title: Variability in transmissibility of the 2009 H1N1 pandemic in Canadian communities.
abstract: BACKGROUND
  The prevalence and severity of the 2009 H1N1 pandemic appeared to vary significantly across populations and geographic regions. We sought to investigate the variability in transmissibility of H1N1 pandemic in different health regions (including urban centres and remote, isolated communities) in the province of Manitoba, Canada.
  
  
  METHODS
  The Richards model was used to fit to the daily number of laboratory-confirmed cases and estimate transmissibility (referred to as the basic reproduction number, R0), doubling times, and turning points of outbreaks in both spring and fall waves of the H1N1 pandemic in several health regions.
  
  
  RESULTS
  We observed considerable variation in R0 estimates ranging from 1.55 to 2.24, with confidence intervals ranging from 1.45 to 2.88, for an average generation time of 2.9 days, and shorter doubling times in some remote and isolated communities compared to urban centres, suggesting a more rapid spread of disease in these communities during the first wave. For the second wave, Re, the effective reproduction number, is estimated to be lower for remote and isolated communities; however, outbreaks appear to have been driven by somewhat higher transmissibility in urban centres.
  
  
  CONCLUSIONS
  There was considerable geographic variation in transmissibility of the 2009 pandemic outbreaks. While highlighting the importance of estimating R0 for informing health responses, the findings indicate that projecting the transmissibility for large-scale epidemics may not faithfully characterize the early spread of disease in remote and isolated communities.
authors.affiliation: Centre for Disease Modelling, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada. luiz.guidolin@nrc-cnrc.gc.ca.
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Mostaço-Guidolin
authors.forename: Amy
authors.initials: A
authors.lastname: Greer
authors.forename: Beate
authors.initials: B
authors.lastname: Sander
authors.forename: Jianhong
authors.initials: J
authors.lastname: Wu
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Moghadas