The spatial structure of epidemic emergence: geographical aspects of poliomyelitis in north-eastern USA, July-October 1916.

The great epidemic of poliomyelitis which swept New York City and surrounding territory in the summer of 1916 eclipsed all previous global experience of the disease. We draw on epidemiological information that is included in the seminal US Public Health Bulletin 91, 'Epidemiologic studies of poliomyelitis in New York City and the northeastern United States during the year 1916' (Washington DC, 1918), to re-examine the spatial structure of the epidemic. For the main phase of transmission of the epidemic, July-October 1916, it is shown that the maximum concentration of activity of poliomyelitis occurred within a 128-km radius of New York City. Although the integrity of the poliomyelitis cluster was maintained up to approximately 500 km from the metropolitan focus, the level and rate of propagation of disease declined with distance from the origin of the epidemic. Finally, it is shown that the geographical transmission of the epidemic in north-eastern USA probably followed a process of mixed contagious-hierarchical diffusion.