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Variable mortality[edit] Mortality varies widely in a pandemic. In the 1918 pandemic: In U.S.

Army camps where reasonably reliable statistics were kept, case mortalit y often exceeded 5 percent, and in some circumstances exceeded 10 percent. In th e British Army in India, case mortality for white troops was 9.6 percent, for In dian troops 21.9 percent. In isolated human populations, the virus killed at eve n higher rates. In the Fiji islands, it killed 14 percent of the entire populati on in 16 days. In Labrador and Alaska, it killed at least one-third of the entir e native population.[28] Influenza pandemics[edit] Known influenza pandemics[29][30][31] Name of pandemic Date Deaths Case fatality rate Subtype involved Pandemic Severity Index 1889 1890 flu pandemic (Asiatic or Russian Flu)[32] 1889 1890 1 million 0.15% possibly H3N8 or H2N2 NA 1918 flu pandemic (Spanish flu)[33] 1918 1920 20 to 100 million 2% H1N1 5 Asian Flu 1957 1958 1 to 1.5 million 0.13% H2N2 2 Hong Kong Flu 1968 1969 0.75 to 1 million <0.1% H3N2 2 Russian flu 1977 1978 no accurate count N/A H1N1 N/A 2009 flu pandemic[34][35] 2009 2010 18,000 to 284,500 0.03% H1N1/09 N/A Spanish Flu (1918 1920)[edit] Main article: Spanish 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 s train of subtype H1N1. The difference between the influenza mortality age-distributions of the 1918 epi demic 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).[36] The Spanish flu pandemic lasted from 1918 to 1919.[37] Older estimates say it ki lled 40 50 million people[38] while current estimates say 50 million to 100 millio n people worldwide were killed.[26] This pandemic has been described as "the gre atest medical holocaust in history" and may have killed as many people as the Bl ack Death,[30] although the Black Death is estimated to have killed over a fifth of the world's population at the time,[39] a significantly higher proportion. T his 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 sto rms.[38] Indeed, symptoms in 1918 were so unusual that initially influenza was m isdiagnosed 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 hemo rrhages in the skin also occurred."[26] The majority of deaths were from bacteri al pneumonia, a secondary infection caused by influenza, but the virus also kill ed people directly, causing massive hemorrhages and edema in the lung.[36] The Spanish flu pandemic was truly global, spreading even to the Arctic and remo te Pacific islands. The unusually severe disease killed between 2 and 20% of tho se infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[2 6][36] 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.[40] This is unusual since inf luenza is normally most deadly to the very young (under age 2) and the very old (over age 70). The total mortality of the 1918 1919 pandemic is not known, but it is estimated that up to 1% of the world's population was killed. As many as 25 m illion may have been killed in the first 25 weeks; in contrast, HIV/AIDS has kil

[44][45][46] Those over 65 had the greates t death rates. following the isolation of an A/H1N1 influenz a in 7 ill patients in the southwest US. including the WHO. one endemic in birds. com monly referred to as "swine flu". Until H5N1.071 deaths. and two endemic in pigs (swine). while all human influenza viruses had a lysine.000 laboratory confirmed deaths from H1N1.[42] It spread to Singapore in February 1957.[51] On 1 November 2009. that inc luded 6.[48] On 11 June 2009. because the older generation had protective immunity resulting from prior experience with H1N1 strains. a worldwide update by the WHO stated that "199 countries and overseas territories/communities have officially reported a total of over 482. The Hong Kong Flu pandemic of 1968 and 1969 killed an e stimated one million people worldwide."[52] By the end of the pandemic.[26] Asian Flu (1957 1958)[edit] Main article: H2N2 The "Asian Flu" was a category 2 flu pandemic outbreak of avian influenza that o riginated in China in early 1956 lasting until 1958. It originated from mutation in wild ducks combining with a pre-existing human strain.[41] The elderly were particularly vulnerable.The next day.800 . The disease spread rapidly through t he rest the spring. was officially declared by the WHO to be the f irst influenza pandemic of the 21st century and a new strain of Influenza A viru s subtype H1N1 first identified in April 2009. and H3N2 are the only known Influenza A virus subtypes cur rently circulating among humans. On 24 April 2009. reached H ong Kong by April. H1N1/09 Flu Pandemic (2009 2010)[edit] Main article: 2009 flu pandemic An epidemic of influenza-like illness of unknown causation occurred in Mexico in March April 2009. about 15 times the nu mber of deaths in the initial death toll. H1N1. . H1N2. the ongoing outbreak of Influenza A/H1N1. The 1977 virus was similar t o other A/H1N1 viruses that had circulated prior to 1957. and by 3 May. a strain of H1N1 appeared. in which genes from multiple subtypes reassor ted to form a new virus. there were more than 18.[56] Genetic factors in distinguishing between "human flu viruses" and "avian influen za viruses" include: PB2: (RNA polymerase): Amino acid (or residue) position 627 in the PB2 protein e ncoded by the PB2 RNA gene. It was a "benign" pandemic. 6 in Canada. a total of 787 confirmed cases had been report ed worldwide. and US by June. Experts.[49] It is thought to be a mutatio n (reassortment) of four known strains of influenza A virus subtype H1N1: one en demic in humans.3 00 laboratory confirmed cases of the influenza pandemic H1N1 infection.[41] The virus was fir st identified in Guizhou.[47] Russian Flu (1977 1978)[edit] In 1977. there were about 33.[50] The rapid spread of this new virus was likely due to a general lack of pre-existing antibody-mediated immunity in the human population. the actual total of cases and deaths was li kely much higher than reported.led 25 million in its first 25 years.[43] Estimates of worldwide death s vary widely depending on source.[53] Due to inadequate surveillance and l ack of healthcare in many countries. ranging from 1 million to 4 million. and 1 in Spain.500 people were killed by the disease. have since agreed th at an estimated 284. primarily affect ing people born after 1950. the number of confirmed cases rose to 40 in the US. 26 in Mexico. all known avian influenza viruses had a Glu at position 627.[35][54][55] Other pandemic threat subtypes[edit] "Human influenza virus" usually refers to those subtypes that spread widely amon g humans. The virus was included in the 1978 79 vaccine. Death toll in the US was approximately 69. Hong Kong Flu (1968 1969)[edit] Main article: H3N2 The Hong Kong Flu was a category 2 flu pandemic caused by a strain of H3N2 desce nded from H2N2 by antigenic shift. The WHO issued a statement on the outbr eak of "influenza like illness" in the confirmed cases of A/H1N1 influenza had b een reported in Mexico.800 deaths.[43] In the US. and that 20 confirmed cases of the disease had been repo rted in the US.

or how many mutations would render an influenza virus a pandemic strain. according to researchers in Taiwan. 16 have residues typical for human strains. H7N3. is difficult to predict. The result supports the hypothesis that the 1918 pandemi c virus is more closely related to the avian influenza A virus than are other hu man influenza viruses. endemic in avians H7N7 has unusual zoonotic potential H1N2 is currently endemic in humans and pigs H9N2."[61] In mid-April 2009."[58] Highly pathogenic H5N1 avian influenza kills 50% of humans that catch it. ordered by th e number of known human pandemic deaths."[57] "How many mutations would mak e an avian virus capable of infecting humans efficiently. Those few changes turned a bird virus into a killer that could spread from person to person.400 amino ac ids. are: H1N1 caused "Spanish Flu" and the 2009 swine flu outbreak (novel H1N1) H2N2 caused "Asian Flu" H3N2 caused "Hong Kong Flu" H5N1 is "bird flu". In one case. Of the 52 species-ass ociated positions. "When he compared the 1918 virus with today's human flu viruses. with its center in Mexico City. We h ave examined sequences from the 1918 strain. "About 52 key genetic changes distinguish avian influenza strains from those tha t spread easily among people. the others remain ed as avian signatures. who analyzed t he genes of more than 400 A type flu viruses. a boy with H5N1 experienced diarrhea followed rapidly by a coma without d eveloping respiratory or flu-like symptoms. Taubenberge r noticed that it had alterations in just 25 to 30 of the virus's 4.[60] Controversy aros e in October 2005. H10N7 H1N1 Main article: H1N1 Main article: Pandemic_H1N1/09_virus H1N1 is currently endemic in both human and pig populations. which is the only pandemic influenz a virus that could be entirely derived from avian strains. Many fear that this information could be used for bioterrorism[citation needed]. Science.[59] The Influenza A virus subtypes that have been confirmed in humans. an H1N1 variant appeared in Mexico. H7N2. after the H1N1 genome was published in the journal. Dr. A variant of H1N1 w as responsible for the Spanish flu pandemic that killed some 50 million to 100 m illion people worldwide over about a year in 1918 and 1919.HA: (hemagglutinin): Avian influenza HA bind alpha 2 3 sialic acid receptors while human influenza HA bind alpha 2 6 sialic acid receptors. By 26 April the variant had spread wi .