Introduction Nations varied in their response to the 1918–1919 influenza pandemic; however, certain epidemiological characteristics of this pandemic were repeated in many locations. We aimed to compare the epidemiology and public health response to this pandemic in two island nations, on opposite sides of the globe: Iceland and New Zealand.
Methods Historical accounts in both nations were reviewed, along with more recent analysis of the pandemics impact and course.
Results Both nations experienced three pandemic waves from late 1918 onwards. The second wave exacted the largest toll in terms of mortality and peaked in 3 weeks at roughly the same time in mid-November 1918. Iceland and New Zealand had similar pandemic mortality rates (5.4 vs 5.5 per 1000) among individuals of European ethnicity. Disproportionately high pandemic mortality rates among young adults compared to pre and post pandemic years was experienced by both nations. While influenza was a notifiable disease in Iceland before the pandemic, unlike New Zealand (who delayed until mid-pandemic), officials in both nations delayed in enacting response and quarantine measures. However, there is evidence that early public health control measures in specific areas of both nations resulted in lower mortality rates.
Conclusions Our study demonstrates the consistent epidemiological characteristics of the 1918–1919 influenza pandemic; in particular the similar patterns of pandemic waves and mortality, by comparing two geographically diverse island nations. These findings highlight the importance of an early public health response and the impact it can have on the outcome of a pandemic, regardless of its virulence.