The Relationship between Tuberculosis and Influenza Death during the Influenza (H1N1) Pandemic from 1918-19

The epidemiological mechanisms behind the W-shaped age-specific influenza mortality during the Spanish influenza (H1N1) pandemic 1918-19 have yet to be fully clarified. The present study aimed to develop a formal hypothesis: tuberculosis (TB) was associated with the W-shaped influenza mortality from 1918-19. Three pieces of epidemiological information were assessed: (i) the epidemic records containing the age-specific numbers of cases and deaths of influenza from 1918-19, (ii) an outbreak record of influenza in a Swiss TB sanatorium during the pandemic, and (iii) the age-dependent TB mortality over time in the early 20th century. Analyzing the data (i), we found that the W-shaped pattern was not only seen in mortality but also in the age-specific case fatality ratio, suggesting the presence of underlying age-specific risk factor(s) of influenza death among young adults. From the data (ii), TB was shown to be associated with influenza death (P = 0.09), and there was no influenza death among non-TB controls. The data (iii) were analyzed by employing the age-period-cohort model, revealing harvesting effect in the period function of TB mortality shortly after the 1918-19 pandemic. These findings suggest that it is worthwhile to further explore the role of TB in characterizing the age-specific risk of influenza death.

[1]  H. L. Dunn,et al.  Vital statistics rates in the United States 1900-1940 , 1944 .

[2]  Stephen S Morse,et al.  Epidemiological evidence of an early wave of the 1918 influenza pandemic in New York City. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[3]  Jeffery K. Taubenberger,et al.  Characterization of the 1918 influenza virus polymerase genes , 2005, Nature.

[4]  L. Bryder.  'Not always one and the same thing': the registration of tuberculosis deaths in Britain, 1900-1950. , 1996, Social history of medicine : the journal of the Society for the Social History of Medicine.

[5]  J. Taubenberger,et al.  Evidence of an absence: the genetic origins of the 1918 pandemic influenza virus , 2004, Nature Reviews Microbiology.

[6]  Kazuyuki Aihara,et al.  The Time Required to Estimate the Case Fatality Ratio of Influenza Using Only the Tip of an Iceberg: Joint Estimation of the Virulence and the Transmission Potential , 2012, Comput. Math. Methods Medicine.

[7]  W. H. Frost,et al.  Influenza in Maryland: Preliminary Statistics of Certain Localities , 1919 .

[8]  H. Nishiura.  Joint quantification of transmission dynamics and diagnostic accuracy applied to influenza. , 2011, Mathematical biosciences and engineering : MBE.

[9]  S. D. Collins.  Age and Sex Incidence of Influenza and Pneumonia Morbidity and Mortality in the Epidemic of 1928-29 with Comparative Data for the Epidemic of 1918-19. , 1931 .

[10]  J. Taubenberger,et al.  1918 Influenza: the Mother of All Pandemics , 2006, Emerging infectious diseases.

[11]  J. Taubenberger,et al.  Influenza : the Mother of All Pandemics , 2022 .

[12]  Cécile Viboud,et al.  Epidemiologic characterization of the 1918 influenza pandemic summer wave in Copenhagen: implications for pandemic control strategies. , 2008, The Journal of infectious diseases.

[13]  M. Garenne,et al.  The 1918 influenza epidemic's effects on sex differentials in mortality in the United States. , 2000, Population and development review.

[14]  Y. Guan,et al.  Induction of proinflammatory cytokines in human macrophages by influenza A (H5N1) viruses: a mechanism for the unusual severity of human disease? , 2002, The Lancet.

[15]  W. Thompson,et al.  Observations on mortality during the 1918 influenza pandemic. , 2001, Clinical infectious diseases : an official publication of the Infectious Diseases Society of America.

[16]  E. D. Kilbourne.  Influenza Pandemics of the 20th Century , 2006, Emerging infectious diseases.

[17]  Lauri Tabur,et al.  MINISTRY OF INTERIOR , 2000 .

[18]  H. Nishiura.  Case fatality ratio of pandemic influenza , 2010, The Lancet Infectious Diseases.

[19]  G. Shanks,et al.  Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic , 2012, Influenza and other respiratory viruses.

[20]  A. Noymer.  Testing the influenza-tuberculosis selective mortality hypothesis with Union Army data. , 2009, Social science & medicine.

[21]  J. Menken,et al.  Age, period, and cohort effects in demography: a review. , 1982, Population index.

[22]  W. P. Glezen.  Emerging infections: pandemic influenza. , 1996, Epidemiologic reviews.

[23]  G. Shanks,et al.  Pathogenic Responses among Young Adults during the 1918 Influenza Pandemic , 2012, Emerging infectious diseases.

[24]  R. Tarone,et al.  Evaluation of birth cohort patterns in population disease rates. , 1996, American journal of epidemiology.

[25]  G. Dennis Shanks,et al.  Deaths from Bacterial Pneumonia during 1918–19 Influenza Pandemic , 2008, Emerging infectious diseases.

[26]  C. Dye,et al.  Consensus statement. Global burden of tuberculosis: estimated incidence, prevalence, and mortality by country. WHO Global Surveillance and Monitoring Project. , 1999, JAMA.

[27]  Glezen Wp.  Emerging Infections: Pandemic Influenza , 1996 .

[28]  H. Nishiura.  The virulence of pandemic influenza A (H1N1) 2009: an epidemiological perspective on the case–fatality ratio , 2010, Expert review of respiratory medicine.

[29]  Hiroshi Nishiura,et al.  Fever screening during the influenza (H1N1-2009) pandemic at Narita International Airport, Japan , 2011, BMC infectious diseases.

[30]  Kazuyuki Aihara,et al.  Real-time Investigation of Measles Epidemics with Estimate of Vaccine Efficacy , 2012, International journal of biological sciences.

[31]  Christopher Dye,et al.  Global Burden of Tuberculosis: Estimated Incidence, Prevalence, and Mortality by Country , 1999 .

[32]  C. Langford.  The age pattern of mortality in the 1918-19 influenza pandemic: an attempted explanation based on data for England and Wales. , 2002, Medical History.

[33]  A. Noymer.  The 1918 influenza pandemic hastened the decline of tuberculosis in the United States: an age, period, cohort analysis. , 2011, Vaccine.