The influenza pandemic of 1918-1919 in two remote island nations: Iceland and New Zealand

Aim Nations varied in their experience of, and response to, the 1918-19 influenza pandemic. Island communities can provide unique opportunities to study the epidemiology of infectious diseases. We aimed to compare the epidemiology and public health response to this pandemic in two remote island nations, on opposite sides of the globe: Iceland and New Zealand (NZ). Method Historical accounts in both nations were reviewed, along with recent analysis of the pandemics impact and course. Results Marked similarities were noted in epidemic timing, failure of border control, shape of epidemic curves, and delayed use of public health interventions. However, amongst the exposed European populations, Iceland experienced a significantly higher mortality rate (830 vs 550 per 100, 000) compared to NZ (rate ratio: 1.5, 95%CI: 1.4-1.6). There is evidence that some public health measures in specific areas of both nations resulted in lower mortality rates. In particular, Iceland's use of travel restrictions and ship quarantining, appeared to protect 36% of the population. Conclusion The epidemiology of the 1918-19 influenza pandemic was fairly similar for the exposed European populations of Iceland and NZ. Nevertheless, major differences were the significantly higher overall mortality rate in Iceland and the success of Iceland's use of travel restrictions.