Spatiotemporal Patterns and Diffusion of the 1918 Influenza Pandemic in British India.

Spatiotemporal Patterns and Diffusion of the 1918 Influenza Pandemic in British India.
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时空模式和1918年流感大流行在英属印度的扩散。

DOI:
10.1093/aje/kwy209
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发表时间:
2018-12-01
影响因子:
5
通讯作者:
Bansal S
Bansal S
中科院分区:
医学2区
文献类型:
--
作者:
Reyes O;Lee EC;Sah P;Viboud C;Chandra S;Bansal S

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驱动大流行性流感的空间异质性和扩散的因素仍有争议。我们描述了1918年英属印度流感大流行的时空死亡率模式,并研究了人口因素、环境变量和流动过程对观察到的传播模式的作用。分析了1916年1月至1920年12月印度206个地区的发热相关和全因超额死亡率数据,同时控制了印度特有的季节性变化。1918年印度秋季流感浪潮的特征与流感大流行的特征相匹配,年轻人的疾病负担高,负担的空间异质性(中等),全国各地的疫情高度同步,偏离了年度季节性。重要的是,我们发现人口密度和降雨量解释了超额死亡率的空间变化,通过铁路的长途旅行可以预测观察到的疾病的空间扩散。本研究整合了1918年印度流感大流行期间死亡率模式的时空分析,并结合了有关潜在因素和过程的数据,以揭示具有显著气候变异性的大型、密切相关环境中的传播机制。在历史大流行期间,这种异质性的特征对于为未来的大流行做好准备至关重要。
The factors that drive spatial heterogeneity and diffusion of pandemic influenza remain debated. We characterized the spatiotemporal mortality patterns of the 1918 influenza pandemic in British India and studied the role of demographic factors, environmental variables, and mobility processes on the observed patterns of spread. Fever-related and all-cause excess mortality data across 206 districts in India from January 1916 to December 1920 were analyzed while controlling for variation in seasonality particular to India. Aspects of the 1918 autumn wave in India matched signature features of influenza pandemics, with high disease burden among young adults, (moderate) spatial heterogeneity in burden, and highly synchronized outbreaks across the country deviating from annual seasonality. Importantly, we found population density and rainfall explained the spatial variation in excess mortality, and long-distance travel via railroad was predictive of the observed spatial diffusion of disease. A spatiotemporal analysis of mortality patterns during the 1918 influenza pandemic in India was integrated in this study with data on underlying factors and processes to reveal transmission mechanisms in a large, intensely connected setting with significant climatic variability. The characterization of such heterogeneity during historical pandemics is crucial to prepare for future pandemics.
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