Skip to main content

Spatiotemporal patterns of pandemic influenza-related deaths in Allied naval forces during 1918

  • G. D. SHANKS (a1) (a2), M. WALLER (a3) and M. SMALLMAN-RAYNOR (a4)

This paper draws on the mortality records of the French, US and UK Royal navies to reconstruct the spatiotemporal evolution of the 1918–1919 influenza pandemic in global Allied naval forces. For a total of 7658 deaths attributed to respiratory diseases (French and US navies) and all diseases (UK Royal Navy) at 514 locations worldwide, techniques of spatial point pattern analysis were used to generate weekly maps of global mortality intensity in 1918. The map sequence for the main period of pandemic mortality, mid-August to mid-November 1918, revealed a near-simultaneous development of mutiple foci of high disease intensity in three distant locations (Europe, North America, West Africa). Given the relatively slow speed of naval ships in convoy at this time (<12 knots), our findings suggest that the pandemic influenza virus was circulating on three continents at the observed onset of the main mortality wave.

Corresponding author
*Author for correspondence: Professor G. D. Shanks, Australian Army Malaria Institute, Enoggera, QLD 4051, Australia. (Email:
Hide All
1.Murray CJ, et al. Estimation of potential global pandemic influenza mortality on the basis of vital registry data from the 1918–20 pandemic: a quantitative analysis. Lancet 2006; 368: 22112218.
2.Morens DM, Taubenberger JK, Fauci AS. The persistent legacy of the 1918 influenza virus. New England Journal of Medicine 2009; 361: 225229.
3.Louie J, et al. Factors associated with death or hospitalization due to pandemic 2009 influenza A(H1N1) infection in California. Journal of the American Medical Association 2009; 302: 18961902.
4.Shanks GD, et al. Mortality risk factors during the 1918–1919 influenza pandemic in the Australian army. Journal of Infectious Diseases 2010; 201: 18801889.
5.Smallman-Raynor M, Cliff A. War Epidemics: An Historical Geography of Infectious Diseases in Military Conflict and Civil Strife 1850–2000. Oxford: Oxford University Press, 2004.
6.Oxford JS, et al. World War I may have allowed the emergence of ‘Spanish’ influenza. Lancet Infectious Diseases 2002; 2: 111114.
7.Vaughn V, Palmer G. Communicable disease in the United States Army during the summer and autumn of 1918. Journal of Laboratory and Clinical Medicine 1919; 4: 647686.
8.Martin C. An epidemic of fifty cases of influenza among the personnel of a base hospital BEF, France. British Medical Journal 1918, pp. 281282.
9.Delater D. Influenza in the National Army of 1918 [in French]. Revue d'Hygiene 1923; 45: 408426.
10.Shanks GD, et al. Determinants of mortality in naval units during the 1918–19 influenza pandemic. Lancet Infectious Diseases 2011; 11: 793799.
11.Vaughn V. Influenza and pneumonia at Brest, France. Journal of Laboratory and Clinical Medicine 1919; 4: 223225.
12.Medical Research Committee. Studies of influenza in hospitals of the British Armies in France 1918. London: His Majesty's Stationery Office, 1919.
13.War Office. Statistics of the military effort of the British Empire during the Great War 1914–1920. London: His Majesty's Stationery Office, 1922.
14.US Navy. Officers and enlisted men of the United States Navy who lost their lives during the World War. Washington, DC: Government Printing Office, 1920.
15.Diggle P. Statistical Analysis of Spatial Point Patterns, 2nd edn. London: Arnold, 2003.
16.Gatrell A, et al. Spatial point pattern analysis and its application in geographical epidemiology. Transactions of the Institute of British Geographers 1996; 21 (new series): 256274.
17.Hammond JAB, Rolland W, Shore THG. Purulent bronchitis: a study of cases occurring amongst the British troops at a base in France. Lancet 1917 (14 July): 4144.
18.Patterson KD, Pyle GF. The geography and mortality of the 1918 influenza pandemic. Bulletin of the History of Medicine 1991; 65: 421.
19.UK Government. Medical services diseases of the War. London: His Majesty's Stationery Office, 1923, p. 174.
20.Abrahams A, et al. Purulent bronchitis: its influenzal and pneumococcal bacteriology. Lancet 1917 (8 September): 377382.
21.Shanks GD, et al. Relationship between ‘purulent bronchitis’ in military populations in Europe prior to 1918 and the 1918–19 inflenza pandemic. Influenza and Other Respiratory Viruses 2012; 6: 235239.
22.MacNeal W. The influenza epidemic of 1918 in the American Expeditionary Forces in France and England. Archives of Internal Medicine 1919; 23: 657688.
23.MacDonald W, et al. Purulent bronchitis complicating measles and rubella. British Medical Journal 1918, pp. 481486.
24.Eyre JWH, Lowe EC. Report upon the autumn influenza epidemic 1918 as it affected the NZEF in the United Kingdom. Lancet 1919 (5 April): 553560.
25.Barry JM, Viboud C, Simonsen L. Cross-protection between successive waves of the 1918–1919 influenza pandemic: epidemiological evidence from US Army camps and from Britain. Journal of Infectious Diseases 2008; 198: 14271434.
26.Shanks GD, Brundage JF. Pathogenic responses among young adults during the 1918 influenza pandemic. Emerging Infectious Diseases 2012; 18: 201207.
27.Sheng Z, et al. Autopsy series of 68 cases dying before and during the 1918 influenza pandemic peak. Proceedings of the National Academy of Sciences USA 2011; 108: 1641616421.
28.Smith GJ, et al. Dating the emergence of pandemic influenza viruses. Proceedings of the National Academy of Sciences USA 2009; 106: 1170911712.
29.Morens DM, Taubenberger JK. 1918 influenza, a puzzle with missing pieces. Emerging Infectious Diseases 2012; 18: 332335.
30.US Army. The Medical Department of the United States Army in the World War: Administration. Washington Government Printing Office, 1925, pp. 591604.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *



Full text views

Total number of HTML views: 1
Total number of PDF views: 8 *
Loading metrics...

Abstract views

Total abstract views: 92 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 17th November 2017. This data will be updated every 24 hours.