Letters Section Editor: Robert M. Golub, MD, Senior Editor.
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.
Markel H, Lipman HB, Navarro JA, Sloan A, Michalsen J, Stern AM, Cetron MS. Nonpharmaceutical Interventions Implemented During the 1918-1919 Influenza Pandemic—Reply. JAMA. 2007;298(19):2260-2261. doi:10.1001/jama.298.19.2261-a