The 1918 influenza pandemic in Florianopolis: A subtropical city in Brazil
The 1918 influenza pandemic in Florianopolis: A subtropical city in Brazil
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DOI：
10.1016/j.vaccine.2011.02.047
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发表时间：
2011-07-22
期刊：
影响因子：
5.5
通讯作者：
Miller, Mark A.
中科院分区：
文献类型：
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作者：
Alonso, Wladimir J.;Nascimento, Francielle C.;Miller, Mark A.
很少有研究涉及1918-1919年热带和亚热带地区流感大流行的影响和动态。为了弥补这一差距，我们分析了弗洛里亚诺波利斯（巴西）1913年10月至1921年6月间签发的所有死亡证明。弗洛里亚诺波利斯是亚热带州首府，1920年人口为41,298人。在1918年11月和12月（春季），分别有70人和14人死于流感和肺炎，而这些原因造成的年平均死亡率为8.1人，通常集中在1月至8月（夏季至冬季）。我们还通过分析大流行期间的超额死亡率与其他年份相同月份的基线死亡率，确定了大流行造成的死亡率负担。我们总共获得了127例死亡（占总人口的0.33%），几乎是这一时期死亡证明记录的死亡人数的两倍。此前或随后几个月未发现其他流感大流行浪潮。我们的研究结果证实了在大流行情景中观察到的死亡率年龄变化模式，其中年轻人是受影响最大的年龄组。弗洛里亚诺波利斯的大流行进一步表现出一些具体结果的特征：(1)在大流行的初始阶段，肾脏原因导致的死亡率出现了离散高峰；(2)大流行性流感没有影响报告的支气管炎和细支气管炎死亡人数（在大流行前一年异常高）；(3)弗洛里亚诺波利斯的死亡率负担比例低于圣保罗和里约热内卢等大城市中心。我们认为，后一种结果是一个有效和迅速的自愿团结援助网络的结果（正如当时的文件所认可的那样），这在较大的大都市可能更难以实施。(C) 2011 Elsevier Ltd.版权所有。
Few studies have addressed the impact and dynamics of the 1918-1919 influenza pandemic in tropical and sub-tropical areas. To help cover this gap, we analyzed all death certificates issued from October 1913 to June 1921 in Florianopolis (Brazil), a subtropical state capital with a population of 41,298 inhabitants in 1920. In November and December 1918 (spring) there were a total of 70 and 14 deaths due to influenza and pneumonia, respectively, in contrast to a mean annual mortality attributed to-these causes of 8.1 deaths, usually concentrated between January and August (summer to winter). We also determined the mortality burden due to the pandemic through the analysis of excess mortality during the pandemic period against the baseline mortality in the same months from other years. We obtained a total of 127 deaths (0.33% of the total population), nearly twice the number of deaths documented by death certificates from this period. No other influenza pandemic waves were detected in earlier or subsequent months. Our results confirm the observed patterns of age-shift in mortality in pandemic scenarios, with young adults as the most affected age-group. The pandemic in Florianopolis was further characterized by some specific outcomes: (1) there was a discrete peak in mortality due to renal causes in the initial phase of the pandemic; (2) pandemic influenza did not affect the number of reported bronchitis and bronchiolitis deaths (unusually high in the year preceding the pandemic); and (3) the mortality burden was proportionally lower in Florianopolis than in large urban centers such as Sao Paulo and Rio de Janeiro. We suggest that this latter outcome was the result of an effective and prompt network of voluntary solidarity assistance (as endorsed by contemporaneous documents), which was probably more difficult to implement in larger metropolis. (C) 2011 Elsevier Ltd. All rights reserved.