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IJE Advance Access published online on May 21, 2007
International Journal of Epidemiology, doi:10.1093/ije/dym071
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Published by Oxford University Press on behalf of the International Epidemiological Association © The Author 2007; all rights reserved.

Estimates of the reproduction numbers of Spanish influenza using morbidity data

Emilia Vynnycky1,*, Amy Trindall1,3 and Punam Mangtani2

1Modelling and Economics Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, Colindale, London, NW9 5HT, UK.
2Infectious Disease Epidemiology Unit, Department of Infectious and Tropical Diseases, Keppel Street, London, WC1E 7HT, UK.
3Public Health Directorate, West Essex Primary Care Trust, 16th Floor, Terminus House, Terminus Street, West Essex, CM20 1EX, UK.

* Corresponding author. Modelling and Economics Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, Colindale London, NW9 5HT. E-mail: emilia.vynnycky{at}hpa.org.uk.


  Abstract

Background There have been several studies of the transmissibility of the 1918 (Spanish) influenza virus, which has attributed to >20 million deaths. Many of the analyses to date have involved fitting predictions from a transmission model to the observed epidemic curves from different settings.

Methods Using morbidity data from cities in Europe and America and from confined settings during the 1918 influenza pandemic, we contrast the use of several different methods based on the growth rate and final size of the epidemic, which do not rely on transmission models, to estimate the effective and basic reproduction numbers.

Results The effective reproduction number (the average number of secondary infectious cases produced by a typical infectious case in a given population) for the 1918 influenza virus was in the range 1.2–3.0 and 2.1–7.5 for community-based and confined settings, respectively.

Conclusions Assuming further that 30 and 50% of individuals were immune to Spanish influenza after the wave in April 1918 and the first subsequent wave, respectively, these findings imply that, in a totally susceptible population, an infectious case could have led to 2.4–4.3 and 2.6–10.6 cases in community-based and confined settings, respectively. These findings for community-based populations confirm the relatively low transmissibility of the 1918 (Spanish) influenza virus, which has been found by other studies using alternative data sources and methods.

Keywords Modelling, reproduction numbers, Spanish influenza

Accepted 20 March 2007


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