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Sonoma County Gazette
Flu season

Can it Happen Again? 100 Years Since
the 1918 Flu Pandemic

Oct 29, 2018


The peak flu activity in the US usually runs November to April. With the season right around the corner, discussions about prevention and risk arise again. Most persons who contract influenza will recover without any long-lasting problems. However, influenza can cause serious illness and death, particularly among older adults, young children, pregnant women, and those with certain medical conditions. Recent estimates claim that 80,000 Americans died during the 2017-2018 season from influenza. Medical organizations recommend routine annual influenza vaccination for all persons aged ≥6 months that do not have contraindications.

Follow the weekly Influenza surveillance updates:

Flu Pandemics

One hundred years ago, there was an extremely deadly outbreak of Influenza A (H1N1), “Spanish Flu.” Exact numbers are unknown, but estimates suggest that over 50 million people died, about 5% of the world's total population. This epidemic killed between 2-20% of the people infected, and it was particularly lethal in younger, healthy people.

More recent influenza A pandemics (like the 1968 Hong Kong flu) have not been as devastating as that in 1918, but even these smaller outbreaks killed millions of people. In 1918, most of the deaths were from secondary pneumonia. More recently, the availability of antibiotics probably prevented the extreme loss of life.

These particularly dangerous influenza A viruses become so lethal due to a genetic mutation that makes them not currently recognizable to the human immune system. Novel influenza A viruses are particularly worrisome because they can gain the ability to spread from person-to-person easily, thus triggering a pandemic. Since pandemic strains have not been seen before and are due to mutations, existing vaccines may be only tangentially helpful. Public Health agencies do have some other preventive measures to address a pandemic should one arrive, and they practice coordinated responses to outbreaks on the county level.

For more info on pandemic flu from Centers for Disease Control and Prevention,


Prevention and Treatment:

Symptoms of flu are well-known to most of us: signs of upper and/or lower respiratory tract infection, non-specific fevers, headaches, myalgias, and weakness.

Vaccines are really the most effective approach and getting your annual flu shot continues to be the primary recommendation.Getting the vaccine before the season starts is a good idea, since it takes about two weeks for immunity to get established. The vaccines are widely available at this point through pharmacies and medical offices. Given the fact that the virus changes each year, the recommendation is to get a shot of the current vaccine every autumn. The mix of antigens in the vaccine is based on predictions from the previous year and from monitoring disease during winter in the Southern Hemisphere. The injectable vaccine is not living (it contains a piece of the outer protein coat of the virus which triggers the immune response) so people do not actually catch the flu from the shot. They may get some of the inflammatory symptoms like muscle aches and mild fever, which are due to the immune response to the antigen, not to actually getting the infection. The inhaled nasal vaccine was alive but has been altered, and it is thought to be unable to cause the disease as well.

For prevention, taking some basic steps like regular hand washing, covering coughs and sneezes with a sleeve or a tissue, and staying home when people are sick can all be very helpful.

Treatment with antivirals (oseltamivir or zanamivir) is usually reserved for people who are hospitalized, severely ill, or at higher risk for complications. They are usually most effective if started within 2 days of the onset of symptoms.

Treatment won’t stop the disease, but it may shorten it and lessen the severity.

More information:


Hopefully, we will avoid a serious outbreak on this year of the 100th anniversary of the “Spanish Flu”.  Vaccines are really the most effective approach and getting your annual flu shot continues to be the primary recommendation. If the pandemic flu erupts, the Centers for Disease Control will be working hard to quickly develop and distribute an effective vaccine in order to prevent the spread of this potentially devastating virus.


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