Taubenberger, Morens: Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak

[tetano]

ARTICLE: Z-M Sheng et al. Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak. Proceedings of the National Academies of Sciences DOI: 10.1073/pnas.1111179108 (2011).

Study co-authors Jeffery K. Taubenberger, M.D., Ph.D., Laboratory of Infectious Diseases, NIAID, and David M. Morens, M.D., Office of the Director, NIAID, are available to provide comment.






NIH scientists find earliest known evidence of 1918 influenza pandemic (and more)
NIH/National Institute of Allergy and Infectious Diseases ^ | September 19, 2011 | Unknown

Posted on luned? 19 settembre 2011 21.37.08 by decimon

Examination of lung tissue and other autopsy material from 68 American soldiers who died of respiratory infections in 1918 has revealed that the influenza virus that eventually killed 50 million people worldwide was circulating in the United States at least four months before the 1918 influenza reached pandemic levels that fall.

The study, using tissues preserved since 1918, was led by Jeffery K. Taubenberger, M.D., Ph.D., of the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. The researchers found proteins and genetic material from the 1918 influenza virus in specimens from 37 of the soldiers, including four who died between May and August 1918, months before the pandemic peaked. These four cases are the earliest 1918 pandemic influenza cases they know to be documented anywhere in the world, the scientists say.

The clinical disease and tissue damage seen in the pre-pandemic cases were indistinguishable from those evident in cases that occurred during the height of the pandemic. This suggests, says Dr. Taubenberger, that over the course of the pandemic, the virus did not undergo a dramatic change that could explain the unusually high mortality it ultimately caused.

In the current study, the autopsy materials showed that the virus replicated not only in the upper respiratory tract but also the lower respiratory tract, in a pattern very similar to that of the 2009 pandemic influenza virus. The team also found evidence that two virus variants were circulating in 1918. In one, a key viral protein called hemagglutinin bound well to receptors on human respiratory cells, while the hemagglutinin from the other variant bound less efficiently. Despite this difference in binding ability, both viruses caused similar disease symptoms and replicated in a similar pattern within cells lining the respiratory tract, suggesting that differences in hemagglutinin binding capacity alone do not fully explain the unusually high mortality seen in the 1918 pandemic.

Bacterial co-infections were found in all 68 cases studied, the researchers noted. The role played by bacterial co-infections, such as bacterial pneumonia, in contributing to deaths in the 1918 pandemic was previously described by Dr. Taubenberger and his colleagues in a 2008 study. According to the study authors, the new data underscore the crucial role that bacterial infections can play in conjunction with any influenza virus, whether historic or future, and the need for public health officials to prepare to prevent, detect and treat bacterial co-infections during future influenza outbreaks.

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[Anne]

Re: NIH scientists find earliest known evidence of 1918 influenza pandemic (and more)

Re: NIH scientists find earliest known evidence of 1918 influenza pandemic (and more)

http://www.pnas.org/content/early/2011/09/12/1111179108.abstractAutopsy series of 68 cases dying before and during the 1918 influenza pandemic peak

1. Zong-Mei Sheng^a,
2. Daniel S. Chertow^a,
3. Xavier Ambroggio^b,
4. Sherman McCall^c,
5. Ronald M. Przygodzki^d,
6. Robert E. Cunningham^e,
7. Olga A. Maximova^f,
8. John C. Kash^a,
9. David M. Morens^g, and
10. Jeffery K. Taubenberger^a,¹

+ Author Affiliations

1. <address>^aViral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases, </address>
2. <address>^bBioinformatics and Computational Biosciences Branch, </address>
3. <address>^fOffice of the Chief, Laboratory of Infectious Diseases, and </address>
4. <address>^gOffice of the Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892; </address>
5. <address>^cClinical Pathology Laboratory, US Army Medical Research Institute of Infectious Diseases, Fort Detrick, MD 21702; </address>
6. <address>^dDepartment of Veterans Affairs, Washington, DC 20420; and </address>
7. <address>^eDepartment of Biophysics, Armed Forces Institute of Pathology, Rockville, MD 20850 </address>

1. Edited* by Robert G. Webster, St. Jude Children's Research Hospital, Memphis, TN, and approved August 16, 2011 (received for review July 11, 2011)

Abstract

The 1918 to 1919 ?Spanish? influenza pandemic virus killed up to 50 million people. We report here clinical, pathological, bacteriological, and virological findings in 68 fatal American influenza/pneumonia military patients dying between May and October of 1918, a period that includes ∼4 mo before the 1918 pandemic was recognized, and 2 mo (September?October 1918) during which it appeared and peaked. The lung tissues of 37 of these cases were positive for influenza viral antigens or viral RNA, including four from the prepandemic period (May?August). The prepandemic and pandemic peak cases were indistinguishable clinically and pathologically. All 68 cases had histological evidence of bacterial pneumonia, and 94% showed abundant bacteria on Gram stain.

Sequence analysis of the viral hemagglutinin receptor-binding domain performed on RNA from 13 cases suggested a trend from a more ?avian-like? viral receptor specificity with G222 in prepandemic cases to a more ?human-like? specificity associated with D222 in pandemic peak cases. Viral antigen distribution in the respiratory tree, however, was not apparently different between prepandemic and pandemic peak cases, or between infections with viruses bearing different receptor-binding polymorphisms. The 1918 pandemic virus was circulating for at least 4 mo in the United States before it was recognized epidemiologically in September 1918. The causes of the unusually high mortality in the 1918 pandemic were not explained by the pathological and virological parameters examined. These findings have important implications for understanding the origins and evolution of pandemic influenza viruses.