The geographical spread of the 1947 poliomyelitis epidemic in England and Wales: Spatial wave propagation of an enigmatic epidemiological event

Journal of Historical Geography

Volumn 40, Issue , 2013, Pages 36-51

  Smallman Raynor, Matthew ^a   Cliff, Andrew D ^b  

^a UNIVERSITY OF NOTTINGHAM   (United Kingdom)

^b UNIVERSITY OF CAMBRIDGE   (United Kingdom)

Author keywords

1947 Epidemic; England and Wales; Exploratory data analysis; Poliomyelitis; Spatial wave propagation

Indexed keywords

DISEASE SPREAD; EPIDEMIC; EPIDEMIOLOGY; HISTORICAL PERSPECTIVE; POLIOMYELITIS; SPATIAL ANALYSIS; VACCINE;

ENGLAND; UNITED KINGDOM; WALES;

POLIOVIRUS;

EID: 84875773058     PISSN: 03057488     EISSN: 10958614     Source Type: Journal    
DOI: 10.1016/j.jhg.2012.12.003     Document Type: Article

References (98)

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11. Smallman-Raynor, Cliff, Trevelyan, Nettleton and Sneddon, Poliomyelitis. A World Geography (note 3), 335e346.
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26. Notifications of acute polioencephalitis (a rare neurological manifestation of poliovirus infection that was recorded as a separate disease category in the Registrar General's Weekly Return in the years to 1949) have been omitted from the present analysis.
27. The 1471 local government districts were defined according to their legal status in April 1947 and, with the exception of the Inner & Middle Temples, City of London, represented an exhaustive division of the (then) 62 counties of England and Wales.
28. B. Trevelyan, M.R. Smallman-Raynor and A.D. Cliff, The spatial dynamics of poliomyelitis in the U.S.A.: from epidemic emergence to vaccine-induced retreat, 1910e1971, Annals of the Association of American Geographers 95 (2005) 269e293.
29. A.H. Gale, Corrected notifications at the level of standard local government districts are only available in the Registrar General's publications on a temporally aggregated (quarterly and yearly) basis. Following we use the (uncorrected) weekly notifications in the present paper. Gale, Poliomyelitis in England and Wales in 1947 (note 2).
30. As Murray observes, one hospital-based study in London during the 1947 epidemic revealed an initial misdiagnosis of poliomyelitis in cases of glandular fever, meningococcal meningitis, tonsillitis and other enteric diseases. Murray, The 1947 outbreak of poliomyelitis (note 4)
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36. Anonymous, Poliomyelitis (note 27), 260
37. The Times, London, Wednesday 25 June 1947, 4. In addition to the cancellation of the Eton cricket match, The Times cast doubt over the likelihood of Winchester's participation in the annual rowing and shooting events at Henley and Bisley.
38. Anonymous, Poliomyelitis, The Medical Officer 78 (1947) 14-23.
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40. According to this source, the above-average incidence of poliomyelitis in late May was attributable to the reporting of 'single cases or odd cases at intervals from different urban and rural districts'.
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43. Although ports, such as Barrow-in-Furness, hold a prominent place in the early epidemic history of poliomyelitis in England and Wales, investigations by the Ministry of Health were unable to ascribe any significance to their role as points for the introduction of epidemic strains of poliovirus. See A.H. Gale, Discussion on the geographical distribution of poliomyelitis, Proceedings of the Royal Society of Medicine 48 (1955) 931e942.
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45. Although the cause of this second peak is unknown, we note that it occurred approximately 3 weeks after the reopening of schools at the end of the summer vacation. Given an estimated median incubation period of 12 days (range 7e20 days) for the paralytic stage of poliomyelitis, this secondary surge may therefore reflect increased virus transmission associated with heightened population mixing at the start of the new school year.
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49. In the absence of vaccination, Eichner and colleagues estimate the critical community size of poliovirus to be of the order of 250,000 (range: 50,000e500,000). From this estimate, we infer that polioviruses were circulating in endemic form in a dozen or so major towns and cities of England andWales at the time of onset of the 1947 epidemic. Regardless of the specific aetiology of the 1947 epidemic, therefore, occasional cases of the disease would be expected to occur in relation to these endemic reservoirs. This could account for the multi-focal pattern of poliomyelitis activity at the time of onset of the 1947 epidemic (Fig. 3)
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58. Cliff and Haggett, A swashebackwash model of the single epidemic wave (note 10).
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63. Ministry of Health, Report of the Ministry of Health for the Year Ended 31st March note 35 1948 47.
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69. M.R. Smallman-Raynor, C. Nettleton and A.D. Cliff, Wartime evacuation and the spread of infectious diseases: epidemiological consequences of the dispersal of children from London during World War II, Journal of Historical Geography 29 (2003) 396e421. For an examination of the impact of wartime evacuation on the spread of poliomyelitis and other common infectious diseases in England and Wales, 1939e45, see:
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71. B. Benjamin and A.H. Gale, The age distribution of poliomyelitis in England and Wales, Monthly Bulletin of the Ministry of Health and the Public Health Laboratory Service 8 (1949) 208e213
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77. Cliff, Smallman-Raynor, Haggett, Stroup and Thacker, Infectious Diseases (note 38).
78. The unusually early seasonal rise of poliomyelitis in 1947 attracted special comment in the medical press. See, for example: Anonymous, Poliomyelitis, British Medical Journal 2 (1947) 193
79. Anonymous, Poliomyelitis (note 29), 46.
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82. On poliovirus types in the years 1946e50, see: A.P. Goffe, Studies on the distribution of poliomyelitis viruses in England and Wales, Proceedings of the Royal Society of Medicine 48 (1955) 937e941.
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98. All elements dt,t[1,k] were estimated from the longitude and latitude coordinates of district centroids using Pythagoras' theorem on an equirectangular projection