Multinational Impact of the 1968 Hong Kong Influenza Pandemic: Evidence for a Smoldering Pandemic

BackgroundThe first pandemic season of A/H3N2 influenza virus (1968/1969) resulted in significant mortality in the United States, but it was the second pandemic season of A/H3N2 influenza virus (1969/1970) that caused the majority of deaths in England. We further explored the global pattern of morta...

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Bibliographic Details
Published in:The Journal of infectious diseases 2005-07, Vol.192 (2), p.233-248
Main Authors: Viboud, Cécile, Grais, Rebecca F., Lafont, Bernard A. P., Miller, Mark A., Simonsen, Lone
Format: Article
Language:English
Subjects:
Antigens
Biological and medical sciences
Death
Disease Outbreaks
Diseases
Epidemics
Fundamental and applied biological sciences. Psychology
Geography
Hong Kong - epidemiology
Humans
Infections
Infectious diseases
Influenza A virus - classification
Influenza virus
Influenza, Human - epidemiology
Influenza, Human - mortality
Medical genetics
Medical sciences
Microbiology
Mortality
North America - epidemiology
Pandemics
Phylogeny
Seasons
United States - epidemiology
Viruses
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Summary:BackgroundThe first pandemic season of A/H3N2 influenza virus (1968/1969) resulted in significant mortality in the United States, but it was the second pandemic season of A/H3N2 influenza virus (1969/1970) that caused the majority of deaths in England. We further explored the global pattern of mortality caused by the pandemic during this period MethodsWe estimated the influenza-related excess mortality in 6 countries (United States, Canada, England and Wales, France, Japan, and Australia) using national vital statistics by age for 1967–1978. Geographical and temporal pandemic patterns in mortality were compared with the genetic drift of the influenza viruses by analyzing hemagglutinin and neuraminidase sequences from GenBank ResultsIn North America, the majority of influenza-related deaths in 1968/1969 and 1969/1970 occurred during the first pandemic season (United States, 70%; Canada, 54%). Conversely, in Europe and Asia, the pattern was reversed: 70% of deaths occurred during the second pandemic season. The second pandemic season coincided with a drift in the neuraminidase antigen ConclusionWe found a consistent pattern of mortality being delayed until the second pandemic season of A/H3N2 circulation in Europe and Asia. We hypothesize that this phenomenon may be explained by higher preexisting neuraminidase immunity (from the A/H2N2 era) in Europe and Asia than in North America, combined with a subsequent drift in the neuraminidase antigen during 1969/1970
ISSN:0022-1899
1537-6613
DOI:10.1086/431150