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Pandemic Influenza on Troop Ship, 1918 | CDC EID
EID Journal Home > Volume 16, Number 12–December 2010
Volume 16, Number 12–December 2010
Mortality Risk Factors for Pandemic Influenza on New Zealand Troop Ship, 1918
Jennifer A. Summers, Comments to Author Nick Wilson, Michael G. Baker, and G. Dennis Shanks
Author affiliations: University of Otago, Wellington, New Zealand (J.A. Summers, N. Wilson, M.G. Baker); and Australian Army Malaria Institute, Enoggera, Queensland, Australia (G.D. Shanks)
Suggested citation for this article
We describe the epidemiology and risk factors for death in an outbreak of pandemic influenza on a troop ship. Mortality and descriptive data for military personnel on His Majesty's New Zealand Transport troop ship Tahiti in July 1918 were analyzed, along with archival information. Mortality risk was increased among persons 25–34 years of age. Accommodations in cabins rather than sleeping in hammocks in other areas were also associated with increased mortality risk (rate ratio 4.28, 95% confidence interval 2.69–6.81). Assignment to a particular military unit, the field artillery (probably housed in cabins), also made a significant difference (adjusted odds ratio in logistic regression 3.04, 95% confidence interval 1.59–5.82). There were no significant differences by assigned rurality (rural residence) or socioeconomic status. Results suggest that the virulent nature of the 1918 influenza strain, a crowded environment, and inadequate isolation measures contributed to the high influenza mortality rate onboard this ship.
To plan and prepare appropriately for future influenza pandemics, public health authorities need to better understand the epidemiology of previous pandemics. Much remains obscure about the epidemiology of the influenza pandemic of 1918–19, the spread of which depended on the transportation of large numbers of troops during World War I.
Pandemic influenza outbreaks among closed military populations are problematic and sometimes show high mortality rates. Reports on this topic have been published. These include descriptions of 1918 pandemic outbreaks in U.S. and Australian troop and civilian ships in 1918–19 (1–5), descriptions of 1918 pandemic outbreaks in military camps in the United States, the United Kingdom, and New Zealand (2,3,6–8), and more recent influenza outbreaks onboard naval and civilian ships (9–12).
Some studies have investigated specific risk factors for death from the 1918 pandemic. Evidence has shown that lower socioeconomic status increased mortality risk (13,14) and that young adults, for as-yet-unexplained reasons, had disproportionately higher mortality rates (13–16). Rural living versus urban living is another risk factor that has been investigated and has showed conflicting results (17–20). Lower mortality rates were observed among seasoned troops (>6 months experience) compared with newly recruited troops, possibly because of previous exposure to respiratory pathogens in seasoned troops (8,21,22).
The purpose of this study was to examine the 1918 outbreak on His Majesty's New Zealand Transport (HMNZT) Tahiti (Figure 1) and to identify mortality risk factors among persons onboard. During and after World War I, HMNZT Tahiti made numerous trips, transporting reinforcements and supplies from New Zealand to Europe, and bringing home New Zealand troops (Figure 2). On July 10, 1918, HMNZT Tahiti departed New Zealand with the 40th Reinforcements, a unit that consisted largely of infantry replacements. The voyage across the Indian Ocean and around the Cape of Good Hope was uneventful. HMNZT Tahiti was to join a convoy in Freetown, Sierra Leone, before heading to England. Upon reaching Freetown, reports of disease ashore resulted in all ships in the convoy being quarantined at port (7,25). However, a conference was attended by captains and wireless operators from every ship in the convoy onboard the His Majesty's Ship Mantua. The Mantua had experienced an influenza outbreak onboard 2 days after leaving the United Kingdom on August 1, 1918, and is thought to have been responsible for bringing the second wave of the 1918 pandemic to western Africa from England (5,26).
HMNZT Tahiti left Freetown on August 26, 1918, as part of the convoy after being resupplied by local workers (who were another possible source of infection with the new pandemic influenza strain). On the day of sailing, influenza case-patients began to be admitted to the onboard hospital. Over the next few weeks of the voyage, influenza developed in >1,000 of the 1,217 persons onboard (25). By the time HMNZT Tahiti reached Plymouth, England, on September 10, 1918, a total of 68 men had died onboard the ship (23,27). Eight other men and 1 nurse who had been on the ship died of influenza in England. HMNZT Tahiti, the worst affected ship in the convoy, was referred to as the death ship, and a Court of Inquiry was held to investigate this outbreak.
Historical Context and Mortality Data
Historical information was obtained from the official report of the outbreak held in Wellington from Archives New Zealand (27), the Inquiry Report from the Transport Epidemic Committee to the House of Representatives of New Zealand, dated December 9, 1918, and the written account of Colonel E.J. O'Neill as officer commanding the 40th Reinforcements (25). Individualized data on all military personnel on the July 1918 sailing of HMNZT Tahiti recorded in the Cenotaph database were obtained from the Auckland War Memorial Museum (28). An electronic dataset (Roll-of-Honor) covering all deaths among New Zealand military personnel during World War I was obtained from Peter Dennis (Australian Defence Force Academy, University of New South Wales, Canberra, Australian Capital Territory). The Roll-of-Honor and Cenotaph databases were matched to identify persons onboard HMNZT Tahiti whose death from the disease had been listed. The precise cause of death was only reported in the Cenotaph database for 3 of 77 case-patients and was recorded as influenza or pneumonia. One death recorded as a drowning was included because a recently published study showed that the drowning occurred when a febrile soldier aboard HMNZT Tahiti threw himself into the sea (29).
Pandemic Influenza on Troop Ship, 1918 | CDC EID
Suggested Citation for this Article
Summers JA, Wilson N, Baker MG, Shanks GD. Mortality risk factors for pandemic influenza on New Zealand troop ship, 1918. Emerg Infect Dis [serial on the Internet]. 2010 Dec [date cited]. http://www.cdc.gov/EID/content/16/12/1931.htm
Comments to the Authors
Please use the form below to submit correspondence to the authors or contact them at the following address:
Jennifer A. Summers, Department of Public Health, University of Otago, Box 7343, Wellington South, Wellington 5011, New Zealand; email: email@example.com