1. Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA
2. Department of Biostatistics, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA
3. Department of Immunology and Infectious Diseases, Harvard School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA

Correspondence to: Christina E. Mills¹ Email: cmills@mit.edu

Abstract

The 1918 influenza pandemic killed 20–40 million people worldwide¹, and is seen as a worst-case scenario for pandemic planning. Like other pandemic influenza strains, the 1918 A/H1N1 strain spread extremely rapidly. A measure of transmissibility and of the stringency of control measures required to stop an epidemic is the reproductive number, which is the number of secondary cases produced by each primary case². Here we obtained an estimate of the reproductive number for 1918 influenza by fitting a deterministic SEIR (susceptible-exposed-infectious-recovered) model to pneumonia and influenza death epidemic curves from 45 US cities: the median value is less than three. The estimated proportion of the population with A/H1N1 immunity before September 1918 implies a median basic reproductive number of less than four. These results strongly suggest that the reproductive number for 1918 pandemic influenza is not large relative to many other infectious diseases². In theory, a similar novel influenza subtype could be controlled. But because influenza is frequently transmitted before a specific diagnosis is possible and there is a dearth of global antiviral and vaccine stores, aggressive transmission reducing measures will probably be required.

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