title: Transmissibility and mortality impact of epidemic and pandemic influenza, with emphasis on the unusually deadly 1951 epidemic.
abstract: There are important gaps in our current understanding of the influenza virus behavior. In particular, it remains unclear why some inter-pandemic seasons are associated with unusually high mortality impact, sometimes comparable to that of pandemics. Here we compare the epidemiological patterns of the unusually deadly 1951 influenza epidemic (A/H1N1) in England and Wales and Canada with those of surrounding epidemic and pandemic seasons, in terms of overall mortality impact and transmissibility. Based on the statistical and mathematical analysis of vital statistics and morbidity epidemic curves in these two countries, we show that the 1951 epidemic was associated with both higher mortality impact and higher transmissibility than the 1957 and 1968 pandemics. Surprisingly in Liverpool, considered the 'epicenter' of the severe 1951 epidemic, the mortality impact and transmissibility even surpassed the 1918 pandemic.
authors.affiliation: Fogarty International Center, National Institutes of Health, Bethesda, MD 20892, USA. viboudc@mail.nih.gov
authors.forename: Cécile
authors.initials: C
authors.lastname: Viboud
authors.forename: Theresa
authors.initials: T
authors.lastname: Tam
authors.forename: Douglas
authors.initials: D
authors.lastname: Fleming
authors.forename: Andreas
authors.initials: A
authors.lastname: Handel
authors.forename: Mark A
authors.initials: MA
authors.lastname: Miller
authors.forename: Lone
authors.initials: L
authors.lastname: Simonsen
mesh_terms: D003140:Communicable Disease Control; D004196:Disease Outbreaks / Q000266:history / Q000706:statistics & numerical data*; D049673:History, 20th Century; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000266:history / Q000401:mortality / Q000635:transmission; D008954:Models, Biological