Threat Of Influenza Pandemic Research Articles

Measuring Indonesia H1N1 Pandemic Preparedness Through Stakeholder AnalysisA Healthcare Advertising,Health care legislation.

Abstract As part of Asia Flu Cap project, the stakeholder analysis of H1N1 pandemic response in Indonesia aims to identify stakeholders’ capacity strengths, gaps, and constraints in response to influenza pandemic threat. Eighteen stakeholders associated with H1N1 pandemic response were interviewed between June-August 2010. Have experienced with SARS and H5N1, the availability of pandemic preparedness/response strategies, pandemic standard operational procedure and case management guidelines, preparedness of 100 referral hospitals, health center, referral laboratories, international airport border control, and other facilities were Indonesia’s capacity strengths. However, there was management gap of Avian Influenza (AI) control and pandemic preparedness/response between national, province, district, and city committee. In addition, complicated procedures of budget approval and slow disbursement for pandemic preparedness and implementation were identified as constraining bureaucracy. Through experiences with H5N1, Indonesia has built a better organization governance, trained human workforce, and resources to handle H1N1 pandemic.

Mobilising “vulnerability” in the public health response to pandemic influenza

Analysis of public health's growing interest in “vulnerability” has largely focused on health policy, with little interrogation of how vulnerability is being actively appropriated, countered, ignored or reworked by the publics whose health such policy is designed to protect. Once the assemblage of public health is understood as comprised of different forms of expertise and actors, including publics, addressing this gap matters. We examine the use of vulnerability in the specific context of pandemic influenza preparedness. Pandemic preparedness raises some familiar dilemmas for public health governance: how to engage with publics without fuelling social divisions and disruption; and whether to invoke publics as passive recipients of public health advice or to recognise publics as collective agents responding to the threat of pandemic influenza. Thus, we ask how the mobilisation of vulnerability connects with these dilemmas. To examine vulnerability in pandemic preparedness, two forms of qualitative data are analysed: 1) interviews and focus groups with “vulnerable” and “healthy” people (conducted 2011–12) discussing seasonal and pandemic influenza and; 2) international, Australian national and state level pandemic plans (1999–2013). Vulnerability is variously used in plans as a way to identify groups at particular risk of infection because of pre-existing clinical conditions, and as a free-floating social category that could apply to a broad range of people potentially involved in the social disruption a pandemic might entail. Our interview and focus group data indicate that healthy people rework the free-floating extension of vulnerability, and that people designated vulnerable encounter an absence of any collective responsibility for the threat of pandemic influenza. Our analysis suggests that vulnerability's mobilisation in pandemic preparedness limits the connection between public health governance and its publics: here, the openness and unpredictability of people's collective agency is something to be tightly controlled by a government concerned with protecting people from themselves.

Comparative analysis of antibody induction and protection against influenza virus infection by DNA immunization with HA, HAe, and HA1 in mice

Plasmid DNA vaccines are considered alternatives to inactivated influenza virus vaccines to control influenza. Vaccination with a hemagglutinin (HA)-, HA ectodomain (HAe)-, or HA subunit 1 (HA1)-based vaccine can stimulate protective immunity in animals. The aim of this study was to compare their capacity to induce an antibody response and protection against influenza virus infection in mice after DNA vaccination. We constructed three expression vectors encoding full-length HA, HAe, or HA1 of the A/California/07/2009 influenza A virus and designed three animal experiments: (i) BALB/c mice were immunized twice with 30μg of the HA, HAe, or HA1 DNA vaccine with high-voltage electroporation (100V), and 3weeks after boosting, they were challenged with a lethal dose of virus. (ii) Immunization and challenge were as in experiment i, but with low-voltage electroporation (10V). (iii) Mice were immunized once with 50μg of DNA and challenged 1week later. The immunogenic effects of the three DNA vaccines were evaluated in terms of antibody titer, survival rate, bodyweight change, and lung viral titer. In all three experiments, both HA and HAe induced higher antibody and neutralization titers than HA1. Following challenge with a lethal mouse-adapted homologous virus, both HA and HAe reduced the viral titers in lung washes or offered better protection from weight loss than HA1 in experiments ii and iii. Thus, HA1 induces a lower immune response than HA or HAe when used as a DNA vaccination. Our data should be valuable in choosing the optimal candidate vaccine when faced with the threat of pandemic influenza.

Inhibitors of influenza viruses replication: a patent evaluation (WO2013019828)

A series of compounds incorporating two aromatic heterocycles were prepared as inhibitors of influenza virus replication in the patent. Some of them presented potent activity against influenza virus in Madin–Darby canine kidney (MDCK) cells and in influenza therapeutic mouse model. These compounds in the patent were also defined to be pharmaceutically acceptable salts and pharmaceutical compositions that were claimed to be useful for treating influenza. In view of the threat of influenza pandemic, it is necessary to discover new anti-influenza drugs. Although there is a lack of essential biological data and the molecular mechanisms are not clear, these compounds with potent antiviral activity stand for a new type of anti-influenza agents and deserve further studies.

Capacity Building in Response to Pandemic Influenza Threats: Lao PDR Case Study

The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considerable crossover effect of such investments to augment the capacity to combat emerging and re-emerging diseases other than influenza.

An analysis of health system resources in relation to pandemic response capacity in the Greater Mekong Subregion

BackgroundThere is increasing perception that countries cannot work in isolation to militate against the threat of pandemic influenza. In the Greater Mekong Subregion (GMS) of Asia, high socio-economic diversity and fertile conditions for the emergence and spread of infectious diseases underscore the importance of transnational cooperation. Investigation of healthcare resource distribution and inequalities can help determine the need for, and inform decisions regarding, resource sharing and mobilisation.MethodsWe collected data on healthcare resources deemed important for responding to pandemic influenza through surveys of hospitals and district health offices across four countries of the GMS (Cambodia, Lao PDR, Thailand, Vietnam). Focusing on four key resource types (oseltamivir, hospital beds, ventilators, and health workers), we mapped and analysed resource distributions at province level to identify relative shortages, mismatches, and clustering of resources. We analysed inequalities in resource distribution using the Gini coefficient and Theil index.ResultsThree quarters of the Cambodian population and two thirds of the Laotian population live in relatively underserved provinces (those with resource densities in the lowest quintile across the region) in relation to health workers, ventilators, and hospital beds. More than a quarter of the Thai population is relatively underserved for health workers and oseltamivir. Approximately one fifth of the Vietnamese population is underserved for beds and ventilators. All Cambodian provinces are underserved for at least one resource. In Lao PDR, 11 percent of the population is underserved by all four resource items. Of the four resources, ventilators and oseltamivir were most unequally distributed. Cambodia generally showed higher levels of inequalities in resource distribution compared to other countries. Decomposition of the Theil index suggests that inequalities result principally from differences within, rather than between, countries.ConclusionsThere is considerable heterogeneity in healthcare resource distribution within and across countries of the GMS. Most inequalities result from within countries. Given the inequalities, mismatches, and clustering of resources observed here, resource sharing and mobilization in a pandemic scenario could be crucial for more effective and equitable use of the resources that are available in the GMS.

Systems pharmacology uncovers Janus functions of botanical drugs: activation of host defense system and inhibition of influenza virus replication

Given the imminent threat of influenza pandemics and continuing emergence of new drug-resistant influenza virus strains, novel strategies for preventing and treating influenza disease are urgently needed. Herbal medicine, used for thousands of years in combinational therapies (Herb Formula), plays a significant role in stimulating the host immune system in vivo, and meanwhile, in fighting against the pandemic by directly inhibiting influenza virus in vitro. Such potential Janus functions may spark interest in therapeutic manipulation of virus diseases. Unfortunately, the molecular mechanism of the Janus functions of the medicinal herbs in the treatment of influenza remains unclear. In this work, to illustrate the therapeutic concept of Janus functions in the treatment of influenza, we have introduced a novel systems pharmacology model that integrates pharmacokinetic screening, targeting and network analysis of two representative herbs Lonicera japonica and Fructus Forsythiae that are efficient in the treatment of influenza, inflammation and other diseases. 50 Chemicals with favorable pharmacokinetic profiles have been identified for the two herbs, and the ligand–target network was constructed by complementing the literature-based experimental data deposited in DrugBank. The annotation of these chemicals was assigned using a novel drug targeting approach, and mapped to target–disease and drug–target–pathway networks. The overall data suggest that the medicinal herbs function by indirectly suppressing the virus proliferation via regulating the immune systems in hosts, and also, by directly inhibiting virus proliferation through targeting viral proteins essential for the viral life cycle. For the first time, we have demonstrated the mechanism of medicinal herbs in prevention and treatment of virus diseases via the Janus functions on a systematic level.

Advances in the development of universal influenza vaccines

Please cite this paper as: Sarah C. Gilbert. (2012) Advances in the development of universal influenza vaccines. Influenza and Other Respiratory Viruses DOI:10.1111/irv.12013.Despite the widespread availability and use of influenza vaccines, influenza still poses a considerable threat to public health. Vaccines against seasonal influenza do not offer protection against pandemic viruses, and vaccine efficacy against seasonal viruses is reduced in seasons when the vaccine composition is not a good match for the predominant circulating viruses. Vaccine efficacy is also reduced in older adults, who are one of the main target groups for vaccination. The continual threat of pandemic influenza, with the known potential for rapid spread around the world and high mortality rates, has prompted researchers to develop a number of novel approaches to providing immunity to this virus, focusing on target antigens which are highly conserved between different influenza A virus subtypes. Several of these have now been taken into clinical development, and this review discusses the progress that has been made, as well as considering the requirements for licensing these new vaccines and how they might be used in the future.

Cell‐free production of trimeric influenza hemagglutinin head domain proteins as vaccine antigens

In order to effectively combat pandemic influenza threats, there is a need for more rapid and robust vaccine production methods. In this article, we demonstrate E. coli-based cell-free protein synthesis (CFPS) as a method to rapidly produce domains from the protein hemagglutinin (HA), which is present on the surface of the influenza virus. The portion of the HA coding sequence for the "head" domain from the 2009 pandemic H1N1 strain was first optimized for E. coli expression. The protein domain was then produced in CFPS reactions and purified in soluble form first as a monomer and then as a trimer by a C-terminal addition of the T4 bacteriophage foldon domain. Production of soluble trimeric HA head domain was enhanced by introducing stabilizing amino acid mutations to the construct in order to avoid aggregation. Trimerization was verified using size exclusion HPLC, and the stabilized HA head domain trimer was more effectively recognized by antibodies from pandemic H1N1 influenza vaccine recipients than was the monomer and also bound to sialic acids more strongly, indicating that the trimers are correctly formed and could be potentially effective as vaccines.

Short message service sentinel surveillance of influenza-like illness in Madagascar, 2008-2012

The revision of the International Health Regulations (IHR) and the threat of influenza pandemics and other disease outbreaks with a major impact on developing countries have prompted bolstered surveillance capacity, particularly in low-resource settings. Surveillance tools with well-timed, validated data are necessary to strengthen disease surveillance. In 2007 Madagascar implemented a sentinel surveillance system for influenza-like illness (ILI) based on data collected from sentinel general practitioners. Before 2007, Madagascar's disease surveillance was based on the passive collection and reporting of data aggregated weekly or monthly. The system did not allow for the early identification of outbreaks or unexpected increases in disease incidence. An innovative case reporting system based on the use of cell phones was launched in March 2007. Encrypted short message service, which costs less than 2 United States dollars per month per health centre, is now being used by sentinel general practitioners for the daily reporting of cases of fever and ILI seen in their practices. To validate the daily data, practitioners also report epidemiological and clinical data (e.g. new febrile patient's sex, age, visit date, symptoms) weekly to the epidemiologists on the research team using special patient forms. Madagascar's sentinel ILI surveillance system represents the country's first nationwide "real-time" surveillance system. It has proved the feasibility of improving disease surveillance capacity through innovative systems despite resource constraints. This type of syndromic surveillance can detect unexpected increases in the incidence of ILI and other syndromic illnesses.

Microneedle and mucosal delivery of influenza vaccines

In recent years with the threat of pandemic influenza and other public health needs, alternative vaccination methods other than intramuscular immunization have received great attention. The skin and mucosal surfaces are attractive sites probably because of both noninvasive access to the vaccine delivery and unique immunological responses. Intradermal vaccines using a microinjection system (BD SoluviaTM) and intranasal vaccines (FluMist®) are licensed. As a new vaccination method, solid microneedles have been developed using a simple device that may be suitable for self-administration. Because coated microneedle influenza vaccines are administered in the solid state, developing formulations maintaining the stability of influenza vaccines is an important issue to be considered. Marketable microneedle devices and clinical trials remain to be developed. Other alternative mucosal routes such as oral and intranasal delivery systems are also attractive for inducing cross-protective mucosal immunity, but effective non-live mucosal vaccines remain to be developed.

Influenza neuraminidase: A druggable target for natural products

The imminent threat of influenza pandemics and repeatedly reported emergence of new drug-resistant influenza virus strains demonstrate the urgent need for developing innovative and effective antiviral agents for prevention and treatment. At present, influenza neuraminidase (NA), a key enzyme in viral replication, spread, and pathogenesis, is considered to be one of the most promising targets for combating influenza. Despite the substantial medical potential of NA inhibitors (NAIs), only three of these drugs are currently on the market (zanamivir, oseltamivir, and peramivir). Moreover, sudden changes in NAI susceptibility revealed the urgent need in the discovery/identification of novel inhibitors. Nature offers an abundance of biosynthesized compounds comprising chemical scaffolds of high diversity, which present an infinite pool of chemical entities for target-oriented drug discovery in the battle against this highly contagious pathogen. This review illuminates the increasing research efforts of the past decade (2000-2011), focusing on the structure, function and druggability of influenza NA, as well as its inhibition by natural products. Following a critical discussion of publications describing some 150 secondary plant metabolites tested for their inhibitory potential against influenza NA, the impact of three different strategies to identify and develop novel NAIs is presented: (i) bioactivity screening of herbal extracts, (ii) exploitation of empirical knowledge, and (iii) computational approaches. This work addresses the latest developments in theoretical and experimental research on properties of NA that are and will be driving anti-influenza drug development now and in the near future.

From Lessons Learned After 2009 H1N1 Pandemic to TEPIK's Preparedness and Response Plan

In response to the global spread of the H1N1 influenza virus after first being detected in North America in April 2009, WHO declared the first influenza pandemic in more than four decades on June 11 of the same year. In Korea, the arrival of the 2009 H1N1 pandemic influenza triggered an integrated response that was mainly based on the 2006 Pandemic Influenza Preparedness and Response Plan. At least 270 fatal cases, 764 laboratory-thousand confirmed cases, and 3.6 million courses of antiviral agent use were reported to the end of August 2010 in this country. Even if government tried to control and mitigate the impact of pandemic by using public health and medical countermeasures, there were several issues found during the H1N1 pandemic responses. The main difficulty was the delayed and insufficient supply of pandemic vaccine. Therefore the mass vaccination campaign was begun after the peak of pandemic and its mitigation effect on the pandemic disease burden was diminished. The amount of stockpiled antiviral agents by government was not enough in the early phase of pandemic. The rapid antigen test for the H1N1 influenza showed low sensitivity, about 50%. Many infected people were seeking to be diagnosed with rRT-PCR test, which is expensive and not useful for the decision of antiviral use because of late test report. The communications among government, medical societies, general people and mass media were also not satisfactory. Lessons learned from the national response to the H1N1 pandemic made the government to launch the TEPIK in October 2010. TEPIK will incorporate those lessons into the future pandemic preparedness planning. The mission of TEPIK is to ensure the safety of the nation and people from the threat of pandemic influenza. TEPIK focuses to establish government-academic-institute-industry collaborative system with three main strategies; to expedite sharing of RD to establish the preparedness and response of RD and to secure the innovative and leading response technology against pandemic influenza. TEPIK has 34 research projects in eight research areas, which include vaccine; therapeutics; diagnostics; basic/mechanism; clinical/ policy; surveillance/epidemiology; innovative researches; and infrastructures. Research subjects in each research area will be stated in this presentation.

Yeast expressed recombinant Hemagglutinin protein of Novel H1N1 elicits neutralising antibodies in rabbits and mice

Currently available vaccines for the pandemic Influenza A (H1N1) 2009 produced in chicken eggs have serious impediments viz limited availability, risk of allergic reactions and the possible selection of sub-populations differing from the naturally occurring virus, whereas the cell culture derived vaccines are time consuming and may not meet the demands of rapid global vaccination required to combat the present/future pandemic. Hemagglutinin (HA) based subunit vaccine for H1N1 requires the HA protein in glycosylated form, which is impossible with the commonly used bacterial expression platform. Additionally, bacterial derived protein requires extensive purification and refolding steps for vaccine applications. For these reasons an alternative heterologous system for rapid, easy and economical production of Hemagglutinin protein in its glycosylated form is required. The HA gene of novel H1N1 A/California/04/2009 was engineered for expression in Pichia pastoris as a soluble secreted protein. The full length HA- synthetic gene having α-secretory tag was integrated into P. pastoris genome through homologous recombination. The resultant Pichia clones having multiple copy integrants of the transgene expressed full length HA protein in the culture supernatant. The Recombinant yeast derived H1N1 HA protein elicited neutralising antibodies both in mice and rabbits. The sera from immunised animals also exhibited Hemagglutination Inhibition (HI) activity. Considering the safety, reliability and also economic potential of Pichia expression platform, our preliminary data indicates the feasibility of using this system as an alternative for large-scale production of recombinant influenza HA protein in the face of influenza pandemic threat.

Changing perceptions: of pandemic influenza and public health responses.

According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics.

Distribution of viral RNA, sialic acid receptor, and pathology in H5N1 avian influenza patients

Avian influenza virus H5N1 infects and causes severe disease in humans. Despite the increasing number of fatal cases in 15 countries and the threat of influenza pandemic, detailed pathologic and virologic findings in humans are limited. In this study, we describe histopathologic findings, distributions of viral RNA and the Neu5Acα2-3Galβ1-4 sialic acid receptor in human tissues from three fatal avian influenza cases. Many of our findings are in agreement with previously published autopsy studies, that is, viral RNA and receptor were detected in type II pneumocytes, tracheal epithelium, intestinal epithelium, spleen, lymph nodes, and Kupffer's cells. In addition, we detected the viral RNA in glomeruli and renal tubules. There was a good correlation between viral RNA distribution and the presence of the sialic acid receptor. Despite the wide distribution of viral RNA, tissue damage and inflammation were mainly limited to pulmonary tissue.

Properly folded bacterially expressed H1N1 hemagglutinin globular head and ectodomain vaccines protect ferrets against H1N1 pandemic influenza virus.

BackgroundIn the face of impending influenza pandemic, a rapid vaccine production and mass vaccination is the most effective approach to prevent the large scale mortality and morbidity that was associated with the 1918 “Spanish Flu”. The traditional process of influenza vaccine production in eggs is time consuming and may not meet the demands of rapid global vaccination required to curtail influenza pandemic.Methodology/Principal FindingsRecombinant technology can be used to express the hemagglutinin (HA) of the emerging new influenza strain in a variety of systems including mammalian, insect, and bacterial cells. In this study, two forms of HA proteins derived from the currently circulating novel H1N1 A/California/07/2009 virus, HA1 (1–330) and HA (1–480), were expressed and purified from E. coli under controlled redox refolding conditions that favoured proper protein folding. However, only the recombinant HA1 (1–330) protein formed oligomers, including functional trimers that bound receptor and caused agglutination of human red blood cells. These proteins were used to vaccinate ferrets prior to challenge with the A/California/07/2009 virus. Both proteins induced neutralizing antibodies, and reduced viral loads in nasal washes. However, the HA1 (1–330) protein that had higher content of multimeric forms provided better protection from fever and weight loss at a lower vaccine dose compared with HA (1–480). Protein yield for the HA1 (1–330) ranged around 40 mg/Liter, while the HA (1–480) yield was 0.4–0.8 mg/Liter.Conclusions/SignificanceThis is the first study that describes production in bacterial system of properly folded functional globular HA1 domain trimers, lacking the HA2 transmembrane protein, that elicit potent neutralizing antibody responses following vaccination and protect ferrets from in vivo challenge. The combination of bacterial expression system with established quality control methods could provide a mechanism for rapid large scale production of influenza vaccines in the face of influenza pandemic threat.

Keeping the vermin out: Perceived disease threat and ideological orientations as predictors of exclusionary immigration attitudes

AbstractIntegrating evolutionary and social representations theories, the current study examines the relationship between perceived disease threat and exclusionary immigration attitudes in the context of a potential avian influenza pandemic. This large‐scale disease provides a realistic context for investigating the link between disease threat and immigration attitudes. The main aim of this cross‐sectional study (N = 412) was to explore mechanisms through which perceived chronic and contextual disease threats operate on immigration attitudes. Structural equation models show that the relationship between chronic disease threat (germ aversion) and exclusionary immigration attitudes (assimilationist immigration criteria, health‐based immigration criteria and desire to reduce the proportion of foreigners) was mediated by ideological and normative beliefs (social dominance orientation, belief in a dangerous world), but not by contextual disease threat (appraisal of avian influenza pandemic threat). Contextual disease threat only predicted support for health‐based immigration criteria. The conditions under which real‐life disease threats influence intergroup attitudes are scrutinized. Convergence and dissimilarity of evolutionary and social representational approaches in accounting for the link between disease threat and immigration attitudes are discussed. Copyright © 2010 John Wiley & Sons, Ltd.

Methodological Considerations for Future Controlled Influenza Treatment Trials in Complementary and Alternative Medicine

The continuous threat of influenza pandemic, as well as the ongoing costs to human life and health care systems from yearly epidemics, create a continual need for progress in this area of public health. The diversity of available complementary and alternative medicine (CAM) treatment options are well known to the CAM profession, but poorly understood and accepted in mainstream medicine. This situation comes as no surprise given conventional medicine's reliance on repeated, large-scale randomized controlled trials of standardized design to support evidence-based clinical use of influenza antiviral drugs. The relatively low volume of well-conducted clinical trials on the treatment of influenza with CAM therapies compared to the high availability of conventional antiviral drug trials magnifies this problem. The aim of this article is to provide structured guidelines for future CAM influenza studies based on a thorough review of consistent and standard design elements present in the controlled-trial design of conventional antiviral influenza therapies. A selection of high-quality, influenza antiviral controlled trials from the published literature is reviewed, and important design elements are extracted and summarized to show both the consistency and the flexibility within study design elements. The standardized elements from influenza antiviral trials can be considered and mirrored in future CAM studies. In this way, CAM therapies might be looked at on similar grounds as conventional medicines in terms of potential usefulness and benefit in the treatment of influenza.

The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age

Please cite this paper as: Erkoreka A. (2010) The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age. Influenza and Other Respiratory Viruses 4(2), 81–89. Background Studies of the Spanish Influenza pandemic (1918–1920) provide interesting information that may improve our preparation for present and future influenza pandemic threats. Methods We studied archives from France, Italy, Spain and Portugal, obtaining high‐quality data that allowed us to calculate mortality rates associated with the Spanish flu and to characterize the proportional distribution of influenza deaths by age in the capital cities of these countries. Results French and American troops who fought in the First World War began to be affected from April 1918 onwards by a benign influenza epidemic, which hardly caused any deaths. The first occidental European country in which the pandemic spread to large sectors of the population, causing serious mortality, was Spain. The associated influenza provoked in Madrid a mortality rate of 1·31 per 1000 inhabitants between May and June (1918). In the following months of June and July, the epidemic spread to Portugal, but did not reach the Pyrenees. In September 1918, the influenza pandemic spread with tremendous virulence, presenting itself simultaneously during the month of October in South Western European countries. In Madrid, the 1918 excess mortality due in large part to the influenza pandemic is estimated at 5·27 per 1000. In Paris, the 1918 mortality rate provoked by the influenza and pathologies of the respiratory system was 6·08 per 1000. In South Western European countries, mortality rates oscillated between 10·6 and 12·1 per 1000 inhabitants. A study of the age distribution of deaths due to influenza between 1916 and 1921 reveals that the Spanish influenza principally affected men and women between 15 and 44 years of age. Deaths associated with the seasonal influenza of 1916, 1917 and 1921 represented 19·7%, 12·5% and 21·0% of all deaths respectively, whereas during the rawest moments of the Spanish influenza, in 1918, the proportion of deaths due to flu for those aged between 15 and 44 years of age reached 68·2% in Paris and 66·3% in Madrid. Conclusion Victim age is an important criterion that can be used to evaluate the phase and evolution of pandemic influenza. The Spanish Influenza affected particularly the 25‐ to 34‐year‐old and 15‐ to 24‐year‐old age groups.