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. 2022 May;15(5):1301-1317.
doi: 10.1111/1751-7915.14053. Epub 2022 Mar 22.

The beginning and ending of a respiratory viral pandemic-lessons from the Spanish flu

Harald Brüssow  1
Affiliations

The beginning and ending of a respiratory viral pandemic-lessons from the Spanish flu

Harald Brüssow. Microb Biotechnol. 2022 May.

Abstract

The COVID-19 pandemic goes into its third year and the world population is longing for an end to the pandemic. Computer simulations of the future development of the pandemic have wide error margins and predictions on the evolution of new viral variants of SARS-CoV-2 are uncertain. It is thus tempting to look into the development of historical viral respiratory pandemics for insight into the dynamic of pandemics. The Spanish flu pandemic of 1918 caused by the influenza virus H1N1 can here serve as a potential model case. Epidemiological observations on the shift of influenza mortality from very young and old subjects to high mortality in young adults delimitate the pandemic phase of the Spanish flu from 1918 to 1920. The identification and sequencing of the Spanish flu agent allowed following the H1N1 influenza virus after the acute pandemic phase. During the 1920s H1N1 influenza virus epidemics with substantial mortality were still observed. As late as 1951, H1N1 strains of high virulence evolved but remained geographically limited. Until 1957, the H1N1 virus evolved by accumulation of mutations ('antigenic drift') and some intratypic reassortment. H1N1 viruses were then replaced by the pandemic H2N2 influenza virus from 1957, which was in 1968 replaced by the pandemic H3N2 influenza virus; both viruses were descendants from the Spanish flu agent but showed the exchange of entire gene segments ('antigenic shift'). In 1977, H1N1 reappeared from an unknown source but caused only mild disease. However, H1N1 achieved again circulation in the human population and is now together with the H3N2 influenza virus an agent of seasonal influenza winter epidemics.

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Figures

Fig. 1
Fig. 1
The monthly spread of the Spanish flu pandemic from March to December 1918. Source: Vaughan (1921).
Fig. 2
Fig. 2
All‐cause mortality in New York, London, Paris and Berlin between June 1918 and March 1919. Source: Wikipedia Public Domain; Image: courtesy of the National Museum of Health and Medicine.
Fig. 3
Fig. 3
Monthly death rate per 100 000 for three US cities between 1910 and 1918. The fall 1918 peak is not to scale and exceeds that of the preceding years by more than a factor of 10 for New York. Source: Vaughan (1921).
Fig. 4
Fig. 4
Weekly total (top) and excess rate (bottom) of influenza and pneumonia mortality for 95 US cities between 1920 and 1929. Source: Collins (1930).
Fig. 5
Fig. 5
Weekly excess influenza and pneumonia mortality for selected geographical regions across the United States during the influenza winter epidemic 1928–1929. Source: Collins (1930).
Fig. 6
Fig. 6
Age profile for influenza case incidence in US cities during the winter epidemic 1928 to 1929 compared with the age profile of influenza cases during the 1918–1919 pandemic. Source: Collins (1930).
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