Spanish Influenza in Japanese Armed Forces, 1918–1920

Kawana, Akihiko; Naka, Go; Fujikura, Yuji; Kato, Yasuyuki; Mizuno, Yasutaka; Kondo, Tatsuya; Kudo, Kohsuke

doi:10.3201/eid1304.060615

Cited by 22 publications

(19 citation statements)

References 14 publications

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“…In this sense over-crowded places would have been ideal for a susceptible person to be exposed to very high infectious doses of influenza A virus. In 1918 the army camps fit the model by being characterised by a high number of contacts between people and by a high case-fatality rate, sometimes 5 to 8 times higher than the case-fatality rate among civilian communities [23], [24]. This difference in influenza-like illness mortality is sometimes associated to poor conditions in military base hospitals [23] or to a lower lung capacity of soldiers due to the inhalation of gases during the war [20].…”

Section: Discussionmentioning

confidence: 99%

“…In 1918 the army camps fit the model by being characterised by a high number of contacts between people and by a high case-fatality rate, sometimes 5 to 8 times higher than the case-fatality rate among civilian communities [23], [24]. This difference in influenza-like illness mortality is sometimes associated to poor conditions in military base hospitals [23] or to a lower lung capacity of soldiers due to the inhalation of gases during the war [20]. However, of note, many of these reports were from training army camps [24] where soldiers had health-care conditions similar to those offered to civilian communities.…”

Section: Discussionmentioning

confidence: 99%

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Influenza Infectious Dose May Explain the High Mortality of the Second and Third Wave of 1918–1919 Influenza Pandemic

et al. 2010

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BackgroundIt is widely accepted that the shift in case-fatality rate between waves during the 1918 influenza pandemic was due to a genetic change in the virus. In animal models, the infectious dose of influenza A virus was associated to the severity of disease which lead us to propose a new hypothesis. We propose that the increase in the case-fatality rate can be explained by the dynamics of disease and by a dose-dependent response mediated by the number of simultaneous contacts a susceptible person has with infectious ones.MethodsWe used a compartment model with seasonality, waning of immunity and a Holling type II function, to model simultaneous contacts between a susceptible person and infectious ones. In the model, infected persons having mild or severe illness depend both on the proportion of infectious persons in the population and on the level of simultaneous contacts between a susceptible and infectious persons. We further allowed for a high or low rate of waning immunity and volunteer isolation at different times of the epidemic.ResultsIn all scenarios, case-fatality rate was low during the first wave (Spring) due to a decrease in the effective reproduction number. The case-fatality rate in the second wave (Autumn) depended on the ratio between the number of severe cases to the number of mild cases since, for each 1000 mild infections only 4 deaths occurred whereas for 1000 severe infections there were 20 deaths. A third wave (late Winter) was dependent on the rate for waning immunity or on the introduction of new susceptible persons in the community. If a group of persons became voluntarily isolated and returned to the community some days latter, new waves occurred. For a fixed number of infected persons the overall case-fatality rate decreased as the number of waves increased. This is explained by the lower proportion of infectious individuals in each wave that prevented an increase in the number of severe infections and thus of the case-fatality rate.ConclusionThe increase on the proportion of infectious persons as a proxy for the increase of the infectious dose a susceptible person is exposed, as the epidemic develops, can explain the shift in case-fatality rate between waves during the 1918 influenza pandemic.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Influenza Infectious Dose May Explain the High Mortality of the Second and Third Wave of 1918–1919 Influenza Pandemic

et al. 2010

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“…Analysed by year, almost 300 000 excess deaths were attributable to the October 1918–May 1919 influenza season (rate 0.54%), and 182 000 deaths to the December 1919–May 1920 season (rate 0.33%). Previous studies gave lower burden estimates for this pandemic in Japan, ranging from 257 000 to 390 000 deaths [1, 3, 13, 17]; however, two major limitations make these early estimates unreliable. First, these estimates were limited to the first pandemic season, thereby excluding all pandemic-related deaths occurring in the second pandemic season, December 1919–May 1920.…”

Section: Discussionmentioning

confidence: 99%

“…In 1918, Japan was an emerging economic force, reaping the benefits of governmental reforms and integration of industrial technology. Only three studies discuss the 1918–1920 pandemic in Japan, focusing on a primarily qualitative [16, 17] and clinical [13] description, and limited to a single winter season, 1918–1919. Here we compile historical vital statistics from Japan and describe the age and geographical mortality patterns associated with the successive waves of the influenza pandemic during 1918–1920.…”

Section: Introductionmentioning

confidence: 99%

A comparative study of the 1918–1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning

et al. 2009

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SUMMARYHistorical studies of influenza pandemics can provide insight into transmission and mortality patterns, and may aid in planning for a future pandemic. Here, we analyse historical vital statistics and quantify the age-specific mortality patterns associated with the 1918–1920 influenza pandemic in Japan, USA, and UK. All three countries showed highly elevated mortality risk in young adults relative to surrounding non-pandemic years. By contrast, the risk of death was low in the very young and very old. In Japan, the overall mortality impact was not limited to winter 1918–1919, and continued during winter 1919–1920. Mortality impact varied as much as threefold across the 47 Japanese prefectures, and differences in baseline mortality, population demographics, and density explained a small fraction of these variations. Our study highlights important geographical variations in timing and mortality impact of historical pandemics, in particular between the Eastern and Western hemispheres. In a future pandemic, vaccination in one region could save lives even months after the emergence of a pandemic virus in another region.

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“…We previously described the clinical features of Spanish influenza among patients who were hospitalized at several study sites ( 2 ). Recently, additional records of patients affected by the second wave of disease during 1919–1920 were discovered, and these patients were the subjects of this study.…”

Section: The Studymentioning

confidence: 99%

Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919–1920

Kudo¹,

Manabe²,

Jin³

et al. 2017

Emerg. Infect. Dis.

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Spanish Influenza in Japanese Armed Forces, 1918–1920

Abstract: Medical records of Japanese army hospitals show high death rates during the first influenza pandemic.

Cited by 22 publications

References 14 publications

Influenza Infectious Dose May Explain the High Mortality of the Second and Third Wave of 1918–1919 Influenza Pandemic

Influenza Infectious Dose May Explain the High Mortality of the Second and Third Wave of 1918–1919 Influenza Pandemic

A comparative study of the 1918–1920 influenza pandemic in Japan, USA and UK: mortality impact and implications for pandemic planning

Markers of Disease Severity in Patients with Spanish Influenza in the Japanese Armed Forces, 1919–1920

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