Spænska veikin á Íslandi 1918 : lærdómur í læknisfræði og sögu

Abstract

Pandemic influenza has emerged 1-3 times each century. The pandemic in 1918, or the "Spanish flu" was caused by a novel influenza strain which caused the death of 21-50 million people world wide. Descriptions of the epidemic in Iceland give a detailed account on how and when the virus was introduced to the population of Reykjavik, the capital of Iceland, by the crew of two ships, "Botnía". and "Willemoes" on October 19th 1918. The spread of the illness was extremely rapid and peaked 3 weeks later. It caused significant morbidity and mortality among inhabitants of the southern and western part of Iceland. Within 6 weeks, close to 500 individuals had died, thereof more than 50% in Reykjavik. The attack rate in Reykjavik was at least 63% and the case fatality proportion was close to 2.6%. The age-specific mortality was highest among young children, people 20-40 years of age and the elderly. In addition, pregnant women had extremely poor prognosis (37% case fatality). Attempts to halt the spread of the epidemic to the northern and eastern parts of the island were successful. By identifying the individuals who died from the Spanish flu using historical data, it has recently been shown that genetic factors probably did not play a major role in the pathogenesis of fatal cases. These historical data can be used to assist in planning for new pandemics of influenza, which are believed to be inevitable.

Heimsfaraldrar inflúensu ganga yfir einu sinni til þrisvar á öld. Spænska veikin árið 1918 er dæmi um heimsfaraldur þar sem nýtt afbrigði inflúensuveirunnar olli dauða 21-50 milljóna manna um heim allan á skömmum tíma. Hér á landi greina samtímaheimildir frá því hvernig veikin barst til Reykjavíkur með skipverjum á Botníu og Willemoes þann 19. október 1918. Útbreiðsla veikinnar var hröð og náði hámarki þremur vikum síðar. Hún lagðist þungt á íbúa margra þéttbýliskjarna suðvesturhornsins, Suðurlands og hluta Vestfjarða. Áður en sex vikur voru liðnar höfðu tæplega 500 manns látist af völdum spænsku veikinnar, þar af ríflega helmingurinn í Reykjavík. Þar veiktust að minnsta kosti 63% íbúa og dánarhlutfall þeirra sem veiktust var nálægt 2,6%. Dánarhlutfall hérlendis var hæst meðal ungra barna, fólks á aldrinum 20-40 ára og aldraðra. Einnig urðu barnshafandi konur illa úti (37% dánarhlutfall). Tilraunir til að hefta útbreiðslu veikinnar til Norðurlands og Austurlands báru góðan árangur. Með því að auðkenna þá sem létust af völdum faraldursins hefur nýlega verið sýnt fram á að erfðaþættir skiptu að líkindum litlu máli hvað varðar dánartíðni. Þessar upplýsingar geta nýst við undirbúning viðbragðsáætlana gegn nýjum heimsfaraldri inflúensu.