Characterization of five of the eight RNA segments of the 1918 influenza virus indicates that it was the common ancestor of both subsequent human and swine H1N1 lineages, and experiments testing models of virulence using reverse genetics approaches with 1918 influenza genes have begun in hopes of identifying genetic features that confer virulence in humans. Clues are being sought by examining viruses preserved in frozen and fixed tissues of victims of the 1918 flu. The chapter continues with an account of molecular studies underway to determine the origin of the 1918 virus and the source(s) of its exceptional virulence. It describes the epidemiology and symptomology of that deadly viral strain, limited efforts toward prevention and treatment, and the resulting social disruption and its exacerbation by the actions of public officials and the media. The chapter begins with a review of the events of 1918, the lessons they offer, and the historical and scientific questions they raise. As the contributors to this chapter demonstrate, there is still much to be learned from past pandemics that can strengthen defenses against future threats. Yet the world is vulnerable to the next pandemic, perhaps even more than in 1918, when the pace and frequency of global travel was considerably less than today. Since then, mankind has gained several advantages against the disease: experience of three better characterized pandemics (1918, 1957, and 1968) knowledge of influenza viruses capacity to design and manufacture vaccines and antiviral drugs to forestall (if not prevent) infection and molecular technology that may one day pinpoint the viral components that produce virulence, and thereby identify targets for more effective vaccines and drugs.

In the early 20th century, science was sufficiently sophisticated to anticipate that influenza, which had twice reached pandemic proportions in the late 19th century, would recur, but was largely powerless to blunt the devastating impact of the 1918 (H1N1) pandemic.

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