National Museum of Health/AP
Influenza victims crowd into an emergency hospital near Fort Riley, Kansas in this 1918
file photo.

Strep Infections Were the Biggest Killer in the 1918 Flu Pandemic, New Study Suggests

February 06, 2009 02:59 PM
by Lindsey Chapman
U.S. researchers are learning that people killed during the 1918 flu pandemic may not have died from the flu after all; the findings have implications for strategies against future pandemics.

Researching the Past

A strep throat infection may have been the deadly culprit affecting people during the 1918 flu pandemic, Reuters has reported.

Available information about the pandemic indicates that people who became sick during this time died within 7 to 11 days, which is more indicative of a bacterial infection than a viral infection like the flu.

Researchers suggested that the findings could lead to a new strategy for fighting a future influenza pandemic, which health officials say is inevitable. For example, storing antibiotics for fighting future bacterial infections could be “at least as important as stockpiling antiviral drugs to battle flu,” according to Reuters.

Today, many people receive flu shots to reduce their chances of falling ill during flu season, yet evidence is mounting that more should be done to stop the flu, according to New Scientist.

Vaccines are known to help stop the spread of flu, but figuring out just how effective they are would require medical professionals to withhold the shot from certain individuals. Doing so is unethical, so the next best option health experts have is comparing illness rates among those who are vaccinated to those who are not.

The comparisons have resulted in considerable debate, with some researchers suggesting that flu shots are as effective as medical professionals claim, and others saying the number of deaths prevented by the flu vaccine might not be as high as previously thought.

“No one suggests that seniors should not be vaccinated: there is no doubt that flu shots reduce their risk of dying because of flu. But health professionals must accept that flu shots do not have the impossible benefits claimed, and start working on more effective prevention programmes,” wrote New Scientist’s Robert Taylor.

The U.S. Centers for Disease Control and Prevention has reported that approximately 36,000 people in the United States die each winter from the flu.

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Background: More explanations for the deaths

In August 2008, the National Institutes of Health released a report indicating that a majority of deaths caused during the 1918 flu pandemic resulted from a pneumonia infection after the flu virus. “In essence, the virus landed the first blow while bacteria delivered the knockout punch,” Dr. Anthony S. Fauci stated.

Historical Context: The 1918 pandemic

According to The Great Pandemic Web site, the influenza pandemic swept the United States in three waves throughout 1918 and 1919. Exact estimates of how many people died are varied, but more recent numbers indicate that approximately 675,000 Americans were killed, and between 30 million and 50 million were affected globally.

More people died of influenza than were killed in World War I. Interestingly, the close timing to World War I and the speed with which influenza affected communities caused many people to forget how severe the spread of the illness was. One historian said, “the disease moved too fast, arrived, flourished and was gone before … many people had time to fully realize just how great was the danger.”

Influenza last achieved pandemic levels in 1968, according to Time magazine but it wasn’t terribly worse “than a typical bad flu season.” In fact, most people who lived during this period didn’t even know there was a pandemic. Antibiotics for bacterial infections were a large help to reducing the number of fatalities from this episode.

Predicting what will happen during the next flu pandemic is difficult, writes John M. Barry. The population now has more elderly people with weaker immune systems. Effects on people and the economy would be more severe than in the past.

Key Players: Flu survivors

In 2008, researchers found that survivors of the 1918 flu pandemic were still producing antibodies to the virus 90 years later, according to The Washington Post. Dr. James E. Crowe Jr., a professor of pediatrics, microbiology and immunology at Vanderbilt University explained that the findings represented the first evidence of people demonstrating immunity to the 1918 virus. “It’s important to know that you can develop immunity to such a pandemic virus. That has implications for new pandemic viruses," Crowe explained.

Reference: Strep throat, flu


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