Oxford J S, Sefton A, Jackson R, Innes W, Daniels R S, Johnson N P A S
Department of Medical Microbiology and Retroscreen Virology, St Bartholomew's and the Royal London, Queen Mary, School of Medicine and Dentistry, University of London, London, UK.
Lancet Infect Dis. 2002 Feb;2(2):111-4. doi: 10.1016/s1473-3099(02)00185-8.
The 1918 influenza pandemic caused 40 million deaths, and so dwarfed in mortality and morbidity the preceding pandemic of 1889 and the 1957 and 1968 pandemics. In retrospect, much can be learnt about the source, the possible subterranean spread of virus, and the genetic basis of virulence. The World Health Organization has urged every nation to prepare a pandemic plan for the first global outbreak of the 21st century. We present an appraisal of epidemiological and mortality evidence of early outbreaks of respiratory disease in France and the UK in the years 1915 to 1917. Certain of these earlier focal outbreaks--called epidemic bronchitis rather than influenza--occurred during the winter months when influenza was known to be in circulation, and presented with a particular heliotrope cyanosis that was so prominent in the clinical diagnosis in the world pandemic outbreak of 1918-1919 (the Great Pandemic). The outbreaks in army camps at Etaples in France and Aldershot in the UK in 1916-1917 caused very high mortality in 25-35 year olds. Increased deaths from bronchopneumonia and influenza were also recorded in England. We deduce that early focal outbreaks of influenza-like disease occurred in Europe and on the balance of probability the Great Pandemic was not initiated in Spain in 1918 but in another European country in the winter of 1916 or 1917. We suggest that the pandemic had its origins on the Western Front, and that World War I was a contributor.
1918年的流感大流行导致4000万人死亡，其在死亡率和发病率方面远远超过了1889年的上一次大流行以及1957年和1968年的大流行。回顾过去，可以从病毒的来源、可能的地下传播以及毒力的遗传基础中学到很多东西。世界卫生组织敦促每个国家为21世纪的首次全球疫情爆发制定大流行计划。我们对1915年至1917年法国和英国呼吸道疾病早期爆发的流行病学和死亡率证据进行了评估。这些早期的局部爆发——当时被称为流行性支气管炎而非流感——发生在已知有流感传播的冬季，其特征是出现一种特殊的淡紫色发绀，在1918 - 1919年全球大流行（大流感）的临床诊断中非常突出。1916 - 1917年法国埃塔普勒和英国奥尔德肖特的军营爆发导致25 - 35岁人群的死亡率极高。英国也记录到支气管肺炎和流感导致的死亡人数增加。我们推断，欧洲曾出现过类似流感疾病的早期局部爆发，而且从可能性来看，1918年的大流行并非始于西班牙，而是始于1916年或1917年冬季的另一个欧洲国家。我们认为大流行起源于西线，第一次世界大战是一个促成因素。
