The showboat flu is starting to slow down

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NOBLES at the courts of Queen Elizabeth I and Mary Queen of Scots referred to it as the 'newe acquaintance'. In 1568, a Thomas Willis said that it appeared to be sent 'by some blast of stars', and in 1775 it was reported that 20,000 people had been 'seized in one night.'

Two hundred years on, influenza is still making headlines as a 'killer' epidemic 'swept' through the country last week, claiming at least 16 lives. More than 200,000 people in England and Wales, and thousands more in Scotland, have gone down with Beijing flu since the epidemic began in mid-October.

A vaccine shortage due to bureaucratic bungling by manufacturers and the Department of Health has added spice to the crop of flu stories, but the epidemic of the winter of 1993/94 is unlikely to rate more than a footnote in a history of 20th-century epidemiology.

Experts say the illness, though widespread, is relatively mild in most people, and latest figures suggest that the average rate of increase of new illnesses is already slowing down. Flu deaths among frail, elderly patients are not unusual, particularly in the old people's homes and on geriatric wards where they have occurred so far.

In a non-epidemic year there are between 3,000 and 4,000 deaths from flu. And although some hospitals, schools and businesses say they are 'under pressure', the current epidemic has caused minor disruptions in comparison with previous outbreaks.

Influenza epidemics and pandemics are largely unpredictable, and occur when there is a major change - known as genetic drift - in the structure of the virus, producing a strain to which few people are resistant. As a rough guide, this happens every 10 years or so, although minor changes can also cause havoc. In the 18th and 19th centuries there were probably about eight influenza epidemics, and the outbreak in the winter of 1889/90 killed more than 10 million people.

The worst flu pandemic on record was in 1918/19, when Spanish flu killed 20 million worldwide, and created panic. Police in Chicago were ordered to arrest people who sneezed in the street, and in Australia it was an offence not to wear an anti-microbe mask.

The next major outbreak occurred in 1957 when Asian flu claimed one million lives, and 1968 when Hong King flu killed 700,000 people. At its peak, there were around 900 cases per 100,000 and up to 4,000 deaths a week. In 1976, a combination of Australian and English strains of the virus took their toll in January and February. Court cases were cancelled and many schools were closed.

Mail was delayed because there were not enough postal workers, while London Transport had a conductor shortage. Flights from Heathrow were cancelled. A Cardiff hospital, with a tenth of its nurses off sick, had to close wards and open a sick bay for staff.

The last epidemic year was 1989. The outbreak started mid to late November and between 19,000 and 25,000 deaths were eventually attributed to flu. The outbreak peaked at an incidence of 538 cases per 100,000.

The current wave of influenza - due to Beijing A virus in the northern hemisphere - began on a showboat on the Mississippi river in August, according to the World Health Organisation. It took its name from the Chinese capital because it was first isolated in Beijing last year.

The first hint that something unusual was developing in Britain came in late October from Dr Douglas Fleming, director of the Royal College of General Practitioners' flu monitoring bureau in Birmingham. He said that cases of flu and flu- like illnesses were running at twice the level of last year - 50 per 100,000 cases in England and Wales. Early this month, Dr Kenneth Calman, the chief medical officer, hinted that there was an epidemic with 122 cases per 100,000 - the official threshold is 100 per 100,000.

Scotland was affected first but the virus has now spread throughout England and Wales. It began to make its presence felt in southern England this month, and between 31 October and 7 November the rate of increase more than doubled to 145 cases per 100,000 people. Latest provisional figures from the Royal College show an average of 178 cases per 100,000, with a regional breakdown showing the North at 201 and the Midlands at 192.

Dr Fleming said yesterday; 'There is an epidemic and it is bigger than anything we have had since 1989, but it does not look to be accelerating at quite the rate it did then. On present figures it is not as bad as 1989 and I think that will hold.'

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