Bird flu – the pandemic clock is ticking
Box 2 | Past flu pandemics
There were three influenza pandemics in the 20th century, the most deadly being the Spanish flu of 1918-19, which occurred immediately after World War I. At the time, it was not known what caused the flu. We now know that the Spanish flu was caused by a H1N1 type Influenza A virus, which killed between 20 and 50 million people world wide.
Human influenza viruses are normally types H1, 2 or 3 and N1 or 2. The Asian flu of 1957-58 was caused by a H2N2 virus and the 1968-69 Hong Kong flu was caused by a H3N2 type influenza virus. Both were created by the genetic rearrangement of human flu virus and avian flu virus (see also Box 1: An ever-changing virus).
In the past, pandemics have occurred every 30 years or so. The last pandemic was in 1968, so scientists predict that another pandemic could occur any time soon, if given the right conditions. There is the added concern that the worlds' ageing population and others with a poor immune system are especially vulnerable to the flu.
The 1918-19 flu pandemic in Australia
The following article from A History of the Pharmacy Board of New South Wales by Dr Gregory Haines, published by the Pharmacy Board of New South Wales and the Australian Pharmaceutical Publishing Company (1997), is reproduced with the kind permission of Dr Haines and the Pharmacy Board of New South Wales.
Before the emergency of the Great War had passed, a new crisis which would fully engage pharmacists had already begun to show itself. The winter of 1918 saw a sudden increase in the incidence of influenza in New South Wales. This was the prelude to the 1919 influenza pandemic which was to claim 6387 lives in the state. The death rate was about to frighten and generate enormous alarm: for each 100,000 people in the population, 319 were going to die.
Just over half of all Australian deaths due to the 1919 influenza pandemic were recorded in New South Wales. The state government took initial steps in 1918 to try to prevent the spread of the anticipated outbreak of the disease. Health authorities had been aware of the influenza outbreaks in Europe and Britain from July 1918. At that stage, what became known as Spanish Influenza was not exhibiting unusual virulence, though its spread was anticipated.
The government made the wearing of masks compulsory in shops, hotels, churches, theatres and on public transport in the populous parts of the state. Those who had become infected were to be isolated and quarantine rules were tightened. Price control on treatments for influenza was enforced and one Sydney pharmacist was severely fined in October 1918 when he was found to have overcharged. In December 1918, representatives of the Pharmaceutical Society and the medical association met and formulated a stock mixture and a solid inhalation for use should the disease spread into Sydney from North Head Quarantine Station.
Early in 1919 the government strengthened its public health measures. It insisted on the use of masks. Libraries, reading rooms, theatres, music halls, auction rooms and billiard rooms and indoor or outdoor church services within the County of Cumberland were prohibited. Space regulations limited the number of people able to gather in shops, hotels, tea rooms and restaurants. Shops were forbidden to hold crowd-attracting bargain or clearance sales. Travel on long-distance trains was restricted and quarantine regulations were further tightened. Troops returning from the war were quarantined at North Head and the Sydney Cricket Ground.
The epidemic peaked in the winter of 1919 and abated by the February of the following year. While it lasted, the influenza pandemic increased work and risk for those engaged in pharmacy. It also prevented or limited the activities of pharmacy organisations, either by preventing their meetings or by robbing erstwhile participants of energy. The Australasian Pharmaceutical Conference, which had not met since 1913, thanks to the war, did not gather until 1921, due to the pandemic.
Boxes
Box 1. An ever-changing virus
Box 3. Controlling an outbreak
Box 4. Vaccines for pandemics
Box 5. Antivirals bring hope
Related sites
Estimating the impact of the next influenza pandemic: Enhancing preparedness (World Health Organisation)
Information about influenza pandemics (Centers for Disease Control and Prevention, US)
Flu vaccine (The Science Show, 7 February 2004)
History of influenza pandemics (Health And Wellness, Alberta Government, Canada)
Chronology of the 1918 Spanish influenza
epidemic in Georgia (University of Georgia)
It all started in Kansas (Relevance: The Quarterly Journal of The Great War Society, USA)
In search of an enigma: The 'Spanish lady' (MRC, National Institute for Medical Research, UK)
Statistics from the influenza epidemic
(Stanford University, USA)
The influenza pandemic of 1918
(Stanford University, USA)
The 1918 Spanish flu pandemic, and the Hong Kong incident (NinthDay.com)
Global epidemiology of influenza: Past and present (Annual Review of Medicine, 2000, 51: 407-421)
Posted July 2005.