title: Transmissibility of the influenza virus in the 1918 pandemic.
abstract: BACKGROUND
  With a heightened increase in concern for an influenza pandemic we sought to better understand the 1918 Influenza pandemic, the most devastating epidemic of the previous century.
  
  
  RESULTS
  We use data from several communities in Maryland, USA as well as two ships that experienced well-documented outbreaks of influenza in 1918. Using a likelihood-based method and a nonparametric method, we estimate the serial interval and reproductive number throughout the course of each outbreak. This analysis shows the basic reproductive number to be slightly lower in the Maryland communities (between 1.34 and 3.21) than for the enclosed populations on the ships (R(0) = 4.97, SE = 3.31). Additionally the effective reproductive number declined to sub epidemic levels more quickly on the ships (within around 10 days) than in the communities (within 30-40 days). The mean serial interval for the ships was consistent (3.33, SE = 5.96 and 3.81, SE = 3.69), while the serial intervals in the communities varied substantially (between 2.83, SE = 0.53 and 8.28, SE = 951.95).
  
  
  CONCLUSIONS
  These results illustrate the importance of considering the population dynamics when making statements about the epidemiological parameters of Influenza. The methods that we employ for estimation of the reproductive numbers and the serial interval can be easily replicated in other populations and with other diseases.
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA. lfwhite@bu.edu
authors.forename: Laura Forsberg
authors.initials: LF
authors.lastname: White
authors.forename: Marcello
authors.initials: M
authors.lastname: Pagano
mesh_terms: D004196:Disease Outbreaks / Q000266:history*; D049673:History, 20th Century; D006801:Humans; D053124:Influenza A Virus, H5N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D016013:Likelihood Functions