Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 5, Number 2—April 1999

The Next Influenza Pandemic: Lessons from Hong Kong, 1997

René Snacken*Comments to Author , Alan P. Kendal†, Lars R. Haaheim‡, and John M. Wood
Author affiliations: *Scientific Institute of Public Health Louis Pasteur, Brussels, Belgium;; †The Rollins School of Public Health, Emory University, Atlanta, Georgia, USA;; ‡University of Bergen, Bergen, Norway; §National Institute for Biological Standards and Control, Potters Bar, United Kingdom

Main Article


Influenza landmarks in humans this century

Year Colloquial Name (Subtype) Source Impact
1918 (1) Spanish flu (H1N1 viruses like swine flu) Possible emergence from swine or an avian host of a mutated H1N1 virus Pandemic with >20 million deaths globally
1957 (2) Asian flu (H2N2) Possible mixed infection of an animal with human H1N1and avian H2N2 virus strains in Asia Pandemic, H1N1virus disappeared
1968 (2) Hong Kong flu (H3N2) High probability of mixed infection of an animal with human H2N2 and avian H3Nx virus strains in Asia Pandemic, H2N2 virus disappeared
1977 (3) Russian flu (H1N1) Source unknown but virus is almost identical to human epidemic strains from 1950. Reappearance detected at almost the same time in China and Siberia Benign pandemic, primarily involving persons born after the 1950s. H1N1 virus has cocirculated with H3N2 virus in humans since 1977
Incidents with limited spread
1976 (4) Swine flu (H1N1) United States/New Jersey. Virus enzootic in U.S. swine herds since at least 1930 Localized outbreak in military training camp, with one death
1986 (5) (H1N1) The Netherlands. Swine virus derived from avian source One adult with severe pneumonia
1988 (6) Swine flu (H1N1) United States/Wisconsin. Swine virus Pregnant woman died after exposure to sick pig
1993 (7) (H3N2) The Netherlands. Swine reassortant between old human H3N2 (1973/75-like) and avian H1N1 Two children with mild disease. Fathers suspected to have transmitted the virus to the children after having been infected by pigs.
1995 (8) (H7N7) United Kingdom Duck virus One adult with conjunctivitis
1997 (9) Chicken flu (H5N1) Hong Kong Poultry virus 18 confirmed human case, 6 deaths

Main Article

  1. Webster  RG, Bean  WJ, Gorman  OT, Chambers  TM, Kawaoka  Y. Evolution and ecology of influenza A viruses. Microbiol Rev. 1992;56:15279.PubMedGoogle Scholar
  2. Kawaoka  Y, Krauss  S, Webster  RG. Avian-to-human transmission of the PB1 gene of influenza A viruses in the 1957 and 1968 pandemics. J Virol. 1989;63:46038.PubMedGoogle Scholar
  3. Scholtissek  C, Von Hoynigen  V, Rott  R. Genetic relatedness between the new 1977 epidemic strains (H1N1) of influenza and human influenza strains isolated between 1947 and 1957 (H1N1). Virology. 1978;86:6137. DOIGoogle Scholar
  4. Kendal  AP, Goldfield  M, Noble  GR, Dowdle  WR. Identification and preliminary antigenic analysis of swine influenza-like viruses isolated during an influenza outbreak at Fort Dix, New Jersey. J Infect Dis. 1977;136:S3815.PubMedGoogle Scholar
  5. de Jong  JC, Paccaud  MF, DeRonde-Verloop  FM, Huffels  NH, Verweij  JC, Weijers  TF, Isolation of swine-like influenza (A(H1N1) viruses from man in Switzerland and the Netherlands. Annales de L'Institute Pasteur/Virilogie 1988;139:429-37.
  6. Rota  PA, Rocha  EP, Harmon  MW, Hinshaw  VS, Sheerer  MG, Kawaoka  Y, Laboratory characterization of a swine influenza virus isolated from a fatal case of human influenza. J Clin Microbiol. 1989;27:14136.PubMedGoogle Scholar
  7. Claas  ECJ, Kawaoka  Y, de Jong  JC, Webster  RG. Infection of children with avian-human reassortment influenza virus from pigs in Europe. Virology. 1994;204:4537. DOIPubMedGoogle Scholar
  8. Kurtz  J, Manvell  RJ, Banks  J. Avian influenza virus isolated from a woman with conjunctivitis. Lancet. 1996;348:9012. DOIPubMedGoogle Scholar
  9. De Jong  JC, Class  EJC, Osterhaus  ADME, Webster  RG, Lim  WL. A pandemic warning? Nature. 1997;389:554. DOIPubMedGoogle Scholar
  10. Crosby  AW. America's forgotten pandemic. Cambridge: University Press; 1989.
  11. Frost  WH. Statistics of influenza morbidity with special reference to certain factors in case incidence and case fatality. Public Health Rep. 1920;35:58497.
  12. Collins  SD. Trend and age variation of mortality and morbidity from influenza and pneumonia. In: A review and study of illness and medical care with special reference to long term trends. Public Health Monograph no. 48. Washington: U.S. Government Printing Office; 1957. p. 51-73.
  13. Bland  PB. Influenza in its relation to pregnancy and labor. American Journal of Obstetrics. 1919;79:18497.
  14. Kosmack  G. The occurrence of epidemic influenza in pregnancy. American Journal of Obstetrics. 1919;79:23847.
  15. Kendal  AP, Minuse  E, Maasab  HF, Hennessy  AV, Davenport  FM. Influenza neuraminidase antibody patterns of man. Am J Epidemiol. 1973;98:96103.PubMedGoogle Scholar
  16. Webster  RG. Influenza: an emerging disease. Emerg Infect Dis. 1998;4:43641. DOIPubMedGoogle Scholar
  17. Scholtissek  C. Molecular aspects of the epidemiology of influenza virus disease. Experiment. 1987;43:11972001. DOIGoogle Scholar
  18. Hampson  AW, Cox  NJ. Global surveillance for pandemic influenza. Are we prepared? In: Brown LE, Hampson AW, Webster RG, editors. Options for the control of influenza III. Amsterdam: Elsevier Science Publishers BV; 1996. p. 50-9.
  19. Reichelderfer  PS, Kendal  AP, Shortridge  KF, Hampson  A. Influenza surveillance in the pacific basin. Seasonality of virus occurrence: a preliminary report. In: Current topics in medical virology. Chan YC, Doraisingham S, Ling AE, editors. Singapore: World Scientific; 1989. p. 412-44.
  20. Claas  ECJ, Osterhaus  ADME, van Beek  R, de Jong  JC, Rimmelzwaan  GF, Senne  DA, Human influenza A H5N1 virus related to a highly pathogenic avian influenza virus. Lancet. 1998;351:4727. DOIPubMedGoogle Scholar
  21. Claas  ECJ, de Jong  JC, van Beek  R, Rimmelzwaan  GF, Osterhaus  ADME. Human influenza virus A/Hong Kong/156/97 (H5N1) infection. Vaccine. 1998;16:9778. DOIPubMedGoogle Scholar
  22. Subbarao  K, Klimov  A, Katz  J, Regnery  H, Lim  W, Hall  H, Characterization of an avian influenza A (H5N1) virus isolated from a child with a fatal respiratory illness. Science. 1998;279:3936. DOIPubMedGoogle Scholar
  23. Monto  AS, Iacuzio  DA, La Montagne  JR. Pandemic influenza-confronting a reemergent threat. J Infect Dis. 1997;176(Suppl):S13. DOIPubMedGoogle Scholar
  24. World Health Organization. Influenza pandemic preparedness plan. Responding to an influenza pandemic or its threat: the role of WHO and guidelines for national and regional planning. Geneva: The Organization; 1999.
  25. Fry  J. Epidemic influenza. Patterns over 20 years (1949-1968). J R Coll Gen Pract. 1969;17:1003.PubMedGoogle Scholar
  26. Serfling  RE. Methods for current statistical analysis of excess pneumonia-influenza deaths. Public Health Rep. 1963;78:494506.PubMedGoogle Scholar
  27. Lui  K, Kendal  AP. Impact of influenza epidemics on mortality in the United States from October 1972 to May 1985. Am J Public Health. 1987;77:7126. DOIPubMedGoogle Scholar
  28. Snacken  R. Weekly monitoring of influenza impact in Belgium (1993-1995). PharmacoEconomics 1996;9 Suppl 3):34-7.
  29. Reichelderfer  PS, Kappus  KD, Kendal  AP. Economical laboratory support system for influenza virus surveillance. J Clin Microbiol. 1987;25:9478.PubMedGoogle Scholar
  30. Centers for Disease Control and Prevention. Influenza A in Florida and Tennessee, July-August 1998, and virologic surveillance of influenza May-August 1998. MMWR Morb Mortal Wkly Rep. 1998;47:7569.PubMedGoogle Scholar
  31. Hampson  AW. Surveillance of influenza pandemic. J Infect Dis. 1997;176(Suppl 1):S813. DOIPubMedGoogle Scholar
  32. Budnick  LD, Moll  ME, Hull  HF, Mann  JM, Kendal  AP. A pseudo-outbreak of influenza A associated with use of laboratory stock strain. Am J Public Health. 1984;74:6079. DOIPubMedGoogle Scholar
  33. Cox  NJ, Nakajima  S, Black  R, Kendal  AP. Oligonucleotide mapping of viral ribonucleic acid as an aid in identifying laboratory contaminants of influenza virus. Diagn Microbiol Infect Dis. 1986;4:2319. DOIPubMedGoogle Scholar
  34. Snacken  R, Manuguerra  JC, Taylor  P. European influenza surveillance scheme on the Internet. Methods Inf Med. 1998;37:26670.PubMedGoogle Scholar
  35. Belshe  RB. Influenza as a zoonosis: how likely is a pandemic? Lancet. 1998;351:4601. DOIPubMedGoogle Scholar
  36. La mobilisation de la Croix-Rouge Américaine pendant l'épidémie de grippe 1918-1919. La Tribune de Genève, 1920;1-27 (archival source: International Federation of the Red Cross, box 19746).
  37. Ghendon  Y. Introduction to pandemic influenza through history. Eur J Epidemiol. 1994;10:4513. DOIPubMedGoogle Scholar

Main Article

Page created: December 10, 2010
Page updated: December 10, 2010
Page reviewed: December 10, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.