Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality
Open accessAbstract
The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889-90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.
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In contrast with previous influenza pandemics such as the 1918-1920 Spanish influenza and the 1957 pandemic, the mortality impact of the COVID-19 pandemic has primarily affected older age groups.
“In contrast with previous influenza pandemics such as the 1918–1920 Spanish influenza that primarily affected the young,37 or the 1957 pandemic that affected both the young and old,38 the mortality impact of the COVID-19 pandemic has primarily affected older age groups.”
From Estimating the burden of the COVID-19 pandemic on mortality, life expectancy and lifespan inequality in England and Wales: a population-level analysis (2021) · cites this paper as [37]
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References 65 · Cited by 186
Research works printed but not linked: 1
- [35]Myers RJ (1940) Errors and bias in the reporting of ages in census data. Transactions of the Actuarial Society of America 41: 395– 415.
- Authors
- Gagnon, A., Miller, M. S., Hallman, S. A., Bourbeau, R., Herring, D. A., Earn, D. J., & Madrenas, J.
- Affiliations
- Université de Montréal (CA)
- Icahn School of Medicine at Mount Sinai (US)
- Western University (CA)
- McMaster University (CA)
- Michael G. DeGroote Institute for Infectious Disease Research (CA)
- Corresponding author
- Gagnon, Alain
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2013-08-05
- Volume
- 8
- Issue
- 8
- Pages
- e69586
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3734171
- OpenAlex
- W2054393027
- Cited by
- 186
- References
- 65
- Citations by year
- 2026: 19 · 2025: 7 · 2024: 17 · 2023: 20 · 2022: 23 · 2021: 31 · 2020: 24 · 2019: 12 · 2018: 9 · 2017: 4 · 2016: 4 · 2015: 11 · 2014: 5
- FWCI
- 4.86
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion, cc-by)
- Funders
- Canadian Institutes of Health Research
- Natural Sciences and Engineering Research Council of Canada
- Topics
- Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
- Health Sciences › Medicine › Epidemiology › Respiratory viral infections research
- Life Sciences › Immunology and Microbiology › Immunology › Immune responses and vaccinations
- Keywords
- 1918 influenza pandemic, young adult mortality, age-specific mortality, H1N1 influenza, early life exposure, immunological memory, immune dysregulation, T cell receptor repertoire, fetal maturity, pandemic influenza preparedness
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Canada, Child, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Influenza, Human, Male, Middle Aged, United States, Age Distribution, Young Adult, Pandemics
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