Michael Friedmann

Dr. Griswold

SPED 760

Module 2 Assignment

February 5, 2023

 

 

 

HISTORY OF AUTISM SPECTRUM DISORDER – SPANISH FLU OF 1918

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“A Discussion on the Lack of Foundational Evidence that Vaccinations Cause Autism”

 

            In 1918, a deadly pandemic quickly spread throughout the world, and it was soon after referred to, or labeled, as the Spanish Flu, due to erroneous suppositions that it had begun in Spain. The fact remains that Spain was not the factual origin, nor ground zero for the Spanish Flu, but due to wartime media censorship by warring nations, the influenza outbreaks within the militaries of those nations were not accurately reported, and the media was censored in its outbreak-related reporting, leading to the reports of influenza in Spain, a country not engaged in wartime activities. In fact, Spain was the only country to factually report its influenza cases, leading to the inevitable misidentification of the influenza outbreak as the Spanish Flu, with the world unfortunately linking the spreading influenza outbreak to Spain, even as it spread from one nation to another, taking, by its end, nearly 50 million lives.

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            Interestingly, the first reported case of Spanish Flu was not even on the European mainland, nor in Spain, but rather in the United States, at Fort Riley in Kansas. On the morning of March 4, 1918, “just before breakfast” a young Private Albert Gitchell (with the U.S. Army) “reported to the hospital” where he “complained of the cold-like symptoms of sore throat, fever and headache.” It was not long after this, that more than “100 of his fellow soldiers” began reporting “similar symptoms.” It was these reports on March 4, that marked “what are believed to be the first cases in the historic influenza pandemic of 1918, later known as [the] Spanish flu” (History.com, 2010, no page). This outbreak of influenza on the American mainland “would eventually kill 675,000 Americans” and “an estimated 50 million people around the world, proving to be a far deadlier force than even the First World War” (History.com, 2010, no page). While there are additional accounts that “the 1918 flu was first observed in Europe, the United States, and parts of Asia before [it] swiftly spread around the world” the outbreak at Fort Riley, Kansas, marked the first official reports of a flu-like illness that spread rapidly amongst U.S. Army personnel. Not long after those first reports at Fort Riley, Kansas, “similar outbreaks in army camps and prisons in various regions of the [United States]” began. As U.S. soldiers began deploying to Europe to aid “Allies on the battlefields of France” fighting in World War I, those flu-like symptoms traveled with them, and began infecting thousands. “In March 1918 alone, 84,000 American soldiers headed across the Atlantic; another 118,000 followed the next month…[and] once it (the Spanish Flu) arrived on a second continent, [it] showed no signs of abating: 31,000 cases were reported in June in Great Britain” (History.com, 2021, no page). By that time, the pandemic was no longer able to be contained, if any efforts had even been made at all to do so. Medical science had a very limited understanding at that time of influenza, virulent strains of disease and how they spread and the ability to vaccinate against them.

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              According to history, the influenza strain of 1918 “showed no mercy for combatants on either side of the trenches [and] over the summer, the first wave of the epidemic hit German forces on the Western Front, where they were waging a final, no-holds-barred offensive that would determine the outcome of the war” (History.com, 2010, no page). The commander of the German Army, Crown Prince Rupprecht “wrote on August 3” that the Spanish Flu “had a significant effect on the already weakening morale of [his] troops [and] “poor provisions, heavy losses, and the deepening influenza have deeply depressed the spirits of men in the III Infantry Division” (History.com, 2010, no page). Not long thereafter, with no successful containment of the influenza virus in Western Europe, the Spanish Flu, “due to its exceptionally high rate of virulence and the massive transport of men on land and aboard ship due to the war effort” spread across the globe, and “by the end of the summer, numerous cases had been reported in Russia, North Africa and India; China, Japan, the Philippines and even New Zealand would eventually fall victim as well” (History.com, 2010, no page).

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            The drastic rise in exposure and infection which spread quickly through populations around the globe were directly due to a lack of effective or available drugs or vaccines at that time to treat influenza. “Citizens were ordered to wear masks; schools, theaters and businesses were shuttered, and bodies piled up in makeshift morgues before the virus ended its deadly global march” (History.com, 2010, no page). Fast forward to 2019 (oddly and ironically, 100 years exactly to the date from the last influenza pandemic) and the world again experienced a fast moving, rapid exposure, and infection of a virulent strain of influenza which killed (as of January 31, 2023) “6,812,798” (World Health Organization, n.d., no page) people globally. The rapid infection rate amongst U.S. Army personnel in 1918 made “making an influenza vaccine a U.S. military priority” (World Health Organization, n.d., no page) and “early experiments with influenza vaccines [were] carried out” almost immediately, with the “U.S. Army Medical School [testing] 2 million doses in 1918, [yet all] results [were] inconclusive” (World Health Organization, n.d., no page).

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              “The 1918 influenza pandemic was the most severe pandemic in recent history” (CDC, 2019, no page) even more so than the Covid-19 pandemic the world experienced between 2018 and 2020 (which is still ongoing); with morbidity rates significantly impacted and mitigated due to public safety precautions, such as travel restrictions, mask wearing, and vaccinations, along with public awareness, which may have helped to mitigate and minimize the spread of a new strain of the very same virus which caused the deaths of 50 million people in 1918. The Spanish Flu of 1918 was caused by a virulent strain of “the H1N1 virus with genes of avian origin” (World Health Organization, n.d., no page). “In virology, influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus” with “major outbreaks of H1N1 strains in humans [including] the Spanish flu, the 1977 Russian flu pandemic and the 2009 swine flu pandemic” (Dolin, n.d., no page). “We know now that influenza (also known as the flu) is caused by a virus – but for many years it was thought to be caused by a bacterial infection” (CDC, 2019, no page). It was Richard Pfeiffer, a German scientist, who in 1892, “isolated a small bacterium from the noses of patients with flu, naming it ‘bacillus influenzae’” (CDC, 2019, no page). While the Spanish Flu of 1918 was caused by the H1N1 influenza virus, the virus responsible for the Covid-19 Pandemic is the SARS-CoV-2 coronavirus, and while both share similarities in how they are transmitted, how they attack the respiratory system in humans, they also share similarities in their symptoms and complications.

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              Early vaccination efforts taken in the 2019 Covid-19 Pandemic were hampered by a lack of understanding of the mutations which had occurred with the SARS-CoV-2 coronavirus, similar to the hurdles faced by early virologists working diligently to find a vaccination for the 1918 Spanish Flu, but it was “not until the 1930’s, when the influenza virus was identified, that progress towards an effective vaccine could…begin” (History.com, 2010, no page). Identifying the genetic makeup of the SARS-CoV-2 coronavirus was fundamental to how modern-day virologists developed vaccinations to counter the rapid spread and impact to those with underlying comorbidities who suffered the most significant complications when they contracted Covid-19. “Flu viruses mutate very rapidly, and uncontrolled spread gives rise to many different strains, which fall into 2 main types affecting humans – influenza A and Influenza B” (CDC, 2019, no page). The difficulty experienced by virologists while attempting to create a vaccination for the Covid-19 virus also encountered a virus that was rapidly mutating into one new strain after another, with multiple variations of Covid-19 discovered present in the human population by 2022. The ability of the Covid-19 virus to literally adapt and evolve so quickly to its affected population made it increasingly difficult to find one effective vaccination that could combat the spread of a virus that was constantly altering itself and mutating and re-infecting the same populations over and over again.

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              In the case of the 1918 Spanish Flu, it was not until 1933, when “British researchers Wilson Smith, C.H. Andrewes and P.P. Laidlaw at London’s National Institute for Medical Research (NIMR) made a breakthrough [in] isolating and identifying the influenza virus [when] they found no bacteria in throat washings from patients with influenza and discovered that the disease was caused by a virus” (History.com, 2010, no page). By 1945, “with support from the US Army, the first inactivated flu vaccine was developed by Thomas Francis Jr. and Jonas Salk at the University of Michigan [and] approved for military use, followed in 1946 by an approval for civilian use” (History.com, 2010, no page). Both Dr. Thomas Francis, Jr., and Dr. Jonas Salk would later “be closely associated with the polio vaccine.

 

               The Spanish Flu of 1918, as well as the Covid-19 Pandemic of 2018 to 2022 (still on-going) hold a great fascination for me as an educator, as I worked in education prior to the Covid-19 Pandemic, and during and after it became reduced from the status of a public health hazard, which impacted how schools were able to operate, and allowed students and educators to return to in-person learning. As an educator, I witnessed the impacts of remote learning, and of the lack of socialization, of routine, or in-person structured learning, on all ages and demographics of the student population. It was shocking to witness how elementary-aged and middle school-aged students had experienced drastic behavioral changes and an inability to retain and recall information. Observationally, it also appeared as though all school districts were being inundated with more students presenting with ASD and with emotional/behavioral disorders. For an educator, working with marginalized population and demographics of students, trying to understand why a virus such as influenza or coronavirus can have such an impact on how people learn, how they interact, and the prevalence or incidence of learning disabilities and ASD in the aftermath of a pandemic is fundamental to the understanding of why such events occur and how to counteract them when they do. The Spanish Flu of 1918 “is believed to have caused behavioral and achievement problems in infected children [with] symptoms attributed to the disease [including] impaired attention and memory as well as lack of impulse control” (Billings, 1997, no page). Furthermore, “the flu can also result in serious complications, particularly in vulnerable people like young children, older persons, pregnant women and people with medical conditions such as asthma, diabetes or heart disease [with] the most common complication [being] pneumonia, typically caused by a secondary bacterial infection” (CDC, 2019, no page). 

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               The significance of the Spanish Flu of 1918 as well as the Covid-19 Pandemic help those of us, who work in the field, to better understand how vaccinations and or viruses such as influenza or coronavirus affect pregnant women and/or unborn fetuses and contribute to or fail to contribute to the incidence or prevalence of autism, which is paramount to our understanding of what causes or does not cause autism. We look at the medical science involved in order to better understand the future outcomes of those individuals we strive so diligently to understand, and for whom we work for, searching and isolating functional interventions in order to provide a quality of life for them. “The cause or causes of autism are unknown [yet] several environmental factors during pregnancy…have been associated with an increased risk for this disorder [with] one such factor [being] maternal rubella infection” (Offit, 2016, no page). “Because natural rubella infection during pregnancy has been shown to increase the risk of autism…Kaiser Permanente in Northern California examined the risk of autism in children whose mothers had been infected with influenza virus [while] also examining whether influenza immunization during pregnancy increased the risk of autism” (Zero et al., 2016, no page). In the case of the Kaiser Permanente study, “investigators performed a cohort study of 196,929 children of whom 3,103 had autism spectrum disorder who were born at Kaiser Permanente Northern California between Jan. 1, 2000, and Dec. 31, 2010 [and] they found no statistically significant association between either natural influenza infection or influenza vaccination and the development of autism spectrum disorder” (Offit, 2016, no page). Offit (2016) notated that “these findings shouldn’t be surprising” given the fact that “natural rubella virus infection increases the risk of autism because rubella virus enters the bloodstream, crosses the placenta, and infects the unborn child during development [while] rubella vaccine virus, on the other hand, because it is significantly attenuated, does not increase the risk of congenital abnormalities if given during pregnancy” (Offit, 2016, no page). Furthermore, “influenza virus, as distinct from rubella virus, does not cause viremia [and] the virus does not enter the bloodstream and cannot cross the placental barrier [and the] influenza vaccination, which consists of inactivated virus, also cannot infect the unborn child” (Offit, 2016, no page). Offit (2016) concluded that the findings of that investigation conducted by Kaiser Permanente in Northern California between 2000 and 2010 were “consistent with the biological differences between rubella and influenza infection and vaccination” as well as their impacts to unborn fetus. While such a study continues to leave us with questions on what the causes of autism may be, it does answer some fundamental questions pertaining to influenza and vaccinations and how they both fail to have a direct impact on pregnancy and the development of a healthy fetus. Relying on the science behind such studies, which come out of events such as the Spanish Flu of 1918 and the Covid-19 Pandemic, both of which propagated the advancement of new medical treatments and vaccinations establishes a medical and scientific precedent to relieve the concerns of parents and/or those expecting (soon to be) parents, that the vaccinations they may be concerned about truly have no scientific or medical basis for causing autism.

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              In 2012, Emily Willingham penned an article for Forbes, intitled “Influenza, Fever, And Autism: How Much Should You Worry?” As a matter of record, Willingham holds a “PhD in biology and completed a fellowship in pediatric urology.” In her science-focused article, which included more than one, Willingham challenged the link between vaccinations and autism, and argued vehemently that vaccinations and influenza were not contributing factors to the prevalence or development of autism in utero. Willingham challenged the Danish study of 98,000 children based upon self-reporting as highly unreliable. As we struggle to try and find the reasons behind why some children are born with ASD, we should never struggle past the point of reliability, and recognize that the answers to why ASD occurs within our current and past populations is rooted deeply within our DNA, our genetics, and the answers rest somewhere deep in medical science. Researching, as an educator, working with students who suffer from ASD, is a tried-and-true method of gaining fundamental and practical information that will inevitably help us to move forward with better interventions, better capabilities, and greater understandings of how to communicate with those who see the world through a slightly different lens than we do. While we strive to uncover better ways to teach them, perhaps we should never let go of the notion that perhaps it is they who are trying to teach us to just pay a little more attention to the smaller details around us.

 

CONCLUSION/REFLECTION:

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              As a long-time academic and scholar, and teacher, and life-long learner, and father, I found this assignment instructional, educational, and immersive. I am inquisitive by nature, and latched onto the history aspect of this assignment, and the curiosity and connection between the Spanish Flu of 1918 and the Covid-19 Pandemic, which I personally experienced through multiple lenses. I found that the information was important to understanding how viruses, particularly H1N1 and SARS-CoV-2 do not appear to have an impact on fetus development, nor do vaccinations. I find that when we previously discussed how some people in the population believe that vaccines cause autism, I would argue that as educators working with students with ASD, that it is important to recognize the medical science involved, in order to help the parents of those students with ASD better understand how ASD occurs and how it does not occur. When working with ASD, we learn together, or we do not learn at all.

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REFERENCES:

 

Billings, M. (1997). The Influenza Pandemic of 1918. The 1918 influenza pandemic. Retrieved February 5, 2023, from http://virus.stanford.edu/uda/

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CDC. (2019, March 20). 1918 pandemic (H1N1 virus). Centers for Disease Control and Prevention. Retrieved February 5, 2023, from https://www.cdc.gov/flu/pandemic-resources/1918-pandemic-h1n1.html

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Dolin R. Epidemiology of influenza. https://www.uptodate.com/contents/search. Accessed Feb. 05, 2023.

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Grohskopf LA, et al. Prevention and control of seasonal influenza with vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2020-2021 influenza season. MMWR Recommendations and Reports. 2020; doi:10.15585/mmwr.rr6908a1.

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History.com Editors. (2021, March 3). First cases reported in Spanish flu epidemic - history. History. Retrieved February 5, 2023, from https://www.history.com/this-day-in-history/first-cases-reported-in-deadly-influenza-epidemic

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History.com Editors. (2010, October 12). Spanish flu - symptoms, how it began & ended - history. Spanish Flu. Retrieved February 5, 2023, from https://www.history.com/topics/world-war-i/1918-flu-pandemic

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Key facts about human infections with variant viruses. Centers for Disease Control and Prevention. https://www.cdc.gov/flu/swineflu/keyfacts-variant.htm. Accessed Feb. 05, 2023.

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Offit, P. (2016, December 12). In the journals: Autism and flu. Children's Hospital of Philadelphia. Retrieved February 5, 2023, from https://www.chop.edu/news/journals-autism-and-flu

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Types of influenza viruses. Centers for Disease Control and Prevention.

https://www.cdc.gov/flu/about/viruses/types.htm. Accessed Feb. 05, 2023.

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Willingham, E. (2012, November 29). Influenza, fever, and autism: How much should you worry? Forbes. Retrieved February 5, 2023, from https://www.forbes.com/sites/emilywillingham/2012/11/12/influenza-fever-and-autism-how-much-should-you-worry/?sh=83aba3238fa0

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Willingham, E. (2013, March 29). Vaccines not linked to autism. again. Forbes. Retrieved February 5, 2023, from https://www.forbes.com/sites/emilywillingham/2013/03/29/vaccines-not-linked-to-autism-again/?sh=4e20c5635b8e

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World Health Organization. (n.d.). A brief history of vaccination. World Health Organization. Retrieved February 5, 2023, from https://www.who.int/news-room/spotlight/history-of-vaccination/a-brief-history-of-vaccination

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World Health Organization. (n.d.). History of influenza vaccination. World Health Organization. Retrieved February 5, 2023, from https://www.who.int/news-room/spotlight/history-of-vaccination/history-of-influenza-vaccination

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World Health Organization. (n.d.). Who coronavirus (COVID-19) dashboard. World Health Organization. Retrieved February 5, 2023, from https://covid19.who.int/

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Zerbo, O, Qian Y, Yoshida C, et al. Association Between Influenza Infection and Vaccination During Pregnancy and Risk of Autism Spectrum Disorder. JAMA Pediatr. 2016 Nov 28. [Epub ahead of print] doi:10.1001/jama-pediatrics.2016.3609