Multicriteria decision analysis (MCDA) involves techniques which relatively recently have received great increase in interest for their capabilities of solving spatial decision problems. One of the most frequently used techniques of MCDA is Analytic Hierarchy Process (AHP). In the AHP, decision-makers make pairwise comparisons between different criteria to obtain values of their relative importance. The AHP initially only dealt with crisp numbers or exact values in the pairwise comparisons, but later it has been modified and adapted to also consider fuzzy values. It is necessary to empirically validate the ability of the fuzzified AHP for solving spatial problems. Further, the effects of different levels of fuzzification on the method have to be studied. In the context of a hypothetical GIS-based decision-making problem of locating a dam in Costa Rica using real-world data, this paper illustrates and compares the effects of increasing levels of uncertainty exemplified through different levels of fuzzification of the AHP. Practical comparison of the methods in this work, in accordance with the theoretical research, revealed that by increasing the level of uncertainty or fuzziness in the fuzzy AHP, differences between results of the conventional and fuzzy AHPs become more significant. These differences in the results of the methods may affect the final decisions in decision-making processes. This study concludes that the AHP is sensitive to the level of fuzzification and decision-makers should be aware of this sensitivity while using the fuzzy AHP. Furthermore, the methodology described may serve as a guideline on how to perform a sensitivity analysis in spatial MCDA. Depending on the character of criteria weights, i.e. the degree of fuzzification, and its impact on the results of a selected decision 1 rule (e.g. AHP), the results from a fuzzy analysis may be used to produce sensitivity estimates for crisp AHP MCDA methods.

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Objectives: The COVID-19 pandemic highlights questions regarding reinfections and immunity resulting from vaccination and/or previous illness. Studies addressing related questions for historical pandemics are limited.Methods: We revisit an unnoticed archival source on the 1918/19 influenza pandemic. We analysed individual responses to a medical survey completed by an entire factory workforce in Western Switzerland in 1919.Results: Among the total of n = 820 factory workers, 50.2% reported influenza-related illness during the pandemic, the majority of whom reported severe illness. Among male workers 47.4% reported an illness vs. 58.5% of female workers, although this might be explained by varied age distribution for each sex (median age was 31 years old for men, vs. 22 years old for females). Among those who reported illness, 15.3% reported reinfections. Reinfection rates increased across the three pandemic waves. The majority of subsequent infections were reported to be as severe as the first infection, if not more. Illness during the first wave, in the summer of 1918, was associated with a 35.9% (95%CI, 15.7–51.1) protective effect against reinfections during later waves.Conclusion: Our study draws attention to a forgotten constant between multi-wave pandemics triggered by respiratory viruses: Reinfection and cross-protection have been and continue to be a key topic for health authorities and physicians in pandemics, becoming increasingly important as the number of waves increases.