The effect of public health measures on the 1918 influenza pandemic in US cities
The effect of public health measures on the 1918 influenza pandemic in US cities
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DOI：
10.1073/pnas.0611071104
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发表时间：
2007-05-01
影响因子：
11.1
通讯作者：
Ferguson, Neil M.
中科院分区：
文献类型：
--
作者：
Bootsma, Martin C. J.;Ferguson, Neil M.
在1918年流感大流行期间，美国，与欧洲不同，中国在公共卫生干预方面投入了相当大的努力。与欧洲相比，美国秋季大流行浪潮的地理差异也更大，一些城市的死亡率只有一个大峰值，而另一些城市则出现了双峰流行。在这里，我们研究不同城市采取的公共卫生措施的差异是否可以解释观察到的流行模式和总体死亡率的变化。我们发现，1918年特定城市的人均超额死亡率与1917年的人均死亡率显著相关，表明总体死亡率存在一些内在变化，可能与社会人口因素有关。在23个城市的子集中，我们有关于干预措施时间的部分数据，发现超额死亡率与流行病干预措施引入的早期之间存在更强的相关性。然后，我们用一个流行病模型拟合了16个城市的每周死亡率，这些城市几乎有完整的干预时间数据，并估计了干预措施的影响。该模型很好地再现了观察到的流行模式。与理论论点一致，我们发现，所使用的有时限的干预措施仅适度降低了总死亡率（可能为10-30%），而且由于干预措施实施得太晚，取消得太早，其影响往往非常有限。弗朗西斯科、圣路易斯、密尔沃基和堪萨斯城采取了最有效的干预措施，将传播率降低了30- 50%。我们的分析还表明，在大流行期间，由于死亡率高，个人被动地减少了接触率。
During the 1918 influenza pandemic, the U.S., unlike Europe, put considerable effort into public health interventions. There was also more geographic variation in the autumn wave of the pandemic in the U.S. compared with Europe, with some cities seeing only a single large peak in mortality and others seeing double-peaked epidemics. Here we examine whether differences in the public health measures adopted by different cities can explain the variation in epidemic patterns and overall mortality observed. We show that city-specific per-capita excess mortality in 1918 was significantly correlated with 1917 per-capita mortality, indicating some intrinsic variation in overall mortality, perhaps related to sociodemographic factors. In the subset of 23 cities for which we had partial data on the timing of interventions, an even stronger correlation was found between excess mortality and how early in the epidemic interventions were introduced. We then fitted an epidemic model to weekly mortality in 16 cities with nearly complete intervention-timing data and estimated the impact of interventions. The model reproduced the observed epidemic patterns well. in line with theoretical arguments, we found the time-limited interventions used reduced total mortality only moderately (perhaps 10-30%), and that the impact was often very limited because of interventions being introduced too late and lifted too early. San Francisco, St. Louis, Milwaukee, and Kansas City had the most effective interventions, reducing transmission rates by up to 30-50%. Our analysis also suggests that individuals reactively reduced their contact rates in response to high levels of mortality during the pandemic.