In August 1957, the "Asian flu" was exactly where "swine-origin influenza A (H1N1)" is today. A new, aggressive flu strain had emerged in...
In August 1957, the “Asian flu” was exactly where “swine-origin influenza A (H1N1)” is today.
A new, aggressive flu strain had emerged in the spring, triggering sporadic outbreaks throughout the Northern Hemisphere’s normally flu-free summer. As scientists raced to develop and produce a vaccine, Americans debated how seriously to take the threat of a pandemic.
At first, the illness struck mostly in group-living situations such as summer camps and military bases. But the virus was spreading inexorably, and a mass gathering of children in the new school year would be like wind blowing on dry grass that had been showered with sparks. By October, the country was afire with influenza.
U.S. public-health experts now are looking to the past as they try to anticipate what may happen with the H1N1 flu in the next two or three months.
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The pandemic virus of 1957 caused an illness that was briefly harsh but rarely fatal. Like this year’s strain, it emerged in the spring and smoldered over the summer. More than 80 summer camps have suffered swine-flu outbreaks; the picture in 1957 was much the same. As with many pandemic strains, the Asian flu also had an inordinate effect on younger people. By the time the 1957 pandemic had ended, 40 percent of deaths had occurred among people younger than 65, a much larger percentage than in seasonal-flu outbreaks. Analysis of the first 44,000 U.S. swine-flu cases revealed the infection was most common in people ages 5 to 24 — 20 times as common, in fact, as in people older than 65. Eighty-three percent of fatal cases occurred in people younger than 65.
It began in Hong Kong
The origins of the flu outbreak reported in Hong Kong in April 1957 remain shrouded in mystery. However, it was quickly known that it had an unusually high “attack rate”: A substantial fraction of people fell ill once the virus began to circulate in a community. That prompted U.S. officials to ask for samples, and the first arrived May 13. Scientists soon determined it was a radically new strain of the H2N2 class of influenza.
The new bug hopscotched into North America, striking first on naval vessels and coastal military installations. Flu appeared in Newport, R.I., on June 2 and soon after in California. The attack rate was 30 percent on ships and 5 to 10 percent on shore stations, according to reports from the Communicable Disease Center (now the Centers for Disease Control and Prevention).
The virus soon moved into the civilian world.
The first well-studied outbreak occurred in Grinnell, Iowa, where 1,688 people from 43 states and nine countries, mostly women, had gathered in June for a church conference. At least one was from Davis, Calif., where an outbreak had occurred recently.
The first Iowa case appeared June 26. Within days there were dozens more, and a dormitory was designated an infirmary. By July 1, with the toll at 200 cases, the conference disbanded.
Returning home, delegates effectively seeded the entire continent. Curiously, no communitywide outbreaks followed, probably because summer’s heat and humidity are somewhat inimical to flu. Whatever the reason, people at the CDC were assured there wouldn’t be an all-out epidemic — at least until fall.
“We were very encouraged by the Grinnell experience,” recalled D.A. Henderson, 80, a distinguished scholar at the University of Pittsburgh’s Center for Biosecurity, based in Baltimore.
(Henderson was working then with the CDC’s Epidemic Intelligence Service; he and his colleagues recently published an analysis of the 1957 pandemic and its possible lessons for the current one.)
Government epidemiologists immediately had to decide whether to order the cancellation of a 53,000-person Boy Scout jamboree scheduled July 12-24 in Valley Forge, Pa.
“We knew that most were going to be in two-person pup tents, they were going to eat in small groups and spend a lot of time outdoors,” Henderson said. “We decided the amount of contact would be limited.” So they let the event proceed.
Ultimately, 350 people became ill.
“There was no big epidemic,” said W. Yates Trotter Jr., then a 27-year-old physician sent as a CDC observer. “But you wouldn’t expect it to happen immediately. My guess is that a lot of people carried it home.”
Children’s camps were among the few places where flu continued to spread. Camp Roosevelt in Maryland had 70 cases and closed early on July 11. Seven camps in Northern California reported flu, with 123 of 505 children contracting the infection.
Vaccine arrived quickly
The CDC already had asked six vaccine manufacturers to make a vaccine as quickly as possible.
By Sept. 11, 5.4 million doses had been released: 1.8 million to the Defense Department, the rest for civilian uses.
Late that summer, Walter Cronkite hosted a 30-minute CBS Radio special on the impending epidemic. Americans also heard a warning from Deputy Surgeon General W. Palmer Dearing, who said, “10 to 20 percent of the people of the United States could eventually become ill.”
Medical opinion about what lay ahead was diverse. A physician on the Chicago Board of Health urged everyone to get the vaccine. But Morris Greenberg of the New York City Department of Health countered, “It is a little difficult to see why one would try to protect the entire population against an illness so mild.” New Orleans’ public-health officer covered all the options: “The slogan for this impending national disaster adopted in this community is: ‘Don’t become hysterical. Contact your family physician.’ “
In late August, the Association of State and Territorial Health Officers endorsed use of the vaccine. It encouraged people to stay at home and not go to the hospital unless they were seriously ill. Hospitals were warned of a flood of patients. Schools were encouraged to stay open unless there was a dire shortage of students, teachers or bus drivers.
Meanwhile, a preview of the fall drama was under way in Tangipahoa Parish, in southeast Louisiana.
Public schools — still segregated — had opened as usual in mid-July. (The early start allowed a long spring break when children picked strawberries, the region’s cash crop.) The black schools, generally more crowded, began experiencing high absenteeism two weeks into the term. By Aug. 5, 10 were closed for a week. The seven white schools stayed open, although several had single-day absentee rates of nearly 50 percent.
CDC epidemiologists learned that flu had hit high schools before elementary schools. A person’s risk of becoming ill rose steadily with the size of the family. Blood sampling and questionnaires ultimately led scientists to calculate an astonishing attack rate: 60 percent of children — and 42 percent of the entire Tangipahoa Parish population of 60,000.
That same month, 44 Turkish exchange students bound for U.S. colleges were not allowed to board a ship in Rotterdam because 15 had the flu. They flew to New York instead, and three were hospitalized upon arrival.
The ship, the Arosa Sky, arrived five days later. Of 850 people aboard, 250 had come down with flu.
By the end of August, the epidemic was on the wane in or essentially gone from Asia, where it had spread explosively in the spring. It was on the upswing, though, in southern Europe, Central and South America, and coastal Africa.
Infections at schools
Fall arrived, and the virus swept through U.S. schools.
In a brief calm before that storm, many communities wondered whether they might escape the virus or if public-health officials were crying wolf.
The answer was no.
School superintendents in 36 cities reported absentee rates each week to the CDC. A report published in 1959 estimated that “over 60 percent of students had clinical illnesses during the fall.” District of Columbia school absenteeism peaked at 23 percent the week ending Oct. 12. In Baltimore, it was the next week; in Boston, two weeks later.
Bell System, then a nationwide telephone monopoly, also made regular reports on adult-worker absenteeism from 36 cities. Bell’s peak “industrial absenteeism,” generally no more than 8 to 10 percent of the work force, lagged behind school absenteeism by two to three weeks. Businesses staggered briefly, recovering in a couple of weeks, as did most flu victims.
Scattered through the news stories and the mimeographed weekly CDC reports, however, were accounts of tragedy: A 2-year-old toddler dying in his mother’s arms on the way to the hospital in Tangipahoa Parish. A 12-year-old camper who died on a hike in San Diego. A 16-year-old exchange student dying of “fulminant hemorrhagic pneumonia” days after arriving in New York.
In general, though, news coverage was low-key, with stories focused on such subjects as how the flu was disrupting high-school and college football schedules.
There was a priority list for the vaccine, starting with President Eisenhower, who was given his flu shot Aug. 26. D.C.’s first shipment Sept. 3 went to police, firefighters and the staff of D.C. General Hospital. Further down the list were employees of the medical examiner’s office, prisons and state schools, water and sewer workers, bus drivers, telephone workers and teachers.
The vaccine was judged 45 to 60 percent effective, but much of it became available during the peak period or right after it. By early November, about 40 million doses had been released, and both a state-by-state allocation scheme and the occupational priority list were dropped. The pandemic was losing steam.
By Thanksgiving, life was nearly back to normal, and health officials were trying to convince the public that flu shots were still worth taking. Their advice was good. Asian flu came back for a third time, in late February, causing another spike in mortality, this time mostly in the elderly.
In all, the 1957-58 pandemic was responsible for about 60,000 “excess deaths” in the United States — deaths exceeding what normally would be expected. About 40,000 occurred in the summer and fall of 1957, 20,000 in the winter of 1958. That’s the equivalent of 107,000 people in the U.S. population today. Seasonal flu contributes to the deaths of about 36,000 people in the United States each year.
Worldwide, mortality is estimated to have been about 2 million.
A dominant strain
The H2N2 pandemic strain of 1957 was so contagious and encountered such a susceptible world that it out-competed all other strains of influenza A circulating at the time. They were of the H1N1 family, as is this year’s. H1N1 flu reappeared as the “Russian flu” of 1977, probably the consequence of a laboratory accident in eastern Asia. The H2N2 Asian strain was driven into oblivion by the “Hong Kong flu” of 1968, a member of a new family, H3N2.
Today, few people remember either of those pandemics.
Whether today’s Americans remember this flu pandemic longer is one of the many things about this disease that only time will answer.