Abstract
BackgroundAs an island and a former British colony, Sri Lanka is a case of special interest for the study of 1918–1919 influenza pandemic because of its potential for isolation from as well as integration into the world epidemiologic system.ObjectivesTo estimate population loss attributable to the influenza pandemic and weekly district-level excess mortality from the pandemic to analyze its spread across the island.MethodsTo measure population loss, we estimated a population growth model using a panel of 100 district-level observations on population for five consecutive censuses from 1891 to 1931, allowing for a one-time drop in population in 1918–1919. To estimate weekly excess mortality from the pandemic, we estimated a seasonally adjusted weekly time series of district-specific mortality estimates from vital registration records, ranked them, and plotted the ranks on weekly maps to create a picture of the geographic pattern of propagation across Sri Lanka.ResultsTotal loss of population from the influenza pandemic was 307 000 or approximately 6·7% of the population. The pandemic peaked in two discrete (northern and southern) regions in early October of 1918 and in a third (central) region in early March 1919.ConclusionsThe population loss estimate is significantly higher than earlier estimates of mortality from the pandemic in Sri Lanka, suggesting underreporting of influenza-attributable deaths and a role for influenza-related fertility declines. The spatial pattern of peak mortality indicates the presence of two distinct entry points and three distinct epidemiologic regions, defined by population density and ethnicity, in colonial Sri Lanka.
Highlights
The influenza pandemic of 1918–19 was one of the most destructive global epidemics in history
During the global pandemic of 1918–1919, influenza was first reported in Sri Lanka in June 1918.11–13 mortality from influenza increased noticeably only in September 1918,14 peaking in most places in the last quarter of that year
A number of interesting new findings include first a coefficient associated with the influenza pandemic that is sizeable, negative, and statistically significant, at À0Á1079 in the restricted model (Table 1, Column 2)
Summary
The influenza pandemic of 1918–19 was one of the most destructive global epidemics in history. The H1N1 family of influenza viruses has, been responsible for the largest number of deaths in human history.[1] Estimates of mortality from the pandemic range from 20 to 40 million,[2 20–50] million,[3 40–50] million,[4] and 50–100 million[5] and include a variety of point estimates, including 20 million,[6 30] million,[7] and 40 million.[8,9,10] As an island nation and a former British colony, Sri Lanka, known as Ceylon, is a case of special interest because of its potential for isolation from as well as integration into the world epidemiologic system. As an island and a former British colony, Sri Lanka is a case of special interest for the study of 1918–1919 influenza pandemic because of its potential for isolation from as well as integration into the world epidemiologic system
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