title: Transmissibility of the 2009 H1N1 pandemic in remote and isolated Canadian communities: a modelling study.
abstract: OBJECTIVE
  During the first wave of the 2009 influenza pH1N1, disease burden was distributed in a geographically heterogeneous fashion. It was particularly high in some remote and isolated Canadian communities when compared with urban centres. We sought to estimate the transmissibility (the basic reproduction number) of pH1N1 strain in some remote and isolated Canadian communities.
  
  
  METHODS
  A discrete time susceptible-exposed-infected transmission model was fit to infection curves simulated from laboratory-confirmed case counts for pH1N1 on each day. The sampling from Poisson distribution was used to estimate the basic reproduction number, R(0), of pH1N1 during the spring wave for five different communities in Manitoba and Nunavut, Canada, where remote and isolated communities experienced a high incidence of infection, and high rates of hospitalisation and intensive care unit admission.
  
  
  METHODS
  Remote and isolated communities in Northern Manitoba, Nunavut, and the largest urban centre (Winnipeg) in the province of Manitoba, Canada.
  
  
  RESULTS
  Using published values of the exposed and infectious periods specific to H1N1 infection, corresponding to the average generation time of 2.78 days, we estimated a mean value of 2.26 for R(0) (95% CI 1.57 to 3.75) in a community located in northern Manitoba. Estimates of R(0) for other communities in Nunavut varied considerably with higher mean values of 3.91 (95% CI 3.08 to 4.87); 2.03 (95% CI 1.50 to 3.19); and 2.45 (95% CI 1.68 to 3.44). We estimated a lower mean value of 1.57 (95% CI 1.35 to 1.87) for R(0) in the Winnipeg health region, as the largest urban centre in Manitoba.
  
  
  CONCLUSIONS
  Influenza pH1N1 appears to have been far more transmissible in rural and isolated Canadian communities than other large urban areas. The differential severity of the pandemic in these regions may be explained partly by differential transmissibility, and suggests the need for more nuanced, targeted or population-specific control strategies in Canada.
authors.affiliation: Centre for Disease Modelling, Department of Mathematics and Statistics, York University, Toronto, Ontario, Canada.
authors.forename: Luiz C
authors.initials: LC
authors.lastname: Mostaço-Guidolin
authors.forename: Chris S
authors.initials: CS
authors.lastname: Bowman
authors.forename: Amy L
authors.initials: AL
authors.lastname: Greer
authors.forename: David N
authors.initials: DN
authors.lastname: Fisman
authors.forename: Seyed M
authors.initials: SM
authors.lastname: Moghadas