Mortality in naval units during the 1918–19 influenza pandemic

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The Lancet Infectious Disease
Oct 2011  Volume 11  Number 10  p721 – 800
http://www.thelancet.com/journals/laninf/issue/current

Historical Review
Determinants of mortality in naval units during the 1918–19 influenza pandemic
G Dennis Shanks, Michael Waller, Alison MacKenzie, John F Brundage

Preview
In 1918, two waves of epidemic influenza arose with very different clinical phenotypes. During the first wave, infection rates were high but mortality was low. During the second wave, high numbers of deaths occurred and mortality differed 30–100 times among seemingly similar groups of affected adults, but the reason for this variation is unclear. In 1918, the crews of most warships and some island populations were affected by influenza during both waves of infection and had no or very few deaths during the second wave.