Cited by 796Influenza Virus Research StudiesMathematical and Theoretical Epidemiology and Ecology ModelsViral Infections and Outbreaks Research

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Transmissibility of 1918 pandemic influenza

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Mills, Christina E., Robins, James M., Lipsitch, Marc·2004·Nature

DOI 10.1038/nature03063PMC PMC7095078

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Abstract

The 1918 influenza pandemic killed 20-40 million people worldwide, 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 case. 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 diseases. 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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Authors: Mills, C. E., Robins, J. M., & Lipsitch, M.
Affiliations: Harvard University (US)
Corresponding author: Mills, Christina E.
ORCID: Robins, James M.
Lipsitch, Marc
Venue: Nature
Publisher: Springer Science and Business Media LLC
Published: 2004-12
Volume: 432
Issue: 7019
Pages: 904-906
ISSN: 0028-0836 (ISSN-L)
1476-4687
DOI: 10.1038/nature03063
PMC: PMC7095078
OpenAlex: W2037844075
Cited by: 796
References: 44
Citations by year: 2026: 9 · 2025: 12 · 2024: 19 · 2023: 28 · 2022: 38 · 2021: 47 · 2020: 84 · 2019: 20 · 2018: 22 · 2017: 21 · 2016: 21 · 2015: 29 · 2014: 40 · 2013: 39 · 2012: 36
FWCI: 28.36
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: Nature (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
RePEc: Research Papers in Economics (submittedVersion)
Funders: U.S. Department of Health and Human Services
Ellison Medical Foundation
National Defense Science and Engineering Graduate
National Institute of Allergy and Infectious Diseases
Fogarty International Center
Topics: Health Sciences › Medicine › Epidemiology › Influenza Virus Research Studies
Physical Sciences › Mathematics › Applied Mathematics › Mathematical and Theoretical Epidemiology and Ecology Models
Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
Keywords: 1918 influenza pandemic, H1N1 influenza, basic reproduction number, transmissibility, SEIR model, epidemic curve, pandemic preparedness
MeSH terms: Cities, Communicable Disease Control, Humans, Influenza, Human, Models, Biological, Probability, Time Factors, United States, Survival Analysis, History, 20th Century

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