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Table 1 Comparison of the 1918–1919 and the 2009 H1N1 influenza pandemics

From: The first influenza pandemic in the new millennium: lessons learned hitherto for current control efforts and overall pandemic preparedness

 

1918–1919

2009

Influenza virus

Avian Influenza A H1N1

Swine-Origin-Influenza A(H1N1)v

Social and political Context

World War I – U.S. troops being deployed to Europe

One of the largest economic recessions in the U.S. with worldwide reach

  

Globalization, ease of travel, population overgrowth, megacities

Source of viral strain emergence

Historians have suggested to potential origins for this pandemic viral strain in China or in the Midwestern US military camps during World War I

Unclear source, phylogeny of the virus demonstrates to be an Eurasian H1N1 swine strain

Seasonality and transmissibility

Highly-transmissible – three succeeding waves of the outbreak

Cases surfaced in early spring in Mexico City and in California, U.S.A.

 

Initial wave spring 1918 with sustained multifocal transmission

Sustained transmission (two generations) only in North America

Affected age groups

Most deaths occurred within the first six months of the pandemic.

Most deaths occurred within a three week time span.

 

Most affected group 15–34 year-old population

Most affected group is the 5 to 30; case-fatality rate has ranged from 5 to 45 years of age

Case management

Insufficiency of healthcare systems

Wider availability of healthcare institutions

 

Absence of effective antimicrobials for treating secondary bacterial pneumonias.

Availability of broad-spectrum antimicrobials for treating secondary bacterial pneumonias

 

Medical intensive care in early phases of development

Sophisticated medical intensive care and mechanical ventilatory support

 

Insufficient infection control activities

More established infection control activities and programs

Virulence

Highly virulent

Virulence only demonstrated as causing most fatalities in Mexico

Availability of vaccine

No

No

Susceptibility to antivirals

No availability of antivirals

Susceptibility to neuraminidase inhibitors (oseltamivir). However, there are growing number of resistant viral strains to oseltamivir

Nosocomial transmission

Highly transmissible in hospital settings

Possibility of nosocomial transmission under investigation with 81 healthcare workers affected in the U.S [23]

Molecular characterization

H1N1 avian strain without evidence of reassortment (4)

H1N1 (triple reassortant – human – avian – swine)

Natural history of the outbreak and outcomes

More than 300 million cases worldwide

By June 11, 2009, 74 nation states have cases, with approximately 27,737 confirmed cases and 141 death

 

More than 50 million people deaths worldwide