Vol. 10, No. 11
Dec. 2018

A century later, UI experts recall deadly flu outbreak, prepare for new flu season

December 7, 2018 --

“Influenza cases increase.” “Influenza claims ten new victims since last issue.” “Faculty members and students have their examinations at University Hospital.”

Those were some of the headlines published in the Daily Iowan, the University of Iowa’s student-run newspaper, in 1918, the year the Spanish Influenza took the lives of 38 students and faculty members.

In the fall of 1918, when the first cases of influenza were confirmed on campus, then-UI President Walter A. Jessup penned a front-page editorial in the DI urging students and faculty to “co-operate to combat the influenza.” When a group of Army trainees at the UI got sick with the flu, the group was quarantined. “They will be confined to the campus and their barracks…to prevent any communicable disease,” according to an Oct. 3, 1918, story in the DI. “People who are suffering from the epidemic are being treated in an isolated ward at the hospital.”

Today, a century later, experts at the State Hygienic Laboratory at the University of Iowa use cutting-edge scientific technology to quickly and accurately identify various infectious diseases, including influenza. Lab microbiologists and molecular scientists were among the first in the nation to successfully detect the deadly H1N1 swine flu in 2009, and also created a novel test to detect the mumps in 2006 when that virus affected nearly 1,500 Iowans.

“The state hygienic lab has a long history of service to Iowa,” says Michael Pentella, a clinical microbiologist, clinical professor of epidemiology in the UI College of Public Health, and director of the State Hygienic Lab. “Too often, because much of our work is done for other government agencies, the public isn’t aware of the University of Iowa’s contribution. But there’s an extraordinary level of expertise and innovation that goes into our work, work that protects the health and well-being of Iowans every day of every year.”

An excerpt of a 1922 Daily Iowan article that references the influenza outbreak of 1918. Image courtesy of University of Iowa Libraries—Special Collections.

A flu epidemic like no other

As the flu spread across Iowa in 1918, health officials warned residents to stay away from large crowds and to place trays of water on radiators at home to keep indoor air moist. There was little else they could do to combat the sickness; the flu virus had yet to be identified, and a vaccine against it still was decades away. By the time the epidemic ended in early 1919, more than 7,000 Iowans and an estimated 20 million people had died worldwide.

“The flu epidemic of 1918 was interesting because it was a hugely pathogenic virus that caused death in mostly young people in the prime of their lives,” says Pentella. “Today, it is typically older people and the very young that we worry will die from influenza, but this epidemic hit people in their 20s, 30s and 40s, and life expectancy plunged around the world because so many people died.”

Physicians were baffled by the disease. City officials across the state ordered the closure of theaters, movie houses, dance halls, pool rooms, and skating rinks, and outdoor athletic facilities reduced their hours or closed completely, according to “Epidemic: Iowa fights the Spanish Influenza,” an article published by the Iowa State Historical Society in 1981. A football game between the UI and Coe College in Cedar Rapids, Iowa, was closed to the public due to concern of disease spread, and was played instead in a nearly empty stadium with only the members of Iowa’s Student Army Training Corps in attendance.

On the UI campus, students were encouraged to use handkerchiefs to cover their mouths when sneezing or coughing, and some faculty meetings were canceled, according to local newspapers from the time. Donations of blankets and bedding were solicitated for use by the student Army cadets in quarantine, and nursing students were asked to pitch in at the university hospital to care for the sick. The DI regularly reported on student, alumni, and faculty deaths, often due to pneumonia caused by the flu.

Pentella was appointed director of the State Hygienic Lab in 2018, in the midst of one of the worst flu seasons in recent history. During the 2017–18 flu season, 270 Iowans died, double the total from the year before. In preparation for the 2018–19 flu season, Pentella and his staff recently issued guidelines for influenza surveillance testing and are encouraging Iowa residents to get the flu vaccine.

“The State Hygienic Lab works with the Iowa Department of Public Health to conduct surveillance activities,” says Pentella. “Our specific role is laboratory-based surveillance, where we test for the influenza virus. If we detect it, we determine the subtype and strain of influenza infecting the patient.”

UI influenza research saves lives

The UI has several important ties to the flu epidemic of 1918. In 1931, Richard Shope, an Iowa native and graduate of the UI’s Roy J. and Lucille A. Carver College of Medicine, discovered a swine influenza that was very close to the human influenza virus. A few years later, in 1936, a group of British scientists, with help from Shope, identified this virus as distantly related to the one that caused the 1918 flu outbreak.

Another UI graduate, Johan Hultin, researched the cause of the 1918 Spanish Flu epidemic as a graduate student in microbiology in the 1950s by trying to isolate the virus from the bodies of Alaskan natives buried in permafrost. Although he was initially unsuccessful, Hultin returned to Alaska four decades later and, with the help of advanced scientific techniques, was able to characterize the flu virus genome. As a result, scientists have since been able to develop vaccines in case of another pandemic related to the Spanish Flu of 1918.

“If you look back to 1918 when they first saw all these fatalities, they didn’t even know what the causative agent was because microbiology was still in its infancy,” says Pentella. “They were trying to determine the cause, and to do this they would take samples from sick people and then try to grow the organism that was causing them to get sick. They grew a bacterium, and they thought it was the cause of the flu, but we now know that it was just a secondary pathogen to the influenza that people were suffering from.”

Besides his work at the state hygienic lab, Pentella also teaches infectious disease epidemiology at the UI College of Public Health, where he brings his experience managing viruses into the classroom. Pentella co-teaches the course with Christine Petersen, associate professor and director of the UI’s Center for Emerging Infectious Diseases. Petersen says she appreciates the strong connection that exists between the lab and the college, one that fosters exciting research topics.

“Currently we’ve got researchers studying the body’s immune response to the flu, as well as the connection between fever and the onset of the flu,” she says. “There’s even research regarding a possible connection between flooding and the flu. It’s critical that we have a better understanding of the flu virus because flu can be deadly.”

A flu vaccine and peace of mind

In the years since the 1918 outbreak, much has changed about the way microbiologists study the flu virus and the way medical professionals combat it, including the creation of a flu vaccine in the early 1940s and the use of large-scale public health campaigns to encourage vaccination.

“The best way to avoid getting the flu is to get the vaccine,” says Jorge Salinas, epidemiologist for UI Hospitals and Clinics and an assistant professor of internal medicine and infectious diseases. “And you need to get the vaccine every year because there is new research that shows that getting the vaccine every year gives you even more protection.”

The strains of flu virus combated by flu vaccines change from year to year, Salinas says, with the specific strains chosen by experts from the Centers for Disease Control (CDC) and the World Health Organization (WHO). “They assess trends of viral infections in the U.S. and elsewhere around the world and try to predict the types of flu most likely to circulate during the coming flu season,” Salinas says.

In 1918, without these types of monitoring abilities, public health officials were at a disadvantage, Salinas says. In addition, the flu virus that circulated in 1918 was likely a strain that most people had never encountered, so their bodies were less able to fight it.

“Every now and then, a new type of influenza emerges and these types of influenza tend to have an even higher mortality rate, and they can sometimes lead to pandemics,” Salinas says. The swine flu of 2009 is one example, he added.

A laboratory dedicated to public safety

Today, the State Hygienic Laboratory collects and studies samples of the influenza virus year-round, Pentella says. The lab uses a range of polymerase chain reaction (PCR) tests to identify infectious diseases. These tests detect select regions of nucleic acids that are unique to the specific pathogens. PCR tests are more reliable than traditional methods and much faster, providing results in just a few hours.

“When the first cases of flu emerge, we ask physicians and laboratories to send us samples and we test it to determine what type of influenza is making people ill,” Pentella says. “Then the sample goes on to be further characterized as to how similar or dissimilar it is to the strain in the current vaccine.”

The State Hygienic Laboratory shares information about local influenza cases with the CDC so experts can continue their surveillance of worldwide flu virus mutations.

“We’re dedicated to detection and surveillance, and I think it’s important work because we find out what influenza viruses are being spread to communities,” says Pentella. “This way doctors and public health officials can inform the public about the health risks. Surveillance is absolutely our first line of defense against an epidemic.”

Pentella says scientists are currently studying the immune response to the influenza virus with the goal of developing a universal flu vaccine, and that if they succeed, a better vaccine could be created.

“There is some research looking into a universal vaccine for influenza that would last for several years,” he says. “But this is novel work and sometimes we’re fortunate and it goes very quickly and other times it takes many years.”

by Lynn Anderson Davy, UI Office of Strategic Communication