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1918 Flu Puzzle Analyzed

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Los Angeles Times

Published: August 18, 2008

Most deaths in the 1918 influenza pandemic were caused not by the virus alone but by common bacterial infections that overwhelmed victims' weakened immune systems, according to two new studies that could change the strategy for the next pandemic.

"We have to realize that it isn't just antivirals that we need," said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases and co-author of one of the studies.

"We need to make sure that we're prepared to treat people with antibiotics," said Fauci, whose study will be released online this month by the Journal of Infectious Diseases.

In both studies, scientists analyzed a trove of historical documents from around the world, examining firsthand accounts, medical records and autopsy reports.

Writing about the 1918 influenza outbreak in the August issue of the journal Emerging Infectious Diseases, researchers reported that few of the deaths were swift.

But to explain the 1918 pandemic's unusual virulence, many scientists had come to think that the virus caused death by provoking an overzealous, destroy-the-village-to-save-it immune response, especially in young adults with robust immune systems.

The two new studies suggest that the 1918 virus did induce severe immune reactions, particularly among young adults. But what made the reactions so deadly was the destruction of the respiratory system's lining, which made it easier for bacteria to infect the lungs.

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