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Andreasen V, Viboud C, Simonsen L. Epidemiologic characterization of the 1918 influenza pandemic summer wave in copenhagen: implications for pandemic control strategies. J Infect Dis. 2008 Jan 15;197(2):270-8.
submited by kickingbird at Jan, 23, 2008 8:16 AM from J Infect Dis. 2008 Jan 15;197(2):270-8.

The 1918-1919 A/H1N1 influenza pandemic killed 50 million people worldwide. Historical records suggest that an early pandemic wave struck Europe during the summer of 1918. Methods. @nbsp; We obtained surveillance data that were compiled weekly, during 1910-1919, in Copenhagen, Denmark; the records included medically treated influenza-like illnesses (ILIs), hospitalizations, and deaths by age. We used a Serfling seasonal regression model to quantify excess morbidity and mortality, and we estimated the reproductive number (R) for the summer, fall, and winter pandemic waves. Results. @nbsp; A large epidemic occurred in Copenhagen during the summer of 1918; the age distribution of deaths was characteristic of the 1918-1919 A/H1N1 pandemic overall. That summer wave accounted for 29%-34% of all excess ILIs and hospitalizations during 1918, whereas the case-fatality rate (0.3%) was many-fold lower than that of the fall wave (2.3%). Similar patterns were observed in 3 other Scandinavian cities. R was substantially higher in summer (2.0-5.4) than in fall (1.2-1.6) in all cities. Conclusions. @nbsp; The Copenhagen summer wave may have been caused by a precursor A/H1N1 pandemic virus that transmitted efficiently but lacked extreme virulence. The R measured in the summer wave is likely a better approximation of transmissibility in a fully susceptible population and is substantially higher than that found in previous US studies. The summer wave may have provided partial protection against the lethal fall wave.

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