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Epidemiology and Surveillance: Lessons from Past Pandemics

Epidemiology and Surveillance: Lessons from Past Pandemics. Arnold S. Monto, MD Professor of Epidemiology University of Michigan School of Public Health Founding Director University of Michigan Bioterrorism Preparedness Initiative Ann Arbor, MI. Basic Questions.

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Epidemiology and Surveillance: Lessons from Past Pandemics

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  1. Epidemiology and Surveillance: Lessons from Past Pandemics Arnold S. Monto, MD Professor of Epidemiology University of Michigan School of Public Health Founding Director University of Michigan Bioterrorism Preparedness Initiative Ann Arbor, MI

  2. Basic Questions • When will the virus arrive and spread? How long from the source? • What will the principal age and other risk groups be? • How many will be affected? • Morbidity? • Mortality?

  3. Source of Pandemic Viruses

  4. Effects of Past Pandemics on the US Source: NVPO.

  5. The 1918 Pandemic in Asia and Africa: Influenza-Associated Deaths • Asia • India: 12.5 million deaths (higher than bubonic plague) • Japan: 257,000 deaths • Rest of Asia: 3,000,000 deaths • Africa • Union of South Africa: 139,471 deaths out of 6,100,000 population • Madagascar: 114,000 deaths out of 3,250,000 population Jordan, ED. Epidemic Influenza, AMA. Chicago, 1927.

  6. Review of Past Pandemics • Age Specificity: • Traditional view: “U” or “J” shaped curves in most pandemics; “W” shaped curve in 1918. • Variations: 1889-1890—Reports from UK of high mortality in young adults • Sparing of elderly in 1918 • Relatively higher death rates in young adults in more recent pandemics • Will past history predict the future?

  7. Pneumonia and Influenza Mortality in Influenza Pandemics *Modified from Dauer & Serfling. Am Rev Resp Dis. 1961; 83:15-28.

  8. Age-Specific Influenza Death Rates Among Females in England and Wales, 1918  Nguyen-Van-Tam, JS, et al. Vaccine. 2003;21:762-68.

  9. 1957

  10. Influenza Attack Rates by Age in Tangipahoa Parish, Louisiana: August, 1957 Langmuir AD. Am Rev Resp Dis. 1961;83:5.

  11. 1968

  12. Weekly Incidence of Influenza-like Diseasesin Hong Kong: June to September 1968 June July Aug. Sept. Week Ending *Cockburn et al. Origin and progress of the 1968-69 Hong Kong Influenza epidemic. Bull. Wld Hlth Org. 1969;41:345-8.

  13. Peak Influenza Activity in the US by State and Week: 1968-69 Oct. Nov. Dec. Jan. Feb. Week Beginning *Sharrar RG. National Influenza Experience in the USA, 1968-69. Bull. Wld Hlth Org. 1969;41:361-6.

  14. Number of Episodes of Illness, Healthcare, Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios* *Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics. Source: NVPO.

  15. Conclusions • The 1918 outbreak was unique in terms of numbers of persons involved and age groups affected. There is a question as to whether 1889-90 affected young adults disproportionately. • It is difficult from historic records to document the presence or effect of the 1918 virus before the second wave. Once that wave began, it spread quickly. • The 1957 virus probably spread for at least 6 weeks in China, starting in February, before emerging. It affected South America before spreading to North America in the early autumn. • The spread of the 1968 virus was well documented from Hong Kong in July. The peak in the US was December-January. • Numbers affected in the future will be based on multiple factors currently unknown, and any estimates must be viewed as provisional.

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