1123. Relationship between “Purulent Bronchitis,” 1914-17 and Pandemic Influenza, 1918-19
Session: Poster Abstract Session: Influenza and H1N1 Diagnosis, Epidemiology, and Viral Outcome
Saturday, October 22, 2011
Room: Poster Hall B1
Background: The uncertain genesis of the influenza pandemic of 1918-19 is of current interest given the 2009 reoccurrence of pandemic H1N1 influenza. Because the 1918-19 pandemic was intimately associated with the First World War, we reviewed mortality registers of British Commonwealth Armies in France/ Belgium and the United Kingdom for evidence of localized outbreaks/epidemic waves of acute respiratory disease-related mortality. We particularly sought evidence that “purulent bronchitis” - a lethal respiratory infectious disease described by military physicians since 1914 - as a possible precursor of the 1918-19 pandemic.

Methods: Geographic locations of burial sites of all non-combat deaths of British soldiers were used as surrogates for disease-related death locations. Plots of >4,000 deaths over 200 military cemeteries during 1914-18 were used to document spatial-temporal trends of disease mortality.

Results: Contemporaneous reports described lethal “purulent bronchitis” as early as 1914 in the Canadian Army in UK and 1917 in the American Army in France. In both the Australian and Canadian Armies, there were dual peaked epidemics of lethal respiratory illnesses during the winter 1916-17 and fall-winter 1918-19.  Among British soldiers in England and Belgium/France, numbers of non-combat deaths per week were approximately twice as high during the winter of 1916-17 as the fall of 1916. We estimate that respiratory illness-related mortality (at least partly due to purulent bronchitis) peaked at approximately 0.5 deaths/1000 men/month during the 1916-17 epidemic period and approximately 2.5 deaths/ 1000 men /month during the late 1918 pandemic period. There was a spatiotemporal trend of increasing non-combat deaths in late 1916 that started in France and moved to England before tapering off in early 1917.

Conclusion: The findings suggest that multiple, possibly related, influenza viruses were circulating prior to the main wave of mortality in late 1918.  This supports genetic evidence that there were three lineages of H1N1 influenza which had separately evolved years prior to the 1918 pandemic.

Subject Category: V. Virology including clinical and basic studies of viral infections, including hepatitis

G. Dennis Shanks, MD, MPH1, Alison MacKenzie, MPH2, Michael Waller, MSc2, Archie Clements, PhD3 and John Brundage, MD, MPH4, (1)Army Malaria Institute, Enoggera, Australia, (2)Centre for Military and Veteran's Health, University of Queensland, Brisbane, Australia, (3)School of Population Health, University of Queensland, Brisbane, Australia, (4)Armed Forces Medical Surveillance Activity, Silver Spring, MD


G. D. Shanks, None

A. MacKenzie, None

M. Waller, None

A. Clements, None

J. Brundage, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.