tag:theconversation.com,2011:/nz/topics/early-infection-11510/articlesEarly infection – The Conversation2018-06-28T19:56:41Ztag:theconversation.com,2011:article/977782018-06-28T19:56:41Z2018-06-28T19:56:41ZAntibiotics before birth and in early life can affect long-term health<figure><img src="https://images.theconversation.com/files/225256/original/file-20180628-112601-zl2hpd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">By the time they turn one, half of Australian babies have had a course of antibiotics. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-portrait-beautiful-young-asian-mother-1047966433?src=sMG7espPHI1MPuB_UtMKOA-3-9">Shutterstock</a></span></figcaption></figure><p>Half of Australian infants have received at least one course of antibiotics by their first birthday. This is <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/jpc.13616">one of the highest rates</a> of antibiotic use in the world. </p>
<p>Although antibiotics are effective and potentially life-saving for bacterial infections in children, they are often prescribed for viral infections, for which they are ineffective. </p>
<p>Unnecessary antibiotics expose individual children to potential side effects, including diarrhoea, vomiting, rashes and allergic reactions. </p>
<p>The overuse of antibiotics also increases the risk of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4143845/">bacterial resistance</a> in the wider community. This is when commonly used antibiotics become ineffective against some bacteria, making it difficult, or even impossible, to treat some infections.</p>
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<p>Researchers are also beginning to realise there may be additional long-term health harms from antibiotic exposure in early life and before birth, including an increased risk of infection, obesity and asthma.</p>
<p>At the moment, most bacteria that cause childhood infections in Australia respond well to antibiotics. But this is likely to change, unless we use antibiotics more carefully. </p>
<h2>The role of gut bacteria</h2>
<p>We have vast numbers of bacteria in our gut, as well as viruses, fungi and other organisms. This microbial community is collectively known as the microbiome. </p>
<p>Our microbiome is essential for normal health and development and has been linked to an ever-growing list of health outcomes such as mental health, immunity, obesity, heart disease and cancer. </p>
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<p>An infant’s first major contact with bacteria and other microbes occurs at birth. Babies born vaginally acquire their initial microbiome from the birth canal and gut. Those delivered by caesarean section are more likely to acquire bugs from their mother’s skin and the hospital. </p>
<p>Antibiotics during pregnancy can alter the mother’s microbiome and therefore the microbial profile her baby acquires. </p>
<p>Antibiotics kill off not only the bacteria causing the infection, but also bacteria of the microbiome, including those that are beneficial. The resulting imbalance of the microbiome is known as dysbiosis. </p>
<p>The baby’s early microbiome, acquired from the mother at delivery, “educates” the infant’s developing immune system in the first weeks and months of life. </p>
<p>Antibiotics in pregnancy can alter the mother’s and therefore the baby’s microbiome, affecting early immune responses. This may increase the risk of infection in childhood. </p>
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<p>In a <a href="https://academic.oup.com/ije/article/47/2/561/4833213">recent Danish study</a>, a mother’s exposure to antibiotics in pregnancy was associated with increased risk her child would develop a severe infection (requiring hospital admission) in the first six years of life. </p>
<p>The increase in risk was greatest among children whose mothers were prescribed more antibiotics and who received them closer to delivery. </p>
<p>There was also some evidence the risk was higher in those delivering vaginally. </p>
<p>This suggests antibiotics affect the mother’s microbiome, with downstream effects for the offspring. Other genetic and environmental factors shared between mother and child are also likely to play a role.</p>
<h2>Obesity</h2>
<p>Antibiotics are widely used in meat production as a growth promoter. An estimated <a href="https://theconversation.com/we-can-beat-superbugs-heres-how-10445">80% of all antibiotic use</a> is in animals. Much of their effect is via the livestock’s microbiome, which has a major role in metabolism and energy harvesting. </p>
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<img alt="" src="https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=409&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=409&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=409&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=514&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=514&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225278/original/file-20180628-112598-a3dg3y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=514&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Antibiotics promote growth in livestock.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/agriculture-industry-farming-animal-husbandry-concept-562342921?src=-5gfWCddsSbHdrjohzN-vQ-1-7">Syda Productions/Shutterstock</a></span>
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<p>Antibiotics may also play a similar role in promoting growth in humans. There is some evidence antibiotic exposure in pregnancy is associated with increased birth weight and obesity in early life. But large studies are needed to account for the other important factors that may also contribute. </p>
<p>The association between antibiotics in early childhood and obesity is clearer. Antibiotic exposure within the first year of life is associated with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4487629/pdf/nihms-703258.pdf">10-15% increased risk of obesity</a>, although the importance of the type and timing of antibiotics is less well understood. </p>
<h2>Asthma</h2>
<p>Childhood asthma has increased in parallel with antibiotic use, leading researchers to investigate a link. </p>
<p>Observational studies have shown an association between antibiotic use in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4352392/">pregnancy</a> or <a href="https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2222.2000.00939.x">infancy</a> and later risk of asthma. This supports the concept of antibiotic-induced dysbiosis (imbalance of bacteria) and the effect on the immune system. </p>
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<p>A <a href="https://www.bmj.com/content/349/bmj.g6979">large population-based Swedish study</a>, however, found the link between asthma and antibiotics was largely attributable to a number of other factors, including respiratory infections contributing to asthma and unrecognised symptoms of asthma being inappropriately treated with antibiotics.</p>
<p>But <a href="http://pediatrics.aappublications.org/content/123/3/1003.long">other studies have found</a> these factors don’t completely explain away the link between antibiotic use and asthma. A better understanding of the role of the microbiome in the development of asthma will help clarify the contribution of antibiotics. </p>
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<img alt="" src="https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/225280/original/file-20180628-112604-1uwraiy.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The science is unclear about the link between antibiotics and asthma.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/person-holding-pink-asthma-inhaler-557548876?src=BeCNrmXJ-G3N_bXe6lXI8g-1-79">D K Grove/Shutterstock</a></span>
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<h2>Other links</h2>
<p>Antibiotic use in early childhood, and particularly the first 12 months of life, is linked to gastrointestinal diseases such as <a href="http://gut.bmj.com/content/60/1/49">Crohn’s</a> and <a href="https://academic.oup.com/aje/article/180/1/76/2739114">coeliac disease</a>. The exact risk is difficult to quantify, but children receiving over seven courses of antibiotics were reported to be at a seven-fold risk of Crohn’s disease.</p>
<p>Other childhood inflammatory diseases, including <a href="http://pediatrics.aappublications.org/content/early/2015/07/15/peds.2015-0036">juvenile idiopathic arthritis</a> have shown a similar association. </p>
<p>However, as with asthma, because these are observational studies, the finding of an association does not prove causation: it’s possible these children were given antibiotics for symptoms of unrecognised gastrointestinal or inflammatory disease, or for an infection. </p>
<p>Finally, antibiotic use in early adulthood is associated with <a href="http://gut.bmj.com/content/67/4/672.long">bowel cancer</a>. The risk increases with more courses of antibiotic. Whether childhood antibiotic use is associated with adult bowel cancer risk has yet to be studied.</p>
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<h2>Antibiotics have their place</h2>
<p>Antibiotics are one of the most important medical innovations and save lives when used appropriately. But inappropriate use leads to potentially untreatable resistant infections and long-term health problems in children and adults. </p>
<p>A <a href="http://www.pnas.org/content/early/2018/03/20/1717295115">recent assessment</a> predicted that without restrictions, global antibiotic use will increase three-fold by 2030. Unless we all work together to reduce antibiotic overuse, we could be assigning our children to a future of chronic ill health. Too much too young underappreciated long-term adverse effects of early antibiotic exposure</p><img src="https://counter.theconversation.com/content/97778/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Penelope Bryant receives funding from NHMRC to study the effect of antibiotics on the microbiome in children. </span></em></p><p class="fine-print"><em><span>Cheryl Jones receives funding from NHMRC CRE for Emerging Infectious Diseases (CREID). APP 1079575 </span></em></p><p class="fine-print"><em><span>David Burgner receives funding from NHMRC, National Heart Foundation Australia, National Blood Authority, HeartKids, Royal Australasian College of Physicians, Murdoch Children's Research Institute, and the DHB Foundation.</span></em></p><p class="fine-print"><em><span>Nigel Curtis does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There may be additional long-term health harms from antibiotic exposure in early life and before birth, including an increased risk of infection, obesity and asthma.Penelope Bryant, Consultant in Paediatric Infectious Diseases and General Paediatrics, Murdoch Children's Research InstituteCheryl Anne Jones, Professor of Paediatrics, The University of MelbourneDavid Burgner, Clinician and Scientist, Murdoch Children's Research InstituteNigel Curtis, Professor of Paediatric Infectious Diseases, Murdoch Children's Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/425412015-06-08T20:11:36Z2015-06-08T20:11:36ZStealth attack: infection and disease on the battlefield<figure><img src="https://images.theconversation.com/files/83324/original/image-20150529-24276-qf55vy.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Prior to world war one, many more soldiers died of infection rather than combat.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/navymedicine/7839561772/in/photolist-9bqyoo-9bnqCZ-5VWDvR-5W2d6f-4YHWgC-cWKPvU-cWKNA9-cWKHuL-eKshWD-cWKVBf-dfubsy-dfu5nB-9bqA7h-dfu5Hk-dfu9Nw-6v5Qj8-dfuazv-dfu4wc-dftV1v-dftXE5-dftVGe-dfu2r4-dfuc6M-dfu5w3-dftYas-dfu8Tr-dfu23i-dfu2BA-dftYwH-dfub3R-dfu4ZF-dftZca-dfucCc-dftZHh-dfu4Xw-dfu8Qm-dfu8AH-dfubS3-dfudcW-dftXQg-dfu67Z-dfu1yi-dfueDq-dfu9qB-dfu29W-dfu9fU-dfu8i5-dftXge-dfu2Zt-do1pQW/">Navy Medicine/Flickr </a></span></figcaption></figure><blockquote>
<p>If I should die, think only this of me: that there’s some corner of a foreign field <br>
That is forever England. There shall be <br>
In that rich earth a richer dust: concealed; <br>
A dust whom England bore, shaped, made aware… <br>
–– <em><a href="http://www.poetryfoundation.org/poetrymagazine/poem/2279">The Soldier</a> by Rupert Brooke</em></p>
</blockquote>
<p>Described by WB Yeats as: “the handsomest young man in England”, the 28-year-old Rupert Brooke was commissioned in the Royal Navy Volunteer Reserve as a Sub-Lieutenant. Without seeing combat, he died aboard a French hospital ship, from a mosquito bite that turned septic. He lies in a corner of an olive grove on the Greek Island of Skyros. </p>
<p>Some 37 million soldiers and civilians died between 1914 and 1918, and Brooke experienced a much calmer passing than many of our Anzacs. Unlike <a href="http://www.anzacs.net/Simpson.htm">Simpson</a> of donkey fame, most were not English-born, though the idea of Empire was still central to the Australian culture.</p>
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<img alt="" src="https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=717&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=717&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=717&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=901&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=901&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83357/original/image-20150529-15238-c09iof.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=901&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Rupert Brooke, 1887-1915.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/michaelrogers/2647218862/in/photolist-8QyWVd-52VFWw-5ybZF4-4qNAaU-8aSx9r-bXMYDs-bXN2CE-bXN1HJ-bXMZbu-bXMXQq-nirj7n-dhDG9x-5yc1br-4RxyoD-j6eppP-jzngwo-i3RhXL-fscTLs-nehSZ6-9qmQNs-7pfpGf-e9GTAQ-6GvPFA-6ZNVLk-fouAxB-aEshaF-dMG8Ch-4Lxg3-foMUpL-bHfTaZ-hX4hUF-6ZSV6W-4Lxi3-4Lxfj-6AUt5L-frYXhn-f6VJwh-4MArN8-f6FtzR-hX3vXj-9sa5ED-6s6MH-7DMr7H-2qSv-hX3x6S-bvNSMD-p9rHa7-788md1-6ekmos-eQa2fr">Pere Ubu/Flickr</a></span>
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<p>Up until the first world war, Brooke’s fate – to die of infection rather than wounds – was <a href="http://www.jstor.org/stable/4450468?seq=1#page_scan_tab_contents">the norm</a> for soldiers. </p>
<p>Apart from being the Gallipoli centenary, 2015 also marks 150 years since the end of the American Civil war, where repeating rifles and machine guns were used for the first time. In that conflict, which came just at the time Pasteur was establishing the <a href="https://theconversation.com/got-milk-how-pasteur-made-mass-food-production-possible-35424">germ theory</a> of infectious disease, and Semmelweis and Lister were initiating the linked practices of <a href="https://theconversation.com/washing-our-hands-of-responsibility-for-hospital-infections-10652">medical hygiene</a> and antiseptic surgery, deaths from infection versus combat were roughly four to one.</p>
<p>At Gallipoli, 5,482 were killed in action, 2,012 succumbed from their wounds (bacterial sepsis would have contributed) and 665 <a href="https://www.awm.gov.au/encyclopedia/gallipoli/fatalities/">died of disease</a>.
Our troops were vaccinated against typhoid on the voyage to Egypt, and both the intensity of fighting and the dry conditions may have influenced these statistics, along with major improvements in surgical and nursing practice. </p>
<p>By the second world war, with sulfonamides and then antibiotics (penicillin was available by D-day), the <a href="http://www.jstor.org/stable/4450468?seq=1#page_scan_tab_contents">deaths from infection</a> versus combat were one-to-nine for US troops.</p>
<p>On the Western Front, the soldiers of the 1st Australian Imperial Force (AIF) were to suffer, along with everyone else, the constancy of lice infestations and the horrors of trench foot, which could lead to amputation and was best dealt with by having a supply of dry socks and smearing the feet with whale grease. </p>
<p>Whale grease also protected fighter pilots from the blow-back from the machine guns firing right in front of their face. The first world war was bad for whales! </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=438&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=438&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=438&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=550&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=550&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83325/original/image-20150529-24283-b48lg0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=550&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Australian troops battled lice, trench foot and trench fever.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/state_library_south_australia/9662891566/in/photolist-fHSR1J-eMgfdz-6qwQX9-g9uD7B-dsVuYr-drwZJy-drwRfz-nyzFEF-5xaa2f-fgWCph-j8CFug-8hSBeu-drx4YQ-nLKXZ6-dbt6TH-7fknji-4gmbrV-8vH1aT-drx4dU-4oKzPo-dwy8AU-87jJdA-oCjMWK-oAyZ38-fgGoEp-hsR8Rx-axVFed-qD9BEp-8HAhmJ-9QVXHh-9ZX5mx-oj5YpP-8vHCLV-px3Rwc-5yAQGL-jFcxSa-9h95XF-drAExk-i3TNuZ-FzLi5-6hPgkM-gGpYP9-otG2yb-dbt8qm-8mv2ry-8vLy5b-i3SdSu-jYsfWV-87jscw-bv8D5w">State Library of South Australia/Flickr</a></span>
</figcaption>
</figure>
<p>Then there was the five-day trench fever caused by Ricketttsia Quintana, while thousands died of tetanus and gangrene.</p>
<p>The nursing sisters and Voluntary Aid Detachment members who cared for them <a href="http://www.australia.gov.au/about-australia/australian-story/australians-on-the-western-front">suffered from</a>: </p>
<blockquote>
<p>severe infections, especially to their hands, from the suppurating wounds they tended. The women too caught the diseases of the trenches: typhus, dysentery, mumps and influenza.</p>
</blockquote>
<p>Influenza in Australian nurses provides, of course, the dramatic conclusion for Tom Keneally’s fine first world war novel, <a href="http://www.randomhouse.com.au/books/tom-keneally/the-daughters-of-mars-9781864712261.aspx">The Daughters of Mars</a>.</p>
<p>Causing the death of some 40 million people worldwide, it was the 1918 influenza pandemic that helped bring the conflict to an end by weakening the armies of both sides. Neither admitted to the problem, and it’s known quite wrongly as the “Spanish influenza”. </p>
<p>The first influenza A virus was not isolated <a href="http://catalogue.nla.gov.au/Record/3255765">until the 1930s</a> so, while everyone came to understand that this scourge of 1918-19 was a viral pneumonia (a bacterial vaccine failed), nothing could be done beyond careful nursing. </p>
<p>There’s debate concerning <a href="http://www.ncbi.nlm.nih.gov/pubmed/20076789">the origins of the 1918 virus</a>, with some believing a less virulent form (seen first in British soldiers) was already raging in 1916-17. Others argue that it really took off in a Kansas recruitment camp and was brought across to France in US troopships. Whichever was the case, the Americans, who came late to the war (1917) were very hard hit, suggesting that a prior, milder infection may have protected some who were there in the earlier years. </p>
<p>Overall, looking at the US military (including those who were never near the front), the <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862337/">deaths from infection</a> versus combat were about two to one, compared with 1.1 to one for other allied troops.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=465&fit=crop&dpr=1 600w, https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=465&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=465&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=585&fit=crop&dpr=1 754w, https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=585&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/83326/original/image-20150529-12352-o5en62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=585&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Canadian soldiers in France, 1916.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/taybot/14565207240/in/photolist-oc5uEL-h535Q8-nvF4WN-rYVTK-bxeACj-4Re5xN-aQNuxr-aQNtoD-aQNvTR-oAoxwY-aQNtBB-aQNtz8-aQNuBX-h526GT-qD9BEp-qS42Aw-aQNusB-bvy4NG-qC4QhF-bvy2My-6yjmRe-q3RK2L-p9axHJ-q3RJZS-iYuYak-aQNw9x-aQNwbv-t1P7SY-a1fhyi-5r5wzM-b3Eurt-4TJ5Ra-ryNdU8-6yppm1-iWbuTr-87jFNN-5PpJLA">Taylor S-K/Flickr</a></span>
</figcaption>
</figure>
<p>Between July 1918 and February 1919, historian Humphrey McQueen <a href="http://trove.nla.gov.au/work/11435906?selectedversion=NBD1030057">records</a> that 10% of the Australian soldiers in Britain contracted influenza (a symptomatic diagnosis) and 209 died. </p>
<p>Perhaps protected by the long voyage out, the disease did not get to Australia until mid-1919, though it hit New Zealand (in a much more severe form) considerably earlier.</p>
<p>Then, for the returned Australian soldiers, more than 3,000 later died of tuberculosis and so many – with lungs irreversibly damaged by gas attacks – suffered severely from various respiratory infections. </p>
<p>Born in 1940, I was taught by some of these damaged men, and by the single women who lost their prospective life partners in this terrible catastrophe. I can’t think of 1914-18 without a profound sense of grief. I never heard a single one of those veterans (or the second world war cohort that followed) speak of the glories of war.</p>
<p><em>This article is based on a talk I gave on 20 May as part of the University of Melbourne’s public <a href="https://events.unimelb.edu.au/all/free-public-lecture">Anzac Centenary Lectures</a> series (@uomFreeLectures). The next Anzac Centenary lecture is June 11 and the series runs until August 27.</em></p><img src="https://counter.theconversation.com/content/42541/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Peter C. Doherty works at the University of Melbourne and is part of an NHMRC Program Grant on Immunity to Influenza. Two of his “lay” books, Sentinel Chickens: what birds tell us about our health and the world and Pandemics: what everyone needs to know deal with aspects of influenza biology and disease. Peter Doherty is a director of The Conversation.</span></em></p>Rupert Brooke was commissioned in the Royal Navy Volunteer Reserve as a Sub-Lieutenant. Without seeing combat, he died aboard a French hospital ship, from a mosquito bite that turned septic.Peter C. Doherty, Laureate Professor, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.