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David M. Morens, MDa Jeffery K. Taubenberger, MD, PhD3 Gregory K. Folkers, MS, MPHa Anthony S. Fauci, MDa National and international pandemic influenza planning has been stimulated by concerns about an unprecedented panzootic of highly pathogenic avian influenza H5N1 virus, fatal to 245 humans as of September 10, 2008.1 In these planning efforts, public health officials have looked to previous influenza pan demics for information about prevention measures adopted and their proven or perceived efficacy. After the isolation of influenza A virus in 1930, and its serologic identification2 as the cause of the 1918-1919 influenza pandemic,3 vaccines were developed and used for seasonal influenza and in the subsequent pandemics of 1957 and 1968. Antiviral medications were used in the last two of these pandemics as well. Before these important advances, however, the prin cipal countermeasure against pandemic influenza had been the application of sound public health practice based predominantly upon what has lately been called "community mitigation."4 A 2007 review of historical information from 43 American cities during the 1918-1919 pandemic, the most explosive and fatal on record, suggests to some that standard public health measures might be beneficial in a future pandemic.4 Thus, it is of interest to consider expert consensus opinion about pandemic influenza prevention at the time of the 1918-1919 pandemic. This article examines one such report (based largely upon European and American experiences) from the principal international public health agency of the time, and compares it to modern prevention/mitigation recommendations.

An Historical Antecedent of Modern Guidelines for Community Pandemic Influenza Mitigation