Managing pandemic influenza in general practice

A guide for preparation, response and recovery
3.7 What has been the impact of previous influenza pandemics?
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There were three influenza pandemics during the 20th century:

  • Spanish flu (H1N1) swept across the world in three waves in 1918 and 1919. It caused an estimated 50 million deaths worldwide (1–2% of the global population) and approximately 10,000 Australians died. The highest number of deaths was in young and healthy people aged 15–35 years; pregnant women were especially vulnerable.
  • Asian flu (H2N2) in 1957 caused approximately 2 million deaths worldwide. During the first wave, school children, young adults and pregnant women were mainly affected. In the second wave, the elderly had the highest death rates.
  • Hong Kong flu (H3N2) occurred in 1968 and 1969 and caused approximately 1 million deaths worldwide. It mainly affected the elderly.

Along with millions of deaths, these influenza pandemics caused social disruption and profound economic losses worldwide.

The first influenza pandemic this century was in 2009; it was referred to as ‘swine flu’ (H1N1). The virus contained genetic material of swine, avian and human origin.18 The virus has also been isolated in turkeys, cats and domestic ferrets.19 While the infection rate was high, there was a comparatively low mortality rate (18,449 laboratory-confirmed deaths as of 31 August 2010 by the WHO).

However, laboratory-confirmed deaths greatly underestimate the real mortality burden; for example, deaths from secondary bacterial infections and exacerbation of pre-existing chronic conditions are not recorded as being in any way related to influenza infection.8

Global mortality estimates by the Global Pandemic Mortality project suggest that there were between 123,000 and 203,000 pandemic respiratory deaths for the last 9 months of 2009 (which is approximately 10-fold higher than the WHO mortality count). The majority (62–85%) were attributed to persons under 65 years of age.8

  1. Simonsen L, Spreeuwenberg P, Lustig R, et al. Global mortality estimates for the 2009 influenza pandemic from the GLaMOR project: a modeling study. PLoS Med 2013;10:e1001558.
  2. Garten RJ, Davis CT, Russell CA, et al. Antigenic and genetic characteristics of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science 2009;325:197–201.
  3. York I, Donis RO. The 2009 pandemic influenza virus: where did it come from, where is it now, and where is it going? Curr Top Microbiol Immunol 2013;370:241–57.