Before the 2009 flu pandemic sickened more than 60 million people nationwide, the virus first saw widespread transmission in four smaller cities, according to a study published in Epidemics.
For the study, researchers at the University of Cambridge in the U.K. analyzed epidemiological data from the 2009 pandemic to create a model of the virus' spread.
They found the pandemic did not pick up steam in major metropolitan hubs like New York City or San Francisco, but rather the following cities:
- Grenada, Miss.
- Albany, Ga.
- Stockton, Calif.
- Omaha, Neb.
About 75 percent of all flu cases in the country could be traced back to one of these cities, researchers found.
The study findings suggest factors beyond population density and travel are important to consider when tracking disease transmission.
"The 'Hollywood' notion of a highly infectious pandemic [starting in a major city] is not the way things happen in reality," lead study author Stephen Kissler, an epidemiologist at University of Cambridge, told Science. Mr. Kissler said he hopes to conduct further research to assess whether flu's spread in smaller cities is unique to the 2009 pandemic or occurred in other years.
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