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In Reply: Dr Dib correctly notes the coincidence of World War I and the influenza pandemic's second wave. More than 4 million men were mobilized in the US armed forces in 1918.¹ Military influenza cases may have contributed to a city's weekly mortality rate, particularly when bases or camps were located near urban centers. However, when adjusting for age- and sex-specific distributions of death rates there did not appear to be city-specific differences to account for this as an explanation for the observations in our study (shown in Figures 55-59 of the online article supplement, http://www.cdc.gov/ncidod/dq/pdf/flu_figures.pdf). Moreover, most soldiers did not return home from Europe until early to mid-1919, after the second peak of the bimodal mortality curves we described. Nevertheless, different national military mobilization levels and their influence on influenza transmission patterns merit further study.

We strongly disagree with Mr Barry's claims. New York City's early, sustained use . . . [Full Text of this Article]

Howard Markel, MD, PhD
howard@umich.edu
Center for the History of Medicine
University of Michigan Medical School
Ann Arbor

Harvey B. Lipman, PhD
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
Atlanta, Georgia

J. Alexander Navarro, PhD; Alexandra Sloan, AB; Joseph Michalsen, BS; Alexandra Minna Stern, PhD
Center for the History of Medicine
University of Michigan Medical School
Ann Arbor

Martin S. Cetron, MD
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
Atlanta, Georgia

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