INFLUENZA

Being written

INFLUENZA. Influenza, commonly known as "the flu," is an infectious disease. The most common symptoms are chills, fever, sore throat, muscle pains, severe headache, coughing, weakness/fatigue and general discomfort. Sore throat, fever and coughs are the most frequent symptoms. In serious cases, influenza causes pneumonia. This can be fatal, particularly for the young and the elderly. Although influenza is often confused with the common cold, influenza is much more severe. Influenza may produce nausea and vomiting, particularly in children, but these symptoms are more common in the unrelated gastroenteritis, sometimes called "stomach flu" or "24-hour flu".

Generally, influenza is transmitted through the air by coughs or sneezes. Influenza can also be transmitted by direct contact with bird droppings or nasal secretions, or through contact with contaminated surfaces. Influenza viruses can be inactivated by sunlight, disinfectants and detergents. As the virus can be inactivated by soap, frequent hand washing reduces the risk of infection.

The first recorded epidemic of influenza in what became the United States occurred in 1647. It appeared many times including a particularly in a strong epidemic in 1890. (1) The worldwide influenza epidemic of 1918 killed an estimated 50 million people---more than the estimated 16 million killed in WORLD WAR I---more people than any other illness in recorded history. (2)

Photo courtesy: National Archives

In the late spring of 1918, the first phase known as the "three-day fever" appeared. There were few deaths. When it reappeared in the fall, the disease was much stronger with some victims dying within hours of their first symptoms. Others died within a few days suffocated to death with their lungs filled with fluid. It struck crowded urban areas and the most remote settlements in the nation. Young adults, the elderly, and young children were the groups mostly affected. In one year, the average life expectancy in the United States dropped 12 years as 25% of the nation's population was afflicted. (3)

In Dubuque the influenza epidemic of 1918 ranks as one of the city's worse health events. The population had already witnessed 611 deaths from the disease in 1917. By October 18, 1918, state health officials had ordered all theaters, schools, churches, movies, and lodge rooms across the state closed. In Iowa, influenza claimed 6,543 lives. In Dubuque, 823 people died. Among the agencies taking an active role in caring for the ill was the DUBUQUE VISITING NURSE ASSOCIATION which maintained a twenty-four hour answering service at its office in the BANK AND INSURANCE BUILDING and operated a "motor service" through the efforts of W. H. Gunn. (4)

Dubuque carpenters were removed from work sites to construct coffins. Football games and other gatherings were canceled. Mayor James SAUL prohibited local colleges from accepting day pupils until the epidemic had subsided. The Dubuque Electric Company put additional trolleys into service to reduce crowding that could lead to the disease spreading.

The newspapers were filled with safeguards to prevent an individual catching the flu. Will's Cascara Bromide Quinine should be taken "at the first sign of a cold." "Anointing" the nose "to protect delicate membranes" was a frequently suggested course of action. Nature's Remedy, a laxative, promised that keeping the organs of digestion and elimination active would protect a person from the illness. De Vilbiss Atomizers promised that "Spanish influenza is preventable" while Munyon's Inhaler was said to "cure" influenza and all diseases of the throat and lungs.

In 1919 more than 614 Dubuque residents died. On October 1st, Spanish influenza became a quarantinable disease as required by state health regulations. The rules specified that the quarantine would be maintained until the infected people had a complete recovery certified to in writing by the attending physician or three days after the temperature returned to normal. Upon recovery, the patient was to have a complete change of clothing with the clothing worn during illness aired in the sun for at least eight hours. The house was to be aired for the same amount of time. (5)

In February, 1920 the United States Surgeon General telegraphed each state health commissioner with three directives. First, the United States Board of Health and the State Board of Health ordered that all new cases of influenza and pneumonia must be promptly reported to the local board of health and victims quarantined and that this information should promptly be reported by telegram to the State Board of Health. In addition deaths must be reported in the same manner. The State Board of Health would report this information daily to the United States Board of Health. Secondly, people were to avoid crowds and avoid breathing into the faces of others. Third, undertakers were forbidden to hold public funerals for those who had died of influenza or pneumonia nor would the bodies of such people be exposed in any way. The Iowa state health officer also wrote to the city council asking that physicians correctly identify Spanish influenza by that name and no other. Posters were available with the symptoms of Spanish influenza. (6)

At a special meeting of the city council on February 3, 1920 it was suggested that all newspapers be asked to inform the public that all churches, theaters and places of gathering should be well ventilated. Keeping schools open was considered important because they could maintain a better record of all communicable disease. The City Sanitary Officer offered a resolution to be offered the State Housing Commissioners--(7)

             Be it resolved: by state housing commissioners that we 
             recommend to the next Iowa legislature that they pass 
             appropriate legislation giving the local board of health 
             the power to compel water companies to put in water mains 
             and furnish city water to such portions of cities as to 
             the local board of health shall deem for the best interest 
             of the people living in such communities

It was moved and carried that the clerk would have notices printed covering instructions relative to holding public funerals over the bodies of anyone who had died of influenza or pneumonia and that a copy be sent to every doctor, undertaker and pastor in the city. It was also moved and carried that anyone having a vault cleaned be instructed not to pay the bill until the vault had been measured by the sanitary officer. It was also moved and carried to continue the same restrictions that had been used in 1919. Large stores were to be closed in the evening. Church services were limited to 45 minutes. Elevators were limited to 6 passengers and street cars could only carry their seating capacity. All moving theaters, dance halls (public and private), and skating rinks were closed. (8)

The swift response of civic leaders paid dividends. The quarantine placed in effect on February 5th to prevent a spread of influenza was lifted on February 14 with the except of reopening of dance halls which were not permitted to be open until February 16th. No deaths had been reported for two days, there had been no new reported cases, and thirty-two people had been released from quarantine. Since influenza and pneumonia had become epidemic in Dubuque around January 28 there had been 450 cases of influenza reported, 30 cases of pneumonia, 21 deaths from pneumonia and 3 deaths from influenza. City leaders had received letters of congratulations on their results from the state board of health within such a short period of time. Dubuque was the only city in Iowa that recognized the advisability of a quarantine and enforced one immediately. In one week the total number of cases for one day was lowered from 50 to less than 10. In nine days, the epidemic was generally controlled. Other cities continued to report to the state board from 50-150 cases each day with no decrease expected. Special praise was given to the Visiting Nurses for their care of patients not admitted to hospitals or able to hire private nurses. (9)

Influenza was blamed in 1947 for the misdiagnosis of "Q Fever." First identified in Queensland, Australia in 1935, the disease showed the initial symptoms of flu. Considered an air-borne disease that could be carried on animals and ticks, "Q Fever" struck fifteen persons working in laboratories of the National Institute of Health in Washington, D.C, in 1940 and 40 workers in stockyard in Texas in 1946. It was not considered a deadly disease and a vaccine was soon developed. (10)

A massive $135-million national swine flu immunization program begun in October, 1976 was stopped at the end of December. In that time only 41 million out of 220 million Americans had received the vaccine. The cause for halting the program was "significant evidence" to link the vaccine with Guillain-Barre syndrome, a rate form of paralysis. Of the 41 million vaccinated, there were 160 deaths, 1,600 cases of non-fatal reaction, and at least 496 cases of Guillain-Barre. Private physicians were allowed to continue vaccinating patients if they received an informed consent paper. (11)

Health officials employed by the DUBUQUE COMMUNITY SCHOOL DISTRICT in 1978 estimated in January that 30% of the cases of illness reported to the schools was flu. Those reporting flu did not have the three days to one week of muscle aches, cough, temperature, and runny rose. Viral gastrointestinal illness often nicknamed "stomach flu" were often confused with real influenza. The state was not usually informed of suspected-influenza outbreaks because the reporting was not considered helpful prevention. The required tests took so long the patient was usually over the illness before the results were received. (12)

In 2009 Dubuque residents braced for the possibility of another flu epidemic. Swine-flu, better known as H1N1, threatened to close schools across the nation. By early 2010 several Iowans had died of the disease, but the initial threat of the disease seemed unfounded. More inclined to affect the young, one theory suggested that older Americans may have had some defense to the disease from their earlier bouts with Asian flu in the 1950s. Vaccines which were scarce in September 2009 were so widely available that by February 2010 that those wishing for the "shot" could receive it at many pharmacies.

A host of options awaited those receiving flu vaccinations in 2011. The patch with microneedles that penetrate the skins and then dissolve releasing their vaccine were still being developed. (13) The traditional "shot" required a needle an inch or more long because the vaccine was was injected deep into muscle. A new type of needle, used only on adults, was called the Sanofi Pasteur's Fluzone Intradermal was one tenth of an inch long. Patients could also receive the traditional vaccination, a special high-dose for seniors, and a squirt of vaccine into the nose. While knowledge of how a person's immune systems weakens over time remained unclear, physicians urged everyone to receive an annual vaccination to provide protection. (14)

The traditional vaccine used for thirty years provided protection against two common Type A strains called H1N1 and H3N2 and one strain of Type B. Flu strains continually change forcing medical personnel to try to anticipate the needs for a coming year and include those subtypes of strains considered most likely. Type A flu causes more serious disease and deaths--especially the HeN2. Type B, a milder form, sickens people and can kill. Two forms of Type B circulate around the world making it difficult to know which to include. A model developed by the Centers for Disease Control estimated it could prevent up to 484 deaths annually depending upon how much Type B flu is spreading. Adding both kinds of Type B eliminated the guessing.

The new quadrivalent vaccine first available in 2013 and available in all nasal versions sold in the United States was capable of guarding against four strains of flu rather than the traditional three. The nasal spray, however, was only for healthy people between the ages of 2-49 who were not pregnant. Younger children, older adults, pregnant women and people with chronic health conditions could receive the new vaccine as a shot. These were sold under the names Fluzone Quadrivalent, Fluarix Quadrivalent, and FluLaval Quadrivalent. Obtaining the new vaccine was difficult. Of the estimated 135-139 million doses of flu vaccine produced in 2013 only about 30 million would be the new version. (15)

Outbreaks of high path avian influenza in commercial turkey flocks Minnesota, Missouri, and Arkansas and a backyard chicken and duck flock in Kansas were reported in March, 2015. Iowa Department of Natural Resources with United States Department of Agriculture Wildlife Services officials tested 150 snow geese for the presence of the disease. The Centers for Disease Control considered the risk to people from high path infections in wild birds or backyard flocks to be low. (16)

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Source:

1. "Questions and Answers," Dubuque Telegraph-Herald, October 1, 1919, p. 6

2. "The Deadly Virus," National Archives and Records Administration, Online: https://www.archives.gov/exhibits/influenza-epidemic/

3. Ibid.

4. "VNA Helps with Influenza Cases," Dubuque Telegraph-Herald, October 20, 1918, p. 17

5. "Influenza May be Quarantined Now," Dubuque Telegraph-Herald, October 1, 1919, p. 8

6. "City Council Proceedings," Dubuque Telegraph-Herald, February 7, 1920, p. 3

7. Ibid.

8. Ibid.

9. "Flu Epidemic in Dubuque Finally is Stamped Out, Telegraph-Herald, February 14, 1920, p. 1

10. "Doctors Say 'Q' Fever Misleading, Telegraph-Herald, April 2, 1947, p. 10

11. "Resumption of Swine Flu Shots Very Unlikely," Telegraph Herald, December 30, 1976, p. 2

12. Schwar, Kathy. "Flu, Other Ills Sock it to Dubuque," Telegraph Herald, January 13, 1978, p. 8

13. Schmid, Randolph E. "Microneedles Could Make Shots Easier," Telegraph Herald, July 19, 2010, p. 6

14. Neergaard, Lauran. "Flu Shot Time, Some Could Get Tiny Needle," Telegraph Herald, September 6, 2011, p. 17

15. Neergaard, Lauran. "Flu Vaccines Now Offer More Protection," Telegraph Herald, September 3, 2013, p. 11

16. "Avian Influenza Testing Planned," Telegraph Herald, March 22, 2015, p. 39