Mortality patterns associated with the 1918 influenza pandemic in Mexico: evidence for a spring herald wave and lack of preexisting immunity in older populations

Abstract

Background: Although the mortality burden of the devastating 1918 influenza pandemic has been carefully quantified in the United States, Japan, and European countries, little is known about the pandemic experience elsewhere. Here, we compiled extensive archival records to quantify the pandemic mortality patterns in 2 Mexican cities, Mexico City and Toluca.

Methods: We applied seasonal excess mortality models to age-specific respiratory mortality rates for 1915-1920 and quantified the reproduction number from daily data.

Results: We identified 3 pandemic waves in Mexico City in spring 1918, autumn 1918, and winter 1920, which were characterized by unusual excess mortality among people 25-44 years old. Toluca experienced 2-fold higher excess mortality rates than Mexico City but did not experience a substantial third wave. All age groups, including that of people 65 years old, experienced excess mortality during 1918-1920. Reproduction number estimates were <2.5, assuming a 3-d generation interval.

Conclusion: Mexico experienced a herald pandemic wave with elevated young adult mortality in spring 1918, similar to the United States and Europe. In contrast to the United States and Europe, there was no mortality sparing among Mexican seniors 65 years old, highlighting potential geographical differences in preexisting immunity to the 1918 virus. We discuss the relevance of our findings to the 2009 pandemic mortality patterns.

Figure 1

Age-specific monthly time series of pneumonia and influenza (P&I) mortality rates for Mexico City, 1916–1920. Areas shaded in red highlight 3 time periods of high mortality associated with three waves of the 1918–20 pandemic occurring in spring (Apr–May 1918), fall (Oct–Dec 1918), and winter (Feb–Mar 1920).

Figure 2

Age-specific weekly time series of respiratory mortality per 10,000 people in the city of Toluca, Mexico State, 1915–1920. Areas shaded in red highlight 3 time periods of high mortality associated with three waves of the 1918–20 pandemic occurring in spring (Apr-2 to Jun-3, 1918), fall (Oct-1 to Dec-23, 1918), and winter (Jan-1 to Mar-11, 1920).

Figure 3

Age-specific estimates of excess respiratory mortality rates during the spring 1918, fall 1918 and winter 1919–20 influenza pandemic waves in Mexico City and Toluca. Estimates are based on 2 independent methods: 1) a Serfling approach using seasonal linear regression to estimate baseline non-influenza mortality [7, 22, 23] and 2) an empirical method using mortality in pre-pandemic years 1915–17 as baseline [5].