Spanish flu

Spanish flu
Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston
Soldiers from Fort Riley, Kansas, ill with Spanish flu at a hospital ward at Camp Funston
DiseaseInfluenza
Virus strainStrains of A/H1N1
LocationWorldwide
First outbreakUnknown (first observed in the U.S.)
DateFebruary 1918 – April 1920[1]
Suspected cases500 million (estimated)[2]
Deaths
25–50 million (generally accepted), other estimates range from 17.4 to 100[3][4][5]
Suspected cases have not been confirmed by laboratory tests as being due to this strain, although some other strains may have been ruled out.
Public health recommendations from the 1918 Illustrated Current News, New Haven, CT

Spanish flu, also known as the Great Influenza epidemic or the 1918 influenza pandemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was March 1918 in Kansas, United States, with further cases recorded in France, Germany and the United Kingdom in April. Two years later, nearly a third of the global population, or an estimated 500 million people, had been infected in four successive waves. Estimates of deaths range from 17.4 million to 100 million, with an accepted general range of 25–50 million, making it one of the deadliest pandemics in human history.

The name "Spanish flu" is a misnomer,[6] rooted in historical othering of infectious disease origin, which is now avoided.[7] The pandemic broke out near the end of World War I, when wartime censors suppressed bad news in the belligerent countries to maintain morale, but newspapers freely reported the outbreak in neutral Spain. These stories created a false impression of Spain as the epicenter, so press outside Spain adopted the name "Spanish" flu. Limited historical epidemiological data make the pandemic's geographic origin indeterminate, with competing hypotheses on the initial spread.[2]

Most influenza outbreaks disproportionately kill the young and old, with a higher survival rate in-between, but this pandemic had unusually high mortality for young adults.[8] Scientists offer several explanations for the high mortality, including a six-year climate anomaly affecting migration of disease vectors with increased likelihood of spread through bodies of water.[9] The virus was particularly deadly because it triggered a cytokine storm, ravaging the stronger immune system of young adults,[10] although the viral infection was apparently no more aggressive than previous influenza strains.[11][12] Malnourishment, overcrowded medical camps and hospitals, and poor hygiene, exacerbated by the war, promoted bacterial superinfection, killing most of the victims after a typically prolonged death bed.[13][14]

The 1918 Spanish flu was the first of three flu pandemics caused by H1N1 influenza A virus; the most recent one was the 2009 swine flu pandemic.[15][16] The 1977 Russian flu was also caused by H1N1 virus, but it mostly affected younger populations.[15][17] The ongoing pandemic of COVID-19, which began in December 2019 and is caused by Severe acute respiratory syndrome coronavirus 2, is the deadliest respiratory virus pandemic since Spanish flu due to its spread worldwide and high death toll.[18]


  1. ^ Cite error: The named reference NIH-NYC was invoked but never defined (see the help page).
  2. ^ a b Taubenberger & Morens 2006.
  3. ^ "Pandemic Influenza Risk Management WHO Interim Guidance" (PDF). World Health Organization. 2013. p. 25. Archived (PDF) from the original on 21 January 2021. Retrieved 21 August 2021.
  4. ^ Cite error: The named reference pmid30202996 was invoked but never defined (see the help page).
  5. ^ Rosenwald MS (7 April 2020). "History's deadliest pandemics, from ancient Rome to modern America". The Washington Post. Archived from the original on 7 April 2020. Retrieved 11 April 2020.
  6. ^ Cite error: The named reference Friday was invoked but never defined (see the help page).
  7. ^ Dionne & Turkmen 2020, pp. 213–230.
  8. ^ Gagnon, Miller & et al 2013, p. e69586.
  9. ^ More AF, Loveluck CP, Clifford H, Handley MJ, Korotkikh EV, Kurbatov AV, et al. (September 2020). "The Impact of a Six-Year Climate Anomaly on the "Spanish Flu" Pandemic and WWI". GeoHealth. 4 (9): e2020GH000277. doi:10.1029/2020GH000277. PMC 7513628. PMID 33005839.
  10. ^ Barry 2004b.
  11. ^ MacCallum WG (1919). "Pathology of the pneumonia following influenza". Journal of the American Medical Association. 72 (10): 720–23. doi:10.1001/jama.1919.02610100028012. Archived from the original on 25 January 2020. Retrieved 16 August 2019.
  12. ^ Hirsch EF, McKinney M (1919). "An epidemic of pneumococcus broncho-pneumonia". Journal of Infectious Diseases. 24 (6): 594–617. doi:10.1093/infdis/24.6.594. JSTOR 30080493. Archived from the original on 24 July 2020. Retrieved 24 May 2020.
  13. ^ Brundage JF, Shanks GD (December 2007). "What really happened during the 1918 influenza pandemic? The importance of bacterial secondary infections". The Journal of Infectious Diseases. 196 (11): 1717–18, author reply 1718–19. doi:10.1086/522355. PMID 18008258.
  14. ^ Morens DM, Fauci AS (April 2007). "The 1918 influenza pandemic: insights for the 21st century". The Journal of Infectious Diseases. 195 (7): 1018–28. doi:10.1086/511989. PMID 17330793.
  15. ^ a b "Influenza Pandemic Plan. The Role of WHO and Guidelines for National and Regional Planning" (PDF). World Health Organization. April 1999. pp. 38, 41. Archived (PDF) from the original on 3 December 2020.
  16. ^ Michaelis M, Doerr HW, Cinatl J (August 2009). "Novel swine-origin influenza A virus in humans: another pandemic knocking at the door". Medical Microbiology and Immunology. 198 (3): 175–83. doi:10.1007/s00430-009-0118-5. PMID 19543913. S2CID 20496301. Archived from the original on 15 May 2021. Retrieved 26 July 2021.
  17. ^ Mermel LA (June 2009). "Swine-origin influenza virus in young age groups". Lancet. 373 (9681): 2108–09. doi:10.1016/S0140-6736(09)61145-4. PMID 19541030. S2CID 27656702. Archived from the original on 27 July 2021. Retrieved 5 April 2021.
  18. ^ Liang ST, Liang LT, Rosen JM (May 2021). "COVID-19: a comparison to the 1918 influenza and how we can defeat it". Postgraduate Medical Journal. 97 (1147): 273–274. doi:10.1136/postgradmedj-2020-139070. PMC 8108277. PMID 33563705. Archived from the original on 10 July 2021. Retrieved 10 July 2021.

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