Bird Flu: Science and Policy

[DewDiligence]

If the 1918 Flu Struck Today,
Death Toll Could Hit 81 Million

http://online.wsj.com/article/SB116674485710357238.html

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ASSOCIATED PRESS
December 22, 2006

LONDON -- A flu virus as deadly as the one that caused the 1918 Spanish flu could kill as many as 81 million world-wide if it struck today, a new study estimates.

By applying historical death rates to modern population data, the researchers calculated a death toll of 51 million to 81 million, with a median estimate of 62 million.

That is surprisingly high, said lead researcher Chris Murray of Harvard University. He did the analysis, in part, because he thought prior claims of 50 million deaths were wildly inflated.

"We expected to end up with a number between 15 and 20 million," Dr. Murray said. "It turns out we were wrong."

The new work is being published in the latest issue of the journal Lancet.

The 1918 flu outbreak killed at least 40 million people world-wide. But flu pandemics have varied widely in their severity. The most recent, in 1957 and 1968, were relatively mild, killing two million and one million people world-wide, respectively.

To get their estimates, Dr. Murray and his colleagues examined all available death registration data from 1914 to 1923. There was sufficient information from 27 countries, including numbers from 24 U.S. states and nine provinces in India.

The researchers compared death rates during the pandemic with average death rates before and after. That revealed how much the pandemic flu contributed to death rates, a figure called excess mortality. They then applied the excess mortality data to world-wide population data from 2004.

If their median estimate of 62 million flu deaths occurred in a single year, the total number of deaths from all causes world-wide would more than double, jumping by 114%.

The study estimates that 96% of the deaths would occur in the developing world. Dr. Murray and colleagues noted there was a 30-fold or more variation in mortality.

"That tells us it's not just the genetic makeup of the virus that will cause deaths, but that there are a lot of other things that intervene," he said. Population density, nutrition and immune status could all play roles, he suggests.
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