title: Estimates of the reproduction numbers of Spanish influenza using morbidity data.
abstract: BACKGROUND
  There have been several studies of the transmissibility of the 1918 (Spanish) influenza virus, which has attributed to >20 million deaths. Many of the analyses to date have involved fitting predictions from a transmission model to the observed epidemic curves from different settings.
  
  
  METHODS
  Using morbidity data from cities in Europe and America and from confined settings during the 1918 influenza pandemic, we contrast the use of several different methods based on the growth rate and final size of the epidemic, which do not rely on transmission models, to estimate the effective and basic reproduction numbers.
  
  
  RESULTS
  The effective reproduction number (the average number of secondary infectious cases produced by a typical infectious case in a given population) for the 1918 influenza virus was in the range 1.2-3.0 and 2.1-7.5 for community-based and confined settings, respectively.
  
  
  CONCLUSIONS
  Assuming further that 30 and 50% of individuals were immune to Spanish influenza after the wave in April 1918 and the first subsequent wave, respectively, these findings imply that, in a totally susceptible population, an infectious case could have led to 2.4-4.3 and 2.6-10.6 cases in community-based and confined settings, respectively. These findings for community-based populations confirm the relatively low transmissibility of the 1918 (Spanish) influenza virus, which has been found by other studies using alternative data sources and methods.
authors.affiliation: Modelling and Economics Unit, Health Protection Agency Centre for Infections, 61 Colindale Avenue, Colindale, London, NW9 5HT, UK. vynnycky@hpa.org.uk
authors.forename: Emilia
authors.initials: E
authors.lastname: Vynnycky
authors.forename: Amy
authors.initials: A
authors.lastname: Trindall
authors.forename: Punam
authors.initials: P
authors.lastname: Mangtani
mesh_terms: D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D018562:Disease Transmission, Infectious / Q000706:statistics & numerical data*; D005060:Europe; D006801:Humans; D007251:Influenza, Human / Q000276:immunology / Q000635:transmission*; D015233:Models, Statistical; D009017:Morbidity; D018570:Risk Assessment / Q000379:methods; D014481:United States