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The Deadliest Epidemic in Recent History

What was the world-wide epidemic that killed at least 25 million people in one year? If you said the Ebola virus, AIDs or syphilis, you are wrong. It was the influenza epidemic of 1918-1920 that started near the end of World War I. It infected 500 million people, and may have killed as many as 100 million, about 5 percent of the world’s population at that time.

Flu Killed More People than World War I
World War I caused more than nine million deaths in four years. The flu epidemic killed more than 25 million in one year. The origin of the virus is not known, but the first US case was recorded on the morning of March 11, 1918 at Camp Funston, Kansas. A company cook named Albert Mitchell reported to the infirmary with typical flu-like symptoms: a low-grade fever, mild sore throat, slight headache, and muscle aches. The doctor told him to go to bed. By noon, 107 soldiers were sick. Within two days, 522 people were sick. Many suffered from severe pneumonia. Then reports started coming in from other military bases around the country. Thousands of sailors docked off the East Coast were sick.

Within seven days, every state in the Union had been infected. By April, European troops and civilians were infected. By mid-April, the disease had spread to China and Japan. By May, the virus was spread throughout Africa and South America.

High Death Rate
In Philadelphia, 158 out of every 1000 people died; in Baltimore, 148 out of 1000 died; in Washington, D. C, 109 out of 1000 died. The number of cases peaked in two to three weeks, lasted two or three more weeks in a given city and then disappeared as quickly as it arrived. The United States had one of the lowest death rates in the world from the disease. Sixty percent of infected Eskimos living in Nome, Alaska died from the disease. Almost 90 percent of the Samoan population was infected with flu, and those who survived the infection often died from starvation because they were too weak to seek out food and water. Eighteen months after the disease appeared, this particular flu bug vanished and did not show up again until 39 years later in 1957.

Pneumonia was the Most Common Cause of Death
It wasn’t just the flu virus that killed so many people, it was a secondary bacterial infection in the lungs caused by a common upper respiratory bacteria, usually Haemophillus Influenza. Without this secondary bacterial infection, many patients might have survived in 1918. Now doctors can cure bacterial infections with antibiotics. Antibiotics are the primary reason why the 1957 and 1968 influenza pandemics did not kill as many people {J Infect Dis, Oct 1, 2008;198(7):962–970}.

Birds to Pigs to Humans
In March of 1997, researchers at the Armed Forces Institute of Pathology in Washington, DC, found a jar with the lungs, packed in formaldehyde, of a 21 year old soldier who died of the flu in 1918. They analyzed the genetic material of the virus and showed that it was the type that is passed from birds to pigs and then to humans. A bird’s immune system tolerates the virus so the virus lives quietly in birds without a strong immune response from the bird. However, when the virus is transmitted to pigs, the pig immune system reacts violently to kill it, so, to survive in pigs, the virus changes to a different form that is so aggressive that it can kill the pig. When transmitted from pigs to humans, it can weaken a person’s immunity so much that a secondary bacterial infection can kill him. Both the Asian flu (1957) and the Hong Kong flu (1968), mutated from pig viruses and were very similar in structure to the flu virus of 1918, but were not as lethal.

Why You Need a Different Flu Immunization Each Year
The flu viruses are so contagious that almost everyone exposed to them gets the flu. Once a flu virus travels throughout the world, so many people are infected that the population becomes immune to it and the virus must change to another form to be able to infect people again. The virus mutates and changes its structure, so each year a new mutated flu virus shows up and most people do not have immunity to that new virus and it can spread rapidly through the population to cause a different flu epidemic. Flu epidemics usually start in China in the spring and summer, and spread to the rest of the world throughout that year. Scientists culture the new flu viruses in China in the spring and make a vaccine from these viruses. This is why you have to take a different vaccine each year.

Flu Can Still Kill
Researchers with the Centers for Disease Control and Prevention found that 830 children were reported to have died from flu-related complications between October 2004 and September 2012 (Pediatrics. pub online Nov 4, 2013).

* Most had not gotten a flu vaccine
* Pneumonia was the most commonly reported complication
* The median age was seven
* 43 percent of the children who died from flu were otherwise healthy
* 33 percent had neurological disorders
* 12 percent had genetic or chromosomal disorders
* 35 percent of the children died before hospital admission
* 63 percent of the children died within seven days of the onset of flu symptoms.

I recommend that you get your flu shot every year – not because flu is likely to kill you, but because it can make you miserable. The flu virus that will come this year is not likely to kill you unless you suffer from heart or lung disease. People with heart or lung diseases should be protected by immunization.

November 10th, 2013
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About the Author: Gabe Mirkin, MD

Sports medicine doctor, fitness guru and long-time radio host Gabe Mirkin, M.D., brings you news and tips for your healthful lifestyle. A practicing physician for more than 50 years and a radio talk show host for 25 years, Dr. Mirkin is a graduate of Harvard University and Baylor University College of Medicine. He is board-certified in four specialties: Sports Medicine, Allergy and Immunology, Pediatrics and Pediatric Immunology. The Dr. Mirkin Show, his call-in show on fitness and health, was syndicated in more than 120 cities. Read More
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