Variola minor in coalfield areas of England and Wales, 1921–34: Geographical determinants of a national smallpox epidemic that spread out of effective control

This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of 1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysi...

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Bibliographic Details
Published in:	Social science & medicine (1982) 2017-05, Vol.180, p.160-169
Main Authors:	Smallman-Raynor, Matthew R., Rafferty, Sarah, Cliff, Andrew D.
Format:	Article
Language:	eng
Subjects:	1921–34 epidemic Adolescent Adult Aged Aged, 80 and over Binary logistic regression Child Child, Preschool Coal Coal mining Coal Mining - manpower Coverage Density Disease Outbreaks - statistics & numerical data Dust England England and Wales Epidemics Female Geographic Mapping Humans Immunization Infancy Infant Local government Logistic Models Male Medical geography Middle Aged Mining industry Population Density Smallpox Smallpox - epidemiology Vaccination - trends Variola virus - pathogenicity Wales
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Summary:	This paper uses techniques of binary logistic regression to identify the spatial determinants of the last national epidemic of smallpox to spread in England and Wales, the variola minor epidemic of 1921–34. Adjusting for age and county-level variations in vaccination coverage in infancy, the analysis identifies a dose-response gradient with increasing odds of elevated smallpox rates in local government areas with (i) medium (odds ratio [OR] = 5.32, 95% Confidence Interval [95% CI] 1.96–14.41) and high (OR = 11.32, 95% CI 4.20–31.59) coal mining occupation rates and (ii) medium (OR = 16.74, 95% CI 2.24–125.21) and high (OR = 63.43, 95% CI 7.82–497.21) levels of residential density. The results imply that the spatial transmission of variola virus was facilitated by the close spatial packing of individuals, with a heightened transmission risk in coal mining areas of the country. A syndemic interaction between common respiratory conditions arising from exposure to coal dust and smallpox virus transmission is postulated to have contributed to the findings. We suggest that further studies of the geographical intersection of coal mining and acute infections that are transmitted via respiratory secretions are warranted. •Spatial risk-modifiers for epidemic smallpox in England and Wales are examined.•The 1921–34 smallpox epidemic was centred on coal mining areas.•A dose-response gradient existed between mining occupation rates and smallpox rates.•A syndemic interaction between respiratory conditions and smallpox is postulated.•The spatial intersection of coal mining and acute infections merits further study.
ISSN:	0277-9536 1873-5347