Links http://www.youtube.com/watch?v=cEN5KGwNGeo http://www.youtube.com/watch?v=5UT7_Sm2564 http://www.youtube.com/watch?

v=X6G4aseKfSo Dystonia Disorder

The dystonias are movement disorders in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures. The movements, which are involuntary and sometimes painful, may affect a single muscle; a group of muscles such as those in the arms, legs, or neck; or the entire body. Those with dystonia usually have normal intelligence and no associated psychiatric disorders.

What are the symptoms of dystonias?

Dystonia can affect many different parts of the body. Early symptoms may include a deterioration in handwriting after writing several lines, foot cramps, and/or a tendency of one foot to pull up or drag; this may occur "out of the blue" or may occur after running or walking some distance. The neck may turn or pull involuntarily, especially when the patient is tired or stressed. Sometimes both eyes will blink rapidly and uncontrollably, rendering a person functionally blind. Other possible symptoms are tremor and voice or speech difficulties. The initial symptoms can be very mild and may be noticeable only after prolonged exertion, stress, or fatigue. Over a period of time, the symptoms may become more noticeable and widespread and be unrelenting; sometimes, however, there is little or no progression.
What Mercury does to the body:

Following is a partial list of the effects mercury has on the body: (1) Mercury aggressively binds to sulphur. Since many proteins have a sulphur binding site in the amino acid cysteine, mercury interferes with numerous phases of protein metabolism which in turn interferes with a massive number of chemical processes in the body. (2) Mercury binds with iodine rendering it useless, causing thyroid starvation and low thyroid function. Symptoms can be low energy, "brain fog", depression, and weight gain. (3) Mercury binds with selenium causing selenium depletion which can have many debilitating effects on the body including a weakened heart and cartilage degeneration. (4) Mercury interferes with the methylation of B-12 causing a rise in homocysteine which in turn causes high cholesterol, heart attacks, and numerous other heart-related issues. (5) Mercury binds to tubulin and actin which make up parts of nerve cells. This in turn causes the cells to quickly deteorate causing the failure of the nerve cell and Alzheimer's-like signatures.

(6) Mercury causes mutations to intestinal flora (friendly bacteria). These mutated bacteria eat the intestinal lining leading to IBS and eventually, allergies. This is why many autistic children have IBS and general digestive issues and eventually have to go on special allergy diets. (7) Mercury has severe depressive effects on the immune system leading to candida (yeast) and frequent general illness. (8) Mercury harbors itself in body tissues so conventional hospital tests are useless to detect it. In fact, these tests will show low mercury levels in hair, blood, and urine. You have to look for special patterns in blood work (called signatures) such has elevated calcium. (9) Calcium is elevated because mercury displaces magnesium which is necessary for calcium utilization. When this happens, constipation results in some people, while diarrhea results in others. This also causes muscle twitching, cramps and other symptoms known to be associated with low calcium and magnesium. In the long term, this can lead to osteoperosis and arthritis. Other symptoms include migraines, frequent cramps, and achy joints and muscles. (10) Mercury prevents the conversion of T4 thyroid hormone to T3 which causes low energy, "brain fog", depression, and numerous symptoms that are known to be associated with low T3. Again, hospital tests for thyroid conditions usually test T4 levels only and completely ignore T3 levels. This causes numerous false "You're OKs" when severe issues with T3 levels actually exist. (11) Mercury interferes with the action of vitamin C causing numerous issues from weak bones to joint issues to circulatory issues and frequent bruising. This can even lead to spider veins and other health problems well-known to be associated with chronic low vitamin C levels. (12) Mercury causes cell mutations which can lead to cancer and moles. When you see someone with numerous moles or "skin tags" around the lymph-drainage areas (neck, underarms, or inner thighs), they are likely to be in stage 3 mercury intoxication. (13) Mercury is well-known to cause miscarriage, birth defects, and cancer. California dentists are required to post a notification in their office notifying patients about these dangers of mercury from amalgam ("silver") fillings. (14) Mercury raises DHT (Dihydrotestosterone) levels which leads to oily skin and baldness. It can also lead to excessive facial hair on woman and increased muscularity in men and women. (15) Mercury interferes with digestive enzyme production causing heartburn, gas, bloating, and other digestive issues. (16) Mercury interferes with hormone production causing various emotional issues in both men and women. It migrates to several organs including the sulphur-rich brain and changes brain chemistry and behavior in children and adults.

(17) Mercury interferes with the circadian rhythm causing some people to lose sleep or have trouble getting to sleep while other people become "night owls". (18) Mercury interferes with insulin production and metabolism causing hypoglycemia in some, diabetes in others. You may also be interested to know... Mercury levels in unborn babies are much higher than in the mother.

FDA Approves Vaccines for 2009 H1N1 Influenza Virus Approval Provides Important Tool to Fight Pandemic
The U.S. Food and Drug Administration announced today that it has approved four vaccines against the 2009 H1N1 influenza virus. The vaccines will be distributed nationally after the initial lots become available, which is expected within the next four weeks. Today's approval is good news for our nation's response to the 2009 H1N1 influenza virus, said Commissioner of Food and Drugs Margaret A. Hamburg, M.D. This vaccine will help protect individuals from serious illness and death from influenza. The vaccines are made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and sanofi pasteur Inc. All four firms manufacture the H1N1 vaccines using the same processes, which have a long record of producing safe seasonal influenza vaccines. The H1N1 vaccines approved today undergo the same rigorous FDA manufacturing oversight, product quality testing and lot release procedures that apply to seasonal influenza vaccines, said Jesse Goodman, M.D., FDA acting chief scientist. Based on preliminary data from adults participating in multiple clinical studies, the 2009 H1N1 vaccines induce a robust immune response in most healthy adults eight to 10 days after a single dose, as occurs with the seasonal influenza vaccine. Clinical studies under way will provide additional information about the optimal dose in children. The recommendations for dosing will be updated if indicated by findings from those studies. The findings are expected in the near future. As with the seasonal influenza vaccines, the 2009 H1N1 vaccines are being produced in formulations that contain thimerosal, a mercury-containing preservative, and in formulations that do not contain thimerosal. People with severe or life-threatening allergies to chicken eggs, or to any other substance in the vaccine, should not be vaccinated. In the ongoing clinical studies, the vaccines have been well tolerated. Potential side effects of the H1N1 vaccines are expected to be similar to those of seasonal flu vaccines.

For the injected vaccine, the most common side effect is soreness at the injection site. Other side effects may include mild fever, body aches, and fatigue for a few days after the inoculation. For the nasal spray vaccine, the most common side effects include runny nose or nasal congestion for all ages, sore throats in adults, and -- in children 2 to 6 years old -- fever. As with any medical product, unexpected or rare serious adverse events may occur. The FDA is working closely with governmental and nongovernmental organizations to enhance the capacity for adverse event monitoring, information sharing and analysis during and after the 2009 H1N1 vaccination program. In the U.S. Department of Health and Human Services, these agencies include the Centers for Disease Control and Prevention. Vaccines against three seasonal virus strains are already available and should be used (see information on the seasonal flu). However, they do not protect against the 2009 H1N1 virus (see information on H1N1 flu).

Seasonal Flu Basics

Influenza (the flu) is a contagious respiratory illness caused by influenza viruses. It spreads from person-to-person and can cause mild to severe illness; and in some cases, can lead to death.
y y y y

In the United States, yearly outbreaks of seasonal flu usually happen during the fall through early spring. The best way to prevent the flu is by getting a flu vaccination each year. Flu viruses can cause illness in people of any age group. Children are most likely to get sick because their immune systems aren t strong enough to fight off the infection. Some groups are more likely to have complications from the seasonal flu. These include: o those age 65 and older o children younger than 2 years old o people of any age who have chronic medical conditions (e.g. diabetes, asthma, congestive heart failure, lung disease) Complications from the flu can include: o bacterial pneumonia o ear or sinus infections o dehydration o worsening of chronic medical conditions

H1N1 update During the week of October 11-17, 2009, influenza activity continued to increase in the United States as reported in FluView. Flu activity is now widespread in 46 states. Nationwide, visits to doctors for influenza-like-illness are increasing steeply and are now higher than what is seen at the peak of many regular flu seasons. In addition, flu-related hospitalizations and deaths continue to go up nation-wide and are above what is expected for this time of year. Flu View

2009-2010 Influenza Season Week 41 ending October 17, 2009

All data are preliminary and may change as more reports are received.

Synopsis:
During week 41 (October 11-17, 2009), influenza activity increased in the U.S.
y

y y y

y y

4,855 (37.5%) specimens tested by U.S. World Health Organization (WHO) and National Respiratory and Enteric Virus Surveillance System (NREVSS) collaborating laboratories and reported to CDC/Influenza Division were positive for influenza. All subtyped influenza A viruses being reported to CDC were 2009 influenza A (H1N1) viruses. The proportion of deaths attributed to pneumonia and influenza (P&I) was above the epidemic threshold. Eleven influenza-associated pediatric deaths were reported. Nine of these deaths were associated with 2009 influenza A (H1N1) virus infection and two were associated with an influenza A virus for which subtype is undetermined. The proportion of outpatient visits for influenza-like illness (ILI) was above the national baseline. All 10 regions reported ILI above region-specific baseline levels. Forty-six states reported geographically widespread influenza activity, Guam and three states reported regional influenza activity, one state, the District of Columbia, and Puerto Rico reported local influenza activity, and the U.S. Virgin Islands did not report.

U.S. Virologic Surveillance:

WHO and NREVSS collaborating laboratories located in all 50 states and Washington D.C. report to CDC the number of respiratory specimens tested for influenza and the number positive by influenza type and subtype. The results of tests performed during the current week are summarized in the table below.
Week 41 No. of specimens tested No. of positive specimens (%) Positive specimens by type/subtype Influenza A A (2009 H1N1) A (subtyping not performed) 4,844 (99.8%) 3,378 (69.7%) 1,436 (29.6%) 12,943 4,855 (37.5%)

A (unable to subtype) A (H3) A (H1) Influenza B

30 (0.6%) 0 (0.0%) 0 (0.0%) 11 (0.2%)

During week 41, influenza B viruses co-circulated at low levels with 2009 influenza A (H1N1) viruses. All subtyped influenza A viruses reported to CDC this week were 2009 influenza A (H1N1) viruses.

Pneumonia and Influenza Hospitalization and Death Tracking:

This new system was implemented on August 30, 2009, and replaces the weekly report of laboratory confirmed 2009 H1N1-related hospitalizations and deaths that began in April 2009. Jurisdictions can now report to CDC either laboratory confirmed or pneumonia and influenza syndromic-based counts of hospitalizations and deaths resulting from all types or subtypes of influenza, not just those from 2009 H1N1 influenza virus. To allow jurisdictions to implement the new case definition, counts were reset to zero on August 30, 2009. From August 30 October 17, 2009, 8,204 laboratory-confirmed influenza associated hospitalizations, 411 laboratory-confirmed influenza associated deaths, 21,823 pneumonia and influenza syndromebased hospitalizations, and 2,416 pneumonia and influenza syndrome-based deaths, were reported to CDC. CDC will continue to use its traditional surveillance systems to track the progress of the 2009-10 influenza season.

Antigenic Characterization:
CDC has antigenically characterized 137 2009 influenza A (H1N1) viruses collected since September 1, 2009. No seasonal A(H1N1), A(H3N2) or B viruses collected during this period were available for testing. All 137 2009 A (H1N1) viruses are related to the A/California/07/2009 (H1N1) reference virus selected by WHO as the 2009 H1N1 vaccine virus. Annual influenza vaccination is expected to provide the best protection against those virus strains that are related to the vaccine strains, but limited to no protection may be expected when the vaccine and circulating virus strains are so different as to be from different lineages. Antigenic characterization of 2009 influenza A (H1N1) viruses indicates that these viruses are only distantly related antigenically and genetically to seasonal influenza A (H1N1) viruses, suggesting that little to no protection would be expected from vaccination with seasonal influenza vaccine.

Antiviral Resistance:
Since September 1, 2009, 114 2009 influenza A (H1N1) virus isolates have been tested for resistance to the neuraminidase inhibitors (oseltamivir and zanamivir). In addition, 466 2009 influenza A (H1N1) original clinical samples were tested for a single known mutation in the virus that confers oseltamivir resistance. Because of the low level of circulation of seasonal influenza A (H1N1), A (H3N2), and influenza B viruses, no samples collected since September 1, 2009 were available for antiviral resistance testing. Additional laboratories perform antiviral testing and report their results to CDC. The results of antiviral resistance testing performed on these viruses are summarized in the table below.
Antiviral Resistance Testing Results on Samples Collected Since September 1, 2009. Samples tested (n) Resistant Viruses, Number (%) Oseltamivir Seasonal Influenza A (H1N1) Influenza A (H3N2) Influenza B 2009 Influenza A (H1N1) Samples tested (n) Resistant Viruses, Number (%) Zanamivir

0 (0)

0 (0)

0 0 580 3

0 (0) 0 (0) (0.5)

0 0 114

0 (0) 0 (0) 0 (0)

Key Flu Indicators

October 23, 2009, 11:30 AM Each week CDC analyzes information about influenza disease activity in the United States and publishes findings of key flu indicators in a report called FluView. During the week of October 11-17, 2009, a review of the key indictors found that influenza activity continued to increase in the United States from the previous week. Below is a summary of the most recent key indicators:
y

y y

Visits to doctors for influenza-like illness (ILI) increased steeply since last week in the United States, and overall, are much higher than what is expected for this time of the year. ILI activity now is higher than what is seen during the peak of many regular flu seasons. Total influenza hospitalization rates for laboratory-confirmed flu are climbing and are higher than expected for this time of year. The proportion of deaths attributed to pneumonia and influenza (P&I) based on the 122 Cities Report has increased and has been higher than what is expected at this time of year for two weeks. In addition, 11 flu-related pediatric deaths were reported this week; 9 of these deaths

were confirmed 2009 H1N1, and two were influenza A viruses, but were not subtyped. Since April 2009, CDC has received reports of 95 laboratory-confirmed pediatric 2009 H1N1 deaths and another 7 pediatric deaths that were laboratory confirmed as influenza, but where the flu virus subtype was not determined. Forty-six states are reporting widespread influenza activity at this time. They are: Alabama, Alaska, Arizona, Arkansas, California, Colorado, Delaware, Florida, Georgia, Idaho, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, Nevada, New Hampshire, New Mexico, New York, North Carolina, North Dakota, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin, and Wyoming. This many reports of widespread activity are unprecedented during seasonal flu. Almost all of the influenza viruses identified so far are 2009 H1N1 influenza A viruses. These viruses remain similar to the virus chosen for the 2009 H1N1 vaccine, and remain susceptible to the antiviral drugs oseltamivir and zanamivir with rare exception.

As many as 5 million in US infected with H1N1-study

Thu Oct 29, 2009 4:13pm EDT

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* Up to 20,000 people hospitalized through July 23-CDC * 6 percent of hospitalized people die, study finds * CDC says 24.8 million doses of H1N1 vaccine available By Julie Steenhuysen CHICAGO, Oct 29 (Reuters) - As many as 5.7 million Americans were infected with the H1N1 virus between April and late July, U.S. researchers said on Thursday, offering the clearest picture yet of how quickly and widely swine flu can spread.

Researchers used computer models to estimate the number of people who have contracted swine flu, which began infecting Americans in April. They estimated that 1.8 million to 5.7 million cases of swine flu occurred between April and July 23, sending between 9,000 and 20,000 people to the hospital. About 6 percent of people who were hospitalized with the virus died, the team, led by Carrie Reed at the U.S. Centers for Disease Control and Prevention, reported in the journal Emerging Infectious Diseases. This suggests that as many as 1,300 people died from their infections between April and July. Officially, 1,000 U.S. deaths have been attributed to H1N1 since April. Dr. Anne Schuchat of the CDC said on Thursday the agency does not have an update beyond July 24. "We do believe many millions of people have already contracted this virus in the United States," Schuchat said. "It's probably now well more than 20,000 hospitalizations," she said. "Really, the priority is to minimize illness and death." Part of the U.S. plan to do that was through widespread vaccinations, but manufacturing delays have stalled those efforts. "We had all hoped to have more vaccine now than we have," Schuchat said. Earlier government estimates had suggested there would be as many as 40 million vaccine doses available for state and local health authorities to distribute by the end of October. Schuchat said 24.8 million doses of the H1N1 vaccine are available, 1.6 million more doses than on Wednesday. The United States has ordered up to 250 million doses of H1N1 vaccine from five companies -- MedImmune, a unit of AstraZeneca (AZN.L), Sanofi-Aventis (SASY.PA), Australia's CSL (CSL.AX), GlaxoSmithKline (GSK.L) and Novartis (NOVN.VX). Except for MedImmune, all had problems making vaccine at first and are still struggling to make the virus grow in eggs, the first step to manufacturing influenza vaccine. Schuchat said state and local health departments have had to adapt their vaccination plans to cope with the delays, and dole out a limited number of doses to people at greatest risk of developing severe disease from H1N1, including people with underlying health conditions and women who are pregnant. Several studies released at the meeting of the Infectious Diseases Society of America in Philadelphiaon Thursday showed that vaccinating pregnant women protected their babies, also. They said babies were less likely to be premature and were bigger if their mothers were vaccinated against flu. [ID:nN29244519]

A separate study showed that people who had been taking cholesterol lowering drugs called statins were less likely to die from flu. [ID:nN29369359] (Additional reporting by Maggie Fox in Washington; Editing by Doina Chiacu)

The Facts About the Flu

Many of us have had at least one bout of the flu in our lifetimes. Most of the time, the flu runs its course with few problems but it can lead to serious complications.
By Krisha McCoy Medically reviewed by Pat F. Bass III, MD, MPH

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In any given year, it's estimated that 5 to 20 percent of Americans get the flu, a respiratory illness also known as influenza. The flu can lead to serious complications, sending more than 200,000 U.S. residents to hospitals each year. In the United States, the flu kills about 36,000 people annually. Each year, the flu spreads in the late fall and winter. In a community, these epidemics usually peak after three weeks and begin to decrease after an additional three to four weeks. There are three types of influenza viruses: A, B, and C. Types A and B are the most common and usually cause serious epidemics every winter; type C is milder and hasn't been linked to any major outbreak. Flu viruses spread through tiny droplets of fluid that contain the virus. When people with the flu cough, sneeze, or touch something after wiping their noses or mouths, they can pass these droplets to the next person. When others inhale infected droplets from the air or make contact with infected surfaces and then touch their mouths or noses, they can become infected. People with the flu can pass their illness to others as early as one day before symptoms develop and up to five days after they get sick. What Are the Symptoms of the Flu? If you are infected with the flu virus, your symptoms probably will develop one to four days later. Flu symptoms usually come on suddenly and may include:
y y y y y

High fever Digestive issues like vomiting and diarrhea Chills Fatigue Body aches

Dry cough and runny nose

In some cases, the flu can lead to other, more serious complications, especially in young children, older adults, and people with preexisting health conditions. Complications of the flu may include:
y y y y y

Pneumonia Ear or sinus infection Convulsions Worsening of a pre-existing condition Confusion or delirium

How to Manage the Flu? Most people can reduce their risk of developing the flu by getting the annual flu vaccine in early fall. Note that the flu vaccine is not approved for children younger than 6 months of age. However, you should not get the flu vaccine without consulting your doctor first especially if you've previously had a severe reaction to the flu vaccine, have an allergy to eggs, have a moderate to severe illness with a fever, or have developed Guillian-Barre syndrome within six weeks of getting a flu vaccine. Call your doctor if your fever lasts more than three days or your symptoms persist for two weeks, you exhibit other worrisome symptoms like disorientation and chest pain, or you have signs of a complication like pneumonia. Your doctor may perform a blood test to identify the specific virus that is causing your symptoms. When you have the flu, you can usually manage your symptoms by getting plenty of rest, avoiding cigarette smoke, drinking lots of fluids, and taking over-the-counter flu medication to manage symptoms. In some cases, your doctor may prescribe an antiviral medication, such as oseltamivir (Tamiflu) or zanamivir (Relenza), to reduce the length of your illness. Expect your flu symptoms to begin improving within a week to 10 days. But, even after you feel better, don't be surprised if some of your symptoms, especially a cough or fatigue, linger a little while longer.

The Truth About Flu Pandemics

How do flu pandemics occur, and how can they be prevented?
By Linda Melone Medically reviewed by Pat F. Bass III, MD, MPH

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Flu pandemics occur when a new influenza (or flu) virus emerges for which people have no or little immunity and no vaccine exists. The lack of immunity enables the disease to spread quickly from person to person and across an entire country. The flu pandemic of 1918, for example, killed an estimated 50 million people worldwide. "Wherever and whenever a pandemic starts, everyone around the world is at risk," says Curtis Allen, spokesman for the Centers for Disease Control and Prevention. "Through measures such as border closures and travel restrictions, countries might delay arrival of the virus, but they cannot stop it." Should You Worry About a Flu Pandemic? "Yes, we should worry. Pandemic is a historical, genetic, and mathematical certainty," says Maurice A. Ramirez, DO, PhD, a senior physician-federal medical officer in the National Disaster Medical System and the founding chair of the American Board of Disaster Medicine. "The really bad pandemics happen every 91 years, plus or minus four years." According to the World Health Organization, the current pandemic H1N1 2009 (swine flu) is of "moderate" severity, with the overwhelming majority of patients recovering, even without medical treatment, within a week of the onset of symptoms. A pandemic often manifests in waves that can last for six to eight weeks, according to Allen. The severity of the disease and the number of deaths caused by a pandemic flu virus vary widely, with no accurate way to predict these prior to the emergence of the virus. "Previous pandemics have reached 25 to 35 percent of the population," says Allen. "And under the best circumstances, assuming the virus causes mild disease, the world could experience an estimated 2 million to 7.4 million deaths (according to projections obtained during the 1957 pandemic)."

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A more severe flu pandemic, such as the 1918 pandemic, could affect many more people. "The mortality rate of people in the United States infected with the virus during the pandemic was around 2.5 percent," says Allen. "Huge surges of people requiring medical help would temporarily overwhelm health services. And large numbers of absenteeism would also interrupt law enforcement, transportation, and communications." What Can You Do to Protect Yourself? From a personal standpoint, practicing good hygiene is still our best line of defense, says Ramirez. Be sure to:
y y y

Wash your hands frequently Cough or sneeze into your elbow, facing the floor Avoid sharing utensils and cups

Stay home as much as possible should an outbreak occur

What's Being Done to Prevent Another Flu Pandemic "The United States is working closely with other countries and the World Health Organization (WHO) to strengthen systems to detect outbreaks of influenza that might cause a pandemic," says Allen. "Planning and preparation information and checklists are being prepared for various sectors of society, including information for families and individuals." In addition, the U.S. Department of Health and Human Services and other federal agencies are providing support, funding, and advice to each state to assist with pandemic planning and preparation. State and federal planning, including links to state pandemic plans, can be found on the CDC Web site. The 1918 flu pandemic (commonly referred to as the Spanish Flu) was an influenza pandemic that spread to nearly every part of the world. It was caused by an unusually virulent and deadly influenza A virus strain of subtype H1N1. Historical and epidemiological data are inadequate to identify the geographic origin of the virus.[1] Most of its victims were healthy young adults, in contrast to most influenza outbreaks which predominantly affect juvenile, elderly, or otherwise weakened patients. The flu pandemic has also been implicated in the sudden outbreak of encephalitis lethargica in the 1920s.[2] The pandemic lasted from March 1918 to June 1920,[3] spreading even to the Arctic and remote Pacific islands. It is estimated that anywhere from 50 to 100 million people were killed worldwide which is from three to seven times the casualties of the First World War (15 million).[4][5][6][7][8] An estimated 50 million people, about 3% of the world's population (approximately 1.6 billion at the time), died of the disease. An estimated 500 million, or 1/3 were infected.[5] Scientists have used tissue samples from frozen victims to reproduce the virus for study. Given the strain's extreme virulence there has been controversy regarding the wisdom of such research. Among the conclusions of this research is that the virus kills via a cytokine storm (overreaction of the body's immune system) which explains its unusually severe nature and the concentrated age profile of its victims. The strong immune systems of young adults ravaged the body, whereas the weaker immune systems of children and middle-aged adults caused fewer deaths.[9] The global mortality rate from the 1918/1919 pandemic is not known, but it is estimated that 10% to 20% of those who were infected died. With about a third of the world population infected, this case-fatality ratio means that 3% to 6% of the entire global population died.[12] Influenza may have killed as many as 25 million in its first 25 weeks. Older estimates say it killed 4050 million people[4] while current estimates say 50100 million people worldwide were killed.[13] This pandemic has been described as "the greatest medical holocaust in history" and may have killed more people than the Black Death.[14] As many as 17 million died in India, about 5% of India's population at the time.[15] In Japan, 23 million people were affected, and 390,000 died.[16] In the U.S., about 28% of the population

suffered, and 500,000 to 675,000 died.[17] In Britain as many as 250,000 died; in France more than 400,000.[18] In Canada approximately 50,000 died.[19] Entire villages perished in Alaska[20] and southern Africa.[which?] Ras Tafari (the future Haile Selassie) was one of the first Ethiopians who contracted influenza but survived,[21] although many of his subjects did not; estimates for the fatalities in the capital city, Addis Ababa, range from 5,000 to 10,000, with some experts opining that the number was even higher,[22] while in British Somaliland one official there estimated that 7% of the native population died from influenza.[23] In Dutch East Indies (now Indonesia), around 1.5 million assumed died from 30 million inhabitants.[24] In Australia an estimated 12,000 people died and in the Fiji Islands, 14% of the population died during only two weeks, and in Western Samoa 22%. This huge death toll was caused by an extremely high infection rate of up to 50% and the extreme severity of the symptoms, suspected to be caused by cytokine storms.[4] Indeed, symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. One observer wrote, "One of the most striking of the complications was hemorrhage from mucous membranes, especially from the nose, stomach, and intestine. Bleeding from the ears and petechial hemorrhages in the skin also occurred."[13] The majority of deaths were from bacterial pneumonia, a secondary infection caused by influenza, but the virus also killed people directly, causing massive hemorrhages and edema in the lung.[10] The unusually severe disease killed between 2 and 20% of those infected, as opposed to the more usual flu epidemic mortality rate of 0.1%.[10][13] Another unusual feature of this pandemic was that it mostly killed young adults, with 99% of pandemic influenza deaths occurring in people under 65, and more than half in young adults 20 to 40 years old.[25] This is unusual since influenza is normally most deadly to the very young (under age 2) and the very old (over age 70), and may have been due to partial protection caused by exposure to a previous Russian flu pandemic of 1889.[26]

[edit] Origins of name

Although the first cases of the disease were registered in the continental U.S, and the rest of Europe long before getting to Spain, the 1918 Flu received its nickname "Spanish flu" because Spain, a neutral country in WWI, had no special censorship for news against the disease and its consequences. Hence the most reliable news on the disease came from Spain, giving the false impression that Spain was the mostif not the onlyaffected zone.[27]

[edit] History
While World War I did not cause the flu, the close troop quarters and massive troop movements hastened the pandemic and probably increased transmission, augmented mutation and may have increased the lethality of the virus. Some researchers speculate that the soldiers' immune systems were weakened by malnourishment as well as the stresses of combat and chemical attacks, increasing their susceptibility to the disease.[28] Price-Smith has made the controversial argument that the virus helped tip the balance of power in the latter days of the war towards the Allied cause. Specifically, he provides data that the viral waves hit the Central Powers before they hit

the Allied powers, and that both morbidity and mortality in Germany and Austria were considerably higher than in Britain and France.[29] A large factor of worldwide flu occurrence was increased travel. Modern transportation systems made it easier for soldiers, sailors, and civilian travelers to spread the disease quickly to communities worldwide.

[edit] Geographic sources

Some scholars have theorized that the flu probably originated in the Far East.[30] Dr. C. Hannoun, leading expert of the 1918 flu for the Institut Pasteur, theorized that the former virus was likely to have come from China, mutated in the United States near Boston, and spread to Brest, France, Europe's battlefields, Europe, and the world using Allied soldiers and sailors as main spreaders.[31] Hannoun considered several other theories of origin, such as Spain, Kansas, and Brest, as being possible but not likely. Historian Alfred W. Crosby observed that the flu seems to have originated in Kansas.[32] Political scientist Andrew Price-Smith published data from the Austrian archives suggesting that the influenza had earlier origins, beginning in Austria in the spring of 1917.[33] Popular writer John Barry echoed Crosby in describing Haskell County, Kansas as the likely point of origin.[34] In the United States the disease was first observed at Fort Riley, Kansas, on March 4, 1918,[35] and Queens, New York, on March 11, 1918. In August 1918, a more virulent strain appeared simultaneously in Brest, France, in Freetown, Sierra Leone, and in the U.S. at Boston, Massachusetts. The Allies of World War I came to call it the Spanish flu, primarily because the pandemic received greater press attention after it moved from France to Spain in November 1918. Spain was not involved in the war and had not imposed wartime censorship.[36] Investigative work by a British team, led by virologist John Oxford[37] of St Bartholomew's Hospital and the Royal London Hospital, has suggested that a principal British troop staging camp in taples, France was at the center of the 1918 flu pandemic, or was the location of a significant precursor virus.[38]

[edit] Patterns of fatality

The influenza strain was unusual in that this pandemic killed many young adults and otherwise healthy victims; typical influenzas kill mostly weak individuals, such as infants (aged 02 years), the elderly, and the immunocompromised. Older adults may have had some immunity from the earlier Russian flu pandemic of 1889.[26] Another oddity was that the outbreak was widespread in the summer and autumn (in the Northern Hemisphere); influenza is usually worse in winter.[39] In fast-progressing cases, mortality was primarily from pneumonia, by virus-induced pulmonary consolidation. Slower-progressing cases featured secondary bacterial pneumonias, and there may have been neural involvement that led to mental disorders in some cases. Some deaths resulted from malnourishment and even animal attacks in overwhelmed communities.[40]

[edit] Deadly second wave

The second wave of the 1918 pandemic was much deadlier than the first. The first wave had resembled typical flu epidemics; those most at risk were the sick and elderly, while younger, healthier people recovered easily. But in August, when the second wave began in France, Sierra Leone and the United States,[41] the virus had mutated to a much deadlier form. This has been attributed to the circumstances of the First World War.[42] In civilian life evolutionary pressures favour a mild strain: those who get really sick stay home, and those mildly ill continue with their lives, go to work and go shopping, preferentially spreading the mild strain. In the trenches the evolutionary pressures were reversed: soldiers with a mild strain remained where they were, while the severely ill were sent on crowded trains to crowded field hospitals, spreading the deadlier virus. So the second wave began and flu quickly spread around the world again.[43] It was the same flu, in that most of those who recovered from first-wave infections were immune, but it was now far more deadly, and the most vulnerable people were those who were like the soldiers in the trenchesyoung, otherwise healthy adults.[44] Consequently, during modern pandemics, health officials pay attention when the virus reaches places with social upheaval, looking for deadlier strains of the virus.[43]

[edit] Devastated communities

Chart of deaths in major cities

Even in areas where mortality was low, so many people were incapacitated that much of everyday life stopped. Some communities closed all stores or required customers to leave their orders outside. There were many reports of places where the health-care workers could not tend the sick nor the grave-diggers bury the dead because they too were ill. Mass graves were dug by steam shovel and bodies buried without coffins in many places.[45] Several Pacific island territories were particularly hard-hit. The pandemic reached them from New Zealand, which was too slow to implement measures to prevent ships carrying the flu from leaving its ports. From New Zealand the flu reached Tonga (killing 8% of the population), Nauru (16%) and Fiji (5%, 9,000 people). Worst affected was Western Samoa, a territory then under New Zealand military administration. A crippling 90% of the population was infected; 30% of adult men, 22% of adult women and 10% of children were killed. By contrast, the flu was kept away from American Samoa by a commander who imposed a blockade.[46] In New Zealand itself 8,573 deaths were attributed to the 1918 pandemic influenza, resulting in a total population fatality rate of 7.4 per thousand (0.74%) .[47]

[edit] Less affected areas

In Japan, 257,363 deaths were attributed to influenza by July 1919, giving an estimated 0.425% mortality rate, much lower than nearly all other Asian countries for which data are available. The Japanese government severely restricted maritime travel to and from the home islands when the pandemic struck. In the Pacific, American Samoa[48] and the French colony of New Caledonia[49] also succeeded in preventing even a single death from influenza through effective quarantines. In Australia, nearly 12,000 perished.[50]

[edit] End of the pandemic

After the lethal second wave struck in the autumn of 1918, the disease died down abruptly. New cases almost dropped to nothing after the peak in the second wave.[9] In Philadelphia for example, 4,597 people died in the week ending October 16, but by November 11 influenza had almost disappeared from the city. One explanation for the rapid decline of the lethality of the disease is that doctors simply got better at preventing and treating the pneumonia which developed after the victims had contracted the virus, although John Barry states in his book that researchers have found no evidence to support this. Another theory holds that the 1918 virus mutated extremely rapidly to a less lethal strain. This is a common occurrence with influenza viruses: there is a general tendency for pathogenic viruses to become less lethal with time, providing more living hosts.[9]

[edit] Cultural impact

The examples and perspective in this article may not represent a worldwide view of the subject. Please improve this article and discuss the issue on the talk page.

American Red Cross nurses tend to flu patients in temporary wards set up inside Oakland Municipal Auditorium, 1918

In the United States, the United Kingdom and other countries, despite the relatively high morbidity and mortality rates that resulted from the epidemic in 19181919, the Spanish flu began to fade from public awareness over the decades until the arrival of news about bird flu and other pandemics in the 1990s and 2000s.[51] This has led some historians to label the Spanish flu a "forgotten pandemic".[32] One of the few major works of American literature written after 1918

that deals directly with the Spanish flu is Katherine Anne Porters Pale Horse, Pale Rider. In 1935 John O'Hara wrote a long short story, "The Doctor's Son", about the experience of his fictional alter ego during the flu epidemic in a Pennsylvania coal mining town. In 1937 American novelist William Keepers Maxwell, Jr. wrote They Came Like Swallows, a fictional reconstruction of the events surrounding his mother's death from the flu. Mary McCarthy, the American novelist and essayist, wrote about her parents' deaths in Memories of a Catholic Girlhood. Bodie and Brock Thoene's "Shiloh Legacy" series led off with an account of the Spanish flu in New York and Arkansas in their novel In My Father's House (1992). In 1997 David Morrell's short story "If I Die Before I Wake"dealing with a small American town during the second wavewas published in the anthology Revelations, which was framed by Clive Barker. In 2006 Thomas Mullen published a novel called The Last Town on Earth about the impact of the Spanish flu on a fictional mill town in Washington. Several theories have been offered as to why the Spanish flu may have been "forgotten" by historians and the public over so many years. These include the rapid pace of the pandemic (it killed most of its victims in the United States, for example, within a period of less than nine months), previous familiarity with pandemic disease in the late 19th and early 20th centuries, and the distraction of the First World War.[52] Another explanation involves the age group affected by the disease. The majority of fatalities, from both the war and the epidemic, were among young adults. The deaths caused by the flu may have been overlooked due to the large numbers of deaths of young men in the war or as a result of injuries. When people read the obituaries of the era, they saw the war or post-war deaths and the deaths from the influenza side by side. Particularly in Europe, where the war's toll was extremely high, the flu may not have had a great, separate, psychological impact, or may have seemed a mere "extension" of the war's tragedies.[53] The duration of the pandemic and the war could have also played a role: the disease would usually only affect a certain area for a month before leaving, while the war, which most expected to end quickly, had lasted for four years by the time the pandemic struck. This left little time for the disease to have a significant impact on the economy. During this time period pandemic outbreaks were not uncommon: typhoid, yellow fever, diphtheria, and cholera all occurred near the same time period. These outbreaks probably lessened the significance of the influenza pandemic for the public.[54]

[edit] Spanish flu research

Main article: Spanish flu research

Centers for Disease Control and Prevention s Dr. Terrence Tumpey examining a reconstructed version of the 1918 flu.

One theory is that the virus strain originated at Fort Riley, Kansas, by two genetic mechanisms genetic drift and antigenic shift in viruses in poultry and swine which the fort bred for food; the soldiers were then sent from Fort Riley to different places around the world, where they spread the disease. However, evidence from a recent reconstruction of the virus suggests that it jumped directly from birds to humans, without traveling through swine.[55][56] This suggestion is slightly controversial,[57] and other research suggests that the strain originated in a mammalian species.[58] An effort to recreate the 1918 flu strain (a subtype of avian strain H1N1) was a collaboration among the Armed Forces Institute of Pathology, Southeast Poultry Research Laboratory and Mount Sinai School of Medicine in New York City; the effort resulted in the announcement (on October 5, 2005) that the group had successfully determined the virus's genetic sequence, using historic tissue samples recovered by pathologist Johan Hultin from a female flu victim buried in the Alaskan permafrost and samples preserved from American soldiers.[59] On January 18, 2007, Kobasa et al. reported that monkeys (Macaca fascicularis) infected with the recreated strain exhibited classic symptoms of the 1918 pandemic and died from a cytokine storm[60]an overreaction of the immune system. This may explain why the 1918 flu had its surprising effect on younger, healthier people, as a person with a stronger immune system would potentially have a stronger overreaction.[61] On September 16, 2008, the body of Yorkshireman Sir Mark Sykes was exhumed to study the RNA of the Spanish flu virus in efforts to understand the genetic structure of modern H5N1 bird flu. Sykes had been buried in 1919 in a lead coffin which scientists hope will have helped preserve the virus.[62] In December 2008, research by Yoshihiro Kawaoka of the University of Wisconsin linked the presence of three specific genes (termed PA, PB1, and PB2) and a nucleoprotein derived from 1918 flu samples to the ability of the flu virus to invade the lungs and cause pneumonia. The combination triggered similar symptoms in animal testing.[63] The original date of appearance of this virus is not clear. An estimated date for its appearance in mammalian hosts has been put at the period 18821913.[64] This ancestor virus diverged about 19131915 into two clades which gave rise to the classical swine and human H1N1 influenza lineages. The last common ancestor of human strains dates to between February 1917 and April 1918. Because pigs are more readily infected with avian influenza viruses than are humans, it is likely that they were the original recipient of the virus. This in turn suggests that the virus was introduced into humans sometime between 1913 and 1918.