( epidemic model |
public health interventions )
*Mathematical Institute, Faculty of Sciences, Utrecht University, Budapestlaan 6, 3508 TA Utrecht, The Netherlands; and
Edited by Burton H. Singer, Princeton University, Princeton, NJ, and approved March 13, 2007 (received for review December 13, 2006) During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. In line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10-30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30-50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.
Medical Sciences
The effect of public health measures on the 1918 influenza pandemic in U.S. cities
MRC Centre for Outbreak Analysis and Modeling, Department of Infectious Disease Epidemiology, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom
Author contributions: N.M.F. designed research; M.C.J.B. and N.M.F. performed research; M.C.J.B. and N.M.F. contributed new reagents/analytic tools; M.C.J.B. and N.M.F. analyzed data; and M.C.J.B. and N.M.F. wrote the paper.
The authors declare no conflict of interest.
Freely available online through the PNAS open access option.
To whom correspondence should be addressed.
www.pnas.org/cgi/doi/10.1073/pnas.0611071104
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