INSIDE THIS ISSUE

December 14, 2018 Shawnee County Health Department Volume 3, Issue 6

100 Years of Influenza

This year marks the 100 year centenary of the 1918-1919 influenza pandemic, more com-monly known as the Spanish Influenza. Even though influenza epidemics and pandemics have been a part of human history dating back to the Middle Ages, the 1918 Spanish Influ-enza is considered to be the most devastating pandemic thus far, with the highest death record in history. No one knows for certain where the 1918 influenza virus originated; however, the epide-miologic evidence suggests Haskell County, Kansas as the most likely site of origin. The earliest record of the influenza outbreak was first reported by Dr. Lohring Miner, a local physician practicing in western Kansas. Dr. Miner notified the U.S. Public Health Services of severe influenza cases with fatalities in Haskell County, Kansas, and his findings were published in the Public Health Reports (now Morbidity and Morality Weekly Report) on April 5, 1918. The influenza outbreak might not have had the rapid global impact, had it not been for the war. It has been suggested soldiers traveling to and from Haskell County may have brought the virus back to Camp Funston, army base located in Fort Riley, Kansas. Camp Funston was the second largest military station in the country, housing and training an average of 56,000 troops. With winter weather, poor sanitation, and overcrowding, the conditions of wartime was conducive to the rapid spread of disease. At that time, there were no influenza vaccines, antiviral, or antibiotics to treat secondary bacterial pneumo-nia infections, since penicillin was not discovered for another ten years. Soon after cases of severe influenza were seen at Camp Funston, reports of influenza outbreaks at other military bases started to appear. It has been suggested the influenza virus followed the soldiers to war, traveling and mu-tating from the United States to France and then across the world. During the spread of influenza across Europe, the virus picked up the name “Spanish Influenza” because Spain was a neutral country in the war, therefore the press could freely report on the number of influenza cases seen in Spain. It is estimated the 1918-1919 influenza pandemic infected one-third of the world’s population and killed 675,000 in the United States and 21 million to 50 million people worldwide. An equivalent death toll today would be 175 to 350 mil-lion people. There has been three other influenza pandemics since 1918 (1957, 1968, and 2009), but none rivaled the death toll of the Spanish Influenza. To better understand the virology of the 1918 influenza virus, Centers for Disease Control and Prevention (CDC) researchers reconstructed the 1918 influenza virus from lung tissue taken from an Alaskan influenza victim who was buried in permafrost in November 1918.

NEED TO REPORT A COMMUNICABLE DISEASE?

Call the Health Department 24/7

785. 806. 6297

Call the Kansas Department of

Health and Environment

Epidemiology Hotline 24/7

877. 427. 7317

Disease Reporting Information:

List of Reportable Diseases

Disease Reporting Information

Kansas Reportable Disease Form

Disease Investigation Guidelines

EPI-SURVeillance

Shawnee County Health

Department

WIC and Administrative Offices

2600 SW East Circle Drive

Topeka, Kansas 66606

785.251.5600

Immunization/

Communicable Disease Clinic

2115 SW 10th Street

Topeka, Kansas 66604

785.251.5700

Environmental Health

1515 NW Saline, Suite 221

Topeka, Kansas 66618

785.251.5608

100 Years of Influenza ………….. 1

November Disease Summary … 3

Source: Public Health Weekly Reports for NOVEM-BER 15, 1918. (1918). Public health reports (Washington, D.C. : 1896), 33(46), 1969-2030.

Source: CDC Commemorating 100 years since 1918 Influenza Pandemic.

100 Years of Influenza Continues... In addition to the millions of lives the 1918 influenza claimed worldwide, what sets the 1918 influenza pandemic apart from more recent pandem-ics is the impact the 1918 virus had young healthy adults. The death rate was highest among adults aged 20-40 years. The death toll among this age group was so high, it reduced the life expectancy in the United States by twelve years. Even though we have made advances in influenza prevention and treat-ment with vaccines and antiviral drugs, people still die every year from influenza and influenza complications. The burden of influenza illness varies from year to year. During 2017-2018 flu season, roughly 79,400 people died from influenza and pneumonia with the highest number of death in the 65 and older age group. Utilizing the Vital Statistics death records from the Kansas Department of Health and Environment (KDHE), we see a similar trend in Kansas and Shawnee County. Over the last ten years, pneumonia and influenza was the cause of death for 6,229 Kansans with 398 deaths in Shawnee County. Roughly 84.4% of pneumonia and influenza deaths in Shawnee County were in people 65 and older. Table 1. Pneumonia and Influenza Deaths in Kansas, 2008-2017

Source: KDHE, Kansas Information for Communities, 2008-2017

Although 100 years has passed since the 1918 influenza pandemic, sci-entists are still studying the 1918 influenza virus today. Continued in-fluenza research supports with vaccine, drug developments, and pan-demic influenza preparedness. Influenza surveillance is ongoing. The CDC is one of 114 member states who take part in the World Health Organization’s global health influenza surveillance system. The CDC also partners with state and local health departments to support with influenza surveillance. The CDC’s commemorative motto for the 100th centenary of 1918 flu pandemic is, “We Remember. We Prepare.” For more information on the current 2018-2019 influenza surveillance, visit the following websites below. KDHE, Kansas Weekly Influenza Surveillance CDC, Weekly U.S. Influenza Surveillance Report

2

Cause of Death 2008-2017 Shawnee County Kansas

Influenza 29 467

Pneumonia 369 5762

Total Pneumonia & Influenza 398 6229

Source: Published by the Topeka Health Service of Shawnee County. Kansas State Historical Society

References: 1. Barry, J. M. (2004). The great influenza: The epic story of the deadliest plague in history. New York: Viking. 2. Barry J. M. (2004). The site of origin of the 1918 influenza pandemic and its public health impli-cations. Journal of translational medicine, 2(1), 3. doi:10.1186/1479-5876-2-3 3. Centers for Disease Control and Prevention. (2018) The 1918 Flu Pandemic: Why it Matters 100 Years Later. Retrieved from https://blogs.cdc.gov/publichealthmatters/2018/05/1918-flu/. Ac-cessed December 12, 2018. 4. Centers for Disease Control and Prevention. (2018) Reconstruction of the 1918 Influenza Pan-demic Virus. Retrieved from https://www.cdc.gov/flu/about/qa/1918flupandemic.htm. Accessed December 12, 2018. 5. Centers for Disease Control and Prevention. (2018) Estimated Influenza Illness, Medical Visits, Hospitalizations, and Deaths in the United States– 2017-2018. Retrieved from https://www.cdc.gov/flu/about/burden/estimates.htm. Accessed December 12, 2018. 6. Institute of Medicine. 2005. The Threat of Pandemic Influenza: Are We Ready? Workshop Sum-mary. Washington, DC: The National Academies Press. https://doi.org/10.17226/11150. 7. Jester, Barbara & Uyeki, Timothy & Jernigan, Daniel. (2018). Readiness for Responding to a Severe Pandemic 100 Years After 1918. American journal of epidemiology. 10.1093/aje/kwy165. 8. Taubenberger, J. K., & Morens, D. M. (2010). Influenza: the once and future pandemic. Public health reports (Washington, D.C.: 1974), 125 Suppl 3(Suppl 3), 16-26.

Source: Halt The Epidemic, 1918, poster, United States Shipping Board Emergency Temple University Libraries

Source: Annual Report of State Board of Health and the State Health Commissioner to the Governor of Virginia for the Fiscal year Ending September 30,1919.

3 Leading the way to a healthier Shawnee County

* Case report counts are provisional numbers. Case statuses may change

with new information or further investigation.

Last month, there were 58 new reports of notifiable diseases and conditions in Shawnee County. Of the 58 new reports,

41 have been classified as Confirmed or Probable Cases by the Shawnee County Health Department and/or the Kansas

Department of Health and Environment based on standardized case definitions. The chart below shows the number of

disease reports which met the criteria of Confirmed or Probable. These are preliminary numbers and may change as case

status changes with new information or further investigation. Below is a summary of select reports investigated in the

month of November of 2018.

Bloodborne: The Health Department inves-

tigated seven Hepatitis B, Chronic reports, five

of the seven were confirmed cases and the oth-

er two reports are currently under investiga-

tion. All 19 Hepatitis C reports received were

confirmed cases.

Respiratory: The one Haemophilus influen-

zae report was a confirmed case. The Health

Department investigated five Streptococcus

pneumoniae reports, four adult and one pedi-

atric report. Of the five Streptococcus pneu-

moniae reports, two were confirmed cases.

The other three reports are currently under

investigation. The Varicella pediatric report

received was a confirmed case. The adult Tu-

berculosis Latent Infection report is still under

investigation.

Food or Waterborne: Of the eight Campyl-

obacteriosis reports investigated, six were

confirmed cases and one report is still under

investigation. The pediatric Cryptosporidiosis

report was a confirmed case. Of the three Sal-

monellosis reports, only one report was a con-

firmed case. The one Vibriosis non-cholera

report, and three Shiga toxin-producing Esch-

erichia coli (STEC) reports were confirmed

cases.

Other: The Health Department received one

pediatric elevated blood lead level report. The

elevated blood lead report was a confirmed

case. The Health Department is currently in-

vestigating two Transmissbale spongioform

encephalophathy (TSE) disease reports and

one Toxic-shock syndrome (streptococcal)

report. Both TSE disease and Toxic-shock syn-

drome reports were in adults.

SUMMARY OF NEWLY CONFIRMED CASES OF

REPORTABLE DISEASES IN SHAWNEE COUNTY, KANSAS

NOVEMBER

Case Report Counts*

Diseases 2018 Nov 2017 Nov 2015-2017 3 Year

November Average

Bloodborne

Hepatitis C, Chronic 19 9 10.67

Foodborne and Waterborne

Campylobacteriosis 6 2 2.33

Cryptosporidiosis 1 2 1.33

Vibriosis (non-cholera Vibrio species infections)

1 0 0

Salmonellosis 1 5 4

Shiga toxin-producing Escherichia coli (STEC)

3 2 1.33

Respiratory

Haemophilus influenzae, invasive disease (Including Hib)

1 0 0.33

Streptococcus pneumoniae, invasive disease

2 2 2.67

Vaccine Preventable

Hepatitis B, Chronic 5 0 0.33

Varicella (Chickenpox) 1 0 0.67

Sexually Transmitted Infections

Chlamydia 102 106 83.33

Gonorrhea 57 61 43.67

Syphilis 3 2 2.67

Other

Blood lead poisoning (All ages) 1 3 1.33

Grand Total 203 194 154.66

NOVEMBER COMMUNICABLE DISEASE SUMMARY