The 1918 Flu Pandemic: Why It Matters 100 Years Later

Group photo of Red Cross nurses in Boston wearing personal protective equipment.

100 years ago, an influenza (flu) pandemic swept the globe, infecting an estimated one-third of the world’s population and killing at least 50 million people. The pandemic’s death tollAmerican soldiers returning home on the Agamemnon, Hoboken, New Jersey was greater than the total number of military and civilian deaths from World War I, which was happening simultaneously.  At the time, scientists had not yet discovered flu viruses, but we know today that the 1918 pandemic was caused by an influenza A (H1N1) virus. The pandemic is commonly believed to have occurred in three waves. Unusual flu-like activity was first identified in U.S. military personnel during the spring of 1918. Flu spread rapidly in military barracks where men shared close quarters. The second wave occurred during the fall of 1918 and was the most severe. A third wave of illness occurred during the winter and spring of 1919.

Here are 5 things you should know about the 1918 pandemic and why it matters 100 years later.

1. The 1918 Flu Virus Spread Quickly

500 million people were estimated to have been infected by the 1918 H1N1 flu virus. At least 50 million people were killed around the world including an estimated 675,000 Americans. In fact, the 1918 pandemic actually caused the average life expectancy in the United States to drop by about 12 years for both men and women.Flu patients in Iowa

In 1918, many people got very sick, very quickly. In March of that year, outbreaks of flu-like illness were first detected in the United States. More than 100 soldiers at Camp Funston in Fort Riley Kansas became ill with flu. Within a week, the number of flu cases quintupled. There were reports of some people dying within 24 hours or less. 1918 flu illness often progressed to organ failure and pneumonia, with pneumonia the cause of death for most of those who died.  Young adults were hit hard. The average age of those who died during the pandemic was 28 years old.

2. No Prevention and No Treatment for the 1918 Pandemic Virus

In 1918, as scientists had not yet discovered flu viruses, there were no laboratory tests to detect, or characterize these viruses. There were no vaccines to help prevent flu infection, noPolicemen patrol the streets in masks in Seattle to ensure public safety. antiviral drugs to treat flu illness, and no antibiotics to treat secondary bacterial infections that can be associated with flu infections. Available tools to control the spread of flu were largely limited to non-pharmaceutical interventions (NPI’s) such as isolation, quarantine, good personal hygiene, use of disinfectants, and limits on public gatherings, which were used in many cities. The science behind these was very young, and applied inconsistently. City residents were advised to avoid crowds, and instructed to pay particular attention to personal hygiene. In some cities, dance halls were closed. Some streetcar conductors were ordered to keep the windows of their cars open in all but rainy weather. Some municipalities moved court cases outside. Many physicians and nurses were instructed to wear gauze masks when with flu patients.

3. Illness Overburdened the Health Care System

An estimated 195,000 Americans died during October alone. In the fall of 1918, the United States experienced a severe shortage of professional nurses during the flu pandemic because large numbers of them were deployed to military camps in the United States and abroad.A black-and-white advertisement for the Chicago School of Nursing. This shortage was made worse by the failure to use trained African American nurses. The Chicago chapter of the American Red Cross issued an urgent call for volunteers to help nurse the ill. Philadelphia was hit hard by the pandemic with more than 500 corpses awaiting burial, some for more than a week. Many parts of the U.S. had been drained of physicians and nurses due to calls for military service, so there was a shortage of medical personnel to meet the civilian demand for health care during the 1918 flu pandemic. In Massachusetts, for example, Governor McCall asked every able-bodied person across the state with medical training to offer their aid in fighting the outbreak.

As the numbers of sick rose, the Red Cross put out desperate calls for trained nurses as well as untrained volunteers to help at emergency centers. In October of 1918, Congress approved a $1 million budget for the U. S. Public Health Service to recruit 1,000 medical doctors and more than 700 registered nurses.

At one point in Chicago, physicians were reporting a staggering number of new cases, reaching as high as 1,200 people each day. This in turn intensified the shortage of doctors and nurses.  Additionally, hospitals in some areas were so overloaded with flu patients that schools, private homes and other buildings had to be converted into makeshift hospitals, some of which were staffed by medical students.

4. Major Advancements in Flu Prevention and Treatment since 1918

The science of influenza has come a long way in 100 years!A man dress in personal protective equipment in a laboratory. Developments since the 1918 pandemic include vaccines to help prevent flu, antiviral drugs to treat flu illness, antibiotics to treat secondary bacterial infections such as pneumonia, and a global influenza surveillance system with 114 World Health Organization member states that constantly monitors flu activity. There also is a much better understanding of non-pharmaceutical interventions–such as social distancing, respiratory and cough etiquette and hand hygiene–and how these measures help slow the spread of flu.

There is still much work to do to improve U.S. and global readiness for the next flu pandemic. More effective vaccines and antiviral drugs are needed in addition to better surveillance of influenza viruses in birds and pigs. CDC also is working to minimize the impact of future flu pandemics by supporting research that can enhance the use of community mitigation measures (i.e., temporarily closing schools, modifying, postponing, or canceling large public events, and creating physical distance between people in settings where they commonly come in contact with one another). These non-pharmaceutical interventions continue to be an integral component of efforts to control the spread of flu, and in the absence of flu vaccine, would be the first line of defense in a pandemic.

5. Risk of a Flu Pandemic is Ever-Present, but CDC is on the Frontlines Preparing to Protect Americans

Four pandemics have occurred in the past century: 1918, 1957, 1968, and 2009. The 1918 pandemic was the worst of them. But the threat of a future flu pandemic remains. A pandemic flu virus could emerge anywhere and spread globally.A crowd of people with the Washington Monument in the distance.

CDC works tirelessly to protect Americans and the global community from the threat of a future flu pandemic. CDC works with domestic and global public health and animal health partners to monitor human and animal influenza viruses. This helps CDC know what viruses are spreading, where they are spreading, and what kind of illnesses they are causing. CDC also develops and distributes tests and materials to support influenza testing at state, local, territorial, and international laboratories so they can detect and characterize influenza viruses.  In addition, CDC assists global and domestic experts in selecting candidate viruses to include in each year’s seasonal flu vaccine and guides prioritization of pandemic vaccine development. CDC routinely develops vaccine viruses used by manufacturers to make flu vaccines. CDC also supports state and local governments in preparing for the next flu pandemic, including planning and leading pandemic exercises across all levels of government. An effective response will diminish the potential for a repeat of the widespread devastation of the 1918 pandemic.

Visit CDC’s 1918 commemoration website for more information on the 1918 pandemic and CDC’s pandemic flu preparedness work.

USDA finds “evidence of manipulation” in vaccine study

A journal is retracting a paper by scientists at the U.S. Department of Agriculture about a vaccine to protect fish from a deadly bacterial infection, after an investigation found evidence of data manipulation.  The retraction notice — which appears in the journal Vaccine — cites an investigation by the USDA. It also notes that the […]

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Methodology of paper linking vaccine to behavioral issues “seriously flawed,” says retraction

After temporarily removing a paper that suggested a link between the vaccine for the human papillomavirus (HPV) and behavioral issues, the journal has now retracted it. Vaccine says the reason is “serious concerns regarding the scientific soundness of the article,” including flawed methodology and unjustified claims. Christopher A. Shaw, a co-author on the paper and a researcher at the […]

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Journal temporarily removes paper linking HPV vaccine to behavioral issues

The editor in chief of Vaccine has removed a paper suggesting a human papillomavirus (HPV) vaccine can trigger behavioral changes in mice. The note doesn’t provide any reason for the withdrawal, although authors were told the editor asked for further review. Two co-authors on the paper — about Gardasil, a vaccine against HPV — have previously suggested […]

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Research Reading Roundup: Research Parasites, CRISPR patent dispute and more

Here is your weekly roundup of research news: Have you seen the #ResearchParasites hashtag on Twitter? It’s in response to a New England Journal of Medicine editorial about data sharing. There are two rebuttal articles found

5 Things You Might Not Know About Human Papillomavirus

Portrait Of Grandmother With Daughter And Granddaughter

Human papillomavirus (HPV) is a common virus that infects both women and men. Although most HPV infections go away on their own, infections that don’t go away (persist) can cause changes in the cells and lead to cancer. With HPV vaccine, we have a powerful tool to prevent most of these cancers from ever developing.

While cervical cancer is the most common and well-known HPV cancer, it’s not the only type of cancer HPV infections can cause. January is Cervical Cancer Awareness Month, and in honor of that, here are five things you might not know about HPV.

HPV infections cause cancers other than cervical cancer.HPV facts

HPV infections can cause

  • cancers of the cervix, vagina, and vulva in women;
  • cancer of the penis in men;
  • and cancers of the anus and back of the throat, including the base of the tongue and tonsils (oropharynx) in men and women.

Every year in the United States, 27,000 women and men are diagnosed with a cancer caused by HPV infection—that’s a new case of cancer every 20 minutes.

HPV vaccination age is recommended at ages 11 or 12.

HPV vaccination is recommended for preteen girls and boys (ages 11-12) to protect against cancer-causing HPV infections before they are exposed to the virus. HPV vaccination provides the best protection when given at the recommended ages of 11-12.

Mom and Kid and NurseScreening isn’t an alternative to HPV vaccination.

Every year, 4,000 women in the U.S. die from cervical cancer—even with routine screening and treatment. There is no routine screening test for the other cancers HPV causes. Many of those HPV cancers are not discovered until they are late stage or invasive and can be very painful, disfiguring, and even deadly.

That’s why it’s so important for girls and boys to get the full HPV vaccine series. HPV vaccines are given as a series of three shots over six months. Women who have had the HPV vaccine should still start getting screened for cervical cancer when they reach age 21.

HPV vaccination also prevents invasive testing and treatment for “precancers.”

Every year in the U.S., more than 300,000 women endure invasive testing and treatment for changes in the cells (lesions) on the cervix that can develop into cancers. Testing and treatment for these “precancers” can cause lasting problems such as cervical instability which can lead to preterm labor and preterm birth. HPV vaccination protects against the types of HPV that cause the majority of the cervical cancers and precancers.

HPV vaccination is protecting children from HPV disease.

In the four years after the vaccine was recommended in 2006, the amount of HPV infections among teen girls in the U.S. dropped by more than half. Also, fewer young women are being diagnosed with cervical precancer caused by HPV infections. HPV vaccination is critical to protecting the next generation against cancers caused by HPV infections.

Fight the Flu: Get a Vax!

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As cold weather sets in, clothing layers increase, scarves are pulled tighter, and noses become redder. This time of year can also bring the dreaded running nose, scratchy throat, cough, body aches, and headache of the seasonal flu. As you fretfully try to protect yourself from the winter season with warmer clothes and hot drinks, are you also taking steps to protect yourself from the bigger threat of the flu?

Flu season is coming, are you ready to fight the flu?

An annual flu vaccine is the first and most important step to preventing the flu. Everyone 6 months and older should get an annual flu vaccine. It takes 2 weeks for protection from a flu vaccine to develop in the body, so you should get vaccinated soon after the flu vaccine becomes available.

While you may be stocking up on hand sanitizer, avoiding crowded events, and distancing yourself from friends or acquaintances who let out a sniffle or two, if you haven’t gotten your seasonal flu vaccine, you haven’t taken the most important step to protect yourself from the flu.

Getting your flu vaccine is easy, having the flu is not.mother taking her child's temperature

Everywhere from your doctor’s office to your local pharmacy, and even the news and social media networks, are sharing important reminders about getting the flu vaccine. Getting a flu vaccine can take just a few minutes of your day. Getting the flu, however, can put you out of work or school for days, sometimes weeks. Taking a little time for your health now could save you from missing important events, work deadlines, or opportunities in the future.

Do your part for those you love.

When you get a flu vaccine, you are not only protecting yourself from the flu, but you are also protecting the people around you who are more vulnerable to serious flu illness. As the holiday season approaches, you may be around young children, older family members, or others who have a high risk of contracting the flu or developing complications from the flu.

The flu is a serious illness that can have life-threatening complications for some people. The flu causes millions of illnesses, hundreds of thousands of hospitalizations, and thousands of deaths each year. Some people, such as older people, young children, pregnant women, and people with certain health conditions, are at high risk for serious flu complications.

Get your flu shot to protect yourself and those around you. Do your part to protect the important people in your life.

Avoid germs during flu season.

While getting a yearly vaccination is the first and most important step in protecting against flu, there are additional steps you can take to avoid germs and the flu. Here are a few tips:

  • Try to avoid close contact with sick people.
  • If you are sick, limit contact with others as much as possible to keep from infecting them. Keep your germs to yourself.
  • 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. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.)
  • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.doctor giving a man a flu shot
  • 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, and mouth. Germs spread this way.
  • Clean and disinfect surfaces and objects that may be contaminated with germs like the flu.


Don’t know where to get your flu shot?

Flu vaccines are offered in many locations, including doctor’s offices, clinics, health departments, pharmacies, and college health centers, by many employers, and even some schools. You don’t have to see your doctor to get a flu shot! There are plenty of locations available that provide vaccinations.

This Vaccine Locator is a useful tool for finding vaccine in your area.

Don’t wait until you are lying sick in bed to wish you had gotten a flu shot. There are steps you can take to prevent the flu and protect those around you. Get your flu vaccine today, and remind someone you care about to do the same. As long as flu viruses are circulating, it is not too late to get a flu vaccine!

How many children are at risk of measles in the United States?

Despite the MMR vaccine controversy resulting from a series of now discredited studies linking the vaccine with autism, childhood vaccination rates remain high in the United States. In 2013, 92% of children aged 19 to

3 critical lessons learned from Louisiana’s flu data

By Melissa Warren, Senior Specialist, Influenza, APHL and Kelsey Vellente, Senior Technician, Food Safety & Infectious Disease, APHL

It’s flu season, the dreaded time of year when everyone hopes that they are not one of the thousands of Americans who falls ill. While the public gets their vaccines, loads up on hand sanitizer and researches magical tea recipes “guaranteed” to fight the flu, public health labs and epidemiologists prepare to test specimens and collect data that will provide a more detailed look at how this potentially serious virus is impacting the public’s health.

3 critical lessons learned from Louisiana’s flu data | www.APHLblog.orgSo what data is collected and what does it tell us? To get a better understanding, we spoke with Julie Hand, public health epidemiologist in the Infectious Disease Epidemiology Section of the Louisiana State Department of Health & Hospitals, who shared some of the most telling pieces of data they collected during the 2014-2015 flu season. (Louisiana has a centralized public health system which means there are no local or county departments of health. All flu surveillance work is performed at the state level.)

In Louisiana (and most other states), flu reporting is voluntary. There is no requirement for clinical staff to notify the state of flu cases. Louisiana has been working closely with hospitals and other clinical facilities to encourage flu reporting. In 2014-2015, approximately 45,000 rapid influenza diagnostic test results were reported (up approximately 25,000 from the previous season). More specimens and data provided by clinical facilities means the state can compile a more complete and meaningful picture of the flu season and its impact on the public.

While data was collected across various age ranges and geographic regions of the state, there were two different school outbreaks that were particularly interesting: one was influenza A (H3N2) and the other was influenza B. Both outbreaks peaked in November, only one month after the official start of flu season.

Here are the three critical lessons learned from Louisiana’s flu data:

1. Within those school outbreaks, the majority of people who were vaccinated at the time of infection had not received their vaccination early enough to have immunity.

  • Influenza A outbreak: 34% of those infected had been vaccinated but only 9% of those received their vaccination more than two weeks before the outbreak.
  • Influenza B outbreak: 16% of those infected had been vaccinated but only 1% received it more than two weeks before the outbreak.

Why does this matter? After receiving the flu vaccine, it takes about two weeks for your body to develop immunity. So while people thought they were protected, their bodies were not yet immune to the circulating flu virus. Flu season is a time to be proactive not reactionary – don’t wait for an outbreak to get vaccinated.

2. Antibiotics were prescribed to a surprisingly high number patients in those outbreaks, however antibiotics do not work to fight viruses such as influenza.

  • Influenza A outbreak: 20% of patients received antibiotics
  • Influenza B outbreak: 29% of patients received antibiotics

As stated above, antibiotics don’t fight viruses like influenza – they fight bacterial infections. Overuse of antibiotics when they will not be effective – such as in cases like this – contributes to the growing public health threat of antibiotic resistance. Medical professionals should be aware that treating flu with antibiotics isn’t recommended and is contributing to a larger public health problem.

3. In Louisiana during the 2014-2015 flu season, only those who received the quadrivalent vaccine were protected against the most prevalent strain of influenza B.

There are two categories of flu vaccines – trivalent (three strains) and quadrivalent (four strains). They both include a combination of influenza A and B strains, but the genotypes of the strains included in each season’s vaccines vary depending on what is expected to be most prevalent. In 2014-2015, influenza B Yamagata and Victoria lineages were included in the quadrivalent vaccine, but only influenza B Yamagata was included in the trivalent vaccine.

Influenza B accounted for 20% of all reported flu cases in Louisiana (state lab PCR results). Louisiana’s genotyping data showed that of those…

  • 74% were influenza B Victoria – the strain not included in the trivalent vaccine
  • 26% were influenza B Yamagata – the strain included in the trivalent vaccine

As each flu season comes and goes, data is critical to helping departments of public health understand which aspects of flu surveillance can be eliminated, continued and/or adjusted. And with every improvement and every new bit of previously unknown information, officials like Julie and her colleagues can help shape programs that protect the public from this hated virus.

Trump and GOP candidate docs debate science! Should vaccine schedule be slowed?

GOP CANDIDATES DEBATE EARLY VACCINATION Oh, goody. Donald Trump again, this time at Wednesday night’s debate among the legions of Republican Presidential candidates, repeating his long-standing declaration that childhood vaccination causes autism. A claim that–need I even say it?– has … Continue reading »

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