1957-58 (esp. Sep-Oct 57, Spring) – H2N2 “Asian” Influenza/Pneumonia Pandemic~116,000

Blanchard note on fatalities: While we show the 1957 and the 1958 death tolls for influenza and pneumonia from the U.S. PHS, which combine to 118,440 we choose to use the Centers for Disease Control and Prevention number of 116,000 found on its 2019 webpage on this pandemic. Speculate that the lower number seeks to isolate the H2N2 variant and perhaps the narrower epidemic time-frame from the background of influenza and pneumonia deaths that take place every year. The 1957 death-rate was 28.4 influenza and pneumonia deaths per 100,000 population excepting pneumonia of newborn. (US Dept. of HEW. Vital Statistics 1957, Vol. 1, p. CXIX.) However, on page CXX the death-rate per 100,000 is noted as 35.8.)

We note that with a 1958 U.S. population of 174,900,00, a comparable 2021 death-toll (population of 331,420,000), would be 219,809. Most of the 116,000 deaths took place over about six months. As a comparison, there were 354,000 US COVID-19 deaths in 2020 over an eleven-month period.

–116,000 CDC. “1957-1958 Pandemic (H2N2 virus.” Influenza (Flu) webpage. 1-2-2019 review.
— 70,000 Armstrong. Philadelphia, Nurses, and…Spanish Influenza Pandemic of 1918. 2001.
— 70,000 Global Security 2005, Pandemic Influenza.
— 70,000 Johns Hopkins Bloomberg School of Public Health. “Historic Television…” 2006.
— 70,000 Kohn. Encyclopedia of Plague and Pestilence. (Revised). 2001, p. 363.
— 70,000 Shay, David K. Influenza Pandemics of the 20th Century. CDC, 4-20-2005, p. 30.
— 69,800 HHS. Pandemics and Pandemic Scares in the 20th Century. 2-12-2004 revision.
— 69,800 Greene and Moline. The Bird Flu Pandemic: Can It Happen?… 2006.
— 66,000 (excess deaths) Ryan. Pandemic Influenza: Emergency Planning… 2009, p. 16.
— 61,001 Influenza and pneumonia. Public Health Service, US HEW. Vital Statistics 1957, 385.
— 7,463 Influenza (No’s 480-483, line 32) 1957
–53,538 Pneumonia (No’s 490-493, line 33) 1957
— 60,000 Influenza. Garrett. The Coming Plague: Newly Emerging Diseases… 1995, p. 160.
— 57,439 Influenza and pneumonia. Public Health Service, US HEW. Vital Statistics 1958, 102
— 4,442 Influenza 1958
–52,997 Pneumonia 1958
Breakout of deaths from Sep 1, 1957 through March 29, 1958 as reported in the MMWR.
— 2,517 Sep 1-Oct 19. PHS, U.S. HEW. MMWR, 6/42, 10-25-1957, 1.
— 9,240 Sep 1-Dec 30. Daily Review, Hayward, CA. “U.S. Examines…Flu Picture.” 1-8-58, 19
–12,475 Sep 1-Feb 1, 1958 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/5, 2-7-1958, 1.
— 771 Oct 20-26 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/44, 11-8-1957, p. 1.
— 856 Oct 27-Nov 2 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/44, 11-8-1957, 1.
— 887 Nov 3-9 (reporting cities). PHS, U.S. HEW. MMWR, 6/45, 11-15-1957, 1.
— 782 Nov 10-16 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/46, 11-22-1957, 1.
— 693 Nov 17-23 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/48, 12-6-1957, 1.
— 557 Nov 23-30 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/49, 12-13-1957, 1
— 581 Dec 1-7 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/49, 12-13-1957, 1.
— 535 Dec 8-14 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/50, 12-20-1957, 1.
— 566 Dec 15-21 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/51, 12-28-1957, 1.
— 486 Dec 22-28 (108 reporting cities). PHS, U.S. HEW. MMWR, 6/52, 1-4-1957, 2.
— 534 Dec 29-Jan 4 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/1, 1-10-1958, 2.
— 632 Jan 5-11 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/2, 1-17-1958, 1.
— 651 Jan 12-18 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/3, 1-24-1958, 1.
— 665 Jan 19-25 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/4, 1-31-1958, 2.
— 750 Jan 26-Feb 1, 1958 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/5, 2-7-1958, 1.
— 709 Feb 2-8 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/6, 2-14-1958, 1.
— 709 Feb 9-15 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/7, 2-21-1958, 1.
— 754 Feb 16-22 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/8, 2-28-1958, 1.
— 847 Feb 23-Mar 1 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/9, 3-7-1958, 1.
— 814 Mar 2-8 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/10, 3-14-1958, 1.
— 656 Mar 9-15 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/11, 3-21-1958, 1.
— 599 Mar 16-22 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/12, 3-28-1958, 1.
— 520 Mar 23-29 (108 reporting cities). PHS, U.S. HEW. MMWR, 7/13, 4-4-1958, 2.
— 1-4 million deaths world-wide.

Summary of Fatalities by State
(As noted in US HEW Public Health Service Vital Statistics 1957 Mortality Data)

Alabama (1,072) Maine ( 331) Pennsylvania (3,829)
Alaska ( 87) Maryland ( 849) Rhode Island ( 227)
Arizona ( 438) Massachusetts (1,913) So. Carolina ( 189)
Arkansas ( 714) Michigan (2,233) South Dakota ( 243)
California (4,213) Minnesota (1,065) Tennessee (1,351)
Colorado ( 984) Mississippi ( 803) Texas (3,033)
Connecticut ( 689) Missouri (1,813) Utah see MS fn. ( 218)
Delaware ( 144) Montana ( 282) Vermont ( 134)
District of Columbia ( 406) Nebraska ( 524) Virginia (1,504)
Florida (1,290) Nevada ( 64) Washington ( 996)
Georgia (1,620) New Hampshire ( 211) West Virginia ( 800)
Hawaii ( 146) New Jersey (1,828) Wisconsin (1,151)
Idaho ( 194) New Mexico see AZ fn.( 354) Wyoming ( 97)
Illinois (4,365) New York (6,186)
Indiana (1,454) North Carolina (1,600)
Iowa (1,054) North Dakota ( 266) CDC: Dakotas extensively involved.
Kansas ( 350) Ohio (2,887)
Kentucky (1,306) Oklahoma ( 810)
Louisiana (1,213) Oregon ( 595)
Breakout of Influenza and Pneumonia Fatalities by State

Alabama (1,072)
–266 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p106.
–806 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p106.

Alaska ( 87)
–31 Influenza. US HEW, PHS. Vital Statistics 1957 (Vol. I), p. 32.
–56 Pneumonia US HEW, PHS. Vital Statistics 1957 (Vol. I), p. 32.

Arizona ( 438)
— 29 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.
–409 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.

Arkansas ( 714)
–199 1957-58. Gray, et al. “A Retrospective Epidemiologic Analysis…” 2012, p. 70.
–129 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.
–585 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.

California (4,213)
— 182 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.
–4,031 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107

Colorado ( 984)
— 84 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.
–900 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p107.

Connecticut ( 689)
— 30 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 114.
–659 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p114.

Delaware ( 144)
— 7 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 114.
–137 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p114.

District of Columbia ( 406)
— 15 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 115.
–391 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p115.

Florida (1,290)
— 147 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 115.
–1,143 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p115

Georgia (1,620)
— 339 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 115.
–1,281 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p115
— 9 Atlanta, Oct 6-12. Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-57, 1
— 4 “ Oct 13-19. Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-57, 1.
— 14 “ Oct-20-26. Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-57, 1.
— 22 “ Oct 27-Nov 2. Anniston Star. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-57, 1.
— 43 “ Nov 3-8. Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-57, 1.

Hawaii ( 146)
— 12 Influenza. US HEW, PHS. Vital Statistics 1957 (Vol. I), p. 36.
–134 Pneumonia US HEW, PHS. Vital Statistics 1957 (Vol. I), p. 32.

Idaho ( 194)
— 43 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 115.
–151 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p115.

Illinois (4,365)
— 210 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 122.
–4,155 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p122
— 18 State. Freeport Journal-Standard, IL, “Flu Epidemic Hits…Down South,” 11-1-1957, 2.
— 12 ~Oct-Nov 9, Dixon State Sch. for Mentally Retarded. PHS, MMWR, 6/45, 11-15-57, 2.

Indiana (1,454)
— 212 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 122.
–1,242 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p122

Iowa (1,054)
–217 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 123.
–837 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p123

Kansas ( 350)
— 82 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 123.
–268 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p123

Kentucky (1,306)
— 252 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 123.
–1,054 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p123
— 274 State, Nov. Public Health Service, U.S. HEW. MMWR, 7/1, 1-10-1958, 2.

Louisiana (1,213)
— 157 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 123.
–1,056 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p123

Maine ( 331)
— 51 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 130.
–280 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p130.

Maryland ( 849)
— 68 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 130.
–781 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p130.

Massachusetts (1,913)
— 85 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 131.
–1,828 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p131

Michigan (2,233)
— 193 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 131.
–2,040 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p131

Minnesota (1,065)
–182 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 131.
–983 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p131

Mississippi ( 803)
–173 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 131.
–630 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p131

Missouri (1,813) (1957)
— 280 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 138.
–1,553 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p138

Montana ( 282)
— 24 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 138.
–258 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p138

Nebraska ( 524)
— 97 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 139.
–427 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p139

Nevada ( 64)
— 6 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 139.
–58 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p139

New Hampshire ( 211)
— 21 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 139.
–190 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p139

New Jersey (1,828)
— 128 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 139.
–1,700 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p139

New Mexico ( 354)
— 52 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 146.
–302 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p146

New York (6,186)
— 470 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 146.
–5,716 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p146
— 181 NYC, Oct 20-26. PHS, “Provisional…Week…Nov 2, 1957.” MMWR, 6/44, 11-8-1957, 1.
— 151 “ Oct 27-Nov 2. PHS, “…Week…Nov 2, 1957.” MMWR, 6/44, 11-8-1957, p. 1.
— 95 Upper State, by Nov 2. PHS, US HEW. MMWR, 6/45, 11-15-1957, p. 2.

North Carolina (1,600)
— 320 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 147.
–1,280 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p147

North Dakota ( 266)
— 47 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 147.
–219 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p147

Ohio (2,887)
— 438 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 147.
–2,449 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p147

Oklahoma ( 810)
–167 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 147.
–643 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p147

Oregon ( 595)
— 39 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 154.
–556 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p154.
–212 Nov. PHS, U.S. HEW. MMWR, 7/1, 1-10-1958, p. 2.

Pennsylvania (3,829)
— 478 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 154.
–3,351 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p154.

Rhode Island ( 227)
— 10 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 155.
–217 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p155.

South Carolina ( 189)
— 37 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 155.
–152 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p155.

South Dakota ( 243)
— 44 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 155.
–199 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p155.

Tennessee (1,351)
— 291 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p. 155.
–1,060 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p155.

Texas (3,033)
— 459 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.162.
–2,574 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p162.

Utah ( 218)
— 40 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.162.
–178 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p162.

Vermont ( 134)
— 20 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.163.
–114 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p163.

Virginia (1,504)
— 200 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.163.
–1,304 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p163.

Washington ( 996)
–106 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.163.
–890 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p163.

West Virginia ( 800)
–154 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.163.
–646 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p163.

Wisconsin (1,151)
–153 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.168.
–998 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p168.

Wyoming ( 97)
–18 Influenza, line 32, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p.168.
–79 Pneumonia, line 33, 1957. US HEW, PHS. Vital Statistics 1957 (Vol. II Mortality Data), p168.

Narrative Information

CDC (Communicable Disease Center, Atlanta), 1960: “It is unlikely that the point of origin of the new strain, A₂, or Asian influenza virus will ever be precisely located. The first reported outbreak of the disease was in late February, 1957, in Kweichow Province, near Kweiyang, deep in the Chinese mainland. In early March, Yunan Province was affected, and by the middle of the month the disease was occurring in many parts of China.

“In early April, epidemic influenza appeared in Hong Kong, probably introduced via refugees from the Chinese mainland. Almost concurrently, an outbreak occurred in Singapore, probably introduced by ships. These two outbreaks, identified a month later as being due to a variant type A influenza virus, served to call international attention to the possibility of rapid world-wide involvement.

“From Hong Kong and Singapore, both major shipping centers, the disease spread rapidly to Taiwan, Borneo, Japan, the Philippines, and thence throughout most of the Orient. In Many, localized outbreaks were reported in Australia, India, Malaya, and Indonesia. In June the remaining countries of Asia were involved, and a well-defined westward spread across the Middle East was noted. Reaching the east coast of Africa by the end of the month. At this time, localized outbreaks also began to occur in several countries of Europe, Rumania, Czechoslovakia, and particularly the Netherlands, probably introduced from Indonesia by ship and aircraft. Outbreaks were not uncommon on ships bound for England, Hawaii, and the United States, and localized concentrations of cases occurred in the continental United States and Alaska.

“In July, the disease, while continuing to spread in epidemic form in the Middle East and in Africa, reached South and Central America; epidemics were reported in Ecuador, Bolivia, Chile, Columbia, Panama, and Mexico. In Europe, the disease continued to appear in localized outbreaks throughout the Netherlands, and broke out in similar form in England and Southern Italy. Greenland, New Zealand, and Newfoundland, among others, also reported outbreaks during this month.

“In August, while the disease subsided in Asia, a widespread epidemic occurred in Australia. Epidemics were also reported from the remaining countries of Africa, Central and South America. Scattered outbreaks continued to occur throughout Europe, and Italy experienced a widespread epidemic.

“In September, influenza declined in the Middle East, but widespread epidemics occurred in Europe and began in North America. In October the epidemics in Europe and North America reached their peaks, the Scandinavian countries being the last to be affected. Meanwhile, influenza was declining in Central and South America, as well as Africa. Japan, however, experienced a severe second wave during this month.

“In November, Influenza was subsiding everywhere, and by early December had essentially completed its course around the world.

“The initial recognized cases and outbreaks of Asian influenza in the United States occurred among military personnel. Numerous cases had been diagnosed aboard ships bound for the United States, especially the West Coast. The first outbreak to be recognized in the United States, however, occurred on June 2, 1957, at Newport, Rhode Island, among military personnel aboard destroyers taking part in naval exercises. Shortly thereafter, a series of outbreaks was reported from California, without known connection to Newport; approximately 10,000 cases occurred on military reservations on the West Coast.

“The first recognized civilian outbreak began at a teen-age girls’ conference at Davis, California, beginning June 20. During the following several weeks, more than 15 similar outbreaks were reported in children’s’ camps in California. Secondary and sporadic cases continued to occur in California during the remaining summer months.

“Many examples of spread and resultant seeding of A2 influenza virus across United States were recognized. In late June a conference was held in Grinnell, Iowa, involving 1,800 young persons from 43 States and several foreign countries. Several of those attending had been in contact with Asian influenza in California, and over 200 cases of influenza occurred among the participants. About 50 further cases were detected among the conferees after they had returned to their homes….

“The first dynamic spread of Asian strain influenza throughout a community occurred in Tangipahoa Parish, Louisiana. There, in August, epidemics developed among school children, industries, and spread widely throughout the community. This was particularly significant, for in this parish school opened in July because of the agricultural need for children to assist in gathering the strawberry crop in the spring.

“During the remainder of the summer, A2 influenza virus was seeded throughout the United States, via routes similar to those described. It remained for colder weather, school openings, closer crowding, and similar factors to catalyze the resultant nation-wide epidemic during the autumn months….

“As of December 16, 1957, at least 1,758 counties, or 57 percent of the 3,068 United States counties had experienced influenza outbreaks, or had confirmed Asian strain cases. Certainly this total must be regarded as incomplete.

“….the West Coast was involved first, followed shortly by Louisiana and Mississippi, which experienced extensive epidemics involving large areas. Then in early September, the highly populated areas of the East were hit in rapid succession. New York City was one of the first large cities with an epidemic. At approximately the same time, New Mexico, Utah, and Arizona suffered explosive school and community outbreaks. During October the epidemic seemed to progress toward the central and northern areas of the county, although the southeastern States were involved relatively late. The last geographic areas to be extensively involved were the Dakotas.

(United States Department of Health, Education, and Welfare, Public Health Service. Asian Influenza 1957-1960: The Epidemiology of Asian Influenza 1957-1960 – A Descriptive Brochure. Atlanta, GA: Epidemiology Branch, Communicable Disease Center, July 1960.

CDC, 2019: “In February 1957, a new influenza A (H2N2) virus emerged in East Asia, triggering a pandemic (“Asian Flu”). This H2N2 virus was comprised of three different genes from an H2N2 virus that originated from an avian influenza A virus, including the H2 hemagglutinin and the N2 neuraminidase genes. It was first reported in Singapore in February 1957, Hong Kong in April 1957, and in coastal cities in the United States in summer 1957. The estimated number of deaths was 1.1 million worldwide and 116,000 in the United States.” (CDC. “1957-1958 Pandemic (H2N2 virus.” Influenza (Flu) webpage. 1-2-2019 review.)

Gray: “The pandemics in 1957 and 1968 showed more typical mortality trends , primarily affecting young children and the elderly populations. The 1957 pandemic was caused by the H2N2 virus (Asian flu) and later shifted into the H3N2 virus (Hong Kong flu),which caused the 1968 pandemic. The 1957 pandemic killed 69,800 Americans while the 1968 pandemic killed 33,800 (Henderson et al. 2009, Schulman and Kilbourne 1969) ….

“The goal of our study was to analyze the effects of the four influenza pandemics in the state of Arkansas. We anticipated a decrease in overall mortality rates as the pandemics approach the present day due to the improvements in medical technology, vaccinations, and better healthcare in general. The mortalities in each pandemic were classified by: sex, age, and geographic region, and analyzed for statistical differences….National data also shows that more deaths from influenza are typically seen in the young and elderly populations (<14 and 65+ respectively) (Simonsen et al. 1998) ….The geographic regions were based on the five local health units established by the Arkansas Department of Health: Northwest, Northeast, Southwest, Southeast, and Central. We determined if the urban or rural areas of the state exhibited greater mortalities due to influenza. We hypothesized that more influenza-related deaths were recorded in the rural areas within each pandemic occurrence due to decreased access to medical treatment. Individual geographic regions were also analyzed across the four pandemics to evaluate mortalities over time.” (pp 69-70.) “Methods. The data for this study were collected from death certificates at the Arkansas Department of Health-Health Statistics in Little Rock. The death certificates were available in the form of microfiche for the first three pandemics… Once certificates with an influenza cause of death were found, certificate number, age, sex, date of death, county of death, and primary and secondary causes of death were recorded. Census data were also collected to establish population numbers during the pandemics. These population numbers were used to derive the expected number of deaths for each category (sex, age, and geographic region). The data were collected from the US Census Bureau (American FactFinder) from the years closest to the pandemics (1920, 1960, 1970, and 2010). Once the state populations were recorded, death rates were calculated for each pandemic by dividing the total number of influenza deaths by the state population. These death rates were used to establish the expected numbers of deaths for each sex, region, and age range for the individual pandemics and were used in chi square test of goodness of fit analyses. The expected numbers were calculated by multiplying the death rate for that pandemic by the number of people in the given sex, region, or age range. After all expected numbers were calculated, chi-square tests for goodness of fit were performed using the observed numbers recorded from the death certificates to determine significant differences. An alpha level of 0.05 was used for significance…. “Results…. The 1957 and 1968 pandemics had the highest deaths in the northwest and northeast regions, respectively….” (p. 70.) “In the 1957 and 1968 pandemics, there were 3-4 times more deaths in the 65+ group than the next closest group. Furthermore, the 65+ population had about half the population of the next lowest group. This means that the 65+ group saw the most deaths from the smallest population. These two pandemics more closely represented the typical flu season mortalities and support why it is crucial for the elderly population, and their care-givers, to take all necessary precautions during flu season.” (p. 72.) “Although the regions were affected differently across the four pandemics, it is clear that the urban areas contained the highest mortalities. Efforts to promote good hygiene and vaccination, especially for those who are immunodeficient, should be strongly emphasized in those areas. Increasing bacterial resistance to antibiotics has been well documented in the last 60 years, and now there is increasing resistance to antivirals. Both of these classes of medicine have helped reduce influenza mortalities, but they are now becoming less effective. It is crucial that proper planning is made to best prepare for any possible future pandemics. Appropriate readiness will reduce the numbers of those infected with influenza and, consequently, the number of mortalities it causes. Influenza is a virus that will remain ever-watched and the avian flu (H5N1) in Asia may serve as a reminder that a future influenza pandemic is very possible….” (p. 74.) (Gray, A. J., D. Nguyne, B. M. Rowley. “A Retrospective Epidemiologic Analysis of Influenza Pandemics in Arkansas.” Journal of the Arkansas Academy of Science, Vol. 66, 2012, p. 67-76.) HHS: “In February 1957, the Asian influenza pandemic was first identified in the Far East. Immunity to this strain was rare in people less than 65 years of age, and a pandemic was predicted. In preparation, vaccine production began in late May 1957, and health officials increased surveillance for flu outbreaks. “Unlike the virus that caused the 1918 pandemic, the 1957 pandemic virus was quickly identified, due to advances in scientific technology. Vaccine was available in limited supply by August 1957. The virus came to the U.S. quietly, with a series of small outbreaks over the summer of 1957. When U.S. children went back to school in the fall, they spread the disease in classrooms and brought it home to their families. Infection rates were highest among school children, young adults, and pregnant women in October 1957. Most influenza-and pneumonia-related deaths occurred between September 1957 and March 1958. The elderly had the highest rates of death. “By December 1957, the worst seemed to be over. However, during January and February 1958, there was another wave of illness among the elderly. This is an example of the potential "second wave" of infections that can develop during a pandemic. The disease infects one group of people first, infections appear to decrease and then infections increase in a different part of the population. Although the Asian flu pandemic was not as devastating as the Spanish flu, about 69,800 people in the U.S. died.” (US Dept. Health and Human Services, National Vaccine Program Office, Pandemics and Pandemic Scares in the 20th Century, Historical Overview. Wash.: 2-12-2004.) Kohn: “The H2N2 virus, a subtype of the Asian A2 influenza virus and closely related to that which caused the Asiatic Influenza Pandemic of 1889–90, first arrived in the United States in June 1957: at Newport, Rhode Island, where naval exercises were being held offshore (June 2), and shortly thereafter at various military bases in California (June 11–20). These outbreaks were characterized by mild cases and high attack rates but did not involve the civilian communities nearby. During the summer, small localized outbreaks were reported from far-flung areas of the country, such as California, Virginia, Iowa, and Pennsylvania; most of these occurred among groups of summer campers living and traveling in crowded conditions and also among migrant workers. They were closely monitored by the local health authorities, who feared that a major epidemic might erupt at any time. “The U.S. government released an additional $800,000 to deal with the imminent epidemic, and the Influenza Surveillance Unit was established in July 1957 as an arm of the United States Public Health Service; its job was to collect and disseminate information about the disease and especially to measure general epidemiological trends. Facilities were provided so that laboratory and epidemiological studies could be conducted. Emergency health services were organized and vaccine production accelerated to meet the anticipated demand. However, the government did not provide funding for a nationwide vaccination campaign, and of the 30 million vaccine doses tested for release when the epidemic peaked, only 7 million were given to the public, and that was on a purely voluntary basis. “During August 1957, the pace began to quicken, with intense outbreaks reported from agricultural communities across Louisiana and Mississippi; they began among schoolchildren and spread very rapidly throughout a locality. Early in September, the epidemic erupted along the densely populated East Coast; New York City was one of the earliest of the big cities to be attacked. Almost simultaneously, the flu virus caused serious eruptions in communities across New Mexico, Utah, and Arizona. School openings played a crucial role in the diffusion of the epidemic, which continued to move from the West, East, and Gulf coasts toward the central and northern sections of the country during October. North and South Dakota were among the last areas to be involved. “In general, the epidemic peaked over most areas in mid-October. Forty-five million cases of influenza were estimated to have occurred during October–November 1957 alone. The epidemic subsided with the onset of winter, but incidence (mainly intense outbreaks affecting older people in scattered localities) increased briefly during late February and early March 1958. Mortality reports indicate that most of the deaths occurred in two distinct flu waves: the first wave peaked early in November 1957, and the second wave peaked during the week of March 1, 1958, even though the morbidity levels then were far lower than late in 1957. Secondary bacterial pneumonia caused many of the deaths during this second phase. Overall, the epidemic was apparently responsible for 70,000 deaths across the country—a greater proportion of them among the very young and among the elderly and the infirm, as opposed to the adult (middle-aged and young) population. Officials estimated that children in the five- to 15-year-old age group suffered attack rates as high as 60 percent, but their mortality rates were low.” (Kohn, George Childs (Ed.). “U.S. Influenza Epidemic of 1957-58,” p. 363 in Encyclopedia of Plague and Pestilence From Ancient Times to the Present (Revised Edition). NY: Checkmark Books, 2001.) PHS, July-Oct: “The U. S. National Health Survey states in its report on current statistics on respiratory diseases for the week ended December 7 (Report No. 9) that "special tallies of cases reported in the sample for the period July-October showed that during those months the incidence of new bed cases of the acute upper respiratory diseases was highest in the age group 5-19 years. Among people in this age range there were 40 new cases per 1,000 persons per week. The children under 5 years of age had the next highest rate, with 28 new cases per 1,000 persons per week. Persons over 65 years of age were least frequently affected, at a rate of 9 new cases per 1,000 persons per week. The rate for the age group 20-64 was 16 new cases per 1,000 persons per week.” (PHS, “Provisional Information…Notifiable Diseases…Deaths in Selected Cities… January 4, 1958.” MMWR, 7/1, 1-10-1958, p. 1.) PHS, Sep 14: “As expected reports of scattered outbreaks of influenza are being received which indicate a gradually increasing incidence. Reports received from the States indicate an estimated cumulative total of approximately 100,000 cases to date. This is shown by reports of increasing absenteeism in schools in Oregon, Colorado, Mississippi, and Texas, and a slight rise in absenteeism in a few industries in California. Reports of influenza in several areas of Mississippi, Texas, Utah, Oklahoma, and Tennessee also suggest an increasing incidence…. “Indiana has reported a localized outbreak in a college in which 100 of 800 students were ill with an influenza-like illness….Saginaw County [MI] reports unusual absenteeism from 2 of the public schools because of influenza-like illness. The school with a census of 650 reports 106 absent; the other school reports 65 absent of 600. Other schools in the county have normal absenteeism…. “The Tennessee Department of Public Health has reported over 500 sporadic cases of influenza during September, although no extensive outbreaks of influenza occurred during August…. “The highest incidence reported has been in Louisiana with a high attack rate in Tangipahoa Parish. It is now evident that the disease is widespread in New Orleans and in other parts of the State. “About 60 members of the University of Florida football team have become ill with influenza since the first of September…. “About 125 cases of influenza have been reported among 545 Mexican migrant workers in Col. “Dr. A. C. Hollister, California State Department of Public Health, has forwarded the results of a follow-up study of persons attending the girls’ convention at Davis. The attack rate in this group was more than 89 percent [1 death]…. In the Imperial Valley over 4,000 Mexican migrant workers have been screened medically since August 30. Of these at least 400 have been put to bed with an influenza-like disease…. “Influenza has now spread throughout Puerto Rico, where the epidemic began in San Juan. The number of cases reported each week has increased as follows: Week ended: Number August 24----- - 10 August 31----- - 314 September 7---- 4,257 September 14--- 14,674 [4 deaths] “….Dr. Arbona, Puerto Rico Department of Health, estimates the possible number of cases for the week ending September 14, 1957, as 129,400. This estimate is based on absenteeism from schools and industries. Dr. Arbona believes that Puerto Rico is nearing the peak of the outbreak. He states that an analysis of the statistics from the outpatient clinics of several health centers indicates that the school-age population is more heavily affected than any other group…” (Public Health Service. “Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended September 14, 1957. Epidemiological Reports, Influenza.” Morbidity and Mortality Weekly Report, Vol. 6, No. 37, 9-20-1957, 1-2.) PHS, Sep 21: “A further increase in incidence of influenza and influenza-like disease occurred during the past week. Epidemics, some of them explosive in nature, were reported in a number of schools and colleges located in various parts of the country. On the basis of reports from State health officers and the Armed Forces, the number of cases of influenza reported for the week ended September 21 was about 122,650. The cumulative total reported to date is an estimated 222,650….” (Public Health Service. “Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended September 21, 1957. Epidemiological Reports, Influenza.” MMWR, Vol. 6, No. 38, 9-27-1957, p. 1.) PHS, Sep 28: “The incidence of influenza and influenza-like disease continued to increase in most parts of the United States during the past week. A large number of localized outbreaks were reported in schools, based principally on absenteeism rates. The estimated number of cases of influenza and of cases suspected of having influenza was 200,000 which brings the total to 422,650…. “…The District of Columbia had reports of 18 sporadic cases. In 1 of its institutions located outside of the city, 83 percent of the population made up of children were ill with influenza….Georgia reported a 50 percent increase in the number of influenza cases…. “…The estimated number of cases of influenza in Alabama increased 6-fold over the previous week…. Epidemics were occurring in 4 universities….An increase in incidence of influenza was reported in 61 counties of Texas…. “In the Mountain Division there were reports of outbreaks in a number of States. Montana reported outbreaks in 3 counties; 2 of these began on Indian reservations with spread to the general population in 1 of them….Arizona has reported a very marked increase in incidence. The actual number of cases is estimated to be several times greater than the number notified by physicians…. “In the Pacific States, epidemics are continuing in schools and colleges. In Washington, the number of acute respiratory infections reported for the week were over 1,000 which included 125 in an outbreak in a university. Oregon reported several new outbreaks in schools and institutions. Twenty-three cases of pneumonia and 3 additional isolations of Asian type of virus related to school outbreaks were reported. California reports that, until the past 2 weeks, influenza-like disease occurred principally in closed groups in barracks, camps, and institutions. Many epidemics are now occurring in public schools and universities. It is stated that 15 percent of the population of 1 area of the State are affected by increased prevalence of the infection, and that a general increase exists in 2 other areas….” (Public Health Service. “Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended September 28, 1957. Epidemiological Reports, Influenza.” MMWR, 6/39, 10-4-1957, 1-2.) PHS, Oct 5: “For the week ended October 4 the reports of influenza and influenza-like disease followed the pattern of the previous 3 or 4 weeks, namely an increase in cases in many areas. The estimated total number of cases was 350,000….The estimated cumulative total of 1,077,000 includes delayed reports from several States. These figures must be considered as very rough estimates and should not be regarded as showing the true incidence of influenza. “Most of the influenza-like illnesses continue to be reported in schools, colleges, institutions, and other closed groups. During the past week the number of new outbreaks reported in schools increased in Massachusetts, New York, New Jersey, Ohio, and Kansas. Most other States continued to report such outbreaks. Up to the present time only a few States have reported epidemics in their general populations. Widespread occurrence has been evident in Louisiana, Mississippi, Alabama, Arizona, and in New York City, while localized epidemics in the general population have been reported in Utah, Wyoming, California, Texas, South Carolina, and Florida. Case reports by physicians suggest that sporadic occurrence has been statewide in New Mexico, Oklahoma, Missouri, Indiana, Oregon, South Dakota, North Carolina, Georgia, Tennessee, and Delaware. Only one State—Louisiana—appears to have its peak but localized outbreaks are still occurring there. “As yet there has been no marked rise in death-rates that might be attributed to the occurrence of influenza. Total deaths in 114 cities located in all parts of the country have been somewhat above the median since the first of September…but not over 10 percent in any one week. The data from these cities on influenza and pneumonia deaths show no marked increase over normal occurrence at this time of the year. “ few deaths have been reported, mostly in California and Louisiana, which were considered to be directly attributable to influenza. Nearly all of them were complicated by pneumonia which in some cases was caused by staphylococci. Most have occurred in persons 15 to 35 years of age. “In Puerto Rico the estimated total number of cases of influenza is about 632,000, but the numbers reported weekly are now decreasing steadily. Cases continued to occur most frequently in women and in children of school age. During the week ended October 4, there were 7 deaths, all under 1 year of age except a 12-year-old male….” (Public Health Service. “Provisional Information on Selected Notifiable Diseases in the United States and on Deaths in Selected Cities for Week Ended October 5, 1957….Influenza.” MMWR, 6/40, 10-4-1957, 1-2.) PHS, Oct 12: “Influenza and influenza-like disease continues to increase in many parts of the country. The number of cases for the week ended October 12 is estimated to have been not less than 360,000, and the cumulative total not less than 1,437,000. Some States report only absenteeism in schools or other populations, some report the absenteeism rates, and others depend on case reports by physicians; consequently, the validity of any estimate is open to question. The reports do indicate that an increasing number of schools in Maine, Vermont, Massachusetts, Connecticut, New York, New Jersey, Ohio, Michigan, Maryland, Virginia, and California had high absenteeism rates during the past week. Colorado reports that school and Institutional outbreaks have terminated, but family and community outbreaks have “picked up.” In California, epidemics of respiratory disease with high attack rates began in secondary schools and colleges, but at the present time, they are most frequent in elementary schools scattered over the State. The attack rates in the latter have been lower and incidence in the general population has been relatively low but has been increasing. “Reports of cases by physicians to health authorities increased in Michigan, Iowa, Kentucky, and Tennessee. In South Carolina, many cases were being reported from several parts of the State, and in some instances, whole families were ill with influenza-like disease. Mississippi reports that the disease is now occurring in all parts of the State. A high incidence was also reported in Arizona, Alabama, Texas, Virginia, and North Carolina. “In the past one of the measures of the effect of influenza has been an excess of mortality not only from influenza and pneumonia but also from other causes. Deaths in the latter group probably occur most often in persons with chronic diseases and in elderly or debilitated persons who are unable to survive an attack of influenza or influenza and pneumonia. Prior to the past week or two the current epidemic appeared to have little effect on mortality in the United States. “The total number of deaths for all causes reported for the week ended October 12 in 112 cities increased about 10 percent as compared with the previous week…The number of deaths from influenza and pneumonia in these cities increased from 337 to 499 or 48 percent. Some of the large cities that reported increases for all causes were Buffalo, Newark, New York City, Detroit, and Chicago. Cities having increases in influenza and pneumonia deaths included New York City, Philadelphia, Detroit, and Chicago. About one-third of the increase in total deaths in New York City and Chicago could be accounted for by the increase in deaths from influenza and pneumonia. Dr. Morris Greenberg, New York City Department of Health, reported that about 25 deaths have been investigated by the medical examiner in which death occurred within 24 hours after the onset of an acute respiratory disease….A few deaths were reported elsewhere: 3 in California, 1 in New Jersey. Virginia reported 2 cases of pneumonia in 1 county, and Oregon had reports of 51 cases of pneumonia for the week. “The presence of illness caused by the Asian strain of type A influenza virus has been confirmed in all sections of the country, although not every State has reported isolations of virus or serologic confirmation…. “In Alaska 1,700 cases of influenza-like disease have been reported in the Fairbanks schools.” (PHS, U.S. HEW. “Provisional Information on Selected Notifiable Diseases… [US]… Deaths in Selected Cities for Week Ended October 12, 1957…Influenza.” MMWR, 6/41, 10-18-1957, 1-2.) PHS, Oct 19: “Influenza and influenza-like disease occurred in all parts of the country during the past week….A…estimate of the number of new cases for the week ended October 19…could be in the range of a million or more. “Since precise morbidity data for the Nation as a whole are not available, the excess in the total number of deaths in large cities has been found to be one of the most reliable measures of the impact of an epidemic, and as such has been accepted extensively in the past. Currently, data are available from 108 cities on the number of deaths from influenza and pneumonia. Since September 1, 1957, there have been 2,517 deaths from these causes as compared with 1,825 for 1956 (1956 is used for comparison because there was no influenza epidemic occurring during September and October of that year). “In epidemics occurring prior to 1954 there were increases in the number of deaths from all causes as well as from influenza and pneumonia. Currently, the numbers of deaths from all causes are available on a weekly basis for 114 cities located in those sections of the Nation which contain about one-third of the population of the country as a whole. Since September 1 of this year, there have been 73,839 deaths from all causes in the 114 cities as compared with 69,660 for the same period last year. Thus, the two figures of excess deaths, 692 for influenza and pneumonia and 4,179 from all causes, can be interpreted as a rough measure of the effect or impact of influenza in the 114 cities. It cannot be assumed, however, that that impact is of the same magnitude in the remaining two-thirds of the country…. “Dr. N. J. Rose, Illinois Department of Health, has reported an epidemic of influenza occurring in a State school for the mentally retarded in which 1,243 of 4,800 are ill. The peak of the epidemic has now been passed in the female division, where 7 deaths occurred, and the male division is now actively affected….” (PHS, “Provisional Information on Selected Notifiable Diseases… [US]… Deaths in Selected Cities for Week Ended October 19, 1957.” MMWR, 6/42, 10-25-1957, 1-2.) PHS, Oct 26: “….Several reports of outbreaks of influenza in institutions housing mentally retarded persons and in custodial schools have been reported in 5 States. Attack rates as high as 90 to 95 percent have been noted. Occurrence of pneumonia has been relatively frequent, and high mortality rates have been reported…. “The numbers of deaths from all causes and from influenza and pneumonia continued to rise in the large cities for the week ended October 26 as compared with the previous week. Deaths from all causes rose 6 percent…and from influenza and pneumonia, 28 percent. Cities in all geographic divisions except the Mountain and Pacific showed increases. However, New York City app ears to have reached its peak in numbers of deaths, but these still are in excess of those for last year. Since September 1 of the current year, there have been 6,438 more deaths from all causes in the 114 cities than for the same period last year. The excess in number of deaths from influenza and pneumonia is 1,187 for 108 cities…The estimated death rate from influenza and pneumonia in the 108 cities for the week ended October 26 was 83 per 100,000 population on an annual basis as compared with an estimated rate of 30 for the same week last year….” (PHS, “Provisional Information on Selected Notifiable Diseases… [US]… Deaths in Selected Cities for Week Ended October 26, 1957.” MMWR, 6/43, 11-1-1957, 2.) PHS, Oct: “It is now possible to compare mortality from influenza and pneumonia for the whole population of the country in the current epidemic with some previous years when influenza was prevalent. Preliminary figures based on a 10-percent sample of deaths indicate that mortality from influenza and pneumonia in the country as a whole in October 1957 was slightly in excess of 50 per 100,000 population. It is possible that the sample for November may be slightly higher, because the peak in number of deaths from this cause was reached in the first week of November in the 108 large cities. The peak in mortality in the epidemic of A-prime influenza which spread over much of the country in the winter of 1952-53 was reached in February 1953. The mortality was estimated as 75.9 deaths per 100,000 for that month. Corresponding figures for the peak months in the 1928-29 and 1918 epidemics were about 590 in January 1929 and about 2,890 in October 1918. All of the above have been expressed as rates on an annual basis.” (PHS, “Provisional Information…Notifiable Diseases…Deaths in Selected Cities…January 4, 1958.” MMWR, 7/1, 1-10-1958, 1.) PHS, Nov 2: “The number of cases of influenza and influenza-like disease remains high. Based on reports from 40 States, the number of new cases for the week ended November 2 is estimated to be 1,250,000 or more…. The number of deaths from all causes in 114 large cities increased about 2 percent for the current week over the previous week. The number of deaths from influenza and pneumonia in 108 large cities was 856 as compared with 771 for the previous week, an increase of 11 percent – also the lowest in some weeks. For the previous week there was an increase of 27 percent in influenza and pneumonia deaths as compared with the week ended October 19; the week before (October 12) the increase was 26 percent, and prior to that there was an increase of 47 percent from 1 week to the other. For the week ended November 2, the number of deaths from influenza and pneumonia in New York City dropped to 151 as compared with 181 for the previous week….Boston, Buffalo, Philadelphia, Chicago, Cleveland, Minneapolis, St. Louis, Atlanta, Louisville, and Portland, Oregon, reported Increases, mostly moderate, during the past week….” (PHS, “Provisional Information…Notifiable Diseases… Deaths in Selected Cities for Week Ended November 2, 1957.” MMWR, 6/44, 11-8-1957, 1-2.) PHS, Nov 9: “….The estimated total number of cases for the week ended November 9 in 38 States is about 1,100,000…. “Deaths from influenza and pneumonia increased only about 4 percent as compared with 11 percent for the previous week. The total for the week (887) was about 3 times higher than the number (291) for the same week of 1956. The excess number of deaths from influenza and pneumonia since September 1 is 2,410 in excess of the number for the same period last year. Nearly 90 percent of this excess occurred in the past 6 weeks…. “Dr. N. J. Rose, Illinois Department of Public Health, reports that there have been 36 influenza-associated deaths in that State, 12 of which occurred in the Dixon State School epidemic….” (PHS, “Provisional Information on Selected Notifiable Diseases… [US]… Deaths in Selected Cities for Week Ended November 9, 1957.” MMWR, 6/45, 11-15-1957, 1-2.) PHS, Nov 16: “….The total number of cases obtained by adding the totals reported or estimated by 36 States for the week ended November 16 is 780,000. As shown below, the number of deaths from all causes and from influenza and pneumonia in large cities has declined. The number of deaths from all causes (12,222) for 114 large cities and the number from influenza and pneumonia (782) in 108 cities dropped 3 and 13 percent, respectively, as compared with the previous week….” (PHS, “Provisional Information on Selected Notifiable Diseases… [US]… Deaths in Selected Cities for Week Ended November 16, 1957.” MMWR, 6/46, 11-22-1957, 1-2.) PHS, Nov 23: “There was a marked reduction in the number of reported cases of influenza and influenza-like disease in many States for the week ended November 23 and estimates of incidence in some others were much below those for previous weeks. On the basis of various types of reports from 33 States, the total for the week is estimated to be 450,000. There were numerous statements that there was a statewide decline, that no new community-wide outbreaks had occurred, or that absenteeism in schools was returning to or had reached normal levels. A few reports stated that a larger proportion of cases seemed to be occurring in adults. However, no increase in industrial absenteeism was reported. “The number of deaths from all causes reported in the 114 cities for the week ended November 23 (12,303) increased slightly less than 1 percent as compared with 12,222 for the previous week. However, influenza and pneumonia deaths which numbered 691 in 108 cities decreased about 12 percent, from 782 for last week….” (PHS, “Provisional Information…Notifiable Diseases… Deaths in Selected Cities…November 23, 1957.” MMWR, 6/47, 11-30-1957, 1-2.) PHS, Nov 30: “Incidence of influenza and mortality from influenza and pneumonia continues to decline in all parts of the country. The number of deaths from all causes in 114 large cities for the week ended November 30 was 10,214, and the deaths from influenza and pneumonia in 108 cities totaled 556. The number of deaths for all causes was 11,913 for the previous week; and for influenza and pneumonia the number was 693. In September, October, and November 1956, less than 3 percent of all deaths reported in large cities of the United States was due to influenza and pneumonia. During September 1957, the percent ranged from 2.6 to 2.9. In October, the proportion of influenza and pneumonia deaths rose each week and reached 7 percent for the week ended November 9. However, there was considerable variation from city to city within the limits of 3 to 15 percent. The 7 percent is a marked contrast with the proportions in 1918 when 50 to 80 percent of all deaths in a number of cities was due to influenza and pneumonia at the height of the epidemic. In the 1928-29 epidemic, the proportions in various cities ranged from 25 to 55 percent. The low proportion of influenza and pneumonia deaths in the current epidemic indicates that mortality has been relatively low as compared with some epidemics that occurred prior to the time when sulfonamides and antibiotics were available for treatment of the complications of influenza.” (PHS, “Provisional Information…Notifiable Diseases…Deaths in Selected Cities…December 7, 1957.” MMWR, 6/48, 12-6-1957, 1-2.) PHS, Dec 7: “Reports from most States indicate a decreasing incidence of influenza and influenza-like disease tor the week ended December 7. Some stated that incidence was only slightly above the normal seasonal level, while others indicated that school and industrial absenteeism rates have declined to normal levels. However, the Arizona Commissioner of Health stated that “significant increases’’ in influenza-like disease were reported in 3 counties during the past week… A report from the California Department of Public Health stated that 1 State mental institution where there was an epidemic of influenza in late August and early September experienced a second outbreak in November. In both epidemics confirmation was made of type A (Asian) infections by H-I tests. “The number of deaths from all causes in 114 large cities was 12,696 and deaths from influenza and pneumonia in 108 cities totaled 581. This apparent increase over the previous week when the numbers reported were 10,491 and 557, respectively, undoubtedly occurred because of the lag in reporting over the Thanksgiving Day holiday….” (PHS, “Provisional Information…Notifiable Diseases… Deaths in Selected Cities…December 7, 1957.” MMWR, 6/49, 12-13-1957, 1.) PHS, Dec 14: “Influenza incidence continues to decline in all parts of the United States. Deaths from all causes declined in every geographic division for the week ended December 14 from figures reported for the previous week. The totals for these weeks were 11,825 and 12,611, respectively. The only divisions reporting deaths above the expected values for the week ended December 14 were the Middle Atlantic and Mountain Divisions. The high mortality in these areas was the result of a greater than expected number of deaths in New York City and Tucson. The number of deaths from influenza and pneumonia for the week ended December 14 was 535 as compared with 581 for the previous week. The numbers were higher than expected in 5 divisions: East North Central, West North Central, South Atlantic, West South Central, and Mountain. “The California State Department of Public Health reports that each of several indexes used for surveillance of influenza incidence indicated that the peak was reached about the middle of October in California. One of the indexes, the California Health Survey, indicated that a total of 1,812,000 new cases of upper respiratory disease occurred during the week ended October 27, which is a fourfold increase over the same period In 1954-55. About two-thirds of these cases were reported as Asian influenza….” (PHS, “Provisional Information…Notifiable Diseases…Deaths in Selected Cities…December 14, 1957.” MMWR, 6/50, 12-20-1957, 1.) PHS, Dec 21: “Although reports from States indicate a decreasing incidence of influenza throughout the country, the number of deaths from all causes in 114 large cities increased slightly above that for the previous week, that is, 11,997 as compared with 11,804. The increase was evident for each geographic area except the New England, East North Central, and Mountain Divisions. The numbers of deaths were above the expected value in the Middle Atlantic, South Atlantic, and Mountain Divisions. Thirteen cities reported a greater than expected number of deaths. The number of deaths from influenza and pneumonia was 566 as compared with 535 for the previous week. The numbers were above expected values for the country as a whole and particularly in the East North Central, West North Central, South Atlantic, Mountain, and Pacific Divisions.” (PHS, “Provisional Information…Notifiable Diseases…Deaths in Selected Cities… December 21, 1957.” MMWR, 6/51, 12-28-1957, 2.) PHS, Feb 22, 1958: “The number of deaths from all causes reported in the 114 large cities was 13,013 for the week ended February 22 as compared with 12,439 for the previous week. The numbers were above the expected level for this time of the year…The number of deaths from influenza and pneumonia in the 108 large cities also showed an increase, 754 being reported this week as compared with 705 for the previous week. The number reported is above the expected value and above the 3-year median for the week (418). The numbers were above the expected in 6 of die 9 geographical divisions…A satisfactory explanation for the rise in influenza and pneumonia deaths since January 1 has not been found….” (PHS, “Provisional Information… Notifiable Diseases…Deaths…Selected Cities…February 22, 1958.” MMWR, 7/8, 2-28-1958, 1.) PHS, March 1, 1958: “The number of deaths from influenza and pneumonia in 108 cities increased from 764 for the week ended February 22 to 847 for the week ended March 1. The latter number is only 40 less than the number for the peak week in November. For the current week, the New England, Mountain, and Pacific groups of cities were the only ones reporting less than expected numbers. A few cities have reported more deaths from this cause in recent weeks than they reported during the peak period in November 1957. Such cities are located in various section s o f the country. The number of deaths from all causes in 114 cities increased to 13,422 for the week ended March 1, which is 2.8 percent above the total for the previous week and 19.2 percent above the adjusted average (11,256). “Dr. Harry Gibson, Acting Commissioner of Health, Alaska, stated in a report dated February 25 that a widespread outbreak of influenza-like illness has been occurring throughout southeast Alaska, from Yakutat south to Ketchikan. The illness is reported to be prostrating with high attack rates but low mortality….” (PHS, “Provisional Information…Notifiable Diseases…Deaths… Selected Cities…March 1, 1958.” MMWR, 7/9, 3-7-1958, 1-2.) Shay: “Characterized by localized outbreaks prior to explosive spread in early fall. Most deaths were in older age groups. Most excess deaths were categorized as cardiovascular rather than pneumonia deaths. 1st wave: Sept, Oct, Nov 1957. (Shay, CDC, 2005, slide 25.) Etheridge: “The first wave struck particularly hard at teenagers, probably because they experienced the highest contact rate of any segment of the population, far surpassing the number of contacts of the housewife, her preschool children, or her husband at work.” (Etheridge. History of the CDC, p. 85.) Shay: “2nd wave: Jan, Feb, March 1958.” (Shay, Centers for Disease Control, 2005, slide 25.) Greene: “Originated from mutation in wild ducks combining with a pre-existing human strain.” (Greene 2006) Newspapers Nationwide: Jan 18, 1958 (UPS): “Washington…Public Health Service officials said today the great Asian flu epidemic appears to have subsided – for the time being…The first wave of the epidemic, which rolled across the nation beginning in September, took a heavier toll than is generally realized. Surgeon General Leroy H. Burney estimates that about 20 million Americans came down with the disease during the last four months of 1957. That makes it the biggest epidemic, from the viewpoint of total cases, since the terrible 1918 ‘pandemic.’…. “In the 108 major cities which submit weekly vital statistics to public health headquarters, there were 9,240 deaths from influenza and pneumonia during the last four months. This represents a jump of more than 4000 deaths over the figure for comparable period of 1956. In these same cities, which represent less than one-third of the total U.S. population, the number of deaths from all causes was about 17,500 greater during the same period of 1956. A large proportion of these 17,500 ‘excess deaths’ are attributable to the Asian flu epidemic, according to Dr. Carl C. Dauer, Public Health Service influenza control officer. Dauer said a flu epidemic always causes an upswing in the death rate from heart disease, tuberculosis and other chronic disease. Victims of these ailments are ‘pushed over the line’ by an attack of flu, and although their deaths are not listed as due to influenza or pneumonia, they are as truly victims of the epidemic as anyone else… “Dr. William H. Stewart, assistant to the surgeon general, said the impact of Asian flu was ‘considerably lessened’ by the extensive advance preparations, particularly the widespread use of vaccine. Stewart said about 40 million doses of vaccine moved into medical channels in the past four months, and most of this presumably has been shot into arms. ‘Since the vaccine offers 60 to 70 percent protection, he said, ‘the vaccination program clearly had an important part in curbing the spread of the epidemic.’….” (Daily Review, Hayward, CA. “Experts Divided. U.S. Examines Asian Flu Picture.” 1-8-1958, p. 19.) Alabama: Nov 30: “According to Dr. D. G. Gill, Alabama Health Officer, the peak of the Asian flu epidemic has been reached and passed….Last week the Health Department received reports of 11,000 cases of the ‘flu’ in Alabama as against 19,000 the previous week….” (Anniston Star, AL. “Flu Peak Past.” 11-30-1957, p. 4. Arkansas: Oct 16: “Dixon, Ill. (AP) – An outbreak of flu has taken lives and put 1,154 persons on the sick list at the Dixon State School, the superintendent announced today. Supt. Robert E. Wallace said the flu-type disease -- not yet precisely identified -- begun its sweep through the state institution two weeks ago. It apparently was at a peak in the school today, and new cases are being recorded at the rate of 100 a day. There are a total of 5,000 children and adults at the school. They live in buildings in a community that resembles a college campus at the northern edge of Dixon. The residents are mentally retarded. They are given training with the aim of making them independent. Wallace said two deaths occurred last week and three this week. He said those who succumbed were either aged or in a weakened physical condition. The 1,154 on the sick list now compares with a normal 75 to 250. Approximately 300 persons who were stricken have recovered. The school’s hospital is over-taxed, and many of the sick are being kept abed in their dormitories. About 25 percent of the members of the staff of around 500 is absent. Volunteers from the various non-medical departments have assumed nursing duties. All group activities and visits have been canceled…” (Mt. Vernon Register-News, IL. “Flu Sweeps Dixon State School; 5 Die.” 10-16-1957, p. 1.) Oct 25: “By United Press….The situation…grew worse at the Dixon State School for the Mentally Retarded. Forty-seven new flu cases were reported Thursday, bringing the total to 2,284 including 54 employes. Ten deaths already have hit the institution, 959 patients are confined to bed; 39 are in isolation and of that number 9 are listed in poor condition and 2 in critical condition.” (Daily Register, Harrisburg, IL. “Flu Onslaught Closes More Illinois Schools.” 10-25-1957, 8.) Nov 1: “Rosiclare, Ill. (AP) -- Flu has reached epidemic proportions in this Shawnee National Forest area observers said, and physicians wondered how the expected influx of deer hunters today would affect the situation. Hundreds of persons had contracted flu here in Hardin County, the state's smallest, which borders southern Indiana. The entire county, mostly forest and farmland, has a population of about 7,000 persons. “School officials closed the county's five rural schools, and the grade and high schools in Rosiclare and Cave-In-Rock. Physicians at Hardin County Hospital said flu patients had filled it, causing the staff to open a temporary hospital ward in a vacant annex. Fifteen women workers were aiding doctors and nurses in caring for patients. Numerous others were sick at home with flu. Most of those ill were children and teen-agers, but there was also a noticeable increase in adult patients….In addition to closing schools, officials ordered Rosiclare churches and theaters to close during the flu outbreak. “The Hardin County school closings brought to more than a dozen the total number of towns with schools now inoperative because of flu in Illinois. They include: Mount Carmel in Wabash County; Olney, Dundas, Parkersburg, Berryville and Calhoun in Richland County; Rosiclare, Cave-In-Rock and rural schools in Hardin County; Whittington and Ewing in Franklin County; Kell in Marion County; those of Bond County Unit School Dist. 1, and Lewistown in west central Illinois. Flu in Illinois appeared now concentrated in the southeast. “Illinois' death toll from flu remained at 18. Eleven of these deaths occurred in the Dixon state school epidemic. “High school football games were postponed….” (Freeport Journal-Standard, IL, “Flu Epidemic Hits County Down South,” 11-1-1957, p. 2.) Georgia: Nov 9: “Atlanta (UP) – Health authorities and hospitals battled today against a flu-pneumonia epidemic here that claimed 43 lives in a single week -- more than eight times the normal death toll. Charles Turner, statistician for the Fulton County Health Department, said 43 deaths were counted for the week ending Friday as compared with 22 deaths the week before. He said the average casualty rate this time of year for pneumonia and related ailments is about five to six per week. Turner, who called the situation here ‘alarming,’ expressed the belief after talking with doctors of the department that the epidemic here had reached its peak and would probably start declining soon. He said most of 'the fatalities were in the age group beginning at the mid-fifties. “This is the way the death toll built up in Atlanta: Week of Oct. 12, nine deaths; Oct. 19, four; Oct. 26. 14; Nov. 2. 22; this week, 43….Influenza and rotated complaints have caused the closing of schools in 23 Georgia counties.” (Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-1957, p. 1, col. 4.) Sources Anniston Star, AL. “Atlanta Hit by Epidemic; 43 Are Dead.” 11-9-1957, p. 1, col. 4. 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