The Spanish flu

IF 3.2 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Patrick Berche
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引用次数: 7

Abstract

The Spanish flu occurred at the end of the First world war, in disastrous epidemiological conditions on populations exhausted by four years of war. At that time, there were no vaccines, no antibiotics, no oxygen and no resuscitation. It was even thought that the infectious agent was a bacterium. Humanity was poorly equipped to fight against a pandemic that caused 50–100 million deaths. The first palpable signs of the outbreak were the rapidly spreading multiple epidemics among young recruits in the American military training camps in March 1918. The flu then spread to the civilian populations and circled the globe twice, sparing no country, even the most remote islands, in tropical as well as polar climates, evolving in successive waves up until April 1919. The first was mild (lethality 0.21%), the second was lethal (lethality 2–4%), and during the third wave, lethality declined (1%), after which the flu became seasonal, with low lethality (0.1%). Between 20 and 40 years of age, patients often died within a few days of pneumonia, with respiratory distress leading to cyanosis, frequently associated with bacterial superinfection. The influenza virus, Myxovirus influenzae, was first discovered in 1931 by Richard Shope in pigs, and then in 1933 by Wilson Smith, Patrick Laidlaw and Christopher Andrews in humans during a seasonal influenza epidemic in London. In 1943, it was first observed under the electron microscope. Hemagglutinin and neuraminidase, the two main virulence factors, were discovered in the 1940s by George Hirst and Alfred Gottschalk. An RNA virus composed of 13,500 nucleotides in eight segments, it was initially sequenced in the 1980s, when Jeffrey Taubenberger determined the complete nucleotide sequence of the 1918 virus from lung tissue samples from patients who died of influenza. The 1918 H1N1 virus was found to have originated in birds. In 2005, it was successfully resuscitated in cell culture. It is 40,000 times more virulent in primates than the seasonal H1N1 virus. The lethality of the second wave could have been due to mutations in the hemagglutinin H1 gene, which would have resulted in a stronger affinity for α,2–6 galactose sialic acids, the virus' receptors on human epithelial cells. That said, the origin of the Spanish flu virus remains controversial. It probably emerged and circulated in the population before March 1918 in America, although European origin has also been evoked. The high mortality in the 20–40 age group remains an enigma. Some experts point to reduced immune response in patients previously exposed to related viral hemagglutinins during the 1889 pandemic. In any event, even though it concerns a markedly different virus, the history of the Spanish flu sheds light on the difficulties of management during today's pandemic.

西班牙流感
西班牙流感发生在第一次世界大战结束时,在因四年战争而疲惫不堪的人口中造成了灾难性的流行病。当时,没有疫苗,没有抗生素,没有氧气,也没有复苏。甚至有人认为传染源是一种细菌。人类在抗击造成5000万至1亿人死亡的大流行病方面装备不足。爆发的第一个明显迹象是1918年3月在美国军事训练营的年轻新兵中迅速蔓延的多种流行病。随后,流感向平民人群传播,两次环绕全球,没有一个国家幸免,即使是最偏远的岛屿,在热带和极地气候下,直到1919年4月,一波接一波地演变。第一次是轻微的(致死率0.21%),第二次是致命的(致死率2-4%),在第三波期间,致死率下降(1%),之后流感成为季节性流感,致死率低(0.1%)。在20至40岁之间,患者通常在肺炎后几天内死亡,呼吸窘迫导致发绀,通常与细菌重复感染有关。1931年,理查德·肖普首先在猪身上发现了流感黏液病毒,1933年,在伦敦季节性流感流行期间,威尔逊·史密斯、帕特里克·莱德劳和克里斯托弗·安德鲁斯在人类身上发现了流感黏液病毒。1943年,人们首次在电子显微镜下观察到它。血凝素和神经氨酸酶是20世纪40年代由乔治·赫斯特和阿尔弗雷德·戈特沙尔克发现的两种主要毒力因子。这是一种由8段13500个核苷酸组成的RNA病毒,最初是在20世纪80年代测序的,当时杰弗里·陶本伯格(Jeffrey Taubenberger)从死于流感的患者的肺组织样本中确定了1918年病毒的完整核苷酸序列。1918年H1N1病毒被发现起源于禽类。2005年,它在细胞培养中成功复苏。它对灵长类动物的毒性是季节性H1N1病毒的4万倍。第二波的致命性可能是由于血凝素H1基因的突变,这可能导致病毒对人类上皮细胞上的α, 2-6半乳糖唾液酸具有更强的亲和力。尽管如此,西班牙流感病毒的起源仍然存在争议。它可能在1918年3月之前在美国出现并在人群中传播,尽管欧洲的起源也被唤起。20-40岁年龄组的高死亡率仍然是个谜。一些专家指出,1889年流感大流行期间,先前接触过相关病毒血凝素的患者免疫反应降低。无论如何,尽管它涉及的是一种明显不同的病毒,但西班牙流感的历史揭示了在今天的大流行期间管理的困难。
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来源期刊
Presse Medicale
Presse Medicale 医学-医学:内科
自引率
3.70%
发文量
40
审稿时长
43 days
期刊介绍: Seule revue médicale "généraliste" de haut niveau, La Presse Médicale est l''équivalent francophone des grandes revues anglosaxonnes de publication et de formation continue. A raison d''un numéro par mois, La Presse Médicale vous offre une double approche éditoriale : - des publications originales (articles originaux, revues systématiques, cas cliniques) soumises à double expertise, portant sur les avancées médicales les plus récentes ; - une partie orientée vers la FMC, vous propose une mise à jour permanente et de haut niveau de vos connaissances, sous forme de dossiers thématiques et de mises au point dans les principales spécialités médicales, pour vous aider à optimiser votre formation.
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