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The effect of public health measures on the 1918 influenza pandemic in U.S. cities.
Proc Natl Acad Sci U S A. 2007 May 01; 104(18):7588-93.PN

Abstract

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.

Authors+Show Affiliations

Mathematical Institute, Faculty of Sciences, Utrecht University, Budapestlaan 6, 3508 TA Utrecht, The Netherlands.No affiliation info available

Pub Type(s)

Historical Article
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17416677

Citation

Bootsma, Martin C J., and Neil M. Ferguson. "The Effect of Public Health Measures On the 1918 Influenza Pandemic in U.S. Cities." Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 18, 2007, pp. 7588-93.
Bootsma MC, Ferguson NM. The effect of public health measures on the 1918 influenza pandemic in U.S. cities. Proc Natl Acad Sci U S A. 2007;104(18):7588-93.
Bootsma, M. C., & Ferguson, N. M. (2007). The effect of public health measures on the 1918 influenza pandemic in U.S. cities. Proceedings of the National Academy of Sciences of the United States of America, 104(18), 7588-93.
Bootsma MC, Ferguson NM. The Effect of Public Health Measures On the 1918 Influenza Pandemic in U.S. Cities. Proc Natl Acad Sci U S A. 2007 May 1;104(18):7588-93. PubMed PMID: 17416677.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The effect of public health measures on the 1918 influenza pandemic in U.S. cities. AU - Bootsma,Martin C J, AU - Ferguson,Neil M, Y1 - 2007/04/06/ PY - 2007/4/10/pubmed PY - 2007/6/21/medline PY - 2007/4/10/entrez SP - 7588 EP - 93 JF - Proceedings of the National Academy of Sciences of the United States of America JO - Proc Natl Acad Sci U S A VL - 104 IS - 18 N2 - 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. SN - 0027-8424 UR - https://www.unboundmedicine.com/medline/citation/17416677/The_effect_of_public_health_measures_on_the_1918_influenza_pandemic_in_U_S__cities_ L2 - http://www.pnas.org/cgi/pmidlookup?view=long&pmid=17416677 DB - PRIME DP - Unbound Medicine ER -