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Encyclopedia > Spanish Flu
Flu

The 1918 flu pandemic (commonly referred to as the 'Spanish flu') was a category 5 influenza pandemic caused by an unusually severe and deadly Influenza A virus strain of subtype H1N1. Many of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. Image File history File links Flu_und_legende_color_c. ... Influenza, commonly known as flu, is an infectious disease of birds and mammals caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses). ... Genera Influenzavirus A Influenzavirus B Influenzavirus C Isavirus Thogotovirus The Orthomyxoviridae are a family of RNA viruses which infect vertebrates. ... For the H5N1 subtype of Avian influenza see H5N1. ... Flu season is mostly a colloquial term used to describe the regular outbreak in flu cases, or even cases of the common cold during the late fall or winter. ... Flu research includes molecular virology, pathogenesis, host immune responses, genomics, and epidemiology. ... Model of Influenza Virus from NIH The flu vaccine is a vaccine to protect against the highly variable influenza virus. ... This article is about flu treatment in humans for mild human flu, which includes both efforts to reduce symptoms and treatments for the flu virus itself. ... The Influenza Genome Sequencing Project is funded by the National Institute of Allergy and Infectious Diseases (NIAID) which is a component of the National Institutes of Health (NIH), which is an agency of the United States Department of Health and Human Services. ... Influenza A virus subtype H5N1, also known as A(H5N1) or simply H5N1, is a subtype of the Influenza A virus which can cause illness in humans and many other animal species. ... The Pandemic Severity Index (PSI) is a scale or index created in January 2007 by the United States Centers for Disease Control and Prevention (CDC) designed to mimic the system for indexing the severity of hurricanes (which is the Saffir-Simpson Hurricane Scale for tropical cyclones). ... Influenza A virus, the virus that causes Avian flu. ... In biology, Strain can be used two ways. ... H1N1 is a subtype of the species Influenza A virus (sometimes called bird flu virus). ...


The Spanish flu pandemic lasted from 1918 to 1919, spreading even to the Arctic and remote Pacific islands. While older estimates put the number of killed at 40–50 million people, current estimates are that 50 million to 100 million people worldwide died, possibly more than that taken by the Black Death. This extraordinary toll resulted from the extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms. Between 2 and 20% of those infected by Spanish flu died, as opposed to the normal flu epidemic mortality rate of 0.1%. In some remote Inuit villages, mortality rates of nearly 100% were recorded. Unusually, the epidemic mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old. The red line indicates the 10°C isotherm in July, commonly used to define the Arctic region border Artificially coloured topographical map of the Arctic region The Arctic is the region around the Earths North Pole, opposite the Antarctic region around the South Pole. ... This article concerns the mid fourteenth century pandemic. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...

Chart of deaths in major cities
Chart of deaths in major cities

The disease was first observed at Queens, New York, U.S. on March 11, 1918. The Allies of World War I came to call it the Spanish Flu, primarily because the pandemic received greater press attention in Spain than in the rest of the world, as Spain was not involved in the war and had not imposed wartime censorship.[1] Image File history File links Size of this preview: 787 × 600 pixelsFull resolution (992 × 756 pixel, file size: 1. ... Image File history File links Size of this preview: 787 × 600 pixelsFull resolution (992 × 756 pixel, file size: 1. ... For other uses, see Queens (disambiguation) and Queen. ... This article is about the state. ... For other uses of terms redirecting here, see US (disambiguation), USA (disambiguation), and United States (disambiguation) Motto In God We Trust(since 1956) (From Many, One; Latin, traditional) Anthem The Star-Spangled Banner Capital Washington, D.C. Largest city New York City National language English (de facto)1 Demonym American... is the 70th day of the year (71st in leap years) in the Gregorian calendar. ... 1918 (MCMXVIII) was a common year starting on Tuesday of the Gregorian calendar (see link for calendar) or a common year starting on Wednesday of the Julian calendar. ... Map of the World showing the participants in World War I. Those fighting on the Allies side (at one point or another) are depicted in green, the Central Powers in orange, and neutral countries in gray. ... For other uses, see Censor. ...


Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm, which explains its unusually severe nature and the unusual age profile of its victims. A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ...

Contents

History

The difference between the influenza mortality age-distributions of the 1918 epidemic and normal epidemics. Deaths per 100,000 persons in each age group, United States, for the interpandemic years 1911–1917 (dashed line) and the pandemic year 1918 (solid line).[2]

The global mortality rate from the 1918/1919 pandemic is not known, but is estimated at 2.5 to 5% of the human population, with 20% or more of the world population suffering from the disease to some extent. Influenza may have killed as many as 25 million in its first 25 weeks (in contrast, AIDS killed 25 million in its first 25 years). Older estimates say it killed 40–50 million people[3] while current estimates say 50 million to 100 million people worldwide were killed.[4] This pandemic has been described as "the greatest medical holocaust in history" and may have killed as many people as the Black Death.[5] Image File history File links W_curve. ... Image File history File links W_curve. ... Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ... For other uses, see AIDS (disambiguation). ... This article concerns the mid fourteenth century pandemic. ...


An estimated 7 million died in India, about 2.78% of India's population at the time. In the Indian Army, almost 22% of troops who caught the disease died of it (cite needed). In the U.S., about 28% of the population suffered, and 500,000 to 675,000 died. In Britain as many as 250,000 died; in France more than 400,000. In Canada approximately 50,000 died. Entire villages perished in Alaska and southern Africa. In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%. For other uses of terms redirecting here, see US (disambiguation), USA (disambiguation), and United States (disambiguation) Motto In God We Trust(since 1956) (From Many, One; Latin, traditional) Anthem The Star-Spangled Banner Capital Washington, D.C. Largest city New York City National language English (de facto)1 Demonym American... For other uses, see Alaska (disambiguation). ... Categories: Africa geography stubs | Southern Africa ... The Republic of the Fiji Islands occupies an archipelago in the South Pacific Ocean, east of Vanuatu, west of Tonga and south of Tuvalu. ... The Independent State of Samoa (conventional long form) or Samoa (conventional short form) is a country comprising a group of islands in the South Pacific Ocean. ...


This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.[3] Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."[4] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.[2] For music group see Dengue Fever (rock band) Dengue and dengue hemorrhagic fever (DHF) are acute febrile diseases, found in the tropics, with a geographical spread similar to malaria. ... Cholera (or Asiatic cholera or epidemic cholera) is an extreme diarrheal disease caused by the bacterium Vibrio cholerae. ... This is about the disease typhoid fever. ... minor Petechia A petechia (IPA pronunciation: ), plural petechiae (IPA pronunciation: ) is a small red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels). ... Bacterial pneumonia is an infection of the lungs by bacteria. ... A secondary infection is an infection by a microorganism subsequent to and simultaneous with an infection by a different microorganism. ... For other uses, see Bleeding (disambiguation). ... This page is about the condition called edema. ...


The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[2][4] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.[6] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70). Crude death rate by country Mortality rate is a measure of the number of deaths (in general, or due to a specific cause) in some population, scaled to the size of that population, per unit time. ...


While World War I did not cause the flu, the close quarters and mass movement of troops quickened its spread. Researchers speculate that the soldiers' immune systems were weakened by the stresses of combat and chemical attacks, increasing their susceptibility to the disease. “The Great War ” redirects here. ...


A large factor in the spread of the disease was the increased amount of travel. The modernization of transportation made it easier for sailors to spread the disease more quickly and to a wider range of communities.

American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918

Two poems, dedicated to the Spanish flu, were popular in those days: Image File history File links Size of this preview: 745 × 600 pixelsFull resolution‎ (1,021 × 822 pixels, file size: 117 KB, MIME type: image/jpeg)Image available online here. ... Image File history File links Size of this preview: 745 × 600 pixelsFull resolution‎ (1,021 × 822 pixels, file size: 117 KB, MIME type: image/jpeg)Image available online here. ... A WWII-era poster encouraged American women to volunteer for the Red Cross as part of the war effort. ... Oakland redirects here. ...

I had a little bird,
Its name was Enza,
I opened the window,
And in-flew-enza.
-American Skipping Rhyme circa 1918

Obey the laws
And wear the gauze.
Protect your jaws
From septic paws.

Patterns of fatality

The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims — typical influenzas kill mostly infants (aged 0-2 years), the old, and the immunocompromised. Another oddity was that this influenza outbreak struck hardest in summer and fall (in the Northern Hemisphere). Typically, influenza is worse in the winter months. In biology, Strain can be used two ways. ... “Baby” redirects here. ... ...


People without symptoms could be struck suddenly and within hours be too feeble to walk; many died the next day. Symptoms included a blue tint to the face and coughing up blood caused by severe obstruction of the lungs. In some cases, the virus caused an uncontrollable hemorrhaging that filled the lungs, and patients drowned in their body fluids. In still others, the flu caused an uncontrollable loss of bowel functions and the victim would die from losing critical intestinal lining. To meet Wikipedias quality standards, this article or section may require cleanup. ... The heart and lungs (from an older edition of Grays Anatomy) The lung is an organ belonging to the respiratory system and interfacing to the circulatory system of air-breathing vertebrates. ...


In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in a minority of cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities. This article is about human pneumonia. ... Consolidation is a clinical term for solidification into a firm dense mass. ... The nervous system of an animal coordinates the activity of the muscles, monitors the organs, constructs and processes input from the senses, and initiates actions. ... The Scream, the famous painting commonly thought of as depicting the experience of mental illness. ...


Devastated communities

Street car conductor in Seattle not allowing passengers aboard without a mask in 1918.
Street car conductor in Seattle not allowing passengers aboard without a mask in 1918.

While in most places less than one-third of the population was infected, only a small percentage of whom died, in a number of towns in several countries entire populations were wiped out. Image File history File links Download high resolution version (600x830, 109 KB) Summary Street car conductor in Seattle not allowing passengers aboard without a mask. ... Image File history File links Download high resolution version (600x830, 109 KB) Summary Street car conductor in Seattle not allowing passengers aboard without a mask. ...


Even in areas where mortality was low, those incapacitated by the illness were often so numerous as to bring much of everyday life to a stop. Some communities closed all stores or required customers not to enter the store but place their orders outside the store for filling. There were many reports of places with no health care workers to tend the sick because of their own ill health and no able-bodied grave diggers to bury the dead. Mass graves were dug by steam shovel and bodies buried without coffins in many places. A steam shovel is a large steam-powered excavating machine designed for lifting and moving material such as rock and soil. ...


Unaffected locales

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck. The only sizeable inhabited place with no documented outbreak of the flu in 1918–1919 was the island of Marajó at the mouth of the Amazon River in Brazil. In the Pacific, American Samoa[7] and the French colony of New Caledonia [8] also succeeded in preventing even a single death from influenza through effective quarantines. A sattelite view of Marajo Marajó is an island located at the mouth of the Amazon River in Brazil. ... This article is about the river. ... This article does not cite any references or sources. ...


Spanish flu research

Main article: Spanish flu research

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms — genetic drift and antigenic shift — in viruses in poultry and swine which the fort bred for local consumption. But evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine.[9] On October 5, 2005, researchers announced that the genetic sequence of the 1918 flu strain, a subtype of avian strain H1N1, had been reconstructed using historic tissue samples.[10][11][12] On 18 January 2007, Kobasa et al reported that infected monkeys (Macaca fascicularis) exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm.[13] Since the 1918 flu virus has long been extinct in the wild, until recently no samples were available and so modern flu research techniques couldnt be easily brought to bear. ... Fort Riley is a census-designated place and United States Army post, in Northeast Kansas, on the Kansas River. ... This article is about the U.S. state. ... This article is about the general scientific term. ... In population genetics, genetic drift is the statistical effect that results from the influence that chance has on the success of alleles (variants of a gene). ... Antigenic shift is the process by which two different strains of influenza combine to form a new subtype having a mixture of the surface antigens of the two original strains. ... Avian influenza (also known as bird flu) is a type of influenza virulent in birds. ... For other uses, see 5th October (Serbia). ... Year 2005 (MMV) was a common year starting on Saturday (link displays full calendar) of the Gregorian calendar. ... is the 18th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ... Binomial name Macaca fascicularis Raffles, 1821 The Crab-eating Macaque (Macaca fascicularis) is an arboreal macaque native to South-East Asia. ... A cytokine storm is a potentially fatal immune reaction consisting of a positive feedback loop between cytokines and immune cells. ...


Famous victims

Guillaume Apollinaire Guillaume Apollinaire (August 26, 1880 – November 9, 1918) was a poet, writer, and art critic. ... is the 313th day of the year (314th in leap years) in the Gregorian calendar. ... 1918 (MCMXVIII) was a common year starting on Tuesday of the Gregorian calendar (see link for calendar) or a common year starting on Wednesday of the Julian calendar. ... Felix Arndt (May 20, 1889-October 16, 1918) was a United States pianist and composer of popular music. ... is the 289th day of the year (290th in leap years) in the Gregorian calendar. ... Sigmund Freud (IPA: ), born Sigismund Schlomo Freud (May 6, 1856 – September 23, 1939), was an Austrian neurologist and psychiatrist who founded the psychoanalytic school of psychology. ... is the 43rd day of the year in the Gregorian calendar. ... Henry G. Ginaca (1876 - 1918) was an American engineer who invented, at the direction of Hawaiian pineapple magnate James Dole in 1911, a machine that could peel and core pineapples in an automated fashion. ... is the 292nd day of the year (293rd in leap years) in the Gregorian calendar. ... 1918 (MCMXVIII) was a common year starting on Tuesday of the Gregorian calendar (see link for calendar) or a common year starting on Wednesday of the Julian calendar. ... Charles Tomlinson Griffes (Elmira, New York September 17, 1884 – April 8, 1920 in New York City} was an American composer. ... April 8 is the 98th day of the year (99th in leap years) in the Gregorian calendar. ... Phoebe Apperson Hearst (1842-1919) was born in Franklin County, Missouri, United States. ... For other people named William Randolph Hearst, see William Randolph Hearst (disambiguation) William Randolph Hearst I (April 29, 1863 – August 14, 1951) was an American newspaper magnate. ... is the 103rd day of the year (104th in leap years) in the Gregorian calendar. ... Jacinta Marto (1910-1920) and her brother Francisco Marto (1908-1919), also known as Blessed Jacinta Marto and Blessed Francisco Marto, together with their cousin, Lúcia dos Santos (1907-2005) were the children from Aljustrel near Fátima in Portugal who reported witnessing two apparitions of an angel in... Fātima was originally an Arabic name, meaning She who weans, being the name of the only proved surviving child of the prophet Muhammad; after the advent of Islam it became a common Muslim name for women. ... is the 94th day of the year (95th in leap years) in the Gregorian calendar. ... Jacinta Marto (1910-1920) and her brother Francisco Marto (1908-1919), also known as Blessed Jacinta Marto and Blessed Francisco Marto, together with their cousin, Lúcia dos Santos (1907-2005) were the children from Aljustrel near Fátima in Portugal who reported witnessing two apparitions of an angel in... Fātima was originally an Arabic name, meaning She who weans, being the name of the only proved surviving child of the prophet Muhammad; after the advent of Islam it became a common Muslim name for women. ... is the 51st day of the year in the Gregorian calendar. ... Year 1920 (MCMXX) was a leap year starting on Thursday (link will display 1920) of the Gregorian calendar. ... Statue dedicated to Edmond Rostand in Cambo-les-Bains Edmond Eugène Alexis Rostand (April 1, 1868 - December 2, 1918) was a French poet and dramatist. ... Cyrano de Bergerac is a play written in 1897 by Edmond Rostand based on the life of the real Cyrano de Bergerac. ... is the 336th day of the year (337th in leap years) in the Gregorian calendar. ... Photograph by Anton Josef Trčka Egon Schiele (June 12, 1890 – October 31, 1918) (pronounced approximately SHEE-luh) was an Austrian painter, a protege of Gustav Klimt, and a major figurative painter of the early 20th century. ... is the 304th day of the year (305th in leap years) in the Gregorian calendar. ... Yakov Sverdlov Snow-covered statue of Sverdlov in Yekaterinburg Yakov Mikhaylovich Sverdlov (Russian: Я́ков Миха́йлович Свердло́в), born Yankel Movshevich Eiman (Russian: Я́нкель Мовшевич Эйман); known under pseudonyms Andrey, Mikhalych, Max, Smirnov, Permyakov (June 3 [O.S. May 22] 1885 – March 16, 1919) was a Bolshevik party leader and an official of pre-Soviet Union Soviet Russia. ... For other uses, see Bolshevik (disambiguation). ... For other uses, see March (disambiguation). ... Year 1919 (MCMXIX) was a common year starting on Wednesday (link will display the full calendar). ... For the politician, see Max Weber (politician). ... is the 165th day of the year (166th in leap years) in the Gregorian calendar. ...

References

  1. ^ See: Talk:Spanish_flu#Origin of the name "spanish flu"[not specific enough to verify]
  2. ^ a b c Taubenberger, J; Morens D (2006). "1918 Influenza: the mother of all pandemics.". Emerg Infect Dis 12 (1): 15–22. PMID 16494711. 
  3. ^ a b Patterson, KD; Pyle GF (Spring 1991). "The geography and mortality of the 1918 influenza pandemic.". Bull Hist Med. 65 (1): 4–21. PMID 2021692. 
  4. ^ a b c "1: The Story of Influenza", in Knobler S, Mack A, Mahmoud A, Lemon S: The Threat of Pandemic Influenza: Are We Ready? Workshop Summary (2005). Washington, D.C.: The National Academies Press, 60–61. 
  5. ^ Potter, CW (Oct 2006). "A History of Influenza". J Appl Microbiol. 91 (4): 572–579. PMID 11576290. 
  6. ^ Simonsen, L; Clarke M, Schonberger L, Arden N, Cox N, Fukuda K (Jul 1998). "Pandemic versus epidemic influenza mortality: a pattern of changing age distribution.". J Infect Dis 178 (1): 53–60. PMID 9652423. 
  7. ^ Influenza of 1918 (Spanish Flu) and the US Navy
  8. ^ World Health Organization Writing Group (2006). "Nonpharmaceutical interventions for pandemic influenza, international measures.". Centers for Disease Control and Prevention (CDC) Emerging Infectious Diseases (EID) Journal 12 (1): 189. 
  9. ^ Sometimes a virus contains both avian adapted genes and human adapted genes. Both the H2N2 and H3N2 pandemic strains contained avian flu virus RNA segments. "While the pandemic human influenza viruses of 1957 (H2N2) and 1968 (H3N2) clearly arose through reassortment between human and avian viruses, the influenza virus causing the 'Spanish flu' in 1918 appears to be entirely derived from an avian source (Belshe 2005)." (from Chapter Two : Avian Influenza by Timm C. Harder and Ortrud Werner, an excellent free on-line Book called Influenza Report 2006 which is a medical textbook that provides a comprehensive overview of epidemic and pandemic influenza.)
  10. ^ Special report at Nature News: The 1918 flu virus is resurrected, Published online: 5 October 2005; doi:10.1038/437794a
  11. ^ Taubenberger, Jeffery K.; Ann H. Reid, Raina M. Lourens, Ruixue Wang, Guozhong Jin and Thomas G. Fanning (2005). "Characterization of the 1918 influenza virus polymerase genes". Nature 437: 889-893. doi:10.1038/nature04230. 
  12. ^ Also: Tumpey, Terrence M.; Christopher F. Basler, Patricia V. Aguilar, Hui Zeng, Alicia Solórzano, David E. Swayne, Nancy J. Cox, Jacqueline M. Katz, Jeffery K. Taubenberger, Peter Palese and Adolfo García-Sastre (2005). "Characterization of the Reconstructed 1918 Spanish Influenza Pandemic Virus". Science 310: 77-80. doi:10.1126/science.1119392. 
  13. ^ Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus Nature. 18 January 2007;445:319

The Asian Flu was a pandemic outbreak of influenza that originated in China in 1957 and spread worldwide that same year. ... H3N2 is a subtype of the species Influenza A virus (sometimes called bird flu virus). ... Left: An RNA strand, with its nitrogenous bases. ... Nature is a prominent scientific journal, first published on 4 November 1869. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Nature is a prominent scientific journal, first published on 4 November 1869. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Science is the journal of the American Association for the Advancement of Science (AAAS). ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... Nature is a prominent scientific journal, first published on 4 November 1869. ... is the 18th day of the year in the Gregorian calendar. ... Year 2007 (MMVII) is the current year, a common year starting on Monday of the Gregorian calendar and the AD/CE era in the 21st century. ...

Further reading

  • Barry, John M. (2004). The Great Influenza: The Epic Story of the Greatest Plague in History. Viking Penguin. ISBN 0-670-89473-7. 
  • Crosby, Alfred W. (1990). America's Forgotten Pandemic: The Influenza of 1918. Cambridge: Cambridge University Press. ISBN 0-521-38695-0. 
  • Johnson, Niall (2006). Britain and the 1918-19 Influenza Pandemic: A Dark Epilogue. London and New York: Routledge. ISBN 0-415-36560-0. 
  • Johnson, Niall (2003). "Measuring a pandemic: Mortality, demography and geography". Popolazione e Storia: 31-52. 
  • Johnson, Niall (2003). "Scottish ’flu – The Scottish mortality experience of the “Spanish flu". Scottish Historical Review 83 (2): 216-226. 
  • Johnson, Niall; Juergen Mueller (2002). "Updating the accounts: global mortality of the 1918–1920 ‘Spanish’ influenza pandemic". Bulletin of the History of Medicine 76: 105–15. 
  • Little, Jean (2007). If I Die Before I Wake: The Flu Epidemic Diary of Fiona Macgregor, Toronto, Ontario, 1918, Dear Canada. Markham, Ont.: Scholastic Canada. ISBN 9780439988377. 
  • Noymer, Andrew; Michel Garenne (2000). "The 1918 Influenza Epidemic's Effects on Sex Differentials in Mortality in the United States". Population and Development Review 26 (3): 565-581. ISSN 0098-7921. 
  • Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NP (2002). "World War I may have allowed the emergence of "Spanish" influenza". The Lancet infectious diseases 2 (2): 111-4. PMID 11901642. 
  • Oxford JS, Sefton A, Jackson R, Johnson NP, Daniels RS (1999). "Who's that lady?". Nat. Med. 5 (12): 1351-2. doi:10.1038/70913. PMID 10581070. 
  • Phillips, Howard; David Killingray (eds) (2003). The Spanish Flu Pandemic of 1918: New Perspectives. London and New York: Routledge. 
  • Rice, Geoffrey W.; Edwina Palmer (1993). "Pandemic Influenza in Japan, 1918-1919: Mortality Patterns and Official Responses". Journal of Japanese Studies 19 (2): 389-420. ISSN 0095-6848. 
  • Rice, Geoffrey W. (2005). Black November: the 1918 Influenza Pandemic in New Zealand. ISBN 1-877257-35-4. 
  • Tumpey TM, García-Sastre A, Mikulasova A, et al (2002). "Existing antivirals are effective against influenza viruses with genes from the 1918 pandemic virus". Proc. Natl. Acad. Sci. U.S.A. 99 (21): 13849-54. doi:10.1073/pnas.212519699. PMID 12368467. 

--130. ... Dear Canada is a series of historical novels for older children first published starting in 2001 to the present by Scholastic Canada Ltd. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ... ISSN, or International Standard Serial Number, is the unique eight-digit number applied to a periodical publication including electronic serials. ... A digital object identifier (or DOI) is a standard for persistently identifying a piece of intellectual property on a digital network and associating it with related data, the metadata, in a structured extensible way. ...

External links

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CDC - Influenza (Flu) | What Everyone Should Know About Flu and the Flu Vaccine (306 words)
The flu is a contagious respiratory illness caused by influenza viruses.
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The 1918 Spanish Flu Epidemic (2699 words)
The Spanish flu, also known as the "Spanish Lady," is said to have originated in the United States at Fort Riley KS, the first of 107 cases being reported on 11 March, 1918.
Spanish Influenza, which appeared in Spain in May, has all the appearances of grip or la grippe, which has swept over the world in numerous epidemics far back as history runs.
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