Influenza transmission in households during the 1918 pandemic.

TitleInfluenza transmission in households during the 1918 pandemic.
Publication TypeJournal Article
Year of Publication2011
AuthorsFraser C, Cummings DAT, Klinkenberg D, Burke DS, Ferguson NM
JournalAm J Epidemiol
Date Published2011 Sep 1
KeywordsFamily Health, History, 20th Century, Humans, Influenza, Human, Maryland, Models, Statistical, Pandemics

Analysis of historical data has strongly shaped our understanding of the epidemiology of pandemic influenza and informs analysis of current and future epidemics. Here, the authors analyzed previously unpublished documents from a large household survey of the "Spanish" H1N1 influenza pandemic, conducted in 1918, for the first time quantifying influenza transmissibility at the person-to-person level during that most lethal of pandemics. The authors estimated a low probability of person-to-person transmission relative to comparable estimates from seasonal influenza and other directly transmitted infections but similar to recent estimates from the 2009 H1N1 pandemic. The authors estimated a very low probability of asymptomatic infection, a previously unknown parameter for this pandemic, consistent with an unusually virulent virus. The authors estimated a high frequency of prior immunity that they attributed to a largely unreported influenza epidemic in the spring of 1918 (or perhaps to cross-reactive immunity). Extrapolating from this finding, the authors hypothesize that prior immunity partially protected some populations from the worst of the fall pandemic and helps explain differences in attack rates between populations. Together, these analyses demonstrate that the 1918 influenza virus, though highly virulent, was only moderately transmissible and thus in a modern context would be considered controllable.

Alternate JournalAm. J. Epidemiol.
PubMed ID21749971
PubMed Central IDPMC3695637
Grant ListG0800596 / / Medical Research Council / United Kingdom
U54 GM088491 / GM / NIGMS NIH HHS / United States
/ / Medical Research Council / United Kingdom
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