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November 21, 2007

Nonpharmaceutical Interventions Implemented During the 1918-1919 Influenza Pandemic—Reply

Author Affiliations

Letters Section Editor: Robert M. Golub, MD, Senior Editor.

JAMA. 2007;298(19):2260-2261. doi:10.1001/jama.298.19.2261-a

In Reply: Dr Dib correctly notes the coincidence of World War I and the influenza pandemic's second wave. More than 4 million men were mobilized in the US armed forces in 1918.1 Military influenza cases may have contributed to a city's weekly mortality rate, particularly when bases or camps were located near urban centers. However, when adjusting for age- and sex-specific distributions of death rates there did not appear to be city-specific differences to account for this as an explanation for the observations in our study (shown in Figures 55-59 of the online article supplement, http://www.cdc.gov/ncidod/dq/pdf/flu_figures.pdf). Moreover, most soldiers did not return home from Europe until early to mid-1919, after the second peak of the bimodal mortality curves we described. Nevertheless, different national military mobilization levels and their influence on influenza transmission patterns merit further study.

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