Age and secular distributions of virus-proven influenza patients in successive epidemics 1961-1976 in Cirencester: epidemiological significance discussed.

A general practice population of around 3900, under continuous clinical and laboratory surveillance, experienced 20 outbreaks of influenza between March 1960 and March 1976. Four epidemics were caused by subtype H2N2 type A viruses, seven by subtype H3N2 type A viruses and nine outbreaks by type B viruses. The age of every person proved virologically to have influenza is related to the age structure of the community and to the phase of the epidemic in which the virus-positive specimens were collected. Children 0-15 years old suffered a higher incidence rate than adults 16-90+. Pre-school children 0-4 suffered the highest rate of infection by viruses of both influenza A subtypes, whereas older schoolchildren 10-15 suffered the highest rate of type B infections. Despite these high incidence rates neither pre-school nor schoolchildren appear to have been the major disseminators of any of these influenza viruses in the community. Adults of all ages suffered a high rate of infection even into extreme old age, and the indiscriminate age distribution among adults was sustained in the successive epidemics. Such age-patterns are not those caused by a highly infectious immunizing virus surviving by means of direct transmissions from the sick, whose prompt development of the disease continues endless chains of transmissions. An alternative epidemic mechanism--whereby the virus does not spread from the sick but becomes latent in them, reactivating seasonally so that they later infect their companions--would produce age patterns similar to those recorded here for influenza patients. The suggested mechanism is illustrated by a simple conceptual model and the influenzal age patterns are discussed in relation to the recycling of influenza A subtypes.