Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918
Identifieur interne : 000F16 ( Istex/Corpus ); précédent : 000F15; suivant : 000F17Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918
Auteurs : J. S Oxford ; A. Sefton ; R. Jackson ; W. Innes ; R. S Daniels ; N. P. A. S JohnsonSource :
- International congress series [ 0531-5131 ] ; 2001.
English descriptors
- Teeft :
- Aldershot barracks, Annual report, Bronchitis, Cyanosis, Early outbreaks, Elsevier science, Etaples, Explosive outbreaks, Great pandemic, Heliotrope, Heliotrope cyanosis, High mortality, Influenza, Influenza activity, Influenza deaths, International congress series, Norway, Outbreak, Pandemic, Pandemic virus, Purulent, Purulent bronchitis, Respiratory disease, Short period, Statistical yearbooks, Unusual level, Young adults, Young persons.
Abstract
Abstract: The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence. In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds. We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.
Url:
DOI: 10.1016/S0531-5131(01)00336-3
Links to Exploration step
ISTEX:6B17126093669B12693ED53C13E2AFFB222C6888Le document en format XML
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(http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</mods:affiliation></affiliation></author><author><name sortKey="Innes, W" sort="Innes, W" uniqKey="Innes W" first="W" last="Innes">W. Innes</name><affiliation><mods:affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</mods:affiliation></affiliation></author><author><name sortKey="Daniels, R S" sort="Daniels, R S" uniqKey="Daniels R" first="R. S" last="Daniels">R. S Daniels</name><affiliation><mods:affiliation>Virology Division, NIMR, London NW7 1AA, UK</mods:affiliation></affiliation></author><author><name sortKey="Johnson, N P A S" sort="Johnson, N P A S" uniqKey="Johnson N" first="N. P. A. S" last="Johnson">N. P. A. S Johnson</name><affiliation><mods:affiliation>Department of Geography, University of Cambridge, Cambridge CB2 3EN, UK</mods:affiliation></affiliation></author></analytic><monogr></monogr><series><title level="j">International congress series</title><title level="j" type="abbrev">ICS</title><idno type="ISSN">0531-5131</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="2001">2001</date><biblScope unit="volume">1219</biblScope><biblScope unit="supplement">C</biblScope><biblScope unit="page" from="155">155</biblScope><biblScope unit="page" to="161">161</biblScope></imprint><idno type="ISSN">0531-5131</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0531-5131</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Aldershot barracks</term><term>Annual report</term><term>Bronchitis</term><term>Cyanosis</term><term>Early outbreaks</term><term>Elsevier science</term><term>Etaples</term><term>Explosive outbreaks</term><term>Great pandemic</term><term>Heliotrope</term><term>Heliotrope cyanosis</term><term>High mortality</term><term>Influenza</term><term>Influenza activity</term><term>Influenza deaths</term><term>International congress series</term><term>Norway</term><term>Outbreak</term><term>Pandemic</term><term>Pandemic virus</term><term>Purulent</term><term>Purulent bronchitis</term><term>Respiratory disease</term><term>Short period</term><term>Statistical yearbooks</term><term>Unusual level</term><term>Young adults</term><term>Young persons</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Abstract: The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence. In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds. We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.</div></front></TEI><istex><corpusName>elsevier</corpusName><keywords><teeft><json:string>influenza</json:string><json:string>bronchitis</json:string><json:string>international congress series</json:string><json:string>cyanosis</json:string><json:string>purulent</json:string><json:string>pandemic</json:string><json:string>outbreak</json:string><json:string>high mortality</json:string><json:string>purulent bronchitis</json:string><json:string>influenza deaths</json:string><json:string>etaples</json:string><json:string>influenza activity</json:string><json:string>explosive outbreaks</json:string><json:string>heliotrope cyanosis</json:string><json:string>early outbreaks</json:string><json:string>great pandemic</json:string><json:string>elsevier science</json:string><json:string>short period</json:string><json:string>annual report</json:string><json:string>respiratory disease</json:string><json:string>statistical yearbooks</json:string><json:string>unusual level</json:string><json:string>young persons</json:string><json:string>young adults</json:string><json:string>pandemic virus</json:string><json:string>aldershot barracks</json:string><json:string>norway</json:string><json:string>heliotrope</json:string></teeft></keywords><author><json:item><name>J.S Oxford</name><affiliations><json:string>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</json:string></affiliations></json:item><json:item><name>A Sefton</name><affiliations><json:string>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</json:string></affiliations></json:item><json:item><name>R Jackson</name><affiliations><json:string>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</json:string></affiliations></json:item><json:item><name>W Innes</name><affiliations><json:string>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</json:string></affiliations></json:item><json:item><name>R.S Daniels</name><affiliations><json:string>Virology Division, NIMR, London NW7 1AA, UK</json:string></affiliations></json:item><json:item><name>N.P.A.S Johnson</name><affiliations><json:string>Department of Geography, University of Cambridge, Cambridge CB2 3EN, UK</json:string></affiliations></json:item></author><subject><json:item><lang><json:string>eng</json:string></lang><value>Pandemic</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>Heliotrope cyanosis</value></json:item><json:item><lang><json:string>eng</json:string></lang><value>‘Epidemic’ catarrh</value></json:item></subject><arkIstex>ark:/67375/6H6-J58Z5R5G-W</arkIstex><language><json:string>eng</json:string></language><originalGenre><json:string>Full-length article</json:string></originalGenre><abstract>Abstract: The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence. In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds. We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. 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[7]</json:string><json:string>[6]</json:string><json:string>[22]</json:string><json:string>[8]</json:string><json:string>[17]</json:string><json:string>Stuart-Harris et al. [5]</json:string><json:string>[1]</json:string><json:string>[21]</json:string><json:string>J.S. Oxford et al.</json:string><json:string>[3]</json:string><json:string>[20]</json:string><json:string>March 1917</json:string><json:string>[7,9]</json:string><json:string>[14]</json:string><json:string>[9]</json:string><json:string>[2]</json:string><json:string>[13]</json:string><json:string>[19]</json:string></ref_bibl><bibl></bibl></unitex></namedEntities><ark><json:string>ark:/67375/6H6-J58Z5R5G-W</json:string></ark><categories><inist><json:string>1 - sciences appliquees, technologies et medecines</json:string><json:string>2 - sciences biologiques et medicales</json:string><json:string>3 - sciences medicales</json:string><json:string>4 - physiologie humaine appliquee a l'etude des populations et des conditions de vie. ecophysiologie humaine</json:string></inist></categories><publicationDate>2001</publicationDate><copyrightDate>2001</copyrightDate><doi><json:string>10.1016/S0531-5131(01)00336-3</json:string></doi><id>6B17126093669B12693ED53C13E2AFFB222C6888</id><score>1</score><fulltext><json:item><extension>pdf</extension><original>true</original><mimetype>application/pdf</mimetype><uri>https://api.istex.fr/ark:/67375/6H6-J58Z5R5G-W/fulltext.pdf</uri></json:item><json:item><extension>zip</extension><original>false</original><mimetype>application/zip</mimetype><uri>https://api.istex.fr/ark:/67375/6H6-J58Z5R5G-W/bundle.zip</uri></json:item><istex:fulltextTEI uri="https://api.istex.fr/ark:/67375/6H6-J58Z5R5G-W/fulltext.tei"><teiHeader><fileDesc><titleStmt><title level="a">Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918</title></titleStmt><publicationStmt><authority>ISTEX</authority><publisher scheme="https://scientific-publisher.data.istex.fr">ELSEVIER</publisher><availability><licence><p>©2001 Elsevier Science B.V.</p></licence><p scheme="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</p></availability><date>2001</date></publicationStmt><notesStmt><note type="research-article" scheme="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</note><note type="journal" scheme="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</note><note type="content">Fig. 1: The British Army Base Camp at Etaples, France showing a hospital section.</note><note type="content">Fig. 2: (a) Influenza deaths and cases—selected locations (b) Influenza deaths and cases—selected locations. (c) Influenza deaths and cases—selected locations.</note></notesStmt><sourceDesc><biblStruct type="inbook"><analytic><title level="a">Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918</title><author xml:id="author-0000"><persName><forename type="first">J.S</forename><surname>Oxford</surname></persName><note type="correspondence"><p>Corresponding author</p></note><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation></author><author xml:id="author-0001"><persName><forename type="first">A</forename><surname>Sefton</surname></persName><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation></author><author xml:id="author-0002"><persName><forename type="first">R</forename><surname>Jackson</surname></persName><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation></author><author xml:id="author-0003"><persName><forename type="first">W</forename><surname>Innes</surname></persName><affiliation>Department of Medical Microbiology and Retroscreen Ltd. 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In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence. In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds. We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.</p></abstract><textClass><keywords scheme="keyword"><list><head>Keywords</head><item><term>Pandemic</term></item><item><term>Heliotrope cyanosis</term></item><item><term>‘Epidemic’ catarrh</term></item></list></keywords></textClass></profileDesc><revisionDesc><change when="2001">Published</change></revisionDesc></teiHeader></istex:fulltextTEI><json:item><extension>txt</extension><original>false</original><mimetype>text/plain</mimetype><uri>https://api.istex.fr/ark:/67375/6H6-J58Z5R5G-W/fulltext.txt</uri></json:item></fulltext><metadata><istex:metadataXml wicri:clean="Elsevier, elements deleted: ce:floats; body; tail"><istex:xmlDeclaration>version="1.0" encoding="utf-8"</istex:xmlDeclaration><istex:docType PUBLIC="-//ES//DTD journal article DTD version 4.5.2//EN//XML" URI="art452.dtd" name="istex:docType"><istex:entity SYSTEM="gr1" NDATA="IMAGE" name="gr1"></istex:entity><istex:entity SYSTEM="gr2ab" NDATA="IMAGE" name="gr2ab"></istex:entity><istex:entity SYSTEM="gr2c" NDATA="IMAGE" name="gr2c"></istex:entity></istex:docType><istex:document><converted-article version="4.5.2" docsubtype="fla"><item-info><jid>ICS</jid><aid>313</aid><ce:pii>S0531-5131(01)00336-3</ce:pii><ce:doi>10.1016/S0531-5131(01)00336-3</ce:doi><ce:copyright type="full-transfer" year="2001">Elsevier Science B.V.</ce:copyright></item-info><head><ce:title>Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918</ce:title><ce:author-group><ce:author><ce:given-name>J.S</ce:given-name><ce:surname>Oxford</ce:surname><ce:cross-ref refid="COR1">*</ce:cross-ref><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>A</ce:given-name><ce:surname>Sefton</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>R</ce:given-name><ce:surname>Jackson</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>W</ce:given-name><ce:surname>Innes</ce:surname><ce:cross-ref refid="AFF1"><ce:sup>a</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>R.S</ce:given-name><ce:surname>Daniels</ce:surname><ce:cross-ref refid="AFF2"><ce:sup>b</ce:sup></ce:cross-ref></ce:author><ce:author><ce:given-name>N.P.A.S</ce:given-name><ce:surname>Johnson</ce:surname><ce:cross-ref refid="AFF3"><ce:sup>c</ce:sup></ce:cross-ref></ce:author><ce:affiliation id="AFF1"><ce:label>a</ce:label><ce:textfn>Department of Medical Microbiology and Retroscreen Ltd. (<ce:inter-ref xlink:href="http://www.retroscreen.com">http://www.retroscreen.com</ce:inter-ref>) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF2"><ce:label>b</ce:label><ce:textfn>Virology Division, NIMR, London NW7 1AA, UK</ce:textfn></ce:affiliation><ce:affiliation id="AFF3"><ce:label>c</ce:label><ce:textfn>Department of Geography, University of Cambridge, Cambridge CB2 3EN, UK</ce:textfn></ce:affiliation><ce:correspondence id="COR1"><ce:label>*</ce:label><ce:text>Corresponding author</ce:text></ce:correspondence></ce:author-group><ce:abstract><ce:section-title>Abstract</ce:section-title><ce:abstract-sec><ce:simple-para>The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence.</ce:simple-para><ce:simple-para>In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds.</ce:simple-para><ce:simple-para>We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.</ce:simple-para></ce:abstract-sec></ce:abstract><ce:keywords class="keyword"><ce:section-title>Keywords</ce:section-title><ce:keyword><ce:text>Pandemic</ce:text></ce:keyword><ce:keyword><ce:text>Heliotrope cyanosis</ce:text></ce:keyword><ce:keyword><ce:text>‘Epidemic’ catarrh</ce:text></ce:keyword></ce:keywords></head></converted-article></istex:document></istex:metadataXml><mods version="3.6"><titleInfo><title>Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918</title></titleInfo><titleInfo type="alternative" contentType="CDATA"><title>Early herald wave outbreaks of influenza in 1916 prior to the pandemic of 1918</title></titleInfo><name type="personal"><namePart type="given">J.S</namePart><namePart type="family">Oxford</namePart><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation><description>Corresponding author</description><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">A</namePart><namePart type="family">Sefton</namePart><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R</namePart><namePart type="family">Jackson</namePart><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">W</namePart><namePart type="family">Innes</namePart><affiliation>Department of Medical Microbiology and Retroscreen Ltd. (http://www.retroscreen.com) Virology, St. Bartholomew's and The Royal London School of Medicine and Dentistry, Queen Mary and Westfield College, London E1 4NS, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">R.S</namePart><namePart type="family">Daniels</namePart><affiliation>Virology Division, NIMR, London NW7 1AA, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><name type="personal"><namePart type="given">N.P.A.S</namePart><namePart type="family">Johnson</namePart><affiliation>Department of Geography, University of Cambridge, Cambridge CB2 3EN, UK</affiliation><role><roleTerm type="text">author</roleTerm></role></name><typeOfResource>text</typeOfResource><genre type="research-article" displayLabel="Full-length article" authority="ISTEX" authorityURI="https://content-type.data.istex.fr" valueURI="https://content-type.data.istex.fr/ark:/67375/XTP-1JC4F85T-7">research-article</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued><copyrightDate encoding="w3cdtf">2001</copyrightDate></originInfo><language><languageTerm type="code" authority="iso639-2b">eng</languageTerm><languageTerm type="code" authority="rfc3066">en</languageTerm></language><abstract lang="en">Abstract: The 1918 outbreak dwarfed the immediately preceding pandemic of 1889 and the subsequent 1957 and 1968 pandemics in mortality and morbidity. In retrospect, much can be learnt about the source, the possibly subterranean spread of virus and the genetic basis of virulence. In the recent pandemics of 1957 and 1968, there were so-called ‘herald waves’ either in the summer months, or in particular countries up to 6 months before more worldwide outbreaks. These localised outbreaks would lengthen the time available for preparation of new vaccines and stockpiling of antiviral compounds. We present new epidemiological and mortality evidence of early outbreaks of influenza in France, UK, Norway, Germany and USA in the years 1915 to 1917. Certain of these focal outbreaks which had a very high mortality in the young occurred during the winter months, and were respiratory with a heliotrope cyanosis so prominent in the clinical diagnosis in the world outbreak of 1918. Thus, the upturn of influenza activity in Norway in 1916 was associated with an unusual level of mortality in young adults. Similarly, the outbreak at Etaples in France and Aldershot barracks in the UK in 1916–1917 caused mortality in 25–35 year olds. We deduce from an analysis of these outbreaks that early focal outbreaks occurred mainly in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but possibly in another European country, either France or England, in 1915, 1916 or 1917.</abstract><note type="content">Fig. 1: The British Army Base Camp at Etaples, France showing a hospital section.</note><note type="content">Fig. 2: (a) Influenza deaths and cases—selected locations (b) Influenza deaths and cases—selected locations. (c) Influenza deaths and cases—selected locations.</note><subject><genre>Keywords</genre><topic>Pandemic</topic><topic>Heliotrope cyanosis</topic><topic>‘Epidemic’ catarrh</topic></subject><relatedItem type="host"><titleInfo><title>International congress series</title></titleInfo><titleInfo type="abbreviated"><title>ICS</title></titleInfo><genre type="journal" authority="ISTEX" authorityURI="https://publication-type.data.istex.fr" valueURI="https://publication-type.data.istex.fr/ark:/67375/JMC-0GLKJH51-B">journal</genre><originInfo><publisher>ELSEVIER</publisher><dateIssued encoding="w3cdtf">2001</dateIssued></originInfo><identifier type="ISSN">0531-5131</identifier><identifier type="PII">S0531-5131(00)X0003-9</identifier><part><date>2001</date><detail type="volume"><number>1219</number><caption>vol.</caption></detail><detail type="supplement"><number>C</number><caption>Suppl.</caption></detail><extent unit="issue-pages"><start>1</start><end>1048</end></extent><extent unit="pages"><start>155</start><end>161</end></extent></part></relatedItem><identifier type="istex">6B17126093669B12693ED53C13E2AFFB222C6888</identifier><identifier type="ark">ark:/67375/6H6-J58Z5R5G-W</identifier><identifier type="DOI">10.1016/S0531-5131(01)00336-3</identifier><identifier type="PII">S0531-5131(01)00336-3</identifier><accessCondition type="use and reproduction" contentType="copyright">©2001 Elsevier Science B.V.</accessCondition><recordInfo><recordContentSource authority="ISTEX" authorityURI="https://loaded-corpus.data.istex.fr" valueURI="https://loaded-corpus.data.istex.fr/ark:/67375/XBH-HKKZVM7B-M">elsevier</recordContentSource><recordOrigin>Elsevier Science B.V., ©2001</recordOrigin></recordInfo></mods><json:item><extension>json</extension><original>false</original><mimetype>application/json</mimetype><uri>https://api.istex.fr/ark:/67375/6H6-J58Z5R5G-W/record.json</uri></json:item></metadata></istex></record>Pour manipuler ce document sous Unix (Dilib)
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