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In 1995, a scientific team identified archival influenza autopsy materials collected in the autumn of 1918 and began the slow process of sequencing small viral RNA fragments to determine the genomic structure of the causative influenza virus (10). These efforts have now determined the complete genomic sequence of 1 virus and partial sequences from 4 others. The primary data from the above studies (11–17) and a number of reviews covering different aspects of the 1918 pandemic have recently been published (18–20) and confirm that the 1918 virus is the likely ancestor of all 4 of the human and swine H1N1 and H3N2 lineages, as well as the "extinct" H2N2 lineage. No known mutations correlated with high pathogenicity in other human or animal influenza viruses have been found in the 1918 genome, but ongoing studies to map virulence factors are yielding interesting results. The 1918 sequence data, however, leave unanswered questions about the origin of the virus (19) and about the epidemiology of the pandemic.
During the 1918 pandemic doctors did not have vaccines, antivirals, or antibiotics to treat or prevent infections and associated complications. Since then, four drugs have been developed to fight influenza infections; amantadine, rimantadine, oseltamivir (Tamiflu) and zanamivir (Relenza). Tamiflu and amantadine have both been shown to be effective against engineered viruses containing the parts of the 1918 flu and vaccines have also protected mice against viruses with some of the 1918 influenza components. However, it is still unclear whether drugs or vaccines would be effective against the fully reconstituted 1918 influenza virus. Currently, the U.S. only has 2.5 million doses of Tamiflu in its stockpile, raising concerns that we have not adequately prepared for a potential pandemic caused by avian H5N1 influenza.