly controversial,[56] and other research suggests that the strain originated in a mammalian species.[57]



An effort to recreate the 1918 flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in New York; the effort resulted in the announcement (on October 5, 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered by pathologist Johan Hultin from a female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers.[58]



On January 18, 2007, Kobasa et al. reported that monkeys (Macaca fascicularis) infected with the recreated strain exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm[59] – an overreaction of the immune system. This may explain why the 1918 flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.[60]



On September 16, 2008, the body of Yorkshireman Sir Mark Sykes was exhumed to study the RNA of the Spanish flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hope will have helped preserve the virus.[61]



In December, 2008 research by Yoshihiro Kawaoka of University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from 1918 flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.[62]



[edit] Victims



Influenza ward at Walter Reed Hospital during the Spanish flu pandemic of 1918-1919.

Albertan farmers wearing masks to protect themselves from the flu.[edit] Notable fatalities

Admiral Dot (1864–1918), circus performer under P. T. Barnum[63]

Amadeo de Souza Cardoso, Portuguese painter, (October 25, 1918)

Francisco de Paula Rodrigues Alves, Brazilian re-elected president, (January 16, 1919)[64]

Guillaume Apollinaire, French poet (November 9, 1918)

Felix Arndt, American pianist (October 16, 1918)

Louis Botha, first Prime Minister of the Union of South Africa, (August 27, 1919)[65]

Randolph Bourne, American progressive writer and public intellectual, (December 22, 1918)[66]

Dudley John Beaumont, husband of the Dame of Sark (November 24, 1918) [67]

Larry Chappell, American baseball player, (November 8, 1918)

Angus Douglas, Scottish international footballer, (December 14, 1918)

Harry Elionsky, American champion long-distance swimmer[65]

George Freeth, father of modern surfing and lifeguard (April 7, 1919)

Sophie Halberstadt-Freud, daughter of Austrian psychoanalyst Sigmund Freud, (1920)

Irma Cody Garlow, daughter of Buffalo Bill Cody[63]

Harold Gilman, British painter (February 12, 1919)

Henry G. Ginaca, American engineer, inventor of the Ginaca machine (October 19, 1918)

Myrtle Gonzalez, American film actress (October 22, 1918)[66]

Kenneth Sawyer Goodman, namesake of Chicago's famous Goodman Theatre

Charles Tomlinson Griffes, American composer (April 8, 1920)

Joe Hall, Montreal Canadiens defenceman, a member of the Hockey Hall of Fame (April 6, 1919)

Phoebe Hearst, mother of William Randolph Hearst, (April 13, 1919)

Bohumil Kubišta, Czech painter, (November 27, 1918)

Hans E. Lau, Danish astronomer, (October 16, 1918)[66]

Julian L'Estrange stage and screen actor, husband of actress Constance Collier (October 22, 1918)

Harold Lockwood, American silent film star, (October 19, 1918)[63]

Francisco Marto, Fátima child (April 4, 1919)

Jacinta Marto, Fátima child (February 20, 1920)

Alan Arnett McLeod, Victoria Cross recipient, (6 November, 1918)

Dan McMichael, manager of Scottish association football club Hibernian (1919)

Leon Morane, French aircraft company founder and pre-WW1 aviator (October 20, 1918)

William Francis Murray, Postmaster of Boston and former U.S. Representative (September 21, 1918)

Sir Hubert Parry, British composer, (October 7, 1918)

Henry Ragas, pianist of the Original Dixieland Jass Band

William Leefe Robinson, Victoria Cross winner, (December 31, 1918)

Edmond Rostand, French dramatist, best known for his play Cyrano de Bergerac, (December 2, 1918)

Egon Schiele, Austrian painter (October 31, 1918, Vienna). His wife Edith, who was six months pregnant, succumbed to the disease only three days before.[68]

Reggie Schwarz, South African cricketer and rugby player (November 18, 1918)[66]

Yakov Sverdlov, Bolshevik party leader and official of pre-USSR Russia (March 16, 1919)

Mark Sykes, British politician and diplomat, body exhumed 2008 for scientific research (February 16, 1919)

Frederick Trump, Grandfather of businessman Donald Trump, (March 30, 1918)

Max Weber, German political economist and sociologist (June 14, 1920)

Prince Erik, Duke of Västmanland (Erik Gustav Ludvig Albert Bernadotte), Prince of Sweden, Duke of Västmanland (September 20, 1918)

Vera Kholodnaya, Russian actress (February 16, 1919)

Dark Cloud (actor), aka Elijah Tahamont, American Indian actor, in Los Angeles (1918).

Franz Karl Salvator (1893–1918), son of Archduchess Marie Valerie of Austria and Archduke Franz Salvator, grandson of Empress Elisabeth of Bavaria and Emperor Franz Joseph I of Austria, died unmarried and childless.

Anaseini Takipō, Queen of Tonga from 1909, consort of King George Tupou II of Tonga, survived by one daughter, (November 26, 1918)

King Watzke, American violinist and bandleader, (1920)[66]

Bill Yawkey, Major League Baseball executive and owner of the Detroit Tigers, in Augusta, Georgia (March 5, 1919)

[edit] Notable survivors

Alexandrine of Mecklenburg-Schwerin (1879–1952), Queen of Denmark[39]

Walter Benjamin, (1892-1940) German-Jewish philosopher and Marxist literary critic.[69]

Walt Disney (1901–1966), cartoonist.[39]

Peter Fraser (1884–1950), New Zealand prime minister.[39]

David Lloyd George (1863–1945), British prime minister.[39]

Lillian Gish (1893–1993), early motion picture star.[70]

Joseph Joffre (1852–1931), French World War I general, victor of the Marne.[39]

Prince Maximilian of Baden (1867–1929), Chancellor of Germany during the armistice.[39]

William Keepers Maxwell, Jr. (August 16, 1908–July 31, 2000) American novelist and editor

Edward Munch, (1863–1944) Norwegian painter.[71]

Georgia O'Keeffe, (1887-1986) American modernist painter.[72]

John J. Pershing (1860–1948) American general.[39]

Mary Pickford (1892–1979), early motion picture star.[39]

Katherine Anne Porter (1890–1980), Pulitzer Prize-winning American writer[39]

Franklin D. Roosevelt (1882–1945), American president[39]

Haile Selassie (1892–1975), Emperor of Ethiopia.[21]

Leo Szilard (1898–1964), nuclear physicist, discoverer of the nuclear chain reaction.[73]

Wilhelm II, German Emperor (1859–1941)[39]

Woodrow Wilson (1856–1924) American president.[39]

[edit] See also

List of epidemics

Spanish flu research

SS Talune

[edit] References

Notes

1.^ 1918 Influenza Pandemic
CDC EID.

2.^ Vilensky JA, Foley P, Gilman S (August 2007). "Children and encephalitis lethargica: a historical". Pediatr. Neurol. 37 (2): 79–84. doi:10.1016/j.pediatrneurol.2007.04.012. PMID 17675021. http://linkinghub.elsevier.com/retrieve/pii/S0887-8994(07)00194-4.

3.^ Institut Pasteur. La Grippe Espagnole de 1918 (Powerpoint presentation in French).

4.^ a b c Patterson, KD; Pyle GF (Spring 1991). "The geography and mortality of the 1918 influenza pandemic". Bull Hist Med. 65 (1): 4–21. PMID 2021692.

5.^ a b Centers for Disease Control and Prevention. Jeffery K. Taubenberger and David M. Morens. 1918 Influenza: the Mother of All Pandemics, January, 2006. Retrieved on May 9, 2009.

6.^ Tindall 2007

7.^ The 1918 Influenza Pandemic. Accessed 2009-05-01. Archived 2009-05-04.

8.^ Johnson NP, Mueller J (2002). "Updating the accounts: global mortality of the 1918–1920 "Spanish" influenza pandemic". Bull Hist Med 76 (1): 105–15. doi:10.1353/bhm.2002.0022. PMID 11875246.

9.^ a b c Barry 2004

10.^ a b c Taubenberger, J; Morens D (2006). "1918 Influenza: the mother of all pandemics". Emerg Infect Dis 12 (1): 15–22. PMID 16494711. http://www.cdc.gov/ncidod/EID/vol12no01/05-0979.htm.

11.^ "1918 Influenza: the Mother of All Pandemics". Cdc.gov. http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm. Retrieved 2009-09-02.

12.^ Taubenberger, J., Morens, M. (2006). "1918 Influenza Pandemic". www.cdc.gov. http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm. Retrieved 2009-05-14.

13.^ a b c Knobler 2005, pp. 60–61.

14.^ Potter, CW (October 2006). "A History of Influenza". J Appl Microbiol. 91 (4): 572–579. doi:10.1046/j.1365-2672.2001.01492.x. PMID 11576290. http://www.blackwell-synergy.com/doi/full/10.1046/j.1365-2672.2001.01492.x.

15.^ Flu experts warn of need for pandemic plans. British Medical Journal.

16.^ "Spanish Influenza in Japanese Armed Forces, 1918–1920". Centers for Disease Control and Prevention (CDC).

17.^ Pandemics and Pandemic Threats since 1900, U.S. Department of Health & Human Services.

18.^ The 'bird flu' that killed 40 million. BBC News. October 19, 2005.

19.^ "A deadly virus rages throughout Canada at the end of the First World War". CBC History.

20.^ "The Great Pandemic of 1918: State by State". Archived from the original on 2009-05-06. http://www.webcitation.org/5gZqOpdgM. Retrieved 2009-05-04.

21.^ a b Harold Marcus, Haile Sellassie I: The formative years, 1892–1936 (Trenton: Red Sea Press, 1996), pp. 36f; Pankhurst 1990, p. 48f.

22.^ Pankhurst 1990, p. 63.

23.^ Pankhurst 1990, p. 51f.

24.^ Simonsen, L; Clarke M, Schonberger L, Arden N, Cox N, Fukuda K (July 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution". J Infect Dis 178 (1): 53–60. PMID 9652423.

25.^ a b O Hansen, 1923, Undersøkelser om influenzaens opptræden specielt i Bergen 1918–1922 Skrifter utgit ved Klaus Hanssens Fond. Bergen: Medicinsk avdeling, Haukeland Sykehus, 1923: 3.

26.^ Duncan 2003, p. 7

27.^ Ewald 1994, p. 110.

28.^ Andrew Price-Smith, Contagion and Chaos, MIT Press, 2009.

29.^ 1918 killer flu secrets revealed. BBC News. February 5, 2004.

30.^ Pr. C. HANNOUN :

La Grippe, Ed Techniques EMC (Encyclopédie Médico-Chirurgicale), Maladies infectieuses, 8-069-A-10, 1993.

Documents de la Conférence de l'Institut Pasteur : La Grippe Espagnole de 1918.

31.^ a b Crosby 2003

32.^ Andrew Price-Smith, Contagion and Chaos, Cambridge, MA: MIT Press, 2009.

33.^ Barry, John. The site of origin of the 1918 influenza pandemic and its public health implications, Journal of Translational Medicine, 2:3. Accessed 2009-05-01. Archived 2009-05-04.

34.^ Avian Bird Flu. 1918 Flu (Spanish flu epidemic).

35.^ Channel 4 - News - Spanish flu facts.

36.^ "EU Research Profile on Dr. John Oxford". Archived from the original on 2009-05-11. http://www.webcitation.org/5ghdULukN. Retrieved 2009-05-09.

37.^ Connor, Steve, "Flu epidemic traced to Great War transit camp", The Guardian (UK), Saturday, 8 January 2000. Accessed 2009-05-09. Archived 2009-05-11.

38.^ Key Facts about Swine Influenza [1] accessed 22:45 GMT-6 30/04/2009. Archived 2009-05-04.

39.^ a b c d e f g h i j k l m Collier 1974

40.^ UK Parliament - http://www.parliament.the-stationery-office.com/pa/ld200506/ldselect/ldsctech/88/88.pdf. Accessed 2009-05-06. Archived 2009-05-08.

41.^ Gladwell, Malcolm. "The Dead Zone". The New Yorker (September 29, 1997): 55.

42.^ a b Gladwell, Malcolm. "The Dead Zone". The New Yorker (September 29, 1997): 63.

43.^ Gladwell, Malcolm. "The Dead Zone". The New Yorker (September 29, 1997): 56.

44.^ Fortune article "Viruses of Mass Destruction" written 1st November 2004 [2] accessed 01:12 GMT+1 30/04/2009

45.^ DENOON, Donald, “New Economic Orders: Land, Labour and Dependency”, in DENOON, Donald (éd.), The Cambridge History of the Pacific Islanders, Cambridge University Press, 2004, ISBN 0-521-00354-7, p. 247.

46.^ RICE, Geoffrey, Black November; the 1918 Ifluenza Pandemic in New Zealand, University of Canterbury Press, 2005, ISBN 1877257354, p. 221.

47.^ "Influenza of 1918 (Spanish Flu) and the US Navy". www.history.navy.mil. http://www.history.navy.mil/library/online/influenza_main.htm. Retrieved 2009-05-14.

48.^ 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. http://www.cdc.gov/ncidod/EID/vol12no01/05-1370.htm.

49.^ Anne Grant, History House, Portland. Influenza Pandemic 1919. Portland Victoria.

50.^ Honigsbaum

51.^ Crosby 2003, pp. 320–322.

52.^ 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."

53.^ Morrisey, Carla R. "The Influenza Epidemic of 1918." Navy Medicine 77, no. 3 (May-June 1986): 11–17.

54.^ 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. "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.)

55.^ Taubenberger JK, Reid AH, Lourens RM, Wang R, Jin G, Fanning TG (October 2005). "Characterization of the 1918 influenza virus polymerase genes". Nature 437 (7060): 889–93. doi:10.1038/nature04230. PMID 16208372.

56.^ Antonovics J, Hood ME, Baker CH (April 2006). "Molecular virology: was the 1918 flu avian in origin?". Nature 440 (7088): E9; discussion E9–10. doi:10.1038/nature04824. PMID 16641950.

57.^ Vana G, Westover KM (June 2008). "Origin of the 1918 Spanish influenza virus: a comparative genomic analysis". Molecular Phylogenetics and Evolution 47 (3): 1100–10. doi:10.1016/j.ympev.2008.02.003. PMID 18353690.

58.^ Center for Disease Control: Researchers Reconstruct 1918 Pandemic Influenza Virus; Effort Designed to Advance Preparedness Retrieved on 2009-09-02

59.^ 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.

60.^ USA Today: Research on monkeys finds resurrected 1918 flu killed by turning the body against itself Retrieved on 2008-08-14.

61.^ BBC News: Body exhumed in fight against flu Retrieved on 2008-09-16.

62.^ "Reuters. December 29, 2008. ''Researchers unlock secrets of 1918 flu pandemic.''". Reuters.com. 2008-12-29. http://www.reuters.com/article/newsOne/idUSTRE4BS56420081229. Retrieved 2009-09-02.

63.^ a b c "Influenza 1918 - Among the Victims". American Experience, PBS. http://www.pbs.org/wgbh/amex/influenza/sfeature/victims.html. Retrieved 2009-04-27.

64.^ Frank D. McCann (2004), Soldiers of the Pátria: a history of the Brazilian Army, 1889-1937, Stanford University Press, ISBN 9780804732222, http://books.google.com/books?id=xDep7jGaHPwC&pg=RA2-PA191&dq=Francisco+influenza

65.^ a b Duncan 2003, p. 16

66.^ a b c d e dMAC Health Digest.

67.^ Hathaway, Sibyl (1962). [http://www.archive.org/details/dameofsark006367mbp - Dame of Sark: An Autobiography. 2nd printing.]. New York: Coward-McCann, Inc.. pp. 59. http://www.archive.org/details/dameofsark006367mbp -.

68.^ Frank Whitford, Expressionist Portraits, Abbeville Press, 1987, p. 46. ISBN 0896597806

69.^ Sholem, Gershom. Walter Benjamin: The Story of a Friendship. Trans. The Jewish Publication Society of America. London: Faber & Faber, 1982. 76.

70.^ Lillian Gish: The Movies, Mr. Griffith, and Me, ISBN 0135366496.

71.^ Munch Museum, "A timeline of Munch's life".Munch Museum. Accessed 2009-05-24. Archived 2009-05-27.

72.^ Roxana Robinson, Georgia O'Keeffe: A Life. University Press of New England, 1989. p. 193. ISBN 0874519063

73.^ Richard Rhodes, The Making of the Atomic Bomb, ISBN 0684813785.

Bibliography

Barry, John M. (2004). The Great Influenza: The Epic Story of the Greatest Plague in History. Viking Penguin. ISBN 0-670-89473-7.

Collier, Richard (1974). The Plague of the Spanish Lady - The Influenza Pandemic of 1918–19. USA: Atheneum. ISBN 978-0689105920.

Crosby, Alfred W. (1976). Epidemic and Peace, 1918. Westport, Ct: Greenwood Press. ISBN 0-8371-8376-6.

Crosby, Alfred W. (2003). America's Forgotten Pandemic: The Influenza of 1918 (2 ed.). Cambridge: Cambridge University Press. ISBN 0689105924. http://books.google.com/books?id=KYtAkAIHw24C.

Duncan, Kirsty (2003), Hunting the 1918 flu: one scientist's search for a killer virus (illustrated ed.), University of Toronto Press, ISBN 9780802087485, http://books.google.com/books?id=HPDI_30wRsEC

Ewald, Paul. Evolution of infectious disease, New York, Oxford University Press, 1994.

Hakim, Joy (1995). War, Peace, and all that Jazz. New York: Oxford University Press.

Honigsbaum, Mark. Living with Enza: The Forgotten Story of Britain and the Great Flu Pandemic of 1918, ISBN 978-0230217744.

Knobler S, Mack A, Mahmoud A, Lemon S, ed. "1: The Story of Influenza". The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005). Washington, D.C.: The National Academies Press.

Pankhurst, Richard. An Introduction to the Medical History of Ethiopia. Trenton: Red Sea Press, 1990

Tindall, George Brown & Shi, David Emory. America: A Narrative History, 7th ed. copyright 2007 by W.W Norton & Company, Inc.

[edit] Further reading

Barry, John M., The Great Influenza: The Epic Story of the Deadliest Plague in History, Viking Press, 2004. ISBN-10: 0670894737, ISBN-13: 978-0670894734.

Beiner, Guy (2006). "Out in the Cold and Back: New-Found Interest in the Great Flu". Cultural and Social History 3 (4): 496–505.

Johnson, Niall (2006). Britain and the 1918–19 Influenza Pandemic: A Dark Epilogue. London and New York: Routledge. ISBN 0-415-36560-0.

Johnson, Niall (2003). "Measuring a pandemic: Mortality, demography and geography". Popolazione e Storia: 31–52.

Johnson, Niall (2003). "Scottish ’flu – The Scottish mortality experience of the “Spanish flu". Scottish Historical Review 83 (2): 216–226.

Johnson, Niall; Juergen Mueller (2002). "Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic". Bulletin of the History of Medicine 76: 105–15. doi:10.1353/bhm.2002.0022.

Kolata, Gina (1999). Flu: The Story of the Great Influenza Pandemic of 1918 and the Search for the Virus That Caused It. New York: Farrar, Straus and Giroux. ISBN 0-374-15706-5.

Little, Jean (2007). If I Die Before I Wake: The Flu Epidemic Diary of Fiona Macgregor, Toronto, Ontario, 1918. Dear Canada. Markham, Ont.: Scholastic Canada. ISBN 9780439988377.

Noymer, Andrew; Michel Garenne (2000). "The 1918 Influenza Epidemic's Effects on Sex Differentials in Mortality in the United States". Population and Development Review 26 (3): 565–581. doi:10.1111/j.1728-4457.2000.00565.x.

Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NP (2002). "World War I may have allowed the emergence of "Spanish" influenza". The Lancet infectious diseases 2 (2): 111–4. doi:10.1016/S1473-3099(02)00185-8. PMID 11901642.

Oxford JS, Sefton A, Jackson R, Johnson NP, Daniels RS (1999). "Who's that lady?". Nat. Med. 5 (12): 1351–2. doi:10.1038/70913. PMID 10581070.

Phillips, Howard; David Killingray (eds) (2003). The Spanish Flu Pandemic of 1918: New Perspectives. London and New York: Routledge.

Rice, Geoffrey W.; Edwina Palmer (1993). "Pandemic Influenza in Japan, 1918–1919: Mortality Patterns and Official Responses". Journal of Japanese Studies 19 (2): 389–420. doi:10.2307/132645.

Rice, Geoffrey W. (2005). Black November: the 1918 Influenza Pandemic in New Zealand. Canterbury University Press: Canterbury Univ. Press. ISBN 1-877257-35-4.

Tumpey TM, García-Sastre A, Mikulasova A, et al. (2002). "Existing antivirals are effective against influenza viruses with genes from the 1918 pandemic virus". Proc. Natl. Acad. Sci. U.S.A. 99 (21): 13849–54. doi:10.1073/pnas.212519699. PMID 12368467. http://www.pnas.org/cgi/content/full/99/21/13849.

[edit] External links

Wikimedia Commons has media related to: Spanish flu



Nature "Web Focus" on 1918 flu, including new research

Influenza Pandemic on stanford.edu

The Great Pandemic: The U.S. in 1918-1919. US Dept. of HHS

Little evidence for New York City quarantine in 1918 pandemic. Nov 27, 2007 (CIDRAP News)

Flu by Eileen A. Lynch. The devastating effect of the Spanish flu in the city of Philadelphia, PA, USA

Dialog: An Interview with Dr. Jeffery Taubenberger on Reconstructing the Spanish Flu

The Deadly Virus - The Influenza Epidemic of 1918 US National Archives and Records Administration - pictures and records of the time

The 1918 Influenza Pandemic in New Zealand - includes recorded recollections of people who lived through it

PBS - recovery of flu samples from Alaskan flu victims

An Avian Connection as a Catalyst to the 1918-1919 Influenza Pandemic

Fluwiki.com Annotated links to articles, books and scientific research on the 1918 influenza pandemic

Alaska Science Forum - Permafrost Preserves Clues to Deadly 1918 Flu

Pathology of Influenza in France, 1920 Report

Yesterday's News blog 1918 newspaper account on impact of flu on Minneapolis

"Study uncovers a lethal secret of 1918 influenza virus" University of Wisconsin - Madison, January 17, 2007

Spanish Influenza in North America, 1918–1919

1918 Influenza Virus and memory B-cells - Exposure to virus generates life-long immune response.

BioHealthBase Bioinformatics Resource Center Database of influenza genomic sequences and related information.

Spanish Flu with rare pictures from Otis Historical Archives

"No Ordinary Flu" a comic book of the 1918 flu pandemic published by Seattle & King County Public Health

"Influenza 1918" The American Experience (PBS)

Swine Flu News and Updates From Around the World







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