Influenza often appears to be a cold, is believed to be viral, and can lead to other diseases including pneumonia, as well as death. Kansas was the site of the first official appearance in the United States in the beginning of 1918. At this time treatment options were limited due to no vaccines or antibiotics, along with healthcare persons assuming the disease was a bacterial infection. The paper will explore the epidemic described as the Spanish Influenza epidemic, along with criteria used to identify the pandemic, what was done to stop the spread, and the potential ramifications, as well as the current status are reviewed.

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Identification of Organism and Criterion
The name Spanish Influenza came from “early affliction and large mortalities in Spain, where the disease allegedly killed eight million people in May 1918” (Billings, 2005). Morens and Taubenberger were doctors who studied influenza epidemics in the1990s, specifically reviewing military autopsies and preserved tissues of patients that had died during the 1918 pandemic received from the “National Repository of the Armed Forces Institute of Pathology; after review they concluded that influenza might have been in the U.S. for at least four months or longer before official cases were reported in the spring of 1918 in Kansas from military camps” (Morens and Taubenberger, 2012). There were no official U.S. military camp reports about influenza outbreaks prior to September 1918; military authorities were questioned about the lack of action taken (Billings, 2005). Speculation was often wrong and continuous regarding the origin of the virus. Next infections appeared in Boston during September in 1918 (Billings, 2005). When military men returned home, hospitals filled immediately; there were physician shortages due to war deaths and medical practitioners were still on the battlefield with the troops; medical students were required to help flu infected patients (Billings, 2005). Medical classes were halted, and students were assigned to work as nurses and interns, along with the Red Cross volunteer recruitment and the set up a National Committee on Influenza (Billings, 2005). Everyone that was available to help fight the epidemic was involved, including businesses giving workers time off to volunteer1/2 days (Billings, 2005).

Pandemic Containment Success, Route, and Impact of Infection
Public health departments stepped in to contain the epidemic with limited options; gauze masks were distributed and required to be worn in public, stores were prohibited from conducting sales, funerals were limited to fifteen minutes, and railroads required certificates as proof of no influenza; all public events were canceled and prohibited; there was a shortage of coffins, morticians, and grave diggers due to so many deaths (Billings, 2005). “Doctors and scientists were only beginning to understand microorganism diseases…professionals thought that disease were caused by miasmas or an imbalance in the body’s humors” (U.S. Department of Health & Human Services, 2014). Doctors started connecting high fevers, along with severity and aggressiveness to diagnose influenza. Home remedies were used such as blanket wraps to make a patient sweat, hot baths, Vicks Vapor-Rub, etc., but nothing was effective (U.S. Department of Health & Human Services, 2014). “There were no intensive care units, no respirators, or antiviral agents and antibiotics” (Doshi, 2008) to control and manage the pandemic in 1918.

Mandatory public health guidelines were developed, but poor sanitation, lack of hand washing knowledge, and low climate temperatures, along with reduced ventilation from closed windows during the fall and winter of 1918, contributed to containment difficulties (Morens and Taubenberger, 2006).Scientists are thought to have recognized high levels of mortality rates associated with pneumonia in many parts of the U.S. and along with huge death increases, officials concluded that there was an influenza pandemic; similar occurrences were happening globally. In the United States, two hundred thousand people in the month of October 1918 died (Billings, 2005). The disease affected almost thirty percent of the American population, approximately 700,000 people (Billings, 2005). The Public Health Service started requiring state and local health departments to report incidents of diseases in all communities in 1918, but influenza was not on the reportable disease list when reporting first started (U.S. Department of Health & Human Services, 2014). On September 27, 1918, influenza was declared a reportable disease by the Public Health Service (U.S. Department of Health & Human Services, 2014). By the end of September, every state in American had severe cases of influenza outbreaks. In October 1918, Congress appropriated a million dollars to the Public Health Service to recruit more doctors and nurses, practitioners, and other workers, but often these professionals developed influenza during the course of their job requiring community centers and schools to be turned into emergency hospitals and clinics (U.S. Department of Health & Human Services, 2014). Containment was unsuccessful nationwide and globally.

Possible Resurfacing and Current Status
There are three types of influenza; Type C (mildest); Type B (severer than Type C, but less severe than type A; and Type A, most severe (Main, 2013). Type A H1N1 is the type believed to have caused the 1918 pandemic. Pandemic influenza is produced “when a type A influenza strain emerged with a hemagglutinin (HA) subtype to which few people have prior immunity (Fanning et al., 2002). According to Morens and Taubenberger, every influenza outbreak and epidemic is associated with the “descendants of the 1918 virus, included drifted H1N1 viruses and reasserted H2N2 and H3N2 viruses, and made the 1918 virus the ‘mother of all pandemics’ to ever exist to date” (Morens and Taubenberger, 2006). It is believed that the viruses “still persists enzootically in pigs and circulated in humans going through slow antigenic drifts that caused annual epidemics until the 1950s” (Morens and Taubenberger, 2006). Many believe resurfacing is possible.

For the influenza virus to occur, “binding of the HA protein to sialic acid receptors on host cell surfaces must occur, but because of inconclusive results in testing and binding, it is unknown if the viruses were equally transmissible, had the same patterns of replication related to the respiratory tree, or if one or both existed during the first, second, or third wave of the pandemic” (Morens and Taubenberger, 2006). New pandemic influenza subtypes can occur due to the different strains from 1918, 1957, and 1998, (Milles et al., 2004). Controlling these new subtypes and strains present challenges due to insufficient vaccine production capacity, as well as influenza’s rapid transmission (Mills et al., 2004). Until vaccines are produced in great numbers, limited contact with sick people is our best defense. Mass-vaccinations and prophylaxis is probably the most effective defense long-term against influenza pandemics (Mills et al., 2004).

    References
  • Billings, M. (2005, February). The Influenza Pandemic of 1918. Retrieved June 2015, from Stanford University website: http://virus.stanford.edu/uda
  • Doshi, P. (2008). Trends in Recorded Influenza Mortality: United States, 1900-2004. American Journal of Public Health, 98(8), 939-945.
  • Fanning, T. G., Slemons, R. D., Reid, A. H., Janczewski, T. A., Dean, J., & Taubenberger, J. (2002). 1917 Avian Influenza Virus Sequences Suggest that the 1918 Pandemic Virus Did Not Acquire its Hemagglutinin Directly from Birds. Journal of Virology, 76(15), 7860-7862.
  • Main, J. (2013, August 21). What is Influenza? Retrieved June 2015, from NetDoctor website: http://www.netdoctor.co.uk/
  • Mills, C., Robins, J., & Lipsitch. (2004, December 16). Transmissibility of 1918 Pandemic Influenza. Nature, 432, Retrieved from http://www.nature.com
  • Taubenberger, J., & Morens, D. (2012, February). 1918 Influenza, a Puzzle with Missing Pieces. Emerging Infectious Diseases, 18(2).
  • Taubenberger, J., & Morens, D. (2006). 1918 Influenza: The Mother of all Pandemics. Rev Biomed, 17, 69-79.
  • The Great Pandemic: The United States in 1918-1919. (2014). Retrieved June 2015, from United States Department of Health & Human Services website: http://www.flu.gov/