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Influenza World brings you the latest news and updates in the flu field from around the world.

 
Flu may not have killed most in 1918 pandemic
05 February 2009

By Maggie Fox

WASHINGTON (Reuters Life!) - Strep infections and not the flu virus itself may have killed most people during the 1918 influenza pandemic, which suggests some of the most dire predictions about a new pandemic may be exaggerated, U.S. researchers said on Thursday.

The findings suggest that amassing antibiotics to fight bacterial infections may be at least as important as stockpiling antiviral drugs to battle flu, they said.

Keith Klugman of Emory University in Atlanta and colleagues looked at what information is available about the 1918 flu pandemic, which killed anywhere between 50 million and 100 million people globally in the space of about 18 months.

Some research has shown that on average it took a week to 11 days for people to die -- which fits in more with the known pattern of a bacterial infection than a viral infection, Klugman's group wrote in a letter to the journal Emerging Infectious Diseases.

"We observed a similar 10-day median time to death among soldiers dying of influenza in 1918," they wrote.

People with influenza often get what is known as a "superinfection" with a bacterial agent. In 1918 it appears to have been Streptococcus pneumoniae.

"Neither antimicrobial drugs nor serum therapy was available for treatment in 1918," Klugman's team wrote.

Now there are also vaccines that protect against many different strains of S. pneumoniae, which cause infections from pneumonia to meningitis.

WORST-CASE SCENARIO

Most health experts agree that another pandemic of influenza is inevitable. There were smaller pandemics in 1958 and in 1967.

Many government projections have been based on a worst-case 1918 scenario, in which tens of millions of people would die globally and up to 40 percent of the work force would be out for weeks, either sick, caring for others who are sick, or avoiding public places for fear of infection.

"Based on 1918 we would project less mortality in an era of antibiotics," Klugman said in an e-mail.

"We -are currently modeling this -- assuming of course that the bacterial superinfections remain susceptible to the antibiotics and that sufficient antibiotics are available."

No one knows when a pandemic of flu might strike. Every year seasonal influenza kills between 250,000 and 500,000 people.

A pandemic occurs when a new strain of flu begins infecting people. One big fear is that H5N1 influenza, currently infecting many birds in Asia, Europe and Africa, might make the jump to people.

H5N1 currently infects people only rarely but it has killed 254 out of 405 infected since 2003, according to the World Health Organization. Many countries and companies are stockpiling antiviral drugs and vaccines in case it does strike.

  • "I would describe flu as something that makes you feel very, very ill. You get a headache, aching bones, and are generally fed up"
  • "When I get flu symptoms I feel like a train has run over me"
  • "I felt very sick and, during the first week, I had high temperature. Flu was very different to a cold. I went back to work after two and a half weeks. Then I suffered a setback for another week"
  • "I run a guesthouse; flu would be a real pest for me. I couldn’t cook, I shouldn’t cook, and I wouldn’t cook, so I would need to get a lot of extra help in. It would cost me a lot more money. So flu’s a real problem, a right downturn"
  • "I work on my own and when I can’t work, I have to try not to infect my little children, so they avoid getting the flu as well"
  • "I feel a little numb, like I’m in another dimension. Because in general I have sore throat, headache, I feel all clogged-up. Usually a sensation like I’m floating in the air"
  • "Shivers, sweats, makes you ache. Last time I had flu I was off for two weeks"
  • "I think that I would probably be concerned that I would pass flu onto my children, who might not be able to deal with it as well as I would"
  • "Flu makes you feel like you’ve been hit over the head with a baseball bat. You don’t feel like you can get yourself out of bed as all your energy is drawn from you"
  • "I was incapable of working. It just wasn’t possible at all… and my flu dragged on for more than a week"
  • "I have no strength. It annoys me because I can do nothing, it seems like I’m wasting my time"
  • "Flu’s like being hit by a truck because you feel completely gone. There is no energy left in your body. You are suffering from high temperature. You’re sweating a lot and you feel really unwell"
  • "First of all infinite tiredness, then I feel like sleeping and don’t want to eat"
  • "I felt really miserable because my muscles and my bones were aching. Well, I can hardly describe it, I just felt really awful, absolutely miserable"
  • "It’s like there’s something huge treading on your head, like a deafening noise that destroys the eardrums"
  • "The fever was constantly rising – I immediately measured my temperature as soon as I got home. It was 41°C and it kept rising and I was wondering what’s going on. I was really scared! Everything was hurting and it all happened so fast. Flu came out of the blue"
  • "I always feel like my limbs have iron weights tied to them and I’m going to fall over any minute, a really stuffy runny nose and feel antisocial"
  • "I was totally dependent on others! I was incapable of doing anything at all"
  • "The real flu knocks you for six – you just don’t want to move or do anything. It’s not very nice"
  • "Not being able to go to work. Not being able to do the things I have to do at home and the commitments that I have day by day"