The 1918-1919 influenza pandemic in England and Wales: Spatial patterns in transmissibility and mortality impact

Gerardo Chowell, Luís M A Bettencourt, Niall Johnson, Wladimir J. Alonso, Cécile Viboud

Research output: Contribution to journalArticle

75 Scopus citations


Spatial variations in disease patterns of the 1918-1919 influenza pandemic remain poorly studied. We explored the association between influenza death rates, transmissibility and several geographical and demographic indicators for the autumn and winter waves of the 1918-1919 pandemic in cities, towns and rural areas of England and Wales. Average measures of transmissibility, estimated by the reproduction number, ranged between 1.3 and 1.9, depending on model assumptions and pandemic wave and showed little spatial variation. Death rates varied markedly with urbanization, with 30-40% higher rates in cities and towns compared with rural areas. In addition, death rates varied with population size across rural settings, where low population areas fared worse. By contrast, we found no association between transmissibility, death rates and indicators of population density and residential crowding. Further studies of the geographical mortality patterns associated with the 1918-1919 influenza pandemic may be useful for pandemic planning.

Original languageEnglish (US)
Pages (from-to)501-509
Number of pages9
JournalProceedings of the Royal Society B: Biological Sciences
Issue number1634
StatePublished - Mar 7 2008



  • Demographics
  • England and Wales
  • Influenza
  • Reproduction number
  • Scaling laws
  • Spanish flu pandemic

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Environmental Science(all)
  • Agricultural and Biological Sciences(all)

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