Measles, flu surges alarm health chiefs

A flu pan­demic that had wreaked havoc across Europe reached Aus­tralia 100 years ago

The Weekend Australian - - THE NATION - SEAN PARNELL HEALTH ED­I­TOR

A sum­mer flu surge and a measles out­break have health au­thor­i­ties on alert and urg­ing more Aus­tralians to get vac­ci­nated.

More than 6000 Aus­tralians were di­ag­nosed with in­fluenza in De­cem­ber, three times as many as at the pre­vi­ous year’s end. Hol­i­day travel and pub­lic gath­er­ings put more peo­ple at risk.

Queens­land alone recorded 2028 cases last month, more than three times higher than the fiveyear De­cem­ber av­er­age. The num­ber of cases recorded in Novem­ber was also up.

“We must re­main vig­i­lant dur­ing 2019 be­cause, as we’ve seen in the past, flu can oc­cur at any time of the year and every flu sea­son can be dif­fer­ent,” said Queens­land Health’s Jonathan Malo.

NSW also ex­pe­ri­enced a late surge in flu cases in 2018, which had oth­er­wise been a much bet­ter year than 2017 for flu pre­pared­ness.

“No­ti­fi­ca­tions of in­fluenza did in­crease across NSW in De­cem­ber with 816 cases re­ported but this un­sea­sonal in­crease was also noted in other states and ter­ri­to­ries across Aus­tralia,” a NSW Health spokesman said.

“Test­ing found three strains of in­fluenza — in­fluenza A (H1N1), in­fluenza A (H3N2) and in­fluenza B, the same strains that cir­cu­lated dur­ing win­ter.

“Sup­plies of in­fluenza vac­cine re­main avail­able from gen­eral prac­ti­tion­ers. Preg­nant women in par­tic­u­lar are urged to be vac­ci­nated.”

A spokesman for Vic­to­ria’s De­part­ment of Health and Hu­man Ser­vices said flu cases peaked in Sep­tem­ber last year but there had been a “slight in­crease in no­ti­fi­ca­tions in Novem­ber-De­cem­ber”.

“Flu vac­cine is highly rec­om­mended for peo­ple in higher risk groups such as older peo­ple, preg­nant women and those with pre­ex­ist­ing med­i­cal con­di­tions that put them at risk of se­ri­ous com­pli­ca­tions of the flu,” the spokesman said.

“There are some easy steps to take to pre­vent get­ting and spread­ing the flu, such as cough­ing or sneez­ing into your el­bow and wash­ing your hands thor­oughly.

“If you’re re­ally sick, stay away from work and other places where you’ll spread the flu.”

Aus­tralia’s de­fences against measles have also been tested in re­cent weeks.

NSW Health con­firmed last week that a fifth per­son had con­tracted measles af­ter be­ing ex­posed to an in­fec­tious child vis­it­ing from Thai­land.

In the lat­est case, an un­vac­ci­nated man in his 20s vis­ited Syd­ney’s Dar­ling Har­bour, Town Hall, New­town and Mar­rickville while in­fec­tious be­tween Jan­uary 4 and 8.

Peo­ple who may have been ex­posed to him in that pe­riod may not know if they have con­tracted measles un­til Jan­uary 26.

Symp­toms of measles in­clude fever, sore eyes and a cough fol­lowed three or four days later by a red, blotchy rash spread­ing from the head and neck to the rest of the body.

It is so con­ta­gious that peo­ple who sus­pect they have measles should phone ahead to a GP clinic to en­sure they do not have to spend time around other pa­tients in the wait­ing room.

Health au­thor­i­ties have been alert to the po­ten­tial for sim­i­lar out­breaks af­ter peo­ple with measles were con­firmed to have been in pub­lic while con­ta­gious in Can­berra, New­cas­tle, Bris­bane and Perth.

Au­thor­i­ties want more peo­ple to be vac­ci­nated to help with herd im­mu­nity.

The pro­por­tion of chil­dren be­ing fully im­mu­nised has in­creased in re­cent years, and last year a record num­ber of peo­ple had the flu shot, how­ever there are still pock­ets of con­cern.

One hun­dred years ago on the morn­ing of Jan­uary 25, 1919, Syd­ney res­i­dents woke to read in the news­pa­per of a sus­pected case of in­fluenza in the city.

Over the next week, seven re­turned ser­vice­men would go down with the flu as well as three hospi­tal staff who had looked af­ter them. Within a few days, more cases be­gan to ap­pear through­out the city and from late Fe­bru­ary the num­ber of cases in­creased day by day. It was the be­gin­ning of what was to be­come the great­est so­cial and pub­lic health dis­as­ter in Aus­tralian his­tory. But where did this vir­u­lent virus come from? How did it emerge, who was in­fected, and how did we re­act?

The Span­ish flu, as it came to be called, killed more than 50 mil­lion peo­ple around the world in 1918-19. Aus­tralia waited a lit­tle longer than most other coun­tries, but from late Jan­uary 1919, the coun­try’s days were num­bered.

The 1919 flu pan­demic was the worst pub­lic health dis­as­ter Aus­tralia has ex­pe­ri­enced. The whole coun­try was af­fected, more than 15,000 peo­ple died and pos­si­bly as many as 1.8 mil­lion peo­ple caught the dis­ease over a pe­riod of four months. In NSW alone more than 500,000 peo­ple caught flu in 1919 and more than 6200 died.

Aus­tralia was no stranger to flu epi­demics. At least four in­fluenza epi­demics oc­curred be­tween 1836 and 1891. The one in 1890-91 was by far the most sig­nif­i­cant in the 19th cen­tury and there were more than 200,000 cases in NSW alone. But noth­ing could pre­pare Aus­tralia for the pan­demic of 1918-19.

It is dif­fi­cult to pin down the ori­gins of the 1918-19 pan­demic. Most ev­i­dence points to Fort Ri­ley in Kansas in the US where, in early March 1918, a wave of pneu­mo­nia af­fected many sol­diers wait­ing to travel to Europe. From there the in­fec­tion was most prob­a­bly car­ried by Amer­i­can troops to France, where it quickly spread to the lo­cal pop­u­la­tion. From there it spread through­out western Europe and by Oc­to­ber more than one mil­lion had died from the flu. Aided by a modern sys­tem of in­ter­na­tional trans­port, the dis­ease spread across the world.

Many Aus­tralian and New Zealand troops re­turn­ing home car­ried the in­fec­tion with them. From late Oc­to­ber 1918, Aus­tralia be­gan to ex­pe­ri­ence a stream of ships re­turn­ing from Europe and South Africa — many trans­port­ing troops in­fected with in­fluenza. By the end of Jan­uary 1919, more than 326 troops sus­pected of hav­ing flu, or the mis­for­tune to have had con­tact with some­one who did, were placed in quar­an­tine at the North Head Quar­an­tine Sta­tion.

In New Zealand a par­tic­u­larly vir­u­lent form of in­fluenza had swept through the coun­try dur­ing Novem­ber and De­cem­ber 1918, and within six weeks more than 8500 peo­ple had died. It was with­out any doubt the great­est nat­u­ral dis­as­ter New Zealand has ever ex­pe­ri­enced.

But what caused this pan­demic and what did we know about it? The 1918-19 in­fluenza pan­demic was caused by a virus not dis­cov­ered un­til the 1930s. The in­fluenza virus is a zoonotic in­fec­tion nur­tured in wild birds, and has been so for tens of cen­turies. Many vari­ants ex­ist, some trans­fer­able to other an­i­mals such as ducks, chick­ens or pigs. Type A flu viruses are the ones that cause dis­ease in hu­mans. About one-third of peo­ple in­fected never be­come ill and show no symp­toms but can still trans­mit the in­fec­tion to oth­ers. In­fluenza can also un­leash sec­ondary bac­te­rial in­fec­tions such as pneu­mo­nia and bron­chi­tis.

Although flu cases be­gan to ap­pear in large num­bers in Aus­tralia in late Fe­bru­ary to early April, the pan­demic was most se­vere in the pe­riod from the be­gin­ning of June un­til early July. Dur­ing this time al­most 6000 peo­ple were ad­mit­ted to hospi­tal suf­fer­ing from in­fluenza. But this was the mere tip of the ice­berg, as tens of thou­sands were ill with in­fluenza through­out the coun­try, the ma­jor­ity con­fined to their homes.

From the ev­i­dence we have it is clear that the flu pan­demic came in two dis­tinc­tive waves, the first in mid-April and the sec­ond in late June. While there is no ac­tual ev­i­dence of the num­ber of peo­ple who caught it in 1919, in Syd­ney alone pos­si­bly 37 to 40 per cent of the to­tal pop­u­la­tion caught the flu.

De­spite our long his­tory of flu epi­demics, the pan­demic which af­fected Aus­tralia in 1919 had fea­tures never be­fore ex­pe­ri­enced.

Up un­til this, early in­fluenza out­breaks had largely tar­geted the very young and the very old. By con­trast the 1919 flu was most se­vere on peo­ple aged 25 to 39. In Syd­ney this age group then made up 27 per cent of the pop­u­la­tion yet con­trib­uted 45 per cent of all flu deaths. Fifty-eight per cent of all hospi­tal ad­mis­sions and flu deaths in NSW were also aged be­tween 25 and 39. Of par­tic­u­lar note is the fact that for these ages, the male death rate was al­most dou­ble that of fe­males.

While the pan­demic was no re­specter of wealth and po­si­tion, strik­ing down med­i­cal prac­ti­tion­ers, lawyers and school­teach­ers as well as gov­ern­ment work­ers, lower-class groups suf­fered the high­est mor­tal­ity. Those whose jobs brought them into reg­u­lar con­tact with fel­low work­ers and the pub­lic were most at risk.

In­fluenza af­fected every as­pect of Aus­tralian life. In NSW 5000 mar­riages were de­stroyed by the death of one or both part­ners and many chil­dren found them­selves with­out par­ents.

It is im­por­tant to note that in 1919 while the flu virus was highly in­fec­tive the real killer was pneu­mo­nia. In a num­ber of cases the virus man­aged to lodge deep in­side peo­ple’s lungs, caus­ing a deadly form of vi­ral pneu­mo­nia.

There is lit­tle doubt that the med­i­cal pro­fes­sion were ill pre­pared and ill equipped to deal with the out­break. Very lit­tle was known about vi­ral in­fec­tions and most be­lieved they were sim­ply con­fronting a bac­te­rial dis­ease. An­tibi­otics, which could have pre­vented many deaths, had yet to be dis­cov­ered, and it would be an­other 34 years be­fore the na­ture of in­fluenza was bet­ter un­der­stood.

Given this, the med­i­cal pro­fes­sion was forced to rely on more pro­saic mea­sures such as quaran- tine, iso­la­tion, the use of sprays, dis­in­fec­tants and masks, as well as telling peo­ple to avoid pub­lic gath­er­ings and that at the first sign of symp­toms they should go to bed for at least four days. Pub­lic con­fi­dence in the med­i­cal pro­fes­sion dur­ing the pan­demic re­mained at a very low level.

In late 1918, a vac­cine was pre­pared in Syd­ney from cul­tur­ing the spu­tum of flu pa­tients at the quar­an­tine sta­tion sup­ple­mented by a mix­ture of strep­to­coc­cal and staphy­lo­coc­cal ma­te­rial. Ini­tially two free doses were of­fered to the pub­lic, but such was the pub­lic re­sponse that sup­plies soon ran out.

Inoc­u­la­tion de­pots were es­tab­lished through­out Syd­ney but within days they were over­whelmed as tens of thou­sands fought to get into the queues. In NSW al­most 500,000 peo­ple sought vac­ci­na­tion. But did vac­ci­na­tion pro­vide any de­fence against the flu? Un­for­tu­nately there is very lit­tle ev­i­dence, apart from fig­ures for 12,000 pa­tients treated in pub­lic hos­pi­tals. Of those in­oc­u­lated about 11 per cent caught flu com­pared with 16 per cent of those not in­oc­u­lated. A sur­vey of 752 med­i­cal staff in Syd­ney hos­pi­tals who had been in­oc­u­lated re­vealed that one month later 684 — or 91 per cent — had caught flu.

And how did the gov­ern­ment re­act to the pan­demic? Late in 1918, the com­mon­wealth moved to quar­an­tine all ships ar­riv­ing where any his­tory of flu cases ex­isted. In Novem­ber 1918, the com­mon­wealth called an in­fluenza con­fer­ence and all states agreed to a 13point plan, with the com­mon­wealth as­sum­ing re­spon­si­bil­ity for quar­an­tine, in­ter­state trans­port, bor­der pro­tec­tion and the clo­sure of pub­lic places, while all the states agreed to im­me­di­ately no­tify the com­mon­wealth the mo­ment flu broke out within their bor­ders, where­upon the com­mon­wealth would re­strict move­ment across state bor­ders.

Over the next few weeks re­la­tions be­tween the states and the com­mon­wealth plum­meted as dis­putes broke out. NSW ac­cused Vic­to­ria of not no­ti­fy­ing the com­mon­wealth and other states of its first case of in­fluenza. Tas­ma­nia was ac­cused of in­ter­fer­ing with in­ter­state trade by plac­ing re­stric­tions on ship­ping. Western Aus­tralia held up the in­tercon­ti­nen­tal train while NSW pro­hib­ited en­try into the state of any­one from South Aus­tralia. A day or so later, the Queens­land gov­ern­ment closed its bor­der with NSW.

By Fe­bru­ary it was clear the com­mon­wealth agree­ment was in tat­ters and in­creas­ing in­fluenza cases saw all states elect­ing to go their own way. NSW in­sti­tuted a wide range of re­stric­tions and the clo­sure of all li­braries, the­atres, schools, churches and pub­lic halls, apart from plac­ing re­stric­tions on peo­ple wish­ing to en­ter NSW.

Through­out the pan­demic, panic, fear and hys­te­ria played a cen­tral part. Peo­ple avoided trams and fer­ries, and de­clined to go to church, the pub or to sport­ing events. Many also tried to flee from Syd­ney, crowd­ing on to longdis­tance trains at Cen­tral Sta­tion un­til the gov­ern­ment moved to re­strict such travel. As flu swept through Syd­ney’s suburbs, peo­ple avoided neigh­bours and bar­ri­caded them­selves in their homes.

Un­der­tak­ers re­fused to touch dead bod­ies for fear of in­fec­tion. Water­side work­ers avoided the wharves, tramway work­ers de­manded a “pan­demic pay” in- crease to keep them at work, while shops, res­tau­rants, gov­ern­ment of­fices and busi­nesses strug­gled to stay open and thou­sands were out of work. Face masks were seen all over Syd­ney and a num­ber of the city’s largest depart­men­tal stores in­tro­duced fu­mi­ga­tion sprays and in­hala­tion rooms.

The 1919 flu pan­demic ranks as the great­est so­cial and health dis­as­ter in Aus­tralian his­tory. Nearly two mil­lion caught flu and 15,000 peo­ple died. One hun­dred years later, many be­lieve we are over­due for an­other in­fluenza pan­demic.

The bird flu in 2005 and swine flu in 2009 were hints of what might soon come. If there is an­other pan­demic some­time in the next few years, it will op­er­ate in a unique en­vi­ron­ment. It will strike an in­ter­con­nected world char­ac­terised by un­prece­dented hu­man mo­bil­ity, by a glob­alised econ­omy and by a 24/7 global news net­work.

What have we learned over the last 100 years? Crit­i­cally we should mar­vel at the re­silience and power of the mi­cro­bial world. Mi­crobes are pro­grammed for sur­vival and have the abil­ity to evolve and ad­just to any as­sault we may launch.

We are liv­ing in a time of reemerg­ing in­fec­tious dis­eases and while we are bet­ter pre­pared in terms of new vac­cines and an­tivi­ral and an­tibac­te­rial drugs, the fact re­mains that faced by a vi­ral foe that mu­tates and evolves from one year to the next, we re­main ex­ceed­ingly vul­ner­a­ble.

Many peo­ple tried to leave Syd­ney dur­ing the pan­demic

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