The spatial anatomy of an epidemic: influenza in London and the county boroughs of England and Wales, 1918–1919

From uncertain origins in the spring of 1918, an apparently new variant of influenza A virus spread around the world as three distinct diffusion waves, infecting half a billion and probably killing around 40 million people. This paper examines the spatial structure of influenza transmission during the ten–month course of the epidemic in England and Wales, June 1918–April 1919, using the weekly counts of influenza deaths in London and the county boroughs as collated by the General Register Office, London. In addition, a particular case study of the borough of Cambridge is presented. From mid–1916, Cambridge contained, as well as its undergraduate population, a large naval contingent billeted in both the colleges and the town. It therefore affords the opportunity of studying the effect of the epidemic in contiguous groups with widely differing demographic characteristics. Through the application of a range of statistical methods (average lags, correlations and regressions), it is shown that the three waves that comprised the pandemic had fundamentally different spatial and temporal characteristics. The first, moving through a population that was a virgin soil to the new virus strain, was explosive in its north to south progress across the country. The second wave was somewhat slower in its rate of diffusion and displayed a south to north drift. Finally, the third wave reverted more closely to the form of the first. The spread of all three waves, however, was underpinned by a clearly defined process of spatial contagion. The Cambridge study showed the special characteristics of this pandemic in terms of the ages of those attacked: high rates were experienced across the age spectrum, a feature also seen internationally.     

Toronto's Health Department in action: influenza in 1918 and SARS in 2003

This article compares the Toronto Health Department's role in controlling the 1918 influenza epidemic with its activities during the SARS outbreak in 2003 and concludes that local health departments are the foundation for successful disease containment, provided that there is effective coordination, communication, and capacity. In 1918, Toronto's MOH Charles Hastings was the acknowledged leader of efforts to contain the disease, care for the sick, and develop an effective vaccine, because neither a federal health department nor an international body like WHO existed. During the SARS outbreak, Hastings's successor, Sheela Basrur, discovered that nearly a decade of underfunding and new policy foci such as health promotion had left the department vulnerable when faced with a potential epidemic. Lack of cooperation by provincial and federal authorities added further difficulties to the challenge of organizing contact tracing, quarantine, and isolation for suspected and probable cases and providing information and reassurance to the multi-ethnic population. With growing concern about a flu pandemic, the lessons of the past provide a foundation for future communicable disease control activities.     

AIDS in Africa: a perspective on the epidemic

Issues surrounding the spread of acquired immunodeficiency syndrome (AIDS) in Africa are summarized. Subjects considered include the disease's origins, proportion of the population infected with the human immunodeficiency virus (HIV) and AIDS, the problems in caring for children orphaned by the disease, innovations in drug treatments discovered by African scientists, the spread among women, and the difficulties inherent in incorporating Western-based policy and aid provisions into the African context.     

清末瘟疫与民众心态

在清末,民众面对瘟疫的心态首先是恐惧,由恐惧而导致迷信,还表现为对现代防疫手段的排拒。在中外杂居地居民的心态则更加复杂,但随着防疫的深化和瘟疫的成功扑灭,民众的心态迅速发生变异,这与公共卫生体系的建立及中外文化交流等因素有联系,器物和制度层面的转型,为公共卫生观念的确立作了铺垫。