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Pandemic Awareness

History of Flu Pandemics

The 1918-1919 Influenza Pandemic is the catastrophe against which all modern pandemics are measured.

In February 1957, an influenza pandemic was first identified in the Far East.

In early 1968, an influenza pandemic was first detected in Hong Kong.

On June 11, 2009, the World Health Organization (WHO) declared a global pandemic of H1N1 flu. This action was a reflection of the spread of the new H1N1 flu virus, not the severity of illness caused by the virus.

Other influenza outbreaks threatened to become pandemics, but failed to spread around the globe.

Timelines show how flu pandemics begin and spread.

1918-1919, The Great Pandemic  

The 1918-1919 Influenza pandemic is the catastrophe against which all modern pandemics are measured. It is estimated that approximately 20 to 40 percent of the worldwide population became ill and that over 50 million people died. Approximately 675,000 deaths from the flu occurred in the U.S. alone. Many people died very quickly. Some people who felt fine in the morning were dead by nightfall. Those who did not succumb to the disease within the first few days often died of complications from the flu (such as pneumonia) caused by bacteria.

The 1918-1919 flu was unusual in its ability to kill young adults. Mortality rates were high among healthy adults as well as the usual high-risk groups. The attack rate and mortality was highest among adults 20 to 50 years old. The reasons for this remain uncertain..

The massive mortality due to the influenza epidemic in October of 1918 in Kansas

The massive mortality due to the influenza epidemic in October of 1918 in Kansas. This is representative of what happened in every state in the nation.

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1957-1958  

In February 1957, an influenza pandemic was first identified in the Far East. Immunity to this strain was rare in people less than 65 years of age, and a pandemic was predicted. In preparation, vaccine production began in late May 1957, and health officials increased surveillance for flu outbreaks.

Unlike the virus that caused the 1918 pandemic, the 1957 pandemic virus was quickly identified, due to advances in scientific technology. Vaccine was available in limited supply by August 1957. The virus came to the U.S. quietly, with a series of small outbreaks over the summer of 1957. When U.S. children went back to school in the fall, they spread the disease in classrooms and brought it home to their families. Infection rates were highest among school children, young adults, and pregnant women in October 1957. Most influenza-and pneumonia-related deaths occurred between September 1957 and March 1958. The elderly had the highest rates of death.

By December 1957, the worst seemed to be over. However, during January and February 1958, there was another wave of illness among the elderly. This is an example of the potential "second wave" of infections that can develop during a pandemic. The disease infects one group of people first, infections appear to decrease and then infections increase in a different part of the population. Although the Asian flu pandemic was not as devastating as the 1918-1919 flu, about 69,800 people in the U.S. died.

Resource

Pandemic Influenza Storybook
Personal recollections of prior influenza pandemics, told by survivors, families, and friends.

1968-1969  

In early 1968, the influenza pandemic was first detected in Hong Kong. The first cases in the U.S. were detected as early as September of that year, but illness did not become widespread in the U.S. until December. Deaths from this virus peaked in December 1968 and January 1969. Those over the age of 65 were most likely to die. The same virus returned in 1970 and 1972. The number of deaths between September 1968 and March 1969 for this pandemic was 33,800, making it the mildest pandemic in the 20th century.

There could be several reasons why fewer people in the U.S. died due to this virus. First, the Hong Kong flu virus was similar in some ways to the Asian flu virus that circulated between 1957 and 1968. Earlier infections by the Asian flu virus might have provided some immunity against the Hong Kong flu virus that may have helped to reduce the severity of illness during the Hong Kong pandemic. Second, instead of peaking in September or October, like pandemic influenza had in the previous two pandemics, this pandemic did not gain momentum until near the school holidays in December. Since children were at home and did not infect one another at school, the rate of influenza illness among schoolchildren and their families declined. Third, improved medical care and antibiotics that are more effective for secondary bacterial infections were available for those who became ill.

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2009-2010 H1N1  

In the spring of 2009, a new flu virus spread quickly across the United States and the world. The U.S. government coordinated a public health emergency response within the states that saved lives and helped limit the impact of the outbreak.

The pandemic occurred against a backdrop of pandemic-response planning at all levels of government including years of developing, refining and regularly exercising response plans at the international, federal, state, local, and community levels. Pandemic preparedness efforts were largely based on a scenario of severe human illness caused by other influenza strains. Despite differences in planning scenarios and the actual H1N1 pandemic, many of the systems established through pandemic planning were used and useful for the 2009 pandemic response.

The first case detected in the United States was diagnosed April 15 in a 10-year-old patient in California. By April 21, the Centers for Disease Control had begun working to develop a virus that could be used to make vaccine to protect against this new virus, and on April 26, the U.S. government declared a public health emergency for H1N1 flu. In June, the number of cases in the U.S. had jumped to 18,000 and a total of 74 countries were affected by the pandemic.

Certain groups of people were targeted to receive initially limited supplies of the vaccine based on data indicating they were at higher risk for infection or for severe influenza complications. The initial target groups for vaccination were estimated to consist of about 159 million people and included: pregnant women, people who live with or care for infants younger than 6 months of age, health care and emergency medical services personnel, infants 6 months through young adults 24 years of age, and adults 25 through 64 years of age who are at higher risk for 2009 H1N1 complications because of chronic health disorders or compromised immune systems.

In November, 48 states were reporting cases of H1N1, with young people disproportionately affected. That same month, over 61 million vaccine doses were ready just as reports of flu activity began to decline in parts of the country. The decline in cases marked the beginning of a window of opportunity to vaccinate more people and minimize the impact of the illness. A total of 80 million people were vaccinated against H1N1.

The CDC estimates that from April 2009 to April 2010, between 43 million and 89 million people had H1N1. The CDC’s estimate of the total number of deaths from H1N1 is between 8,870 and 18,300.

On June 23, 2010, the U.S. Public Health Emergency for H1N1 flu expired; on August 10, the World Health Organization declared an end to the global H1N1 flu pandemic.

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Pandemic Flu Threats  

1976: Swine Flu Threat

When a new virus was first identified at Fort Dix, it was labeled the "killer flu." Experts were extremely concerned because the virus was thought to be related to the 1918-1919 flu virus.. The concern that a major pandemic could sweep across the world led to a mass vaccination campaign in the United States. In fact, the virus--later named "swine flu"--never moved outside the Fort Dix area. Research on the virus later showed that if it had spread, it would probably have been much less deadly than the 1918-1919 flu.

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1977: Russian Flu Threat

In May 1977, influenza A/H1N1 viruses isolated in northern China, spread rapidly, and caused epidemic disease in children and young adults (< 23 years) worldwide. The 1977 virus was similar to other A/H1N1 viruses that had circulated prior to 1957. (In 1957, the A/H1N1 virus was replaced by the new A/H2N2 viruses). Because of the timing of the appearance of these viruses, persons born before 1957 were likely to have been exposed to A/H1N1 viruses and to have developed immunity against A/H1N1 viruses. Therefore, when the A/H1N1 reappeared in 1977, many people over the age of 23 had some protection against the virus and it was primarily younger people who became ill from A/H1N1 infections. By January 1978, the virus had spread around the world, including the United States. Because illness occurred primarily in children, this event was not considered a true pandemic. Vaccine containing this virus was not produced in time for the 1977-78 season, but the virus was included in the 1978-79 vaccine.

1997: Bird Flu Threat

The most recent pandemic "threats" occurred in 1997 and 1999. In 1997, at least a few hundred people became infected with the avian A/H5N1 flu virus in Hong Kong and 18 people were hospitalized. Six of the hospitalized persons died. This virus was different because it moved directly from chickens to people, rather than having been altered by infecting pigs as an intermediate host. In addition, many of the most severe illnesses occurred in young adults similar to illnesses caused by the 1918-1919 flu virus. To prevent the spread of this virus, all chickens (approximately 1.5 million) in Hong Kong were slaughtered. The avian flu did not easily spread from one person to another, and after the poultry slaughter, no new human infections were found.

In 1999, another new avian flu virus - A/H9N2 - was found that caused illnesses in two children in Hong Kong. Although neither of these viruses started pandemics, their continued presence in birds, their ability to infect humans, and the ability of influenza viruses to change and become more transmissible among people is an ongoing concern.

Timelines of Flu Pandemics  

Discover how flu pandemics begin and spread throughout the world.

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