Historical and clinical aspects of the 1918 H1N1 pandemic in the United States

One hundred years have passed since the 1918 influenza pandemic caused substantial illness globally, with an estimated 50 million deaths. A number of factors, including World War I, contributed to the spread of the pandemic virus, which often caused high symptomatic attack rates and severe illness. Major achievements over the last 100 years have been made in influenza prevention, diagnosis, and treatment; however, the potential for a severe pandemic to emerge remains unchanged. We provide a review of the historical context and clinical aspects of illness due to the influenza A(H1N1) virus as it emerged and spread in 1918, with a focus on the experience in the United States. Understanding the significant social disruption and burden of illness from the 1918 pandemic can help us imagine the possible impacts of a high severity pandemic if it were to emerge now.