http://www.npr.org/templates/story/s...oryId=93747214

What killed tens of millions of people around the world in the 1918 flu pandemic actually might not have been a flu virus. A new study in the Journal of Infectious Diseases blames different agents: bacteria.

The flu virus weakened lungs, opening the door to fatal bacterial pneumonia in most of the pandemic's 50 million victims, according to researchers at the National Institute of Allergy and Infectious Diseases.

The researchers based their findings on preserved lung tissue from 58 soldiers who were infected by the flu and died in 1918 and 1919. They found tissue changes that are the hallmarks of bacteria, not viruses, as well as the destruction of cells that normally protect lungs from bacteria.

They also studied case reports from 1918 in which doctors said they suspected a second infection. One doctor said that the flu "condemns," but secondary infections "execute."

The new research suggests that with the availability of effective treatments for bacterial infections, a modern-day flu pandemic might not be so deadly.
Also something of interest.. they've reconstructed the virus:

http://www.npr.org/templates/story/s...toryId=4946718

A flu virus that killed tens of millions worldwide after it appeared in 1918 has been recreated in the virological equivalent of the Jurassic Park story. Scientists rebuilt it from pieces of genetic material retrieved from the lungs of people who died 87 years ago. Researchers writing in the journals Science and Nature say the tightly guarded replica is even more virulent than they expected.

Yet public health officials aren't worried that the 1918 flu will again terrorize the population. It's no longer a new virus, and most people in the world have some immunity to the H1N1 virus family.

But scientists are interested in what it can reveal about future pandemics... and they say the copy of the 1918 flu bears an ominous resemblance to the bird flu virus now circulating in Asia. -- Richard Knox

A snapshot of what's known about the 1918 pandemic:

Name: The virus was at the time called the "Spanish Flu" by some. The label came from reports in the medical press that as many 8 million Spanish were killed by it in May 1918. The name is a misnomer, however, it's now thought that the 1918 flu originated in the United States.

Global Death Toll: Estimates range from 20 million to 100 million. Authors of the paper in this week's Nature say 50 million were killed in the pandemic.

Compared with Other Epidemics: The 1918 flu is thought to have killed the most people in the shortest amount of time. However, its spread was aided by modern ships and a world war that required moving huge armies quickly across the globe. The 14th-century's Black Death killed as many as 20 million in Europe alone over a period of two years. However, global population was much smaller, cities weren't as dense, and global transportation relied on wind and animal caravans; considering its high death toll, the bacteria that caused it may have been more deadly.

U.S. Death Toll: About 25 percent of the population was infected, with perhaps 650,000 people dying from the virus.

Symptoms: Normal flu symptoms of fever, nausea, aches and diarrhea. Many developed severe pneumonia attack. Dark spots would appear on the cheeks and patients would turn blue, suffocating from a lack of oxygen as lungs filled with a frothy, bloody substance.

Origins: New research reconstructing the virus suggests it began in birds, then rapidly mutated, leaping to humans.

Ground Zero: Historian John Barry believes the virus made its jump to humans in Kansas. In February 1918, recruits from Haskell County, Kan., reported for duty to Fort Riley, 300 miles away. They were already sick with influenza. Several days after they arrived, flu broke out at the camp. From there it may have spread through the Army to Europe and the rest of the world. It returned to the U.S. in a more lethal form in September 1918, making its first appearance at the Army's Camp Devens, near Boston.

The Victims: Unlike the typical flu, where the highest mortality is in infants and the elderly, the 1918 flu also struck down young, healthy adults. The military, with its overcrowded camps and troops ships, was hit hard. Few were spared: President Woodrow Wilson became ill while negotiating the Treaty of Versailles in early 1919 and had a slow recovery. -- Vikki Valentine
What If ...

What if the virus that caused the 1918 flu, or one similar to it, re-appeared today?

The Bad News: The 1918 virus was a million times more potent than the average modern flu virus.

The Good news: Most people living today would have some immunity to viruses in the 1918 virus' family, called H1N1.


More Good News: The current bird flu virus, which the global public health community is watching, is mostly transmitted from bird to bird. It has infected about 120 humans, but rarely has it spread from human to human, making it not very infectious.

The Bad News: The current bird flu virus, a member of the H5N1 family, could mutate into a form that spreads among humans. No one in the world will have had exposure to this new flu, making it particularly virulent.


The Good News: Modern antiviral drugs may be effective against a pandemic-flu type virus, and supportive care, such as rehydration therapies and ventilators to help lungs under attack, are far more advanced.

The Bad News: The 1918 virus kills chicken eggs. Currently, modern vaccines are made by growing influenza in chicken eggs, extracting the virus and turning it into vaccines. Scientists are experimenting with new ways to produce flu vaccines, but even if they find ways to do this, worldwide production capacity is so limited that it would take months or years to make an adequate supply. -- Vikki Valentine
Origins of the 1918 Flu:

http://www.npr.org/templates/story/s...toryId=5222069

It's not often that you find countries fighting to claim credit for the birth of an epidemic. Take syphilis, a disease which has infected millions -- man, woman and child alike. If you were in Italy when the disease first hit Europe in the 15th and 16th centuries, you called it the "French pox." If you were in France, you called it the "disease of Naples." Or, you could blame it on the Native Americans. Voltaire did. He said Columbus' crew brought it back from the New World.

But when it comes to the deadliest pandemic in history, scientists from two superpowers are calling dibs rather than pointing fingers.

Everyone seems to agree that the 1918 flu epidemic, known as the "Spanish flu," didn't start in Spain. (That name probably came from the fact that only Spain was publishing news about local flu epidemics; there was a blackout on news that might lower morale in Germany, Britain and France.) American experts, such as Jeffrey Taubenberger of the Armed Forces Institute of Pathology and historian John M. Barry, back the theory that the virus, which eventually killed 50 million people, got its start in America's heartland.

The made-in-America version goes like this: Loring Miner, a Haskell County, Kansas, doctor raised the first warning, reporting an "influenza of a severe type" circulating in the area. Haskell County boys may have then carried the virus to a Kansas army camp. From there, the virus caught a ride with tens of thousands of young soldiers on their way to Europe.

John Oxford, a professor of virology at Queen Mary's School of Medicine in London, holds to a different theory: the British Empire nurtured the disease.

The British army had an enormous training camp set up in Etaples, France. On any given day, 100,000 soldiers were milling around. Many were on their way to World War I's Western Front; others, wounded, sick, and often prisoners, were on their way back. The camp had 24 hospitals alone and a team of fearful -- but curious -- pathologists. They recorded post mortems on everything that came their way. "They were worried, even at that stage, in 1916, about the possibility of infectious disease decimating the British army, as had happened in the past with typhus and cholera," says Oxford.

Then, just after the Battle of the Somme in the winter of 1916-1917, dozens of soldiers at the camp fell ill, complaining of aches, pains, cough and shortness of breath. Mortality was high at 40 percent, and some also had what later became known as a telltale sign of the killer flu: Their faces were tinged a peculiar lavender color, a condition known as heliotrope cyanosis.

Two months later, says Oxford, a similar outbreak was reported near London at Aldershot, site of one the biggest barracks in the army. Aldershot pathologists eventually published studies in The Lancet medical journal pinpointing the origin of the 1918 pandemic to Etaples and Aldershot.

Several creepy similarities between the 1918 flu and the H5N1 bird flu virus currently spreading around the globe make such historical detective work relevant, says Oxford. The 1918 virus got its start in birds. And the soldiers in the army camps -- whether in Etaples or Kansas -- lived much like people in Asia and Africa do today: in close quarters, surrounded by lots of birds. There were "zillions" of birds at Etaples, says Oxford: "ducks, geese, chickens, you name it. We have photos of the soldiers plucking them."

What's particularly foreboding for Oxford is that maybe fewer than 100 soldiers died in the initial breakouts at Etaples and Aldershot barracks. "If you were to go back now and talk to people at [Etaples] in 1917 and say 'There are 50 soldiers dead here. Do you think there's any chance 50 million will be dead next year?' They would think you were totally mad," says Oxford. History's message, he says, is that pandemics start out small. He believes the H5N1 virus, which has killed around 90 people so far, could very well turn into a pandemic.

John M. Barry, author of The Great Influenza: The Epic Story of the Deadliest Plague in History, is familiar with Oxford's theory, but he sticks by the rural-Kansas hypothesis. Barry says there is more consistent evidence for Kansas. Both agree that only genetic analysis of tissue samples -- hard to come by -- from these early outbreaks will solve the mystery.

"Ultimately, I don't think it matters where it began," says Barry. "The most important thing is that it can begin anywhere." And for public health officials, says Barry, that means building a worldwide surveillance system that has an eye on a Kansas, or France, as well as Asia.