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Review
. 2019 Jan 21;2019(1):18-25.
doi: 10.1093/emph/eoz001. eCollection 2019.

The origins of the great pandemic

Michael Worobey  1 , Jim Cox  2 , Douglas Gill  3
Affiliations
Review

The origins of the great pandemic

Michael Worobey et al. Evol Med Public Health. .

Abstract

The timing and location of the first cases of the 1918 influenza pandemic are still controversial, a century after the pandemic became widely recognized. Here, we critically review competing hypotheses on the timing and geographical origin of this important outbreak and provide new historical insights into debates within military circles as to the nature of putative pre-1918 influenza activity. We also synthesize current knowledge about why the 1918 pandemic was so intense in young adults. Although it is still not clear precisely when and where the outbreak began and symptom-based reports are unlikely to reveal the answer, indirect methods including phylogenetics provide important clues, and we consider whether intense influenza activity as far back as 1915 in the USA may have been caused by viral strains closely related to the 1918 one.

Keywords: 1918; geography; influenza; origin; pandemic.

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Figures

Figure 1.
Figure 1.
Some key events in the history of influenza that are discussed in this article
Figure 2.
Figure 2.
Slide from Dr William Rolland’s collection, from one of the cases documented in reference 3: Private Cherry, ‘tissue attached diaphragm’ 18 February 1917. No 41234 Private Ernest Cherry, 17th Battalion, Highland Light Infantry, had died in No. 24 General Hospital, Etaples, on 8 February 1917 [13]
Figure 3.
Figure 3.
HA groups and relative pandemic death rates and relative proportion of each age group exposed to a mismatched, putative H3 HA in childhood. Panel (A) is adapted from Fig. 3 of reference 19. It depicts the two recognized phylogenetic groups on the HA evolutionary tree. Note that H3, the putative childhood virus of most young adults who died in the 1918 pandemic is in the opposing group relative to the 1918 H1N1 virus. Panel (B) is adapted from Fig. 1 of Worobey et al. [20] and references therein. The horizontal axis depicts cohorts of various birth years and ages in 1918. The dashed red line indicates the percentage of each birth year cohort showing strong reactivities to H3 antigens. The grey line shows the percentage of each age group that succumbed to the 1918 influenza virus
See this image and copyright information in PMC

References

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