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1918-1919Peer-reviewed · 2 sourcesWell documented

The 1918 Influenza Pandemic Kills More People Than the War It Followed

A novel H1N1 flu strain infects a third of the world's population and becomes the ancestor of every influenza A pandemic since

On the timeline · around 1918-1919 · Modern Pandemics and Modern MedicineThe Birth of Vaccination and EpidemiologyModern Pandemics and Modern MedicineThe 1918 Influenza Pandemic Kills More People Than the War It Followed1870189019101920193019401950

Quick facts

Pathogen
H1N1 influenza A virus
Duration
1918 to 1919, three waves
Estimated toll
At least 50 million dead worldwide, possibly up to 100 million
Infection rate
About one-third of the global population infected
Earliest documented cases
Haskell County, Kansas, March 1918

What happened

The influenza pandemic of 1918-1919, caused by a novel H1N1 strain with genetic material derived from birds, spread in three waves across nearly every populated region of the world within about a year. Wartime censorship in the combatant nations of the First World War suppressed early reporting, while neutral Spain's uncensored press covered it freely, creating the lasting but misleading label Spanish flu, even though the earliest documented cases appeared in Haskell County, Kansas in March 1918. The pandemic infected an estimated one-third of the global population and killed at least 50 million people worldwide, with some estimates reaching 100 million, a case fatality rate above 2.5 percent compared with less than 0.1 percent for typical seasonal flu, and it killed unusually large numbers of healthy young adults rather than only the very old or very young.

Why it matters

Every subsequent influenza A pandemic, including the H2N2 strain of 1957 and the H3N2 strain of 1968, descended genetically from the 1918 virus, making it the root strain of modern pandemic influenza rather than an isolated event. The war it coincided with meant it struck crowded troop transports and field hospitals at the same moment its scale was being deliberately hidden from the public, a pattern of underreporting that historians still work to correct in death-toll estimates today.

How we know

Genetic sequencing of the 1918 virus, reconstructed from preserved lung tissue samples decades later, confirmed its H1N1 subtype and avian-derived genes; peer-reviewed epidemiological reviews synthesize period mortality records from multiple countries into the global toll estimate.

Sources

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Related timelines

  • World War I · See how wartime troop movements and press censorship shaped the pandemic's spread and its misleading "Spanish flu" name.
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