Health Matters: Influenza then and now

Q. What do we think about when we think about the flu?

A. We are in the midst of the flu season — an annual winter occurrence that we approach with a mix of nonchalance and concern.

On one hand, we know influenza can be deadly. We are particularly reminded of the most fatal outbreak since 1900 — the “Spanish” influenza of 1918 that killed 40 to 50 million people worldwide.

In North Dakota, the Fargo Forum announced on Sept. 27, 1918, “Spanish Influenza Hasn’t Hit Fargo.” Within a week, the situation had changed. Fargo reported 100 cases Oct. 4. On Oct. 19, state officials, fearing the disease was spreading too rapidly, issued orders forbidding trains to transport patients suffering from influenza.

Unlike subsequent influenza outbreaks, the Spanish flu killed people in their prime, not the very young, very old, and chronically ill. In addition to the influenza of 1918, we also recollect that the 1957 Asian flu killed 2 million people worldwide, while the Hong Kong strain killed 1 million in 1968.

We can find comfort in the decline in deaths from influenza since 1918. Today, 5 to 20 percent of the population gets the flu each year, and 200,000 of these are hospitalized for flu-related complications.

Since 1976, from 3,000 to 49,000 people have died each year from the flu — a large toll, but a far cry from the toll taken by the pandemics of the past, particularly the Spanish flu. The U. S. death rate from the 1918 Spanish influenza was about 654 deaths per 100,000 population compared to an estimated 16 deaths per 100,000 population in 2009. The flu is not to be taken lightly, but it is not the killer it once was.

Q. What led to the decline in deaths from influenza?

A. The most notable factor in the decline of flu deaths was the development of the tremendous public health infrastructure. This tracks and monitors strains, decides which will be the most dangerous, develops vaccines, communicates information to health professionals and the public about the strain, manufactures and distributes vaccines and evaluates the impact of the flu each year.

This infrastructure is a worldwide public–private partnership in which the Centers for Disease Control and Prevention has a leading role that entails tracking, monitoring, developing vaccines and assessing impact.

This endeavor could not be realized without other public agencies: the U.S. Food and Drug Administration; the National Institutes of Health; the network of state and local health departments; private partners, including primary care physicians, pharmacies, pharmaceutical companies, hospitals, and health care insurers; as well as non-profits such as the World Health Organization and others.

This infrastructure, which spans individual to societal level interventions, is a remarkable achievement in the prevention of premature death. All of us, even those who do not get a flu shot, benefit through lives saved and reduced health care costs. About 42 percent of Americans today are vaccinated each year, some by choice, others by mandate from their employers, which require their workers to have a flu shot. Importantly, even though getting a flu shot is an individual behavior, being vaccinated against influenza would not be possible without the collaboration of thousands of people in thousands of public and private organizations who make this opportunity for prevention possible.

Goldsteen is director of the UND School of Medicine and Health Sciences Master of Public Health degree program, which is jointly offered with North Dakota State University. He has devoted most of his professional life to advancing public health and holds a doctorate in public health.

Submit a question to Health Matters at healthmatters@med.und.edu or Health Matters, 501 North Columbia Road, Stop 9037, Grand Forks, ND 58202-9037. Remember, no personal details, please.

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The content of this column is for informational purposes only and does not substitute for professional medical advice or care. The information provided herein should not be used for diagnosing or treating a health problem or disease. If you have or suspect you may have a health problem, you should consult your health care provider. Never disregard professional medical advice or delay in seeking it because of something you have read in this column.

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