Special Issue "Understanding, Preventing and Controlling Influenza: 100th Anniversary of the 1918 Influenza Pandemic"

A special issue of Tropical Medicine and Infectious Disease (ISSN 2414-6366).

Deadline for manuscript submissions: closed (31 December 2018)

Special Issue Editors

Guest Editor
Prof. David W. Smith

Department of Microbiology, PathWest Laboratory Medicine WA, Nedlands, AustraliaFaculty of Heath and Medical Sciences, University of Western Australia, Nedlands, Australia
Website | E-Mail
Phone: +61419915002
Interests: influenza and other respiratory viruses; mosquito-borne viruses; emerging infections
Guest Editor
Dr. Ian Barr

Deputy Director of the World Health Organization Collaborating Centre for Influenza Reference and Research in Melbourne, Victoria, Australia
Website | E-Mail
Interests: influenza; RSV
Guest Editor
Dr. Lance Jennings

Pathology Department, University of Otago, Christchurch, New Zealand
Website | E-Mail
Interests: influenza and other respiratory viruses

Special Issue Information

This year marks the centenary of the 1918 influenza pandemic, one of the most serious infectious disease outbreaks on record, killing over 50 million people worldwide. Since then we have experienced three further pandemics, the last in 2009, but have fortunately been spared another as severe as 1918. However the threat remains with us, as we see ongoing circulation of animal influenza viruses that have shown the ability to infect humans, especially the A/H1N1 and H7N9 viruses in birds, and the A/H3 variants in swine. We have also come to better understand the importance and impact of inter-pandemic (seasonal) influenza, the importance of modern travel in its spread, and the potential of new technologies in improving our understanding of the virus and how we might deal with it.

This Special Issue of the journal recognizes the importance of influenza, both pandemic and an epidemic. We are seeking contributions on a broad range of aspects of influenza including: what have we learnt from 1918, what drives the evolution of the virus and how do we track it, what makes an influenza virus bad, how do we stop it happening again, and how do we mitigate it if it does?

Prof. David W. Smith
Dr. Ian Barr
Dr. Lance Jennings
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Tropical Medicine and Infectious Disease is an international peer-reviewed open access quarterly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 350 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Influenza
  • Pandemic
  • Epidemic
  • Prevention
  • Evolution
  • Impact

Published Papers (7 papers)

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Research

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Open AccessArticle
Impact of the 1918 Influenza Pandemic in Coastal Kenya
Trop. Med. Infect. Dis. 2019, 4(2), 91; https://doi.org/10.3390/tropicalmed4020091
Received: 15 March 2019 / Revised: 28 May 2019 / Accepted: 30 May 2019 / Published: 8 June 2019
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Abstract
The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been [...] Read more.
The 1918 influenza pandemic was the most significant pandemic recorded in human history. Worldwide, an estimated half billion persons were infected and 20 to 100 million people died in three waves during 1918 to 1919. Yet the impact of this pandemic has been poorly documented in many countries especially those in Africa. We used colonial-era records to describe the impact of 1918 influenza pandemic in the Coast Province of Kenya. We gathered quantitative data on facility use and all-cause mortality from 1912 to 1925, and pandemic-specific data from active reporting from September 1918 to March 1919. We also extracted quotes from correspondence to complement the quantitative data and describe the societal impact of the pandemic. We found that crude mortality rates and healthcare utilization increased six- and three-fold, respectively, in 1918, and estimated a pandemic mortality rate of 25.3 deaths/1000 people/year. Impact to society and the health care system was dramatic as evidenced by correspondence. In conclusion, the 1918 pandemic profoundly affected Coastal Kenya. Preparation for the next pandemic requires continued improvement in surveillance, education about influenza vaccines, and efforts to prevent, detect and respond to novel influenza outbreaks. Full article
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Open AccessArticle
Tuberculosis as a Risk Factor for 1918 Influenza Pandemic Outcomes
Trop. Med. Infect. Dis. 2019, 4(2), 74; https://doi.org/10.3390/tropicalmed4020074
Received: 30 December 2018 / Revised: 14 April 2019 / Accepted: 26 April 2019 / Published: 29 April 2019
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Abstract
Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts [...] Read more.
Tuberculosis (TB) mortality declined after the 1918 pandemic, suggesting that influenza killed those who would have died from TB. Few studies have analyzed TB as a direct risk factor for 1918 influenza morbidity and mortality by age and sex. We study the impacts of TB on influenza-like illness (% of population sick) and case fatality (% of cases dying) by age and sex through case-control comparisons of patients (N = 201) and employees (N = 97) from two Norwegian sanatoriums. Female patients, patients at Landeskogen sanatorium, and patients aged 10–39 years had significantly lower morbidity than the controls. None of the 62 sick employees died, while 15 of 84 sick patients did. The case-control difference in case fatality by sex was only significant for females at Lyster sanatorium and females at both sanatoriums combined. Non-significant case-control differences in case fatality for males were likely due to small samples. Patients 20–29 years for both sexes combined at Lyster sanatorium and at both sanatoriums combined, as well as females 20–29 years for both sanatoriums combined, had significantly higher case fatality. We conclude that TB was associated with higher case fatality, but morbidity was lower for patients than for employees. The results add to the study of interactions between bacterial and viral diseases and are relevant in preparing for pandemics in TB endemic areas. Full article
Open AccessArticle
Accounting for Healthcare-Seeking Behaviours and Testing Practices in Real-Time Influenza Forecasts
Trop. Med. Infect. Dis. 2019, 4(1), 12; https://doi.org/10.3390/tropicalmed4010012
Received: 20 November 2018 / Revised: 8 January 2019 / Accepted: 8 January 2019 / Published: 11 January 2019
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Abstract
For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide [...] Read more.
For diseases such as influenza, where the majority of infected persons experience mild (if any) symptoms, surveillance systems are sensitive to changes in healthcare-seeking and clinical decision-making behaviours. This presents a challenge when trying to interpret surveillance data in near-real-time (e.g., to provide public health decision-support). Australia experienced a particularly large and severe influenza season in 2017, perhaps in part due to: (a) mild cases being more likely to seek healthcare; and (b) clinicians being more likely to collect specimens for reverse transcription polymerase chain reaction (RT-PCR) influenza tests. In this study, we used weekly Flutracking surveillance data to estimate the probability that a person with influenza-like illness (ILI) would seek healthcare and have a specimen collected. We then used this estimated probability to calibrate near-real-time seasonal influenza forecasts at each week of the 2017 season, to see whether predictive skill could be improved. While the number of self-reported influenza tests in the weekly surveys are typically very low, we were able to detect a substantial change in healthcare seeking behaviour and clinician testing behaviour prior to the high epidemic peak. Adjusting for these changes in behaviour in the forecasting framework improved predictive skill. Our analysis demonstrates a unique value of community-level surveillance systems, such as Flutracking, when interpreting traditional surveillance data. These methods are also applicable beyond the Australian context, as similar community-level surveillance systems operate in other countries. Full article
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Open AccessArticle
The ‘Influenza’ Vaccine Used during the Samoan Pandemic of 1918
Trop. Med. Infect. Dis. 2018, 3(1), 17; https://doi.org/10.3390/tropicalmed3010017
Received: 18 January 2018 / Revised: 29 January 2018 / Accepted: 30 January 2018 / Published: 2 February 2018
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Abstract
In 1918, a crude influenza vaccine made from chemically inactivated, mixed cultures of respiratory bacteria was widely used prior to the understanding that influenza was caused by a virus. Such vaccines contained no viral material and probably consisted largely of bacterial endotoxin. The [...] Read more.
In 1918, a crude influenza vaccine made from chemically inactivated, mixed cultures of respiratory bacteria was widely used prior to the understanding that influenza was caused by a virus. Such vaccines contained no viral material and probably consisted largely of bacterial endotoxin. The Australian military used such a vaccine on Samoa in December 1918 and thought it was valuable. Post hoc analyses suggest that the mixed respiratory bacteria vaccine may have actually been of some benefit, but the mechanism of such protection is unknown. Although such a crude vaccine would not be considered in a modern setting, the rapid use of problematic vaccines still remains a risk when new influenza types suddenly appear, as in 1976 and 2009. Full article
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Review

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Open AccessReview
The Critical Interspecies Transmission Barrier at the Animal–Human Interface
Trop. Med. Infect. Dis. 2019, 4(2), 72; https://doi.org/10.3390/tropicalmed4020072
Received: 18 March 2019 / Revised: 12 April 2019 / Accepted: 23 April 2019 / Published: 25 April 2019
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Abstract
Influenza A viruses (IAVs) infect humans and a wide range of animal species in nature, and waterfowl and shorebirds are their reservoir hosts. Of the 18 haemagglutinin (HA) and 11 neuraminidase (NA) subtypes of IAV, 16 HA and 9 NA subtypes infect aquatic [...] Read more.
Influenza A viruses (IAVs) infect humans and a wide range of animal species in nature, and waterfowl and shorebirds are their reservoir hosts. Of the 18 haemagglutinin (HA) and 11 neuraminidase (NA) subtypes of IAV, 16 HA and 9 NA subtypes infect aquatic birds. However, among the diverse pool of IAVs in nature, only a limited number of animal IAVs cross the species barrier to infect humans and a small subset of those have spread efficiently from person to person to cause an influenza pandemic. The ability to infect a different species, replicate in the new host and transmit are three distinct steps in this process. Viral and host factors that are critical determinants of the ability of an avian IAV to infect and spread in humans are discussed. Full article
Open AccessReview
Sowing the Seeds of a Pandemic? Mammalian Pathogenicity and Transmissibility of H1 Variant Influenza Viruses from the Swine Reservoir
Trop. Med. Infect. Dis. 2019, 4(1), 41; https://doi.org/10.3390/tropicalmed4010041
Received: 7 January 2019 / Revised: 2 February 2019 / Accepted: 20 February 2019 / Published: 27 February 2019
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Abstract
Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 [...] Read more.
Emergence of genetically and antigenically diverse strains of influenza to which the human population has no or limited immunity necessitates continuous risk assessments to determine the likelihood of these viruses acquiring adaptations that facilitate sustained human-to-human transmission. As the North American swine H1 virus population has diversified over the last century by means of both antigenic drift and shift, in vivo assessments to study multifactorial traits like mammalian pathogenicity and transmissibility of these emerging influenza viruses are critical. In this review, we examine genetic, molecular, and pathogenicity and transmissibility data from a panel of contemporary North American H1 subtype swine-origin viruses isolated from humans, as compared to H1N1 seasonal and pandemic viruses, including the reconstructed 1918 virus. We present side-by-side analyses of experiments performed in the mouse and ferret models using consistent experimental protocols to facilitate enhanced interpretation of in vivo data. Contextualizing these analyses in a broader context permits a greater appreciation of the role that in vivo risk assessment experiments play in pandemic preparedness. Collectively, we find that despite strain-specific heterogeneity among swine-origin H1 viruses, contemporary swine viruses isolated from humans possess many attributes shared by prior pandemic strains, warranting heightened surveillance and evaluation of these zoonotic viruses. Full article

Other

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Open AccessCommentary
Antiviral Therapy for the Next Influenza Pandemic
Trop. Med. Infect. Dis. 2019, 4(2), 67; https://doi.org/10.3390/tropicalmed4020067
Received: 28 February 2019 / Revised: 2 April 2019 / Accepted: 15 April 2019 / Published: 18 April 2019
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Abstract
Influenza antivirals will play a critical role in the treatment of outpatients and hospitalised patients in the next pandemic. In the past decade, a number of new influenza antivirals have been licensed for seasonal influenza, which can now be considered for inclusion into [...] Read more.
Influenza antivirals will play a critical role in the treatment of outpatients and hospitalised patients in the next pandemic. In the past decade, a number of new influenza antivirals have been licensed for seasonal influenza, which can now be considered for inclusion into antiviral stockpiles held by the World Health Organization (WHO) and individual countries. However, data gaps remain regarding the effectiveness of new and existing antivirals in severely ill patients, and regarding which monotherapy or combinations of antivirals may yield the greatest improvement in outcomes. Regardless of the drug being used, influenza antivirals are most effective when treatment is initiated early in the course of infection, and therefore in a pandemic, effective strategies which enable rapid diagnosis and prompt delivery will yield the greatest benefits. Full article
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