The influenza pandemic of 1918, known as the Spanish Flu, was one of the deadliest and widespread pandemics in human history. The scale of the outbreak, as well as limitations in technology, medicine and communication, create difficulties when trying to uncover accurate figures relating to the pandemic. Estimates suggest that the virus, known as the H1N1 influenza virus, infected more than one quarter of the global population, which equated to approximately 500 million people in 1920. It was responsible for roughly 25 million fatalities, although some projections suggest that it could have caused double this number of deaths. The exact origins of this strain of influenza remain unclear to this day, however it was first noticed in Western Europe in the latter stages of the First World War. Wartime censorship in Europe meant that the severity of the pandemic was under-reported, while news outlets in neutral Spain were free to report openly about the impact of the virus; this gave the illusion that the virus was particularly strong in Spain, giving way to the term "Spanish Flu".

Effects of the virus

By late summer 1918, the pandemic had spread across the entire continent, and the H1N1 virus had mutated into a deadlier strain that weakened the infected's immune system more than traditional influenzas. Some studies suggest that, in contrast to these traditional influenza viruses, having a stronger immune system was actually a liability in the case of the H1N1 virus as it triggered what is known as a "cytokine storm". This is where white blood cells release proteins called cytokines, which signal the body to attack the virus, in turn releasing more white blood cells which release more cytokines. This cycle over-works and greatly weakens the immune system, often giving way to other infections; most commonly pneumonia in the case of the Spanish Flu. For this reason, the Spanish Flu had an uncommonly high fatality rate among young adults, who are traditionally the healthiest group in society. Some theories for the disproportionate death-rate among young adults suggest that the elderly's immune systems benefitted from exposure to earlier influenza pandemics, such as the "Asiatic/Russian Flu" pandemic of 1889.

Decrease in life expectancy As the war in Europe came to an end, soldiers returning home brought the disease to all corners of the world, and the pandemic reached global proportions. Isolated and under-developed nations were especially vulnerable; particularly in Samoa, where almost one quarter of the population died within two months and life expectancy fell to just barely over one year for those born in 1918; this was due to the arrival of a passenger ship from New Zealand in November 1918, where the infected passengers were not quarantined on board, allowing the disease to spread rapidly. Other areas where life expectancy dropped below ten years for those born in 1918 were present-day Afghanistan, the Congo, Fiji, Guatemala, Kenya, Micronesia, Serbia, Tonga and Uganda. The British Raj, now Bangladesh, India and Pakistan, saw more fatalities than any other region, with as many as five percent of the entire population perishing as a result of the pandemic. The pandemic also had a high fatality rate among pregnant women and infants, and greatly impacted infant mortality rates across the world. There were several waves of the pandemic until late 1920, although they decreased in severity as time progressed, and none were as fatal as the outbreak in 1918. A new strain of the H1N1 influenza virus did re-emerge in 2009, and was colloquially known as "Swine Flu"; thankfully it had a much lower fatality rate due to medical advancements across the twentieth century.

Provisional counts of the number of death occurrences in England and Wales due to coronavirus (COVID-19) and influenza and pneumonia, by age, sex and place of death.

This statistic shows the deaths with influenza as an underlying cause in England and Wales in 2023, by age and gender. In this year, influenza was the underlying cause of *** deaths for women aged 90 years and over. Respiratory disease burden in the UK As of 2023, tuberculosis cases had also been on the rise, with ***** new cases and relapses reported in 2023. The ***** age group was most affected by this respiratory disease, accounting for approximately ***** cases. Pneumonia, another serious respiratory condition, caused over ***** deaths among women aged 90 and older in the same year, with a further ***** men in the same age group having pneumonia as their underlying cause of death. Vaccination prevalence and accessibility In the years 2014-2015, **** percent of individuals aged 65 and over in the North West of England were immunized against influenza. This was the region with the highest share of elderly vaccinated against influenza, while this figure was the lowest in London, around **** percent. Community pharmacies have played a crucial role in providing seasonal influenza vaccination services – as of 2023/24, ** percent of community pharmacies in the South of England offered influenza vaccination advanced service, while in London, the figure reached ** percent.

Abstract copyright UK Data Service and data collection copyright owner. The aim of this project was to examine various aspects of the 1918-1919 influenza pandemic in Britain, particularly in England and Wales. The research was undertaken as part of the depositor's PhD project entitled Aspects of the historical geography of the 1918-19 influenza pandemic in Britain for the University of Cambridge. Main Topics: This data collection consists of weekly influenza mortality figures (number of deaths and crude death rate) for all counties, county boroughs, London boroughs, urban districts and metropolitan boroughs in England and Wales, for the duration of the 1918-1919 influenza pandemic. Please note: this study does not include information on named individuals and would therefore not be useful for personal family history research.

Between January and August 2020, there has been approximately 48.2 thousand deaths in England and Wales with COVID-19 as an underlying cause. As illustrated in the table, the number of deaths as a result of COVID-19 are much higher than from either pneumonia or influenza. There has been over three times the number of deaths from COVID-19 than pneumonia and influenza so far in 2020. The overall number of confirmed COVID-19 cases in the UK can be found here. For further information about the coronavirus (COVID-19) pandemic, please visit our dedicated Facts and Figures page.

Analysis from a Coronavirus (COVID-19) Infection Survey pilot, which has been testing for influenza (flu) and respiratory syncytial virus (RSV) since October 2022.

Over 12 million people in the United States died from all causes between the beginning of January 2020 and August 21, 2023. Over 1.1 million of those deaths were with confirmed or presumed COVID-19.

Vaccine rollout in the United States Finding a safe and effective COVID-19 vaccine was an urgent health priority since the very start of the pandemic. In the United States, the first two vaccines were authorized and recommended for use in December 2020. One has been developed by Massachusetts-based biotech company Moderna, and the number of Moderna COVID-19 vaccines administered in the U.S. was over 250 million. Moderna has also said that its vaccine is effective against the coronavirus variants first identified in the UK and South Africa.

Forecast: Total Influenza Vaccination Rates in the UK 2022 - 2026 Discover more data with ReportLinker!

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Pre-release access lists for these reports.

For annual publications for previous winter periods, please see:

• winter 2023 to 2024 report
• winter 2022 to 2023 report
• reports for https://webarchive.nationalarchives.gov.uk/ukgwa/20220401215804/https:/www.gov.uk/government/statistics/annual-flu-reports" class="govuk-link">winter 2012 to 2013 to winter 2020 to 2021, published by Public Health England (PHE)
• reports for https://webarchive.nationalarchives.gov.uk/ukgwa/20140629102650/http:/www.hpa.org.uk/Publications/InfectiousDiseases/Influenza/" class="govuk-link">winter 2010 to 2011 and winter 2011 to 2012, published by the Health Protection Agency (HPA)

Flu vaccine uptake (%) in adults aged 65 and over, who received the flu vaccination between 1st September to the end of February as recorded in the GP record. The February collection has been adopted for our end of season figures from 2017 to 2018. All previous data is the same definitions but until the end of January rather than February to consider data returning from outside the practice and later in practice vaccinations.RationaleInfluenza (also known as Flu) is a highly infectious viral illness spread by droplet infection. The flu vaccination is offered to people who are at greater risk of developing serious complications if they catch the flu. The seasonal influenza programme for England is set out in the Annual Flu Letter. Both the flu letter and the flu plan have the support of the Chief Medical Officer (CMO), Chief Pharmaceutical Officer (CPhO), and Director of Nursing.Vaccination coverage is the best indicator of the level of protection a population will have against vaccine-preventable communicable diseases. Immunisation is one of the most effective healthcare interventions available, and flu vaccines can prevent illness and hospital admissions among these groups of people. Increasing the uptake of the flu vaccine among these high-risk groups should also contribute to easing winter pressure on primary care services and hospital admissions. Coverage is closely related to levels of disease. Monitoring coverage identifies possible drops in immunity before levels of disease rise.The UK Health Security Agency (UKHSA) will continue to provide expert advice and monitoring of public health, including immunisation. NHS England now has responsibility for commissioning the flu programme, and GPs continue to play a key role. NHS England teams will ensure that robust plans are in place locally and that high vaccination uptake levels are reached in the clinical risk groups. For more information, see the Green Book chapter 19 on Influenza.The Annual Flu Letter sets out the national vaccine uptake ambitions each year. In 2021 to 2022, the national ambition was to achieve at least 85 percent vaccine uptake in those aged 65 and over. Prior to this, the national vaccine uptake ambition was 75 percent, in line with WHO targets.Definition of numeratorNumerator is the number of vaccinations administered during the influenza season between 1st September and the end of February.Definition of denominatorDenominator is the GP registered population on the date of extraction including patients who have been offered the vaccine but refused it, as the uptake rate is measured against the overall eligible population. For more detailed information please see the user guide, available to view and download from https://www.gov.uk/government/collections/vaccine-uptake#seasonal-flu-vaccine-uptakeCaveatsRead codes are primarily used for data collection purposes to extract vaccine uptake data for patients who fall into one or more of the designated clinical risk groups. The codes identify individuals at risk, and therefore eligible for flu vaccination. However, it is important to note that there may be some individuals with conditions not specified in the recommended risk groups for vaccination, who may be offered influenza vaccine by their GP based on clinical judgement and according to advice contained in the flu letter and Green Book, and thus are likely to fall outside the listed Read codes. Therefore, this data should not be used for GP payment purposes.

Following variables were used for confounding adjustment. All variables are measured at the time of hospital admission.

Very different influenza seasons have been observed from 2008/09–2011/12 in England and Wales, with the reported burden varying overall and by age group. The objective of this study was to estimate the impact of influenza on all-cause and cause-specific mortality during this period. Age-specific generalised linear regression models fitted with an identity link were developed, modelling weekly influenza activity through multiplying clinical influenza-like illness consultation rates with proportion of samples positive for influenza A or B. To adjust for confounding factors, a similar activity indicator was calculated for Respiratory Syncytial Virus. Extreme temperature and seasonal trend were controlled for. Following a severe influenza season in 2008/09 in 65+yr olds (estimated excess of 13,058 influenza A all-cause deaths), attributed all-cause mortality was not significant during the 2009 pandemic in this age group and comparatively low levels of influenza A mortality were seen in post-pandemic seasons. The age shift of the burden of seasonal influenza from the elderly to young adults during the pandemic continued into 2010/11; a comparatively larger impact was seen with the same circulating A(H1N1)pdm09 strain, with the burden of influenza A all-cause excess mortality in 15–64 yr olds the largest reported during 2008/09–2011/12 (436 deaths in 15–44 yr olds and 1,274 in 45–64 yr olds). On average, 76% of seasonal influenza A all-age attributable deaths had a cardiovascular or respiratory cause recorded (average of 5,849 influenza A deaths per season), with nearly a quarter reported for other causes (average of 1,770 influenza A deaths per season), highlighting the importance of all-cause as well as cause-specific estimates. No significant influenza B attributable mortality was detected by season, cause or age group. This analysis forms part of the preparatory work to establish a routine mortality monitoring system ahead of introduction of the UK universal childhood seasonal influenza vaccination programme in 2013/14.

COVID-19 is the first known coronavirus pandemic. Nevertheless, the seasonal circulation of the four milder coronaviruses of humans – OC43, NL63, 229E and HKU1 – raises the possibility that these viruses are the descendants of more ancient coronavirus pandemics. This proposal arises by analogy to the observed descent of seasonal influenza subtypes H2N2 (now extinct), H3N2 and H1H1 from the pandemic strains of 1957, 1968 and 2009, respectively. Recent historical revisionist speculation has focussed on the influenza pandemic of 1889-1892, based on molecular phylogenetic reconstructions that show the emergence of human coronavirus OC43 around that time, probably by zoonosis from cattle. If the “Russian influenza”, as The Times named it in early 1890, was not influenza but caused by a coronavirus, the origins of the other three milder human coronaviruses may also have left a residue of clinical evidence in the 19th century medical literature and popular press. In this paper, we search digitised 19th century British newspapers for evidence of previously unsuspected coronavirus pandemics. We conclude that there is little or no corpus linguistic signal in the UK national press for large-scale outbreaks of unidentified respiratory disease for the period 1785 to 1890. Methods The data file is a spreadsheet used to record queries made via CQPweb (https://cqpweb.lancs.ac.uk). Search Terms For clarity, in the ensuing descriptions, we use bold font for search terms and italic font for collocates and other quotations. Based on clinical descriptions of COVID-19 (reviewed by Cevik et al., 2020), we identified the following search terms: 1) “cough”, 2) “fever”, 3) “pneumonia”. To avoid confusion with years when influenza pandemics may have occurred, we added 4) “influenza” and 5) “epidemic”. Any combination of terms 1 to 3 co-occurring with term 4 alone or terms 4 and 5 together, would be indicative of a respiratory outbreak caused by, or at the least attributed to, influenza. By contrast, any combination of terms 1 to 3 co-occurring with term 5 alone, or without either of terms 4 and 5, would suggest a respiratory disease that was not confidently identified as influenza at the time. This outbreak would provide a candidate coronavirus epidemic for further investigation. Newspapers Newspapers and years searched were as follows: Belfast Newsletter (1828-1900), The Era (1838-1900), Glasgow Herald (1820-1900), Hampshire & Portsmouth Telegraph (1799-1900), Ipswich Journal (1800-1900), Liverpool Mercury (1811-1900), Northern Echo (1870-1900) Pall Mall Gazette (1865-1900), Reynold’s Daily (1850-1900), Western Mail (1869-1900) and The Times (1785-2009). The search in The Times was extended to 2009 in order to provide a comparison with the 20th century. Searches were performed using Lancaster University’s instance of the CQPweb (Corpus Query Processor) corpus analysis software (https://cqpweb.lancs.ac.uk/; Hardie, 2012). CQPweb’s database is populated from the newspapers listed, using optical character recognition (OCR), so for older publications in particular, some errors may be present (McEnery et al., 2019). Statistics The occurrence of each of the five search terms was calculated per million words within the annual output of each publication, in CQPweb. This is compared to a background distribution constituting the corresponding words per million for each search term over the total year range for each newspaper. Within the annual distributions, for each search term and each newspaper, we determined the years lying in the top 1% (i.e. p<0.05 after application of a Bonferroni correction), following Gabrielatos et al. (2012). These are deemed to be years when that search term was in statistically significant usage above its background level for the newspaper in which it occurs. For years when search terms were significantly elevated, we also calculated collocates at range n. Collocates, in corpus linguistics, are other words found at statistically significant usage, over their own background levels, in a window from n positions to the left to n positions to the right of the search term. In other words, they are found in significant proximity to the search term. A default value of n=10 was used throughout, unless specified. Collocation analysis therefore assists in showing how a search term associates with other words within a corpus, providing information about the context in which that search term is used. CQPweb provides a log ratio method for the quantification of the strength of collocation.

For the week ending July 11, 2025, weekly deaths in England and Wales were 567 below the number expected, compared with 638 below what was expected in the previous week. In late 2022 and through early 2023, excess deaths were elevated for a number of weeks, with the excess deaths figure for the week ending January 13, 2023, the highest since February 2021. In the middle of April 2020, at the height of the COVID-19 pandemic, there were almost 12,000 excess deaths a week recorded in England and Wales. It was not until two months later, in the week ending June 19, 2020, that the number of deaths began to be lower than the five-year average for the corresponding week. Most deaths since 1918 in 2020 In 2020, there were 689,629 deaths in the United Kingdom, making that year the deadliest since 1918, at the height of the Spanish influenza pandemic. As seen in the excess death figures, April 2020 was by far the worst month in terms of deaths during the pandemic. The weekly number of deaths for weeks 16 and 17 of that year were 22,351, and 21,997 respectively. Although the number of deaths fell to more usual levels for the rest of that year, a winter wave of the disease led to a high number of deaths in January 2021, with 18,676 deaths recorded in the fourth week of that year. For the whole of 2021, there were 667,479 deaths in the UK, 22,150 fewer than in 2020. Life expectancy in the UK goes into reverse In 2022, life expectancy at birth for women in the UK was 82.6 years, while for men it was 78.6 years. This was the lowest life expectancy in the country for ten years, and came after life expectancy improvements stalled throughout the 2010s, and then declined from 2020 onwards. There is also quite a significant regional difference in life expectancy in the UK. In the London borough of Kensington and Chelsea, for example, the life expectancy for men was 81.5 years, and 86.5 years for women. By contrast, in Blackpool, in North West England, male life expectancy was just 73.1 years, while for women, life expectancy was lowest in Glasgow, at 78 years.

Total direct medical costs of acute respiratory illness during influenza seasons from 2001 to 2009 in the CPRD/HES population and extrapolated to the UK.