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Online Discussion: Tracking new emerging diseases and the next pandemic.

History of pandemics

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Albert View Drop Down
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    Posted: September 17 2007 at 7:34pm
Here is a little history regarding the last flu pandemics.  If we don't have a panflu this winter, this would be the longest stretch between pandemics since 1889.   If the last 120 years of history can be used as any sort of barometer at measuring the frequency of pandemics,  then it would be safe to assume that we're about to have another one.   
 
 
  • Influenza
    • The "first" pandemic of 1510 travelled from Africa and spread across Europe.[3][4]
    • The "Asiatic Flu", 1889 - 1890. Was first reported in May of 1889 in Bukhara, Russia. By October, it had reached Tomsk and the Caucasus. It rapidly spread west and hit North America in December 1889, South America in February–April 1890, India in February-March 1890, and Australia in March–April 1890. It was purportedly caused by the H2N8 type of flu virus and had a very high attack and mortality rate.
    • The "Spanish flu", 1918 - 1919. First identified early March 1918 in US troops training at Camp Funston, Kansas, by October 1918 it had spread to become a world-wide pandemic on all continents. Unusually deadly and virulent, it ended nearly as quickly as it began, vanishing completely within 18 months. In six months, 25 million were dead; some estimates put the total of those killed worldwide at over twice that number. An estimated 17 million died in India, 500,000 in the United States and 200,000 in the UK. The virus was recently reconstructed by scientists at the CDC studying remains preserved by the Alaskan permafrost. They identified it as a type of H1N1 virus.
    • The "Asian Flu", 1957 - 58. An H2N2 caused about 70,000 deaths in the United States. First identified in China in late February 1957, the Asian flu spread to the United States by June 1957.
    • The "Hong Kong Flu", 1968 - 69. An H3N2 caused about 34,000 deaths in the United States. This virus was first detected in Hong Kong in early 1968 and spread to the United States later that year. Influenza A (H3N2) viruses still circulate today.
     
     
     
     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 17 2007 at 7:45pm
    Other than Cholera outbreaks, here are the previous types of epidemics, which are now very rare and that we haven't seen since the 1300's.  Therefore the chances of having a pandemic that is not from a flu virus is extremely unlikely.  
     
     
     
    Peloponnesian War, 430 BC. Typhoid fever killed a quarter of the Athenian troops and a quarter of the population over four years. This disease fatally weakened the dominance of Athens, but the sheer virulence of the disease prevented its wider spread; i.e. it killed off its hosts at a rate faster than they could spread it. The exact cause of the plague was unknown for many years; in January 2006, researchers from the University of Athens analyzed teeth recovered from a mass grave underneath the city, and confirmed the presence of bacteria responsible for typhoid. [1]
    • Antonine Plague, 165-180. Possibly smallpox brought back from the Near East; killed a quarter of those infected and up to five million in all. At the height of a second outbreak (251–266) 5,000 people a day were said to be dying in Rome.
    • Plague of Justinian, from 541 to 750, was the first recorded outbreak of the bubonic plague. It started in Egypt and reached Constantinople the following spring, killing (according to the Byzantine chronicler Procopius) 10,000 a day at its height and perhaps 40 percent of the city's inhabitants. It went on to eliminate a quarter to a half of the human population that it struck throughout the known world. [1] Some historians have suggested a total European population loss of 50%-60% between 541 and 700.
    • The Black Death, started 1300s. Eight hundred years after the last outbreak, the bubonic plague returned to Europe. Starting in Asia, the disease reached Mediterranean and western Europe in 1348 (possibly from Italian merchants fleeing fighting in the Crimea), and killed twenty million Europeans in six years, a quarter of the total population and up to a half in the worst-affected urban areas.
     
     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 17 2007 at 11:59pm
    Originally posted by Albert Albert wrote:

    Therefore the chances of having a pandemic that is not from a flu virus is extremely unlikely.  
     
     


    so a extreme super flu is it then,
     whats the percentage factor in this time line  that it is likely to too happen

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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 18 2007 at 5:12am
    Originally posted by coleyounger1 coleyounger1 wrote:

    Originally posted by Albert Albert wrote:

    Therefore the chances of having a pandemic that is not from a flu virus is extremely unlikely.  
     
     


    so a extreme super flu is it then,
     whats the percentage factor in this time line  that it is likely to too happen

     
    I'm not sure if it would be a "super flu" pandemic, or if it would even be caused from h5n1, but the next pandemic will most likely be from a flu.   And as far as when?  I'm still leaning toward this winter - or never.   Wink
     
     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote coyote Quote  Post ReplyReply Direct Link To This Post Posted: September 18 2007 at 5:35am
    Albert, thanks for the "history of pandemics"..Sure hope your wrong about this winter,but it does seem like we are getting very,very,close.
    Long time lurker since day one to Member.
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: September 18 2007 at 6:30am
    This is an interesting article.  Of course they compare the 36,000 annual deaths with the 1968 panflu that killed 34,000.  The U.S. population during the late 1960's was around 200 million so it was in fact a severe flu. 
     
    This article also touches on the importance of getting the pneumonia vax to prevent complications from the flu.  The pneumonia (PPV 23) vaccination may only be good for approximately 2 years so people might want to consider getting another one.       
     
     

    Are US flu death figures more PR than science?

    US data on influenza deaths are a mess. The Centers for Disease Control and Prevention (CDC) acknowledges a difference between flu death and flu associated death yet uses the terms interchangeably. Additionally, there are significant statistical incompatibilities between official estimates and national vital statistics data. Compounding these problems is a marketing of fear—a CDC communications strategy in which medical experts "predict dire outcomes" during flu seasons.

    The CDC website states what has become commonly accepted and widely reported in the lay and scientific press: annually "about 36 000 [Americans] die from flu" (www.cdc.gov/flu/about/disease.htm) and "influenza/pneumonia" is the seventh leading cause of death in the United States (www.cdc.gov/nchs/fastats/lcod.htm). But why are flu and pneumonia bundled together? Is the relationship so strong or unique to warrant characterising them as a single cause of death?

    David Rosenthal, director of Harvard University Health Services, said, "People don't necessarily die, per se, of the [flu] virus -- the viraemia. What they die of is a secondary pneumonia. So many of these pneumonias are not viral pneumonias but secondary [pneumonias]." But Dr Rosenthal agreed that the flu/pneumonia relationship was not unique. For instance, a recent study (JAMA 2004;292: 1955-60[Abstract/Free Full Text]) found that stomach acid suppressing drugs are associated with a higher risk of community acquired pneumonia, but such drugs and pneumonia are not compiled as a single statistic.

    CDC states that the historic 1968-9 "Hong Kong flu" pandemic killed 34 000 Americans. At the same time, CDC claims 36 000 Americans annually die from flu. What is going on?

    Meanwhile, according to the CDC's National Center for Health Statistics (NCHS), "influenza and pneumonia" took 62 034 lives in 2001—61 777 of which were attributed to pneumonia and 257 to flu, and in only 18 cases was flu virus positively identified. Between 1979 and 2002, NCHS data show an average 1348 flu deaths per year (range 257 to 3006).

    The NCHS data would be compatible with CDC mortality estimates if about half of the deaths classed by the NCHS as pneumonia were actually flu initiated secondary pneumonias. But the NCHS criteria indicate otherwise: "Cause-of-death statistics are based solely on the underlying cause of death... defined by WHO as `the disease or injury which initiated the train of events leading directly to death.'"

    In a written statement, CDC media relations responded to the diverse statistics: "Typically, influenza causes death when the infection leads to severe medical complications." And as most such cases "are never tested for virus infection...CDC considers these [NCHS] figures to be a very substantial undercounting of the true number of deaths from influenza. Therefore, the CDC uses indirect modelling methods to estimate the number of deaths associated with influenza."

    CDC's model calculated an average annual 36 155 deaths from influenza associated underlying respiratory and circulatory causes (JAMA 2003;289: 179-86[Abstract/Free Full Text]). Less than a quarter of these (8097) were described as flu or flu associated underlying pneumonia deaths. Thus the much publicised figure of 36 000 is not an estimate of yearly flu deaths, as widely reported in both the lay and scientific press, but an estimate—generated by a model—of flu-associated death.

    William Thompson of the CDC's National Immunization Program (NIP), and lead author of the CDC's 2003 JAMA article, explained that "influenza-associated mortality" is "a statistical association between deaths and viral data available." He said that an association does not imply an underlying cause of death: "Based on modelling, we think it's associated. I don't know that we would say that it's the underlying cause of death."

    Yet this stance is incompatible with the CDC assertion that the flu kills 36 000 people a year—a misrepresentation that is yet to be publicly corrected.

    Before 2003 CDC said that 20 000 influenza-associated deaths occurred each year. The new figure of 36 000 reported in the January 2003 JAMA paper is an estimate of influenza-associated mortality over the 1990s. Keiji Fukuda, a flu researcher and a co-author of the paper, has been quoted as offering two possible causes for this 80% increase: "One is that the number of people older than 65 is growing larger...The second possible reason is the type of virus that predominated in the 1990s [was more virulent]."

    However, the 65-plus population grew just 12% between 1990 and 2000. And if flu virus was truly more virulent over the 1990s, one would expect more deaths. But flu deaths recorded by the NCHS were on average 30% lower in the 1990s than the 1980s.

    If passed, the Flu Protection Act of 2005 will revamp US flu vaccine policy. The legislation will require CDC to pay makers for vaccines unsold "through routine market mechanisms." The bill will also require CDC to conduct a "public awareness campaign" emphasising "the safety and benefit of recommended vaccines for the public good."

    Yet this bill obscures the fact that CDC is already working in manufacturers' interest by conducting campaigns to increase flu vaccination. At the 2004 "National Influenza Vaccine Summit," co-sponsored by CDC and the American Medical Association, Glen Nowak, associate director for communications at the NIP, spoke on using the media to boost demand for the vaccine. One step of a "Seven-Step `Recipe' for Generating Interest in, and Demand for, Flu (or any other) Vaccination" occurs when "medical experts and public health authorities publicly...state concern and alarm (and predict dire outcomes)—and urge influenza vaccination" (www.ama-assn.org/ama1/pub/upload/mm/36/2004_flu_nowak.pdf). Another step entails "continued reports...that influenza is causing severe illness and/or affecting lots of people, helping foster the perception that many people are susceptible to a bad case of influenza."

    Preceding the summit, demand had been low early into the 2003 flu season. "At that point, the manufacturers were telling us that they weren't receiving a lot of orders for vaccine for use in November or even December," recalled Dr Nowak on National Public Radio. "It really did look like we needed to do something to encourage people to get a flu shot."

    If flu is in fact not a major cause of death, this public relations approach is surely exaggerated. Moreover, by arbitrarily linking flu with pneumonia, current data are statistically biased. Until corrected and until unbiased statistics are developed, the chances for sound discussion and public health policy are limited.

    http://www.bmj.com/cgi/content/full/331/7529/1412

     
     
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Guests Quote  Post ReplyReply Direct Link To This Post Posted: September 18 2007 at 7:44am
    Recently U.K. scientists have upped the chance of a Pandemic from a low percentage to 20-25%.  This may be a conservative number. In addition, there are numerous outbreaks throughout the globe of various flu and of course the outbreak in what was once called Zaire - home of Ebola.

    It is extremely difficult to second guess the coming strain of flu and formulate the yearly flu vaccines. More research would reflect the misses in terms of when the actual main infecting strain was not covered by the vaccinations.

    posted by Medclinician
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    Post Options Post Options   Thanks (0) Thanks(0)   Quote Albert Quote  Post ReplyReply Direct Link To This Post Posted: October 08 2007 at 12:18pm
    Some of this could be similar to h5n1. 
     
     
     
    Although in 1918 influenza was not a nationally reportable disease and diagnostic criteria for influenza and pneumonia were vague, death rates from influenza and pneumonia in the United States had risen sharply in 1915 and 1916 because of a major respiratory disease epidemic beginning in December 1915 (22). Death rates then dipped slightly in 1917. The first pandemic influenza wave appeared in the spring of 1918, followed in rapid succession by much more fatal second and third waves in the fall and winter of 1918 -1919, respectively (Figure 1). Is it possible that a poorly-adapted H1N1 virus was already beginning to spread in 1915, causing some serious illnesses but not yet sufficiently fit to initiate a pandemic? Data consistent with this possibility were reported at the time from European military camps (23), but a counter argument is that if a strain with a new hemagglutinin (HA) was causing enough illness to affect the US national death rates from pneumonia and influenza, it should have caused a pandemic sooner, and when it eventually did, in 1918, many people should have been immune or at least partially immunoprotected. "Herald" events in 1915, 1916, and possibly even in early 1918, if they occurred, would be difficult to identify.
     
     
     
     
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