NOTIFICATION: V. Toulkidis, " Chronic Fatigue Syndrome," The Medical Journal of Australia 176, no. S9 (2002): S17-S55, https://doi.org/10.5694/j.1326-5377.2002.tb04499.x.
This notification is for the above guidelines, published online on 6 May 2002 in the Medical Journal of Australia (MJA; AMPCo Pty Ltd) and in Wiley Online Library (wileyonlinelibrary.com), and has been issued by agreement between the MJA and John Wiley & Sons Australia. The notification has been issued to inform readers of concerns that the information contained therein is outdated.
As Australia emerges from the coronavirus disease 2019 (COVID-19) pandemic, and H5 avian influenza approaches global spread, it is instructive to reflect on past Australian pandemic experiences. This is underscored by the recent Australian Government’s COVID-19 Response Inquiry Report.1
Within just over a century Australia has been affected by five respiratory virus pandemics: four influenza pandemics and the recent coronavirus pandemic. The deadliest was the Spanish influenza pandemic (1918), followed by the moderately severe Asian (1957) and Hong Kong (1968) influenza pandemics, the mild influenza pandemic originating in North America (2009), and then the COVID-19 pandemic (2020).
The Hong Kong influenza pandemic arose midway between the Spanish influenza and COVID-19 pandemics, during the momentous events of the late 1960s. It spanned Vietnam War protests and Woodstock, and affected United States presidents and Apollo astronauts. However, there are relatively few published accounts of Australia’s experiences. This article reviews historical literature and contemporaneous news reports to extract insights for future pandemic responses. This forgotten pandemic has some notable similarities and differences to Australian experiences of the Spanish influenza and COVID-19 pandemics (Box 1).
Only type A viruses cause pandemic influenza, and they are defined by the two surface antigens haemagglutinin (H) and neuraminidase (N). Both undergo antigenic variation, which sustains virus epidemic potential, and serve as targets for the protective antibody response, with haemagglutinin being the major and more significant antigen. Pandemic influenza is associated with a virus possessing a novel haemagglutinin. Influenza A viruses were initially subtyped as A0, A1 and A2 (H0, H1 and H2) based on haemagglutination-inhibition tests.
The revised 1971 World Health Organization nomenclature recognised distinct antigenic forms of neuraminidase, retrospectively designating the Hong Kong virus as A(H3N2) and its A2 predecessor as A(H2N2), with distinct haemagglutinin but shared neuraminidase. Genomic sequencing now supplements antigenic tests in characterising these viruses. Antigenic variants of the initial A(H3N2) virus continue to circulate alongside A(H1N1) and type B viruses and result in the highest rates of influenza-related morbidity and mortality.2, 3
The Hong Kong influenza virus probably originated in China in early 1968 during the Cultural Revolution, with unclear reports of an epidemic involving Chinese cities including Wuhan, Shanghai and Guiyang.4 In July 1968, a respiratory illness outbreak was identified in Hong Kong, with about half a million cases reported by the end of that month.5
On 16 August 1968, the Hong Kong epidemic was attributed to an influenza virus significantly different from previous strains. Init
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