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. 2014 Mar;142(3):577-91.
doi: 10.1017/S0950268813001441. Epub 2013 Jul 1.

Abrupt transition to heightened poliomyelitis epidemicity in England and Wales, 1947-1957, associated with a pronounced increase in the geographical rate of disease propagation

M R Smallman-Raynor  1 , A D Cliff  2
Affiliations

Abrupt transition to heightened poliomyelitis epidemicity in England and Wales, 1947-1957, associated with a pronounced increase in the geographical rate of disease propagation

M R Smallman-Raynor et al. Epidemiol Infect. 2014 Mar.

Abstract

The abrupt transition to heightened poliomyelitis epidemicity in England and Wales, 1947-1957, was associated with a profound change in the spatial dynamics of the disease. Drawing on the complete record of poliomyelitis notifications in England and Wales, we use a robust method of spatial epidemiological analysis (swash-backwash model) to evaluate the geographical rate of disease propagation in successive poliomyelitis seasons, 1940-1964. Comparisons with earlier and later time periods show that the period of heightened poliomyelitis epidemicity corresponded with a sudden and pronounced increase in the spatial rate of disease propagation. This change was observed for both urban and rural areas and points to an abrupt enhancement in the propensity for the geographical spread of polioviruses. Competing theories of the epidemic emergence of poliomyelitis in England and Wales should be assessed in the light of this evidence.

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Figures

Fig. 1.
Fig. 1.
Monthly series of poliomyelitis notification rates per 100 000 population, 1913–1971. (a) England and Wales (source: General Register Office, London); (b) USA (source: Public Health Reports/Morbidity and Mortality Weekly Report).
Fig. 2.
Fig. 2.
The poliomyelitis season, England and Wales, 1940–1964. For a given year (1940, …, 1964), the count of poliomyelitis notifications in each registration week, w (1, …, 53) was assessed relative to the median weekly count of notifications for that year; weeks above the median were defined as ‘excess weeks'. The bar chart plots the number of years in which registration week w was categorized as an ‘excess week’ in the 25-year observation period. The median value of the set of bars (8) is demarcated by the broken horizontal line; registration weeks above this median are defined as constituting the poliomyelitis season (registration weeks 24–50). The heavy line trace is shown for reference and plots the median poliomyelitis notification rate per 100 000 population for registration week w in the period 1940–1964.
Fig. 3.
Fig. 3.
Time series of poliomyelitis notifications, England and Wales, 1940–1964. Graphs plot the weekly count of notifications for successive poliomyelitis seasons (registration weeks 24–50).
Fig. 4.
Fig. 4.
Spatial phase transitions of poliomyelitis. The solid lines plot, as mean values, the cumulative proportion of districts that (a) first notified (leading edge, LE) and (b) last notified (following edge, FE) cases of poliomyelitis in each week of the poliomyelitis seasons (registration weeks 24–50) for 1940–1946, 1947–1957 and 1958–1964. The shaded envelopes define the 95% confidence levels for the mean estimates. The graphs compare the evidence for 1947–1957 with 1940–1946 (left) and 1958–1964 (right).
Fig. 5.
Fig. 5.
Swash–backwash parameters, I. The solid lines plot, for each week of the poliomyelitis season (registration weeks 24–50), mean values of (a) SA, (b) IA and (c) RA for 1940–1946, 1947–1957 and 1958–1964. The shaded envelopes define the 95% confidence levels for the mean estimates. The graphs compare the evidence for 1947–1957 with 1940–1946 (left) and 1958–1964 (right).
Fig. 6.
Fig. 6.
Swash–backwash parameters, II. The solid lines plot, for each week of the poliomyelitis season (registration weeks 24–50), mean values of (a) VLE, (b) VFE, (c) R0A and (d) duration of infectivity (tFE−tLE) for 1940–1946, 1947–1957 and 1958–1964. The shaded envelopes define the 95% confidence levels for the mean estimates. The graphs compare the evidence for 1947–1957 with 1940–1946 (left) and 1958–1964 (right).
Fig. 7.
Fig. 7.
Swash–backwash parameters for urban and rural areas. The graphs plot, for each week of the poliomyelitis season (registration weeks 24–50), mean values of the swash–backwash parameters for 1940–1946, 1947–1957 and 1958–1964. The information is shown for metropolitan and county boroughs (left), municipal boroughs and urban districts (centre) and rural districts (right).
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