A new influenza virus emerged in China’s southeastern Yunan Province, spreading rapidly to the rest of the world and causing the deaths of an estimated 2 million people. The pandemic, one of the three deadliest of the twentieth century, did not subside until the following year.
Three major influenza pandemics appeared during the twentieth century. These global outbreaks, caused by subtypes of the influenza A virus, were responsible for the deaths of millions of people worldwide. The 1918-1919 pandemic, history’s deadliest, was erroneously thought to have originated in Spain and was thus baptized the Spanish flu. Fifteen years later, British microbiologist Wilson Smith and his colleagues Christopher Howard Andrewes and Patrick Playfair Laidlaw identified the influenza virus
Humans are not the only hosts for the influenza virus. Many nonhuman animals, including horses, pigs, sea mammals, and a variety of birds, also can harbor the virus. It is believed that in 1957, the simultaneous infection of a pig with both human and avian flu led to an exchange of genetic material between the two viruses, allowing the emergence of the H2N2 strain responsible for that year’s Asian flu pandemic. The mixing of genetic material between two different flu viruses, known as antigenic shift, gives rise to a new flu virus. Because the majority of humans lack immunity to new subtypes, their rapid, worldwide spread will create a pandemic. Massive livestock farms such as those in rural China, which raise enormous quantities of birds and mammals, including pigs, create a milieu favorable to the birth of new influenza viruses.
The H2N2 virus emerged in China’s southeast Yunan Province in late February of 1957. By mid-March the disease had reached epidemic proportions in that nation. Refugees from communist China probably brought it to Hong Kong in early April. From there it spread rapidly to Singapore and then to Taiwan, Borneo, and Japan. At that time the international community, under the guidance of the World Health Organization
H2N2 arrived in the United States in June. The West Coast, more specifically California, appeared to have been one of the earliest entry ports for the virus. The flu spread from the coastal areas inland. During the early summer months, only sporadic outbreaks occurred, but in September, Louisiana reported epidemic conditions in more than 50 percent of its counties. By mid-October both New York and Maine reached epidemic conditions in 75 percent of their counties. H2N2 had the tendency to infect school-age children first. It then moved on from the preschool to the adult population. This trend was reflected by the high degree of absenteeism when schools restarted in the fall. An increase in mortality became apparent toward the end of September and reached its highest point during November.
In contrast to influenza pandemics, epidemics flare up yearly. Epidemics see an increase in mortality of the very old and very young, but pandemics are characterized by a marked increase in mortality of the younger population. This was particularly apparent at the time of the Spanish flu and was true, but less obvious, during subsequent pandemics. Almost 40 percent of all influenza-related deaths in the United States during the 1957-1958 Asian flu pandemic occurred in individuals less than 65 years of age.
While the Spanish flu claimed at least 50 million deaths around the world, the 1957-1958 H2N2 pandemic is estimated to have led to 2 million deaths of people worldwide, including 80,000 people in the United States. Even though antibiotics were available at the time of this pandemic, the majority of people died of bacterial pneumonia. Health care costs and loss of productivity were enormous. The total costs of the 1957-1958 pandemic to the U.S. economy have been estimated at greater than $4 billion (in 1958 dollars).
Before the Asian flu pandemic reached its peak in the United States, however, the virus already had been identified and information that was pertinent to the development of an effective vaccine
The Asian flu pandemic ended in 1958. Epidemic flare-ups with the H2N2 virus occurred until it was supplanted in 1968 by the newly emerged Hong Kong flu virus H3N2.
The pandemics of 1918-1919 and 1957-1958 illustrate the inevitability that viral influenza mutation periodically leads to global influenza pandemics. The World Health Organization, which plays an essential role in global pandemic preparedness, has coordinated worldwide influenza surveillance since 1948 and heads an extensive network that includes more than eighty countries. The organization estimates that the next pandemic could kill between 2 and 8 million people worldwide. The impact on the United States will likely be tremendous, with 43 to 100 million people infected and with 89,000 to 207,000 anticipated deaths. The cost to the U.S. economy will probably range between $71 billion and $166 billion.
Vaccines have proven effective in combating human influenza. The Asian flu pandemic began during the early months of 1957 but did not reach pandemic proportions in the United States until the fall of that year. However, the era of jet travel has made it more likely that another pandemic will propagate more rapidly. Early detection of an emerging influenza virus and timely intervention will certainly demand a concerted global effort. The use of antiviral drugs has shown efficacy in the prevention and treatment of influenza. The distribution of such drugs, which would need to be readily available in large amounts at the beginning of an outbreak, could limit the progression of the infection until an ample supply of vaccine becomes available.
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Blakely, Debra E. Mass Mediated Disease: A Case Study Analysis of Three Flu Pandemics and Public Health Policy. Lanham, Md.: Lexington Books, 2006. Examines how media reports of the 1918-1919, 1957-1958, and 1968 influenza pandemics influenced public health policies in the United States. -
Davis, Mike. The Monster at Our Door. New York: New Press, 2005. Discusses the threat of avian influenza, which emerged in the early twenty-first century, as well as the failure of timely immunizations in the 1957-1958 pandemic. -
Dunn, Frederick. “Pandemic Influenza in 1957: Review of International Spread of New Asian Strain.” Journal of the American Medical Association 166 (March 8, 1958): 1140-1148. A detailed, chronological account of the global spreading of the Asian flu virus in 1957-1958. -
Knobler, Stacey L., et al., eds. The Threat of Pandemic Influenza: Are We Ready? Washington, D.C.: National Academy Press, 2005. Weighs the threat of a new influenza pandemic and discusses the management of earlier flu pandemics. -
Nicholson, Karl G., Robert G. Webster, and Alan J. Hay, eds. Textbook of Influenza. Malden, Mass.: Blackwell Science, 1998. First chapter provides a historic background on influenza pandemics. -
Pyle, Gerald. “New Events and Old Assumptions: The 1950’s.” In The Diffusion of Influenza: Patterns and Paradigms, edited by Gerald F. Pyle. Totowa, N.J.: Rowman & Littlefield, 1986. Traces the progress of the H2N2 virus of 1957-1958 within the United States. -
Silverstein, Arthur M. Pure Politics and Impure Science: The Swine Flu Affair. Baltimore: Johns Hopkins University Press, 1981. Discusses the role of politics in decisions pertinent to threatening influenza outbreaks. -
Taubenberger, Jeffery K., and David M. Morens, eds. “Influenza Revisited.” Emerging Infectious Diseases 12, no. 1 (January, 2006). Available at http://www .cdc.gov/ncidod/EID/vol12no01/05-1442.htm. The introductory article of a special issue examining the state of influenza in the early twenty-first century. Also includes discussion of the 1957-1958 and other flu pandemics. -
Treanor, John. “Influenza Virus.” In Principles and Practice of Infectious Diseases, edited by Gerald Mandell, John E. Bennett, and Raphael Dolin. 6th ed. New York: Elsevier/Churchill Livingstone, 2005. Excellent discussion of the role of antigenic variation in the development of influenza epidemics and pandemics.
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