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Public health interventions and epidemic intensity during the 1918 influenza pandemic.
Proc Natl Acad Sci U S A. 2007 May 01; 104(18):7582-7.PN

Abstract

Nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts between persons form an integral part of plans to mitigate the impact of the next influenza pandemic. Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. We obtained data on the timing of 19 classes of NPI in 17 U.S. cities during the 1918 pandemic and tested the hypothesis that early implementation of multiple interventions was associated with reduced disease transmission. Consistent with this hypothesis, cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates approximately 50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (approximately 20%) and less statistically significant than that for peak death rates. This finding was not unexpected, given that few cities maintained NPIs longer than 6 weeks in 1918. Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. These findings support the hypothesis that rapid implementation of multiple NPIs can significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures.

Authors+Show Affiliations

Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD 20892, USA. hatchettr@niaid.nih.govNo affiliation info availableNo affiliation info available

Pub Type(s)

Historical Article
Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17416679

Citation

Hatchett, Richard J., et al. "Public Health Interventions and Epidemic Intensity During the 1918 Influenza Pandemic." Proceedings of the National Academy of Sciences of the United States of America, vol. 104, no. 18, 2007, pp. 7582-7.
Hatchett RJ, Mecher CE, Lipsitch M. Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proc Natl Acad Sci U S A. 2007;104(18):7582-7.
Hatchett, R. J., Mecher, C. E., & Lipsitch, M. (2007). Public health interventions and epidemic intensity during the 1918 influenza pandemic. Proceedings of the National Academy of Sciences of the United States of America, 104(18), 7582-7.
Hatchett RJ, Mecher CE, Lipsitch M. Public Health Interventions and Epidemic Intensity During the 1918 Influenza Pandemic. Proc Natl Acad Sci U S A. 2007 May 1;104(18):7582-7. PubMed PMID: 17416679.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Public health interventions and epidemic intensity during the 1918 influenza pandemic. AU - Hatchett,Richard J, AU - Mecher,Carter E, AU - Lipsitch,Marc, Y1 - 2007/04/06/ PY - 2007/4/10/pubmed PY - 2007/6/21/medline PY - 2007/4/10/entrez SP - 7582 EP - 7 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 - Nonpharmaceutical interventions (NPIs) intended to reduce infectious contacts between persons form an integral part of plans to mitigate the impact of the next influenza pandemic. Although the potential benefits of NPIs are supported by mathematical models, the historical evidence for the impact of such interventions in past pandemics has not been systematically examined. We obtained data on the timing of 19 classes of NPI in 17 U.S. cities during the 1918 pandemic and tested the hypothesis that early implementation of multiple interventions was associated with reduced disease transmission. Consistent with this hypothesis, cities in which multiple interventions were implemented at an early phase of the epidemic had peak death rates approximately 50% lower than those that did not and had less-steep epidemic curves. Cities in which multiple interventions were implemented at an early phase of the epidemic also showed a trend toward lower cumulative excess mortality, but the difference was smaller (approximately 20%) and less statistically significant than that for peak death rates. This finding was not unexpected, given that few cities maintained NPIs longer than 6 weeks in 1918. Early implementation of certain interventions, including closure of schools, churches, and theaters, was associated with lower peak death rates, but no single intervention showed an association with improved aggregate outcomes for the 1918 phase of the pandemic. These findings support the hypothesis that rapid implementation of multiple NPIs can significantly reduce influenza transmission, but that viral spread will be renewed upon relaxation of such measures. SN - 0027-8424 UR - https://www.unboundmedicine.com/medline/citation/17416679/Public_health_interventions_and_epidemic_intensity_during_the_1918_influenza_pandemic_ L2 - http://www.pnas.org/cgi/pmidlookup?view=long&pmid=17416679 DB - PRIME DP - Unbound Medicine ER -