Virus-like particle (VLP)-based vaccines for pandemic influenza

PubMed Central

López-Macías, Constantino

2012-01-01

The influenza pandemic of 2009 demonstrated the inability of the established global capacity for egg-based vaccine production technology to provide sufficient vaccine for the population in a timely fashion. Several alternative technologies for developing influenza vaccines have been proposed, among which non-replicating virus-like particles (VLPs) represent an attractive option because of their safety and immunogenic characteristics. VLP vaccines against pandemic influenza have been developed in tobacco plant cells and in Sf9 insect cells infected with baculovirus that expresses protein genes from pandemic influenza strains. These technologies allow rapid and large-scale production of vaccines (3–12 weeks). The 2009 influenza outbreak provided an opportunity for clinical testing of a pandemic influenza VLP vaccine in the midst of the outbreak at its epicenter in Mexico. An influenza A(H1N1)2009 VLP pandemic vaccine (produced in insect cells) was tested in a phase II clinical trial involving 4,563 healthy adults. Results showed that the vaccine is safe and immunogenic despite high preexisting anti-A(H1N1)2009 antibody titers present in the population. The safety and immunogenicity profile presented by this pandemic VLP vaccine during the outbreak in Mexico suggests that VLP technology is a suitable alternative to current influenza vaccine technologies for producing pandemic and seasonal vaccines. PMID:22330956

Pandemic influenza--including a risk assessment of H5N1.

PubMed

Taubenberger, J K; Morens, D M

2009-04-01

Influenza pandemics and epidemics have apparently occurred since at least the Middle Ages. When pandemics appear, 50% or more of an affected population can be infected in a single year, and the number of deaths caused by influenza can dramatically exceed what is normally expected. Since 1500, there appear to have been 13 or more influenza pandemics. In the past 120 years there were undoubted pandemics in 1889, 1918, 1957, 1968, and 1977. Although most experts believe we will face another influenza pandemic, it is impossible to predict when it will appear, where it will originate, or how severe it will be. Nor is there agreement about the subtype of influenza virus most likely to cause the next pandemic. The continuing spread of H5N1 highly pathogenic avian influenza viruses has heightened interest in pandemic prediction. Despite uncertainties in the historical record of the pre-virology era, study of previous pandemics may help guide future pandemic planning and lead to a better understanding of the complex ecobiology underlying the formation of pandemic strains of influenza A viruses.

Secondary Bacterial Infections Associated with Influenza Pandemics

PubMed Central

Morris, Denise E.; Cleary, David W.; Clarke, Stuart C.

2017-01-01

Lower and upper respiratory infections are the fourth highest cause of global mortality (Lozano et al., 2012). Epidemic and pandemic outbreaks of respiratory infection are a major medical concern, often causing considerable disease and a high death toll, typically over a relatively short period of time. Influenza is a major cause of epidemic and pandemic infection. Bacterial co/secondary infection further increases morbidity and mortality of influenza infection, with Streptococcus pneumoniae, Haemophilus influenzae, and Staphylococcus aureus reported as the most common causes. With increased antibiotic resistance and vaccine evasion it is important to monitor the epidemiology of pathogens in circulation to inform clinical treatment and development, particularly in the setting of an influenza epidemic/pandemic. PMID:28690590

Deaths from bacterial pneumonia during 1918-19 influenza pandemic.

PubMed

Brundage, John F; Shanks, G Dennis

2008-08-01

Deaths during the 1918-19 influenza pandemic have been attributed to a hypervirulent influenza strain. Hence, preparations for the next pandemic focus almost exclusively on vaccine prevention and antiviral treatment for infections with a novel influenza strain. However, we hypothesize that infections with the pandemic strain generally caused self-limited (rarely fatal) illnesses that enabled colonizing strains of bacteria to produce highly lethal pneumonias. This sequential-infection hypothesis is consistent with characteristics of the 1918-19 pandemic, contemporaneous expert opinion, and current knowledge regarding the pathophysiologic effects of influenza viruses and their interactions with respiratory bacteria. This hypothesis suggests opportunities for prevention and treatment during the next pandemic (e.g., with bacterial vaccines and antimicrobial drugs), particularly if a pandemic strain-specific vaccine is unavailable or inaccessible to isolated, crowded, or medically underserved populations.

Anticipation and response: pandemic influenza in Malawi, 2009

PubMed Central

Sambala, Evanson Z.; Manderson, Lenore

2017-01-01

ABSTRACT Background: In 2006, Malawi developed a national influenza plan to mitigate, prevent and manage the burden of infection should an outbreak occur. In 2009, it translated its contingency plan to respond to the unfolding influenza pandemic. However, little is known of how Malawi translated its national influenza plan into response actions, or the success of these responses. Objective: To investigate how Malawi translated its preparedness plan and so broaden our understanding of the outcomes of the responses. Methods: We draw on data from 22 in-depth interviews with government policymakers and people working at a policy level in various non-governmental organisations, conducted to assess the level of preparedness and the challenges of translating this. Results: Through a number of public health initiatives, authorities developed communication strategies, strengthened influenza surveillance activities and updated overall goals in pandemic training and education. However, without influenza drills, exercises and simulations to test the plan, activating the pandemic plan, including coordinating and deploying generic infection control measures, was problematic. Responses during the pandemic were at times ‘weak and clumsy’ and failed to mirror the activities and processes highlighted in the preparedness plan. Conclusions: Participants stressed that in order to achieve a coordinated and successful response to mitigate and prevent the further transmission of pandemic influenza, good preparation was critical. The key elements which they identified as relevant for a rapid response included effective communications, robust evidence-based decision-making, strong and reliable surveillance systems and flexible public health responses. To effectively articulate a viable trajectory of pandemic responses, the potential value of simulation exercises could be given more consideration as a mean of sustaining good levels of preparedness and responses against future pandemics

Pandemic influenza: implications for occupational medicine

PubMed Central

Journeay, W Shane; Burnstein, Matthew D

2009-01-01

This article reviews the biological and occupational medicine literature related to H5N1 pandemic influenza and its impact on infection control, cost and business continuity in settings outside the health care community. The literature on H5N1 biology is reviewed including the treatment and infection control mechanisms as they pertain to occupational medicine. Planning activity for the potential arrival of pandemic avian influenza is growing rapidly. Much has been published on the molecular biology of H5N1 but there remains a paucity of literature on the occupational medicine impacts to organizations. This review summarizes some of the basic science surrounding H5N1 influenza and raises some key concerns in pandemic planning for the occupational medicine professional. Workplaces other than health care settings will be impacted greatly by an H5N1 pandemic and the occupational physician will play an essential role in corporate preparation, response, and business continuity strategies. PMID:19549302

Seasonality in risk of pandemic influenza emergence

PubMed Central

Meyers, Lauren Ancel

2017-01-01

Influenza pandemics can emerge unexpectedly and wreak global devastation. However, each of the six pandemics since 1889 emerged in the Northern Hemisphere just after the flu season, suggesting that pandemic timing may be predictable. Using a stochastic model fit to seasonal flu surveillance data from the United States, we find that seasonal flu leaves a transient wake of heterosubtypic immunity that impedes the emergence of novel flu viruses. This refractory period provides a simple explanation for not only the spring-summer timing of historical pandemics, but also early increases in pandemic severity and multiple waves of transmission. Thus, pandemic risk may be seasonal and predictable, with the accuracy of pre-pandemic and real-time risk assessments hinging on reliable seasonal influenza surveillance and precise estimates of the breadth and duration of heterosubtypic immunity. PMID:29049288

Modeling the economic impact of pandemic influenza: a case study in Turkey.

PubMed

Yoldascan, Elcin; Kurtaran, Behice; Koyuncu, Melik; Koyuncu, Esra

2010-04-01

Influenza pandemics have occurred intermittently throughout the 20th century and killed millions of people worldwide. It is expected that influenza pandemics will continue to occur in the near future. Huge number of deaths and cases is the most troublesome aspect of the influenza pandemics, but the other important trouble is the economic impact of the influenza pandemics to the countries. In this study, we try to detect the cost of a possible influenza pandemic under different scenarios and attack rates. We include the vaccination and antiviral treatment cost for direct cost and we add the work absenteeism cost to the calculations for indirect cost of influenza pandemics. As a case study, we calculate the economic impact of pandemic influenza for Turkey under three different scenarios and three different attack rates. Our optimistic estimation shows that the economic impact of pandemic influenza will be between 1.364 billion dollars and 2.687 billions dollars to Turkish economy depending on the vaccination strategies.

Stockpiling Ventilators for Influenza Pandemics.

PubMed

Huang, Hsin-Chan; Araz, Ozgur M; Morton, David P; Johnson, Gregory P; Damien, Paul; Clements, Bruce; Meyers, Lauren Ancel

2017-06-01

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response.

Stockpiling Ventilators for Influenza Pandemics

PubMed Central

Araz, Ozgur M.; Morton, David P.; Johnson, Gregory P.; Damien, Paul; Clements, Bruce; Meyers, Lauren Ancel

2017-01-01

In preparing for influenza pandemics, public health agencies stockpile critical medical resources. Determining appropriate quantities and locations for such resources can be challenging, given the considerable uncertainty in the timing and severity of future pandemics. We introduce a method for optimizing stockpiles of mechanical ventilators, which are critical for treating hospitalized influenza patients in respiratory failure. As a case study, we consider the US state of Texas during mild, moderate, and severe pandemics. Optimal allocations prioritize local over central storage, even though the latter can be deployed adaptively, on the basis of real-time needs. This prioritization stems from high geographic correlations and the slightly lower treatment success assumed for centrally stockpiled ventilators. We developed our model and analysis in collaboration with academic researchers and a state public health agency and incorporated it into a Web-based decision-support tool for pandemic preparedness and response. PMID:28518041

Pandemic influenza – including a risk assessment of H5N1

PubMed Central

Taubenberger, J.K.; Morens, D.M.

2009-01-01

Summary Influenza pandemics and epidemics have apparently occurred since at least the Middle Ages. When pandemics appear, 50% or more of an affected population can be infected in a single year, and the number of deaths caused by influenza can dramatically exceed what is normally expected. Since 1500, there appear to have been 13 or more influenza pandemics. In the past 120 years there were undoubted pandemics in 1889, 1918, 1957, 1968, and 1977. Although most experts believe we will face another influenza pandemic, it is impossible to predict when it will appear, where it will originate, or how severe it will be. Nor is there agreement about the subtype of influenza virus most likely to cause the next pandemic. The continuing spread of H5N1 highly pathogenic avian influenza viruses has heightened interest in pandemic prediction. Despite uncertainties in the historical record of the pre-virology era, study of previous pandemics may help guide future pandemic planning and lead to a better understanding of the complex ecobiology underlying the formation of pandemic strains of influenza A viruses. PMID:19618626

Rapid detection of pandemic influenza in the presence of seasonal influenza

PubMed Central

2010-01-01

Background Key to the control of pandemic influenza are surveillance systems that raise alarms rapidly and sensitively. In addition, they must minimise false alarms during a normal influenza season. We develop a method that uses historical syndromic influenza data from the existing surveillance system 'SERVIS' (Scottish Enhanced Respiratory Virus Infection Surveillance) for influenza-like illness (ILI) in Scotland. Methods We develop an algorithm based on the weekly case ratio (WCR) of reported ILI cases to generate an alarm for pandemic influenza. From the seasonal influenza data from 13 Scottish health boards, we estimate the joint probability distribution of the country-level WCR and the number of health boards showing synchronous increases in reported influenza cases over the previous week. Pandemic cases are sampled with various case reporting rates from simulated pandemic influenza infections and overlaid with seasonal SERVIS data from 2001 to 2007. Using this combined time series we test our method for speed of detection, sensitivity and specificity. Also, the 2008-09 SERVIS ILI cases are used for testing detection performances of the three methods with a real pandemic data. Results We compare our method, based on our simulation study, to the moving-average Cumulative Sums (Mov-Avg Cusum) and ILI rate threshold methods and find it to be more sensitive and rapid. For 1% case reporting and detection specificity of 95%, our method is 100% sensitive and has median detection time (MDT) of 4 weeks while the Mov-Avg Cusum and ILI rate threshold methods are, respectively, 97% and 100% sensitive with MDT of 5 weeks. At 99% specificity, our method remains 100% sensitive with MDT of 5 weeks. Although the threshold method maintains its sensitivity of 100% with MDT of 5 weeks, sensitivity of Mov-Avg Cusum declines to 92% with increased MDT of 6 weeks. For a two-fold decrease in the case reporting rate (0.5%) and 99% specificity, the WCR and threshold methods

Refining the approach to vaccines against influenza A viruses with pandemic potential

PubMed Central

Czako, Rita; Subbarao, Kanta

2015-01-01

Vaccination is the most effective strategy for prevention and control of influenza. Timely production and deployment of seasonal influenza vaccines is based on an understanding of the epidemiology of influenza and on global disease and virologic surveillance. Experience with seasonal influenza vaccines guided the initial development of pandemic influenza vaccines. A large investment in pandemic influenza vaccines in the last decade has resulted in much progress and a body of information that can now be applied to refine the established paradigm. Critical and complementary considerations for pandemic influenza vaccines include improved assessment of the pandemic potential of animal influenza viruses, proactive development and deployment of pandemic influenza vaccines, and application of novel platforms and strategies for vaccine production and administration. PMID:26587050

Outbreak of pandemic influenza A/H1N1 2009 in Nepal.

PubMed

Adhikari, Bal Ram; Shakya, Geeta; Upadhyay, Bishnu Prasad; Prakash Kc, Khagendra; Shrestha, Sirjana Devi; Dhungana, Guna Raj

2011-03-23

The 2009 flu pandemic is a global outbreak of a new strain of H1N1 influenza virus. Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge world-wide. Nepal has started Laboratory diagnosis of Pandemic influenza A/H1N1 from mid June 2009 though active screening of febrile travellers with respiratory symptoms was started from April 27, 2009. Out of 609 collected samples, 302 (49.6%) were Universal Influenza A positive. Among the influenza A positive samples, 172(28.3%) were positive for Pandemic influenza A/H1N1 and 130 (21.3%) were Seasonal influenza A. Most of the pandemic cases (53%) were found among young people with ≤ 20 years. Case Fatality Ratio for Pandemic influenza A/H1N1 in Nepal was 1.74%. Upon Molecular characterization, all the isolated pandemic influenza A/H1N1 2009 virus found in Nepal were antigenically and genetically related to the novel influenza A/CALIFORNIA/07/2009-LIKE (H1N1)v type. The Pandemic 2009 influenza virus found in Nepal were antigenically and genetically related to the novel A/CALIFORNIA/07/2009-LIKE (H1N1)v type.

Mechanistic insights into influenza vaccine-associated narcolepsy.

PubMed

Ahmed, S Sohail; Steinman, Lawrence

2016-12-01

We previously reported an increased frequency of antibodies to hypocretin (HCRT) receptor 2 in sera obtained from narcoleptic patients who received the European AS03-adjuvanted vaccine Pandemrix (GlaxoSmithKline Biologicals, s.a.) for the global influenza A H1N1 pandemic in 2009 [A(H1N1)pdm09]. These antibodies cross-reacted with a particular fragment of influenza nucleoprotein (NP) - one of the proteins naturally contained in the virus used to make seasonal influenza vaccine and pandemic influenza vaccines. The purpose of this commentary is to provide additional insights and interpretations of the findings and share additional data not presented in the original paper to help the reader appreciate the key messages of that publication. First, a brief background to narcolepsy and vaccine-induced narcolepsy will be provided. Then, additional insights and clarification will be provided on the following topics: 1) the critical difference identified in the adjuvanted A(H1N1)pdm09 vaccines, 2) the contributing factor likely for the discordant association of narcolepsy between the AS03-adjuvanted pandemic vaccines Pandemrix and Arepanrix (GlaxoSmithKline Biologicals, s.a.), 3) the significance of detecting HCRT receptor 2 (HCRTr2) antibodies in some Finnish control subjects, 4) the approach used for the detection of HCRTr2 antibodies in vaccine-associated narcolepsy, and 5) the plausibility of the proposed mechanism involving HCRTr2 modulation in vaccine-associated narcolepsy.

Incidence of medically attended influenza during pandemic and post-pandemic seasons through the Influenza Incidence Surveillance Project, 2009-13.

PubMed

Fowlkes, Ashley; Steffens, Andrea; Temte, Jon; Lonardo, Steve Di; McHugh, Lisa; Martin, Karen; Rubino, Heather; Feist, Michelle; Davis, Carol; Selzer, Christine; Lojo, Jose; Oni, Oluwakemi; Kurkjian, Katie; Thomas, Ann; Boulton, Rachelle; Bryan, Nicole; Lynfield, Ruth; Biggerstaff, Matthew; Finelli, Lyn

2015-09-01

Since the introduction of pandemic influenza A (H1N1) to the USA in 2009, the Influenza Incidence Surveillance Project has monitored the burden of influenza in the outpatient setting through population-based surveillance. From Oct 1, 2009, to July 31, 2013, outpatient clinics representing 13 health jurisdictions in the USA reported counts of influenza-like illness (fever including cough or sore throat) and all patient visits by age. During four years, staff at 104 unique clinics (range 35-64 per year) with a combined median population of 368,559 (IQR 352,595-428,286) attended 35,663 patients with influenza-like illness and collected 13,925 respiratory specimens. Clinical data and a respiratory specimen for influenza testing by RT-PCR were collected from the first ten patients presenting with influenza-like illness each week. We calculated the incidence of visits for influenza-like illness using the size of the patient population, and the incidence attributable to influenza was extrapolated from the proportion of patients with positive tests each week. The site-median peak percentage of specimens positive for influenza ranged from 58.3% to 77.8%. Children aged 2 to 17 years had the highest incidence of influenza-associated visits (range 4.2-28.0 per 1000 people by year), and adults older than 65 years had the lowest (range 0.5-3.5 per 1000 population). Influenza A H3N2, pandemic H1N1, and influenza B equally co-circulated in the first post-pandemic season, whereas H3N2 predominated for the next two seasons. Of patients for whom data was available, influenza vaccination was reported in 3289 (28.7%) of 11,459 patients with influenza-like illness, and antivirals were prescribed to 1644 (13.8%) of 11,953 patients. Influenza incidence varied with age groups and by season after the pandemic of 2009 influenza A H1N1. High levels of influenza virus circulation, especially in young children, emphasise the need for additional efforts to increase the uptake of influenza

Pandemic Paradox: Early Life H2N2 Pandemic Influenza Infection Enhanced Susceptibility to Death during the 2009 H1N1 Pandemic.

PubMed

Gagnon, Alain; Acosta, Enrique; Hallman, Stacey; Bourbeau, Robert; Dillon, Lisa Y; Ouellette, Nadine; Earn, David J D; Herring, D Ann; Inwood, Kris; Madrenas, Joaquin; Miller, Matthew S

2018-01-16

Recent outbreaks of H5, H7, and H9 influenza A viruses in humans have served as a vivid reminder of the potentially devastating effects that a novel pandemic could exert on the modern world. Those who have survived infections with influenza viruses in the past have been protected from subsequent antigenically similar pandemics through adaptive immunity. For example, during the 2009 H1N1 "swine flu" pandemic, those exposed to H1N1 viruses that circulated between 1918 and the 1940s were at a decreased risk for mortality as a result of their previous immunity. It is also generally thought that past exposures to antigenically dissimilar strains of influenza virus may also be beneficial due to cross-reactive cellular immunity. However, cohorts born during prior heterosubtypic pandemics have previously experienced elevated risk of death relative to surrounding cohorts of the same population. Indeed, individuals born during the 1890 H3Nx pandemic experienced the highest levels of excess mortality during the 1918 "Spanish flu." Applying Serfling models to monthly mortality and influenza circulation data between October 1997 and July 2014 in the United States and Mexico, we show corresponding peaks in excess mortality during the 2009 H1N1 "swine flu" pandemic and during the resurgent 2013-2014 H1N1 outbreak for those born at the time of the 1957 H2N2 "Asian flu" pandemic. We suggest that the phenomenon observed in 1918 is not unique and points to exposure to pandemic influenza early in life as a risk factor for mortality during subsequent heterosubtypic pandemics. IMPORTANCE The relatively low mortality experienced by older individuals during the 2009 H1N1 influenza virus pandemic has been well documented. However, reported situations in which previous influenza virus exposures have enhanced susceptibility are rare and poorly understood. One such instance occurred in 1918-when those born during the heterosubtypic 1890 H3Nx influenza virus pandemic experienced the highest

The ghost of pandemics past: revisiting two centuries of influenza in Sweden

PubMed Central

Holmberg, Martin

2017-01-01

Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the ‘configuration’ of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of ‘pandemic’ influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures—households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life. PMID:28855380

Pandemic Influenza Planning: Addressing the Needs of Children

PubMed Central

Barrios, Lisa; Cordell, Ralph; Delozier, David; Gorman, Susan; Koenig, Linda J.; Odom, Erica; Polder, Jacquelyn; Randolph, Jean; Shimabukuro, Tom; Singleton, Christa

2009-01-01

Children represent one quarter of the US population. Because of its enormous size and special needs, it is critically important to address this population group in pandemic influenza planning. Here we describe the ways in which children are vulnerable in a pandemic, provide an overview of existing plans, summarize the resources available, and, given our experience with influenza A(H1N1), outline the evolving lessons we have learned with respect to planning for a severe influenza pandemic. We focus on a number of issues affecting children—vaccinations, medication availability, hospital capacity, and mental health concerns—and emphasize strategies that will protect children from exposure to the influenza virus, including infection control practices and activities in schools and child care programs. PMID:19797738

The first influenza pandemic of the new millennium

PubMed Central

Neumann, Gabriele; Kawaoka, Yoshihiro

2011-01-01

Please cite this paper as: Neumann G, Kawaoka Y. (2011) The first influenza pandemic of the new millennium. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2011.00202.x. In the spring of 2009, a novel influenza A virus of the H1N1 subtype emerged that transmitted efficiently among humans; by June of 2009, the outbreak reached pandemic status. The pandemic virus possesses six viral RNA segments from so‐called triple reassortant swine viruses that emerged in North American pig populations in the late 1990s and two viral RNA segments from Eurasian avian‐like swine influenza viruses. Most human infections with the virus have been mild; however, severe and fatal infections occurred among certain risk groups, but also among those without any known risk factors. Here, we summarize the evolutionary, epidemiological, clinical, and molecular findings on the pandemic virus. We also discuss the arsenal of antiviral compounds and vaccines available to prevent and treat infections with the virus. PMID:21477134

Mathematical assessment of Canada's pandemic influenza preparedness plan.

PubMed

Gumel, Abba B; Nuño, Miriam; Chowell, Gerardo

2008-03-01

The presence of the highly pathogenic avian H5N1 virus in wild bird populations in several regions of the world, together with recurrent cases of H5N1 influenza arising primarily from direct contact with poultry, have highlighted the urgent need for prepared-ness and coordinated global strategies to effectively combat a potential influenza pandemic. The purpose of the present study was to evaluate the Canadian pandemic influenza preparedness plan. A mathematical model of the transmission dynamics of influenza was used to keep track of the population according to risk of infection (low or high) and infection status (susceptible, exposed or infectious). The model was parametrized using available Canadian demographic data. The model was then used to evaluate the key components outlined in the Canadian plan. The results indicated that the number of cases, mortalities and hospitalizations estimated in the Canadian plan may have been underestimated; the use of antivirals, administered therapeutically, prophylactically or both, is the most effective single intervention followed by the use of a vaccine and basic public health measures; and the combined use of pharmaceutical interventions (antivirals and vaccine) can dramatically minimize the burden of the pending influenza pandemic in Canada. Based on increasing concerns of Oseltamivir resistance (wide-scale implementation), coupled with the expected unavailability of a suitable vaccine during the early stages of a pandemic, the present study evaluated the potential impact of non-pharmaceutical interventions (NPIs) which were not emphasized in the current Canadian plan. To this end, the findings suggest that the use of NPIs can drastically reduce the burden of a pandemic in Canada. A deterministic model was designed and used to assess Canada's pandemic preparedness plan. The study showed that the estimates of pandemic influenza burden given in the Canada pandemic preparedness plan may be an underestimate, and that Canada

Pandemic and post-pandemic Influenza A (H1N1) infection in critically ill patients

PubMed Central

2011-01-01

Background There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. Methods A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Results Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Conclusion Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection. PMID:22126648

Pandemic and post-pandemic influenza A (H1N1) infection in critically ill patients.

PubMed

Martin-Loeches, Ignacio; Díaz, Emili; Vidaur, Loreto; Torres, Antoni; Laborda, Cesar; Granada, Rosa; Bonastre, Juan; Martín, Mar; Insausti, Josu; Arenzana, Angel; Guerrero, Jose Eugenio; Navarrete, Ines; Bermejo-Martin, Jesus; Suarez, David; Rodriguez, Alejandro

2011-01-01

There is a vast amount of information published regarding the impact of 2009 pandemic Influenza A (pH1N1) virus infection. However, a comparison of risk factors and outcome during the 2010-2011 post-pandemic period has not been described. A prospective, observational, multi-center study was carried out to evaluate the clinical characteristics and demographics of patients with positive RT-PCR for H1N1 admitted to 148 Spanish intensive care units (ICUs). Data were obtained from the 2009 pandemic and compared to the 2010-2011 post-pandemic period. Nine hundred and ninety-seven patients with confirmed An/H1N1 infection were included. Six hundred and forty-eight patients affected by 2009 (pH1N1) virus infection and 349 patients affected by the post-pandemic Influenza (H1N1)v infection period were analyzed. Patients during the post-pandemic period were older, had more chronic comorbid conditions and presented with higher severity scores (Acute Physiology And Chronic Health Evaluation II (APACHE II) and Sequential Organ Failure Assessment (SOFA)) on ICU admission. Patients from the post-pandemic Influenza (H1N1)v infection period received empiric antiviral treatment less frequently and with delayed administration. Mortality was significantly higher in the post-pandemic period. Multivariate analysis confirmed that haematological disease, invasive mechanical ventilation and continuous renal replacement therapy were factors independently associated with worse outcome in the two periods. HIV was the only new variable independently associated with higher ICU mortality during the post-pandemic Influenza (H1N1)v infection period. Patients from the post-pandemic Influenza (H1N1)v infection period had an unexpectedly higher mortality rate and showed a trend towards affecting a more vulnerable population, in keeping with more typical seasonal viral infection.

Knowledge about pandemic influenza and compliance with containment measures among Australians.

PubMed

Eastwood, Keith; Durrheim, David; Francis, J Lynn; d'Espaignet, Edouard Tursan; Duncan, Sarah; Islam, Fakhrul; Speare, Rick

2009-08-01

To examine the level of stated compliance with public health pandemic influenza control measures and explore factors influencing cooperation for pandemic influenza control in Australia. A computer-assisted telephone interview survey was conducted by professional interviewers to collect information on the Australian public's knowledge of pandemic influenza and willingness to comply with public health control measures. The sample was randomly selected using an electronic database and printed telephone directories to ensure sample representativeness from all Australian states and territories. After we described pandemic influenza to the respondents to ensure they understood the significance of the issue, the questions on compliance were repeated and changes in responses were analysed with McNemar's test for paired data Only 23% of the 1166 respondents demonstrated a clear understanding of the term 'pandemic influenza'. Of those interviewed, 94.1% reported being willing to comply with home quarantine; 94.2%, to avoid public events; and 90.7%, to postpone social gatherings. After we explained the meaning of 'pandemic' to interviewees, stated compliance increased significantly (to 97.5%, 98.3% and 97.2% respectively). Those who reported being unfamiliar with the term 'pandemic influenza,' male respondents and employed people not able to work from home were less willing to comply. In Australia, should the threat arise, compliance with containment measures against pandemic influenza is likely to be high, yet it could be further enhanced through a public education programme conveying just a few key messages. A basic understanding of pandemic influenza is associated with stated willingness to comply with containment measures. Investing now in promoting measures to prepare for a pandemic or other health emergency will have considerable value.

The 1918–1920 influenza pandemic in Peru

PubMed Central

Chowell, G.; Viboud, C.; Simonsen, L.; Miller, M.A.; Hurtado, J.; Soto, G.; Vargas, R.; Guzman, M.A.; Ulloa, M.; Munayco, C.V.

2011-01-01

Background Increasing our knowledge of past influenza pandemic patterns in different regions of the world is crucial to guide preparedness plans against future influenza pandemics. Here, we undertook extensive archival collection efforts from 3 representative cities of Peru (Lima in the central coast, Iquitos in the northeastern Amazon region, Ica in the southern coast) to characterize the age and geographic patterns of the 1918–1920 influenza pandemic in this country. Materials and Methods We analyzed historical documents describing the 1918–1920 influenza pandemic in Peru and retrieved individual mortality records from local provincial archives for quantitative analysis. We applied seasonal excess mortality models to daily and monthly respiratory mortality rates for 1917–1920 and quantified transmissibility estimates based on the daily growth rate in respiratory deaths. Results A total of 52,739 individual mortality records were inspected from local provincial archives. We found evidence for an initial mild pandemic wave during July-September 1918 in Lima, identified a synchronized severe pandemic wave of respiratory mortality in all three locations in Peru during November 1918-February 1919, and a severe pandemic wave during January 1920- March 1920 in Lima and July-October 1920 in Ica. There was no recrudescent pandemic wave in 1920 in Iquitos. Remarkably, Lima experienced the brunt of the 1918–20 excess mortality impact during the 1920 recrudescent wave, with all age groups experiencing an increase in all cause excess mortality from 1918–19 to 1920. Middle age groups experienced the highest excess mortality impact, relative to baseline levels, in the 1918–19 and 1920 pandemic waves. Cumulative excess mortality rates for the 1918–20 pandemic period were higher in Iquitos (2.9%) than Lima (1.6%). The mean reproduction number for Lima was estimated in the range 1.3–1.5. Conclusions We identified synchronized pandemic waves of intense excess

Early-warning signals for an outbreak of the influenza pandemic

NASA Astrophysics Data System (ADS)

Ren, Di; Gao, Jie

2011-12-01

Over the course of human history, influenza pandemics have been seen as major disasters, so studies on the influenza virus have become an important issue for many experts and scholars. Comprehensive research has been performed over the years on the biological properties, chemical characteristics, external environmental factors and other aspects of the virus, and some results have been achieved. Based on the chaos game representation walk model, this paper uses the time series analysis method to study the DNA sequences of the influenza virus from 1913 to 2010, and works out the early-warning signals indicator value for the outbreak of an influenza pandemic. The variances in the CGR walk sequences for the pandemic years (or + -1 to 2 years) are significantly higher than those for the adjacent years, while those in the non-pandemic years are usually smaller. In this way we can provide an influenza early-warning mechanism so that people can take precautions and be well prepared prior to a pandemic.

The ghost of pandemics past: revisiting two centuries of influenza in Sweden.

PubMed

Holmberg, Martin

2017-09-01

Previous influenza pandemics are usually invoked in pandemic preparedness planning without a thorough analysis of the events surrounding them, what has been called the 'configuration' of epidemics. Historic pandemics are instead used to contrast them to the novelty of the coming imagined plague or as fear of a ghost-like repetition of the past. This view of pandemics is guided by a biomedical framework that is ahistorical and reductionist. The meaning of 'pandemic' influenza is in fact highly ambiguous in its partitioning of pandemic and seasonal influenza. The past 200 years of influenza epidemics in Sweden are examined with a special focus on key social structures-households, schools, transportations and the military. These are shown to have influenced the progression of influenza pandemics. Prevailing beliefs around influenza pandemics have also profoundly influenced intervention strategies. Measuring long-term trends in pandemic severity is problematic because pandemics are non-linear events where the conditions surrounding them constantly change. However, in a linearised view, the Spanish flu can be seen to represent a historical turning point and the H1N1 2009 pandemic not as an outlier, but following a 100-year trend of decreasing severity. Integrating seasonal and pandemic influenza, and adopting an ecosocial stance can deepen our understanding and bring the ghost-like pandemic past to life. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Incidence of medically attended influenza during pandemic and post-pandemic seasons through the Influenza Incidence Surveillance Project, 2009–13

PubMed Central

Fowlkes, Ashley; Steffens, Andrea; Temte, Jon; Di Lonardo, Steve; McHugh, Lisa; Martin, Karen; Rubino, Heather; Feist, Michelle; Davis, Carol; Selzer, Christine; Lojo, Jose; Oni, Oluwakemi; Kurkjian, Katie; Thomas, Ann; Boulton, Rachelle; Bryan, Nicole; Lynfield, Ruth; Biggerstaff, Matthew; Finelli, Lyn

2017-01-01

Summary Background Since the introduction of pandemic influenza A (H1N1) to the USA in 2009, the Influenza Incidence Surveillance Project has monitored the burden of influenza in the outpatient setting through population-based surveillance. Methods From Oct 1, 2009, to July 31, 2013, outpatient clinics representing 13 health jurisdictions in the USA reported counts of influenza-like illness (fever including cough or sore throat) and all patient visits by age. During four years, staff at 104 unique clinics (range 35–64 per year) with a combined median population of 368 559 (IQR 352 595–428 286) attended 35 663 patients with influenza-like illness and collected 13 925 respiratory specimens. Clinical data and a respiratory specimen for influenza testing by RT-PCR were collected from the first ten patients presenting with influenza-like illness each week. We calculated the incidence of visits for influenza-like illness using the size of the patient population, and the incidence attributable to influenza was extrapolated from the proportion of patients with positive tests each week. Findings The site-median peak percentage of specimens positive for influenza ranged from 58.3% to 77.8%. Children aged 2 to 17 years had the highest incidence of influenza-associated visits (range 4.2–28.0 per 1000 people by year), and adults older than 65 years had the lowest (range 0.5–3.5 per 1000 population). Influenza A H3N2, pandemic H1N1, and influenza B equally co-circulated in the first post-pandemic season, whereas H3N2 predominated for the next two seasons. Of patients for whom data was available, influenza vaccination was reported in 3289 (28.7%) of 11 459 patients with influenza-like illness, and antivirals were prescribed to 1644 (13.8%) of 11 953 patients. Interpretation Influenza incidence varied with age groups and by season after the pandemic of 2009 influenza A H1N1. High levels of influenza virus circulation, especially in young children, emphasise the need for

Influenza pandemic periodicity, virus recycling, and the art of risk assessment.

PubMed

Dowdle, Walter R

2006-01-01

Influenza pandemic risk assessment is an uncertain art. The theory that influenza A virus pandemics occur every 10 to 11 years and seroarcheologic evidence of virus recycling set the stage in early 1976 for risk assessment and risk management of the Fort Dix, New Jersey, swine influenza outbreak. Additional data and passage of time proved the theory untenable. Much has been learned about influenza A virus and its natural history since 1976, but the exact conditions that lead to the emergence of a pandemic strain are still unknown. Current avian influenza events parallel those of swine influenza in 1976 but on a larger and more complex scale. Pre- and post-pandemic risk assessment and risk management are continuous but separate public health functions.

The use of mathematical models to inform influenza pandemic preparedness and response

PubMed Central

Wu, Joseph T; Cowling, Benjamin J

2011-01-01

Summary Influenza pandemics have occurred throughout history and were associated with substantial excess mortality and morbidity. Mathematical models of infectious diseases permit quantitative description of epidemic processes based on the underlying biological mechanisms. Mathematical models have been widely used in the past decade to aid pandemic planning by allowing detailed predictions of the speed of spread of an influenza pandemic and the likely effectiveness of alternative control strategies. During the initial waves of the 2009 influenza pandemic, mathematical models were used to track the spread of the virus, predict the time course of the pandemic and assess the likely impact of large-scale vaccination. While mathematical modeling has made substantial contributions to influenza pandemic preparedness, its use as a real-time tool for pandemic control is currently limited by the lack of essential surveillance information such as serologic data. Mathematical modeling provided a useful framework for analyzing and interpreting surveillance data during the 2009 influenza pandemic, for highlighting limitations in existing pandemic surveillance systems, and for guiding how these systems should be strengthened in order to cope with future epidemics of influenza or other emerging infectious diseases. PMID:21727183

Influenza pandemic preparedness: motivation for protection among small and medium businesses in Australia.

PubMed

Watkins, Rochelle E; Cooke, Feonagh C; Donovan, Robert J; MacIntyre, C Raina; Itzwerth, Ralf; Plant, Aileen J

2007-07-17

Community-wide preparedness for pandemic influenza is an issue that has featured prominently in the recent news media, and is currently a priority for health authorities in many countries. The small and medium business sector is a major provider of private sector employment in Australia, yet we have little information about the preparedness of this sector for pandemic influenza. This study aimed to investigate the association between individual perceptions and preparedness for pandemic influenza among small and medium business owners and managers. Semi-structured face-to-face interviews were conducted with 201 small and medium business owners or managers in New South Wales and Western Australia. Eligible small or medium businesses were defined as those that had less than 200 employees. Binomial logistic regression analysis was used to identify the predictors of having considered the impact of, having a plan for, and needing help to prepare for pandemic influenza. Approximately 6 per cent of participants reported that their business had a plan for pandemic influenza, 39 per cent reported that they had not thought at all about the impact of pandemic influenza on their business, and over 60 per cent stated that they required help to prepare for a pandemic. Beliefs about the severity of pandemic influenza and the ability to respond were significant independent predictors of having a plan for pandemic influenza, and the perception of the risk of pandemic influenza was the most important predictor of both having considered the impact of, and needing help to prepare for a pandemic. Our findings suggest that small and medium businesses in Australia are not currently well prepared for pandemic influenza. We found that beliefs about the risk, severity, and the ability to respond effectively to the threat of pandemic influenza are important predictors of preparedness. Campaigns targeting small and medium businesses should emphasise the severity of the consequences to their

Characteristics of atopic children with pandemic H1N1 influenza viral infection: pandemic H1N1 influenza reveals 'occult' asthma of childhood.

PubMed

Hasegawa, Shunji; Hirano, Reiji; Hashimoto, Kunio; Haneda, Yasuhiro; Shirabe, Komei; Ichiyama, Takashi

2011-02-01

The number of human cases of pandemic H1N1 influenza viral infection has increased in Japan since April 2009, as it has worldwide. This virus is widespread in the Yamaguchi prefecture in western Japan, where most infected children exhibited respiratory symptoms. Bronchial asthma is thought to be one of the risk factors that exacerbate respiratory symptoms of pandemic H1N1-infected patients, but the pathogenesis remains unclear. We retrospectively investigated the records of 33 children with pandemic H1N1 influenza viral infection who were admitted to our hospital between October and December 2009 and analyzed their clinical features. The percentage of children with asthma attack, with or without abnormal findings on chest radiographs (pneumonia, atelectasis, etc.), caused by pandemic H1N1 influenza infection was significantly higher than that of children with asthma attack and 2008-2009 seasonal influenza infection. Of the 33 children in our study, 22 (66.7%) experienced an asthma attack. Among these children, 20 (90.9%) did not receive long-term management for bronchial asthma, whereas 7 (31.8%) were not diagnosed with bronchial asthma and had experienced their first asthma attack. However, the severity of the attack did not correlate with the severity of the pulmonary complications of pandemic H1N1 influenza viral infection. The pandemic H1N1 influenza virus greatly increases the risk of lower respiratory tract complications such as asthma attack, pneumonia, and atelectasis, when compared to the seasonal influenza virus. Furthermore, our results suggest that pandemic H1N1 influenza viral infection can easily induce a severe asthma attack, pneumonia, and atelectasis in atopic children without any history of either an asthma attack or asthma treatment. © 2011 John Wiley & Sons A/S.

Getting Beyond Getting Ready for Pandemic Influenza

DTIC Science & Technology

2009-01-01

more information, see: http://homeland.house.gov/Hearings/index.asp?ID=89. “…Emerging biological threats such as pandemic influenza or weaponized ...which we have no immediately available cure. Work is clearly underway to prepare for such a biological event.10 However, despite the fact that...Nation to fully withstand the impact of such a devastating widespread biological event. Pandemic influenza would destroy the security of our

Boosting heterosubtypic neutralization antibodies in recipients of 2009 pandemic H1N1 influenza vaccine.

PubMed

Qiu, Chao; Huang, Yang; Wang, Qian; Tian, Di; Zhang, Wanju; Hu, Yunwen; Yuan, Zhenghong; Zhang, Xiaoyan; Xu, Jianqing

2012-01-01

A mass vaccination has been implemented to prevent the spread of 2009 pandemic influenza virus in China. Highly limited information is available on whether this vaccine induces cross-reactive neutralization antibodies against other subtypes of influenza viruses. We employed pseudovirus-based assays to analyze heterosubtypic neutralization responses in serum samples of 23 recipients of 2009 pandemic influenza vaccine. One dose of pandemic vaccine not only stimulated good neutralization antibodies against cognate influenza virus 2009 influenza A (H1N1), but also raised broad cross-reactive neutralization activities against seasonal H3N2 and highly pathogenic avian influenza virus H5N1 and lesser to H2N2. The cross-reactive neutralization activities were completely abolished after the removal of immunoglobin G (IgG). In contrast, H1N1 vaccination alone in influenza-naive mice elicited only vigorous homologous neutralizing activities but not cross-reactive neutralization activities. Our data suggest that the cross-reactive neutralization epitopes do exist in this vaccine and could elicit significant cross-reactive neutralizing IgG antibodies in the presence of preexisting responses. The exposure to H1N1 vaccine is likely to modify the hierarchical order of preexisting immune responses to influenza viruses. These findings provide insights into the evolution of human immunity to influenza viruses after experiencing multiple influenza virus infections and vaccinations.

The 2015 global production capacity of seasonal and pandemic influenza vaccine.

PubMed

McLean, Kenneth A; Goldin, Shoshanna; Nannei, Claudia; Sparrow, Erin; Torelli, Guido

2016-10-26

A global shortage and inequitable access to influenza vaccines has been cause for concern for developing countries who face dire consequences in the event of a pandemic. The Global Action Plan for Influenza Vaccines (GAP) was launched in 2006 to increase global capacity for influenza vaccine production to address these concerns. It is widely recognized that well-developed infrastructure to produce seasonal influenza vaccines leads to increased capacity to produce pandemic influenza vaccines. This article summarizes the results of a survey administered to 44 manufacturers to assess their production capacity for seasonal influenza and pandemic influenza vaccine production. When the GAP was launched in 2006, global production capacity for seasonal and pandemic vaccines was estimated to be 500million and 1.5billion doses respectively. Since 2006 there has been a significant increase in capacity, with the 2013 survey estimating global capacity at 1.5billion seasonal and 6.2billion pandemic doses. Results of the current survey showed that global seasonal influenza vaccine production capacity has decreased since 2013 from 1.504billion doses to 1.467billion doses. However, notwithstanding the overall global decrease in seasonal vaccine capacity there were notable positive changes in the distribution of production capacity with increases noted in South East Asia (SEAR) and the Western Pacific (WPR) regions, albeit on a small scale. Despite a decrease in seasonal capacity, there has been a global increase of pandemic influenza vaccine production capacity from 6.2 billion doses in 2013 to 6.4 billion doses in 2015. This growth can be attributed to a shift towards more quadrivalent vaccine production and also to increased use of adjuvants. Pandemic influenza vaccine production capacity is at its highest recorded levels however challenges remain in maintaining this capacity and in ensuring access in the event of a pandemic to underserved regions. Copyright © 2016. Published by

The 2009-2010 influenza pandemic: effects on pandemic and seasonal vaccine uptake and lessons learned for seasonal vaccination campaigns.

PubMed

Poland, Gregory A

2010-09-07

Individual and national/cultural differences were apparent in response to the 2009-2010 influenza pandemic. Overall pandemic influenza immunization rates were low across all nations, including among healthcare workers. Among the reasons for the low coverage rates may have been a lack of concern about the individual risk of influenza, which may translate into a lack of willingness or urgency to be vaccinated, particularly if there is mistrust of information provided by public health or governmental authorities. Intuitively, a link between willingness to be vaccinated against seasonal influenza and against pandemic influenza exists, given the similarities in decision-making for this infection. As such, the public is likely to share common concerns regarding pandemic and seasonal influenza vaccination, particularly in the areas of vaccine safety and side effects, and personal risk. Given the public's perception of the low level of virulence of the recent pandemic influenza virus, there is concern that the perception of a lack of personal risk of infection and risk of vaccine side effects could adversely affect seasonal vaccine uptake. While governments are more often concerned about public anxiety and panic, as well as absenteeism of healthcare and other essential workers during a pandemic, convincing the public of the threat posed by pandemic or seasonal influenza is often the more difficult, and underappreciated task. Thus, appropriate, timely, and data-driven health information are very important issues in increasing influenza vaccine coverage, perhaps even more so in western societies where trust in government and public health reports may be lower than in other countries. This article explores what has been learned about cross-cultural responses to pandemic influenza, and seeks to apply those lessons to seasonal influenza immunization programs. 2010 Elsevier Ltd. All rights reserved.

[Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics].

PubMed

Gendon, Iu Z; Vasil'ev, Iu M

2012-01-01

Epidemiologic and economic effectiveness of school closure during influenza epidemics and pandemics is discussed. Optimal effect of school closure is observed when this measure is taken at the start of the epidemic or pandemic and for a sufficiently long time. School closure during high morbidity among schoolchildren, in the middle (at the peak) and by the end of epidemic or pandemic does not influence significantly the spread of influenza or morbidity. Significant economic losses and other negative consequences of school closure are noted. School closure may be the most appropriate during the emergence of influenza pandemic when the pandemic vaccine is not yet available, however timely mass immunization of schoolchildren against influenza may be a more appropriate measure than school closure for the reduction of influenza morbidity and spread during seasonal influenza epidemics.

The age distribution of mortality due to influenza: pandemic and peri-pandemic

PubMed Central

2012-01-01

Background Pandemic influenza is said to 'shift mortality' to younger age groups; but also to spare a subpopulation of the elderly population. Does one of these effects dominate? Might this have important ramifications? Methods We estimated age-specific excess mortality rates for all-years for which data were available in the 20th century for Australia, Canada, France, Japan, the UK, and the USA for people older than 44 years of age. We modeled variation with age, and standardized estimates to allow direct comparison across age groups and countries. Attack rate data for four pandemics were assembled. Results For nearly all seasons, an exponential model characterized mortality data extremely well. For seasons of emergence and a variable number of seasons following, however, a subpopulation above a threshold age invariably enjoyed reduced mortality. 'Immune escape', a stepwise increase in mortality among the oldest elderly, was observed a number of seasons after both the A(H2N2) and A(H3N2) pandemics. The number of seasons from emergence to escape varied by country. For the latter pandemic, mortality rates in four countries increased for younger age groups but only in the season following that of emergence. Adaptation to both emergent viruses was apparent as a progressive decrease in mortality rates, which, with two exceptions, was seen only in younger age groups. Pandemic attack rate variation with age was estimated to be similar across four pandemics with very different mortality impact. Conclusions In all influenza pandemics of the 20th century, emergent viruses resembled those that had circulated previously within the lifespan of then-living people. Such individuals were relatively immune to the emergent strain, but this immunity waned with mutation of the emergent virus. An immune subpopulation complicates and may invalidate vaccine trials. Pandemic influenza does not 'shift' mortality to younger age groups; rather, the mortality level is reset by the virulence

Influenza pandemic preparedness: motivation for protection among small and medium businesses in Australia

PubMed Central

Watkins, Rochelle E; Cooke, Feonagh C; Donovan, Robert J; MacIntyre, C Raina; Itzwerth, Ralf; Plant, Aileen J

2007-01-01

Background Community-wide preparedness for pandemic influenza is an issue that has featured prominently in the recent news media, and is currently a priority for health authorities in many countries. The small and medium business sector is a major provider of private sector employment in Australia, yet we have little information about the preparedness of this sector for pandemic influenza. This study aimed to investigate the association between individual perceptions and preparedness for pandemic influenza among small and medium business owners and managers. Methods Semi-structured face-to-face interviews were conducted with 201 small and medium business owners or managers in New South Wales and Western Australia. Eligible small or medium businesses were defined as those that had less than 200 employees. Binomial logistic regression analysis was used to identify the predictors of having considered the impact of, having a plan for, and needing help to prepare for pandemic influenza. Results Approximately 6 per cent of participants reported that their business had a plan for pandemic influenza, 39 per cent reported that they had not thought at all about the impact of pandemic influenza on their business, and over 60 per cent stated that they required help to prepare for a pandemic. Beliefs about the severity of pandemic influenza and the ability to respond were significant independent predictors of having a plan for pandemic influenza, and the perception of the risk of pandemic influenza was the most important predictor of both having considered the impact of, and needing help to prepare for a pandemic. Conclusion Our findings suggest that small and medium businesses in Australia are not currently well prepared for pandemic influenza. We found that beliefs about the risk, severity, and the ability to respond effectively to the threat of pandemic influenza are important predictors of preparedness. Campaigns targeting small and medium businesses should emphasise the

Prevention and control of avian influenza: the need for a paradigm shift in pandemic influenza preparedness.

PubMed

Martinot, A; Thomas, J; Thiermann, A; Dasgupta, N

2007-03-10

Avian influenza presents both challenges and opportunities to leaders around the world engaged in pandemic influenza preparedness planning. Most resource-poor countries will be unable to stockpile antivirals or have access to eventual human vaccines for pandemic flu. Preparedness plans, directed at controlling avian influenza at the source, enable countries simultaneously to promote national and global health, animal welfare and international development. Improving the veterinary infrastructure and capacity of resource-poor countries is one way to prevent potential pandemic flu deaths in resource-rich countries. In this article, Amanda Martinot, James Thomas, Alejandro Thiermann and Nabarun Dasgupta argue that national health leaders need to consider more comprehensive strategies that incorporate veterinary surveillance and improvements in veterinary infrastructure for the control of avian influenza epizootics as part of national pandemic preparedness planning. This, they argue, will require a shift in attitude, from thinking in terms of preparation for an inevitable pandemic to pre-emption of the potential pandemic through prevention measures in the animal population.

Post-pandemic seroprevalence of human influenza viruses in domestic cats

PubMed Central

Ibrahim, Mahmoud; Ali, Ahmed; Daniels, Joshua B.

2016-01-01

The continuous exposure of cats to diverse influenza viruses raises the concern of a potential role of cats in the epidemiology of these viruses. Our previous seroprevalence study of domestic cat sera collected during the 2009 H1N1 pandemic wave (September 2009–September 2010) revealed a high prevalence of pandemic H1N1, as well as seasonal H1N1 and H3N2 human flu virus infection (22.5%, 33.0%, and 43.5%, respectively). In this study, we extended the serosurvey of influenza viruses in cat sera collected post-pandemic (June 2011–August 2012). A total of 432 cat sera were tested using the hemagglutination inhibition assay. The results showed an increase in pandemic H1N1 prevalence (33.6%) and a significant reduction in both seasonal H1N1 and H3N2 prevalence (10.9% and 17.6%, respectively) compared to our previous survey conducted during the pandemic wave. The pandemic H1N1 prevalence in cats showed an irregular seasonality pattern in the post-pandemic phase. Pandemic H1N1 reactivity was more frequent among female cats than male cats. In contrast to our earlier finding, no significant association between clinical respiratory disease and influenza virus infection was observed. Our study highlights a high susceptibility among cats to human influenza virus infection that is correlated with influenza prevalence in the human population. PMID:27030198

Post-pandemic seroprevalence of human influenza viruses in domestic cats.

PubMed

Ibrahim, Mahmoud; Ali, Ahmed; Daniels, Joshua B; Lee, Chang-Won

2016-12-30

The continuous exposure of cats to diverse influenza viruses raises the concern of a potential role of cats in the epidemiology of these viruses. Our previous seroprevalence study of domestic cat sera collected during the 2009 H1N1 pandemic wave (September 2009-September 2010) revealed a high prevalence of pandemic H1N1, as well as seasonal H1N1 and H3N2 human flu virus infection (22.5%, 33.0%, and 43.5%, respectively). In this study, we extended the serosurvey of influenza viruses in cat sera collected post-pandemic (June 2011-August 2012). A total of 432 cat sera were tested using the hemagglutination inhibition assay. The results showed an increase in pandemic H1N1 prevalence (33.6%) and a significant reduction in both seasonal H1N1 and H3N2 prevalence (10.9% and 17.6%, respectively) compared to our previous survey conducted during the pandemic wave. The pandemic H1N1 prevalence in cats showed an irregular seasonality pattern in the post-pandemic phase. Pandemic H1N1 reactivity was more frequent among female cats than male cats. In contrast to our earlier finding, no significant association between clinical respiratory disease and influenza virus infection was observed. Our study highlights a high susceptibility among cats to human influenza virus infection that is correlated with influenza prevalence in the human population.

Comparative community burden and severity of seasonal and pandemic influenza: results of the Flu Watch cohort study.

PubMed

Hayward, Andrew C; Fragaszy, Ellen B; Bermingham, Alison; Wang, Lili; Copas, Andrew; Edmunds, W John; Ferguson, Neil; Goonetilleke, Nilu; Harvey, Gabrielle; Kovar, Jana; Lim, Megan S C; McMichael, Andrew; Millett, Elizabeth R C; Nguyen-Van-Tam, Jonathan S; Nazareth, Irwin; Pebody, Richard; Tabassum, Faiza; Watson, John M; Wurie, Fatima B; Johnson, Anne M; Zambon, Maria

2014-06-01

Assessment of the effect of influenza on populations, including risk of infection, illness if infected, illness severity, and consultation rates, is essential to inform future control and prevention. We aimed to compare the community burden and severity of seasonal and pandemic influenza across different age groups and study years and gain insight into the extent to which traditional surveillance underestimates this burden. Using preseason and postseason serology, weekly illness reporting, and RT-PCR identification of influenza from nasal swabs, we tracked the course of seasonal and pandemic influenza over five successive cohorts (England 2006-11; 5448 person-seasons' follow-up). We compared burden and severity of seasonal and pandemic strains. We weighted analyses to the age and regional structure of England to give nationally representative estimates. We compared symptom profiles over the first week of illness for different strains of PCR-confirmed influenza and non-influenza viruses using ordinal logistic regression with symptom severity grade as the outcome variable. Based on four-fold titre rises in strain-specific serology, on average influenza infected 18% (95% CI 16-22) of unvaccinated people each winter. Of those infected there were 69 respiratory illnesses per 100 person-influenza-seasons compared with 44 per 100 in those not infected with influenza. The age-adjusted attributable rate of illness if infected was 23 illnesses per 100 person-seasons (13-34), suggesting most influenza infections are asymptomatic. 25% (18-35) of all people with serologically confirmed infections had PCR-confirmed disease. 17% (10-26) of people with PCR-confirmed influenza had medically attended illness. These figures did not differ significantly when comparing pandemic with seasonal influenza. Of PCR-confirmed cases, people infected with the 2009 pandemic strain had markedly less severe symptoms than those infected with seasonal H3N2. Seasonal influenza and the 2009 pandemic

Social capital and health-protective behavior intentions in an influenza pandemic.

PubMed

Chuang, Ying-Chih; Huang, Ya-Li; Tseng, Kuo-Chien; Yen, Chia-Hsin; Yang, Lin-hui

2015-01-01

Health-protective behaviors, such as receiving a vaccine, wearing a face mask, and washing hands frequently, can reduce the risk of contracting influenza. However, little is known about how social capital may influence health-protective behavior in the general population. This study examined whether each of the social capital dimensions (bonding, bridging, and linking) contributed to the intention to adopt any of the health-protective behaviors in an influenza pandemic. The data of this study were from the 2014 Taiwan Social Change Survey. A stratified, three-stage probability proportional-to-size sampling from across the nation, was conducted to select adults aged 20 years and older (N = 1,745). Bonding social capital was measured by the frequency of neighborly contact and support. Bridging social capital was measured based on association membership. Linking social capital was measured according to general government trust and trust in the government's capacity to counter an influenza pandemic. Binary logistic regressions were used to assess the multivariate associations between social capital and behavioral intention. The study results indicate that social capital may influence the response to influenza pandemic. Specifically, the intention to receive a vaccine and to wash hands more frequently were associated with the linking dimension and the bonding dimension of social capital, while the intention to wear a face mask was associated with all forms of social capital. The findings of this study suggest that government credibility and interpersonal networks may play a crucial role in health-protective behavior. This study provides new insights into how to improve the effectiveness of influenza prevention campaigns.

Evidence for history-dependence of influenza pandemic emergence

NASA Astrophysics Data System (ADS)

Hill, Edward M.; Tildesley, Michael J.; House, Thomas

2017-03-01

Influenza A viruses have caused a number of global pandemics, with considerable mortality in humans. Here, we analyse the time periods between influenza pandemics since 1700 under different assumptions to determine whether the emergence of new pandemic strains is a memoryless or history-dependent process. Bayesian model selection between exponential and gamma distributions for these time periods gives support to the hypothesis of history-dependence under eight out of nine sets of modelling assumptions. Using the fitted parameters to make predictions shows a high level of variability in the modelled number of pandemics from 2010-2110. The approach we take here relies on limited data, so is uncertain, but it provides cheap, safe and direct evidence relating to pandemic emergence, a field where indirect measurements are often made at great risk and cost.

[History of pandemic influenza in Japan].

PubMed

Matsumoto, Keizo

2010-09-01

In Japan, influenza like epidemics were described many times since Heian era. However, Spanish flu as the modern medicine invaded Japan in 1918, thus almost infected 390,000 patients died with associated pneumonia. After the discovery of influenza virus in 1933, Japan experienced pandemic influenza--Asian flu(H2N2) in 1957. After about 10 years, Hong Kong flu (H3N2) came to Japan at 1968. However, we had many reliable antibiotics but had not any antiviral drug at the early time. After year 2000, we fortunately obtained reliable three antiviral drugs such as amantadine, oseltamivir and zanamivir. Moreover, very useful rapid test kits for influenza A and B viruses were developed and used in Japan. 2009 H1N1 influenza epidemic occured in Japan after the great epidemic in Mexico and North America but elderly patient was few. With together, host conditions regarding with high risk are changing. Lessons from past several pandemic influenza are those that many issues for changing high risk conditions, viral genetic changes, developing antiviral agents, developing new useful vaccins and determinating bacterial secondary pathogens are important.

Pandemic influenza: is there a corporate duty to prepare?

PubMed

McMenamin, Joseph P

2009-01-01

This article considers whether in the wake of an influenza pandemic companies may be exposed to claims of legal liability for failing to provide employees with access to antiviral medications, as the Department of Health and Human Services (HHS) now encourages businesses to do. It begins by describing influenza and influenza pandemics. It then discusses the benefits and limitations of antiviral therapies and the recent creation of antiviral option programs. It concludes by considering whether claims may be brought on the theory that corporate leadership is under a duty to prepare for a pandemic by considering whether to provide access to antiviral protection for employees.

Delaying the international spread of pandemic influenza.

PubMed

Cooper, Ben S; Pitman, Richard J; Edmunds, W John; Gay, Nigel J

2006-06-01

The recent emergence of hypervirulent subtypes of avian influenza has underlined the potentially devastating effects of pandemic influenza. Were such a virus to acquire the ability to spread efficiently between humans, control would almost certainly be hampered by limited vaccine supplies unless global spread could be substantially delayed. Moreover, the large increases that have occurred in international air travel might be expected to lead to more rapid global dissemination than in previous pandemics. To evaluate the potential of local control measures and travel restrictions to impede global dissemination, we developed stochastic models of the international spread of influenza based on extensions of coupled epidemic transmission models. These models have been shown to be capable of accurately forecasting local and global spread of epidemic and pandemic influenza. We show that under most scenarios restrictions on air travel are likely to be of surprisingly little value in delaying epidemics, unless almost all travel ceases very soon after epidemics are detected. Interventions to reduce local transmission of influenza are likely to be more effective at reducing the rate of global spread and less vulnerable to implementation delays than air travel restrictions. Nevertheless, under the most plausible scenarios, achievable delays are small compared with the time needed to accumulate substantial vaccine stocks.

Delaying the International Spread of Pandemic Influenza

PubMed Central

Cooper, Ben S; Pitman, Richard J; Edmunds, W. John; Gay, Nigel J

2006-01-01

Background The recent emergence of hypervirulent subtypes of avian influenza has underlined the potentially devastating effects of pandemic influenza. Were such a virus to acquire the ability to spread efficiently between humans, control would almost certainly be hampered by limited vaccine supplies unless global spread could be substantially delayed. Moreover, the large increases that have occurred in international air travel might be expected to lead to more rapid global dissemination than in previous pandemics. Methods and Findings To evaluate the potential of local control measures and travel restrictions to impede global dissemination, we developed stochastic models of the international spread of influenza based on extensions of coupled epidemic transmission models. These models have been shown to be capable of accurately forecasting local and global spread of epidemic and pandemic influenza. We show that under most scenarios restrictions on air travel are likely to be of surprisingly little value in delaying epidemics, unless almost all travel ceases very soon after epidemics are detected. Conclusions Interventions to reduce local transmission of influenza are likely to be more effective at reducing the rate of global spread and less vulnerable to implementation delays than air travel restrictions. Nevertheless, under the most plausible scenarios, achievable delays are small compared with the time needed to accumulate substantial vaccine stocks. PMID:16640458

Influenza infection in the intensive care unit: Four years after the 2009 pandemic.

PubMed

Pérez-Carrasco, Marcos; Lagunes, Leonel; Antón, Andrés; Gattarello, Simone; Laborda, César; Pumarola, Tomás; Rello, Jordi

2016-03-01

The role of influenza viruses in severe acute respiratory infection (SARI) in Intensive Care Units (ICU) remains unknown. The post-pandemic influenza A(H1N1)pdm09 period, in particular, has been poorly studied. To identify influenza SARI patients in ICU, to assess the usefulness of the symptoms of influenza-like illness (ILI), and to compare the features of pandemic vs. post-pandemic influenza A(H1N1) pdm09 infection. A prospective observational study with SARI patients admitted to ICU during the first three post-pandemic seasons. Patient demographics, characteristics and outcomes were recorded. An influenza epidemic period (IEP) was defined as >100 cases/100,000 inhabitants per week. One hundred sixty-three patients were diagnosed with SARI. ILI was present in 65 (39.9%) patients. Influenza infection was documented in 41 patients, 27 (41.5%) ILI patients, and 14 (14.3%) non-ILI patients, 27 of them during an IEP. Influenza A viruses were mainly responsible. Only five patients had influenza B virus infection, which were non-ILI during an IEP. SARI overall mortality was 22.1%, and 15% in influenza infection patients. Pandemic and post-pandemic influenza infection patients shared similar clinical features. During influenza epidemic periods, influenza infection screening should be considered in all SARI patients. Influenza SARI was mainly caused by subtype A(H1N1)pdm09 and A(H3N2) in post-pandemic seasons, and no differences were observed in ILI and mortality rate compared with a pandemic season. Copyright © 2015 Elsevier España, S.L.U. y Sociedad Española de Enfermedades Infecciosas y Microbiología Clínica. All rights reserved.

Framing risk in pandemic influenza policy and control.

PubMed

Seetoh, Theresa; Liverani, Marco; Coker, Richard

2012-01-01

This article explores differing understandings of 'risk' in relation to pandemic influenza policy and control. After a preliminary overview of methodological and practical problems in risk analysis, ways in which risk was framed and managed in three historical cases were examined. The interdependence between scientific empiricism and political decision-making led to the mismanagement of the 1976 swine influenza scare in the USA. The 2004 H5N1 avian influenza outbreak in Thailand, on the other hand, was undermined by questions of national economic interest and concerns over global health security. Finally, the recent global emergency of pandemic influenza H1N1 in 2009 demonstrated the difficulties of risk management under a context of pre-established perceptions about the characteristics and inevitability of a pandemic. Following the analysis of these cases, a conceptual framework is presented to illustrate ways in which changing relationships between risk assessment, risk perception and risk management can result in differing policy strategies.

Pandemic Influenza Planning in Nursing Homes: Are We Prepared?

PubMed Central

Mody, Lona; Cinti, Sandro

2012-01-01

Avian influenza or Influenza A (H5N1) is caused by a viral strain that occurs naturally in wild birds, but to which humans are immunologically naïve. If an influenza pandemic occurs, it is expected to have dire consequences, including millions of deaths, social disruption, and enormous economic consequences. The Department of Health and Human Resources plan, released in November 2005, clearly affirms the threat of a pandemic. Anticipating a disruption in many factions of society, every segment of the healthcare industry, including nursing homes, will be affected and will need to be self-sufficient. Disruption of vaccine distribution during the seasonal influenza vaccine shortage during the 2004/05 influenza season is but one example of erratic emergency planning. Nursing homes will have to make vital decisions and provide care to older adults who will not be on the initial priority list for vaccine. At the same time, nursing homes will face an anticipated shortage of antiviral medications and be expected to provide surge capacity for overwhelmed hospitals. This article provides an overview of current recommendations for pandemic preparedness and the potential effect of a pandemic on the nursing home industry. It highlights the need for collaborative planning and dialogue between nursing homes and various stakeholders already heavily invested in pandemic preparedness. PMID:17767687

Using Clinical Research Networks to Assess Severity of an Emerging Influenza Pandemic.

PubMed

Simonsen, Lone; Higgs, Elizabeth; Taylor, Robert J; Wentworth, Deborah; Cozzi-Lepri, Al; Pett, Sarah; Dwyer, Dominic E; Davey, Richard; Lynfield, Ruth; Losso, Marcelo; Morales, Kathleen; Glesby, Marshall J; Weckx, Jozef; Carey, Dianne; Lane, Cliff; Lundgren, Jens

2018-05-08

Early clinical severity assessments during the 2009 influenza A H1N1 pandemic (pH1N1) overestimated clinical severity due to selection bias and other factors. We retrospectively investigated how to use data from the International Network for Strategic Initiatives in Global HIV Trials, a global clinical influenza research network, to make more accurate case fatality ratio (CFR) estimates early in a future pandemic, an essential part of pandemic response. We estimated the CFR of medically attended influenza (CFRMA) as the product of probability of hospitalization given confirmed outpatient influenza and the probability of death given hospitalization with confirmed influenza for the pandemic (2009-2011) and post-pandemic (2012-2015) periods. We used literature survey results on health-seeking behavior to convert that estimate to CFR among all infected persons (CFRAR). During the pandemic period, 5.0% (3.1%-6.9%) of 561 pH1N1-positive outpatients were hospitalized. Of 282 pH1N1-positive inpatients, 8.5% (5.7%-12.6%) died. CFRMA for pH1N1 was 0.4% (0.2%-0.6%) in the pandemic period 2009-2011 but declined 5-fold in young adults during the post-pandemic period compared to the level of seasonal influenza in the post-pandemic period 2012-2015. CFR for influenza-negative patients did not change over time. We estimated the 2009 pandemic CFRAR to be 0.025%, 16-fold lower than CFRMA. Data from a clinical research network yielded accurate pandemic severity estimates, including increased severity among younger people. Going forward, clinical research networks with a global presence and standardized protocols would substantially aid rapid assessment of clinical severity. NCT01056354 and NCT010561.

Avian Influenza Pandemic May Expand the Military Role in Disaster Relief

DTIC Science & Technology

2006-03-15

USAWC STRATEGY RESEARCH PROJECT AVIAN INFLUENZA PANDEMIC MAY EXPAND THE MILITARY ROLE IN DISASTER RELIEF by Colonel Frank William Sherod II United... Influenza Pandemic May Expand the Military Role in Disaster Relief 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S...8-98) Prescribed by ANSI Std Z39-18 ABSTRACT AUTHOR: Colonel Frank William Sherod II TITLE: Avian Influenza Pandemic May Expand The Military Role

The Australian response: pandemic influenza preparedness.

PubMed

Horvath, John S; McKinnon, Moira; Roberts, Leslee

2006-11-20

Australia's preparedness for a potential influenza pandemic involves many players, from individual health carers to interdepartmental government committees. It embraces a wide number of strategies from the management of the disease to facilitating business continuity. The key strategy underlying Australia's planned response is an intensive effort to reduce transmission of the virus. This includes actions to reduce the likelihood of entry of the virus into the country and to contain outbreaks when they occur. Containment will provide time to allow production of a matched vaccine. The health strategies are outlined in the Australian health management plan for pandemic influenza. The plan is accompanied by technical annexes setting out key considerations and guidelines in the areas of clinical management and infection control. National plans present overall strategies and guidance, but the operational details can only be determined by individual states and territories, regions, and the services themselves. Primary health care practices will be on the frontline of an influenza pandemic. Every practice needs a plan that defines the roles of staff, incorporates infection control and staff protection measures, and considers business continuity. Most importantly, a practice needs to know how to implement that plan.

[Ethical principles of management and planning during influenza pandemic].

PubMed

Kubar', O I; Asatrian, A Zh

2012-01-01

The article is dedicated to an actual problem of ethical component inclusion into the system of management and planning of epidemic control measures during threat emergence and in the course of influenza pandemic (epidemic) progress. Data regarding development of international ethical guidelines during influenza including WHO recommendations are presented and analysis of normative documents in Russian Federation is given. A necessity of comprehension and accounting of ethical values in pandemic preparedness is shown, main directions of action and responsibility are revealed. Key ethical positions of planning and implementation of measures during influenza pandemic are outlined, compliance with those determines the level of public support and thus provides the effectiveness of the implemented measures.

Cost-Effectiveness of Healthcare Worker Pneumococcal Polysaccharide Vaccination During Pandemic Influenza

PubMed Central

Smith, Kenneth J.; Raymund, Mahlon; Nowalk, Mary Patricia; Roberts, Mark S.; Zimmerman, Richard K.

2010-01-01

Objective In prior influenza pandemics, pneumococcal complications of influenza have caused substantial morbidity and mortality. The usefulness and cost-effectiveness of pneumococcal vaccination for healthcare workers during an influenza pandemic is unknown. Study Design Markov modeling was used to estimate the cost-effectiveness of pneumococcal polysaccharide vaccination (PPV) in previously unvaccinated healthcare workers during an influenza pandemic. Methods Invasive pneumococcal disease (IPD) incidence rates were incorporated into the model, assuming that IPD events occurred at twice the usual rate during the year of pandemic influenza. Both societal and hospital perspectives were examined. Assumptions were that: pneumococcal disease transmission from healthcare worker to patient did not occur, heightened IPD risk occurred for only 1 year, and PPV did not prevent noninvasive pneumonia, all of which potentially bias against vaccination. Results From a societal standpoint, pneumococcal vaccination of healthcare workers during an influenza pandemic is economically reasonable, costing $2,935 per quality adjusted life year gained; results were robust to variation in multiple sensitivity analyses. However, from the hospital perspective vaccinating healthcare workers was expensive, costing $1,676 per employee absence day avoided, given an IPD risk that, though increased, would still remain <1%. Conclusion Vaccinating all healthcare workers to protect against pneumococcal disease during a pandemic influenza outbreak is likely to be economically reasonable from the societal standpoint. However, pneumococcal vaccination is expensive from the hospital perspective, which might prevent implementation of a PPV program unless it is externally subsidized. PMID:20225915

Pandemic influenza communication: views from a deliberative forum.

PubMed

Rogers, Wendy A; Street, Jackie M; Braunack-Mayer, Annette J; Hiller, Janet E

2009-09-01

To use a deliberative forum to elicit community perspectives on communication about pandemic influenza planning, and to compare these findings with the current Australian national communication strategy. Deliberative forum of 12 persons randomly selected from urban South Australia. Forum members were briefed by experts in infection control, virology, ethics and public policy before deliberating on four key questions: what, how and when should the community be told about pandemic influenza and by whom? The forum recommended provision of detailed and comprehensive information by credible experts, rather than politicians, using a variety of media including television and internet. Recommendations included cumulative communication to build expertise in the community, and specific strategies to include groups such as young people, people with physical or mental disabilities, and rural and remote communities. Information provided should be practical, accurate, and timely, with no 'holding back' about the seriousness of a pandemic. The forum expressed confidence in the expert witnesses, despite the acknowledged uncertainty of many of the predictions. The deliberative forum's recommendations were largely consistent with the Australian national pandemic influenza communication strategy and the relevant literature. However, the forum recommended: release of more detailed information than currently proposed in the national strategy; use of non-political spokespersons; and use of novel communication methods. Their acceptance of uncertainty suggests that policy makers should be open about the limits of knowledge in potentially threatening situations. Our findings show that deliberative forums can provide community perspectives on topics such as communication about pandemic influenza.

Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017

PubMed Central

Levitt, Alexandra; Kanade, Neha; Wright-Jegede, Narue; Dopson, Stephanie; Biggerstaff, Matthew; Reed, Carrie; Uzicanin, Amra; Levitt, Alexandra; Dopson, Stephanie; Frank, Mark; Holloway, Rachel; Koonin, Lisa; Rasmussen, Sonja; Redd, Stephen; de la Motte Hurst, Christopher; Kanade, Neha; Rainey, Jeanette; Uzicanin, Amra; Biggerstaff, Matthew; Jernigan, Daniel; Reed, Carrie

2017-01-01

Summary When a novel influenza A virus with pandemic potential emerges, nonpharmaceutical interventions (NPIs) often are the most readily available interventions to help slow transmission of the virus in communities, which is especially important before a pandemic vaccine becomes widely available. NPIs, also known as community mitigation measures, are actions that persons and communities can take to help slow the spread of respiratory virus infections, including seasonal and pandemic influenza viruses. These guidelines replace the 2007 Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States — Early, Targeted, Layered Use of Nonpharmaceutical Interventions (https://stacks.cdc.gov/view/cdc/11425). Several elements remain unchanged from the 2007 guidance, which described recommended NPIs and the supporting rationale and key concepts for the use of these interventions during influenza pandemics. NPIs can be phased in, or layered, on the basis of pandemic severity and local transmission patterns over time. Categories of NPIs include personal protective measures for everyday use (e.g., voluntary home isolation of ill persons, respiratory etiquette, and hand hygiene); personal protective measures reserved for influenza pandemics (e.g., voluntary home quarantine of exposed household members and use of face masks in community settings when ill); community measures aimed at increasing social distancing (e.g., school closures and dismissals, social distancing in workplaces, and postponing or cancelling mass gatherings); and environmental measures (e.g., routine cleaning of frequently touched surfaces). Several new elements have been incorporated into the 2017 guidelines. First, to support updated recommendations on the use of NPIs, the latest scientific evidence available since the influenza A (H1N1)pdm09 pandemic has been added. Second, a summary of lessons learned from the 2009 H1N1 pandemic response is presented

H7N9 Influenza Virus Is More Virulent in Ferrets than 2009 Pandemic H1N1 Influenza Virus.

PubMed

Yum, Jung; Ku, Keun Bon; Kim, Hyun Soo; Seo, Sang Heui

2015-12-01

The novel H7N9 influenza virus has been infecting humans in China since February 2013 and with a mortality rate of about 40%. This study compared the pathogenicity of the H7N9 and 2009 pandemic H1N1 influenza viruses in a ferret model, which shows similar symptoms to those of humans infected with influenza viruses. The H7N9 influenza virus caused a more severe disease than did the 2009 pandemic H1N1 influenza virus. All of the ferrets infected with the H7N9 influenza virus had died by 6 days after infection, while none of those infected with the 2009 pandemic H1N1 influenza virus died. Ferrets infected with the H7N9 influenza virus had higher viral titers in their lungs than did those infected with the 2009 pandemic H1N1 influenza virus. Histological findings indicated that hemorrhagic pneumonia was caused by infection with the H7N9 influenza virus, but not with the 2009 pandemic H1N1 influenza virus. In addition, the lung tissues of ferrets infected with the H7N9 influenza virus contained higher levels of chemokines than did those of ferrets infected with the 2009 pandemic H1N1 influenza virus. This study suggests that close monitoring is needed to prevent human infection by the lethal H7N9 influenza virus.

Pandemic influenza: human rights, ethics and duty to treat.

PubMed

Pahlman, I; Tohmo, H; Gylling, H

2010-01-01

The 2009 influenza A/H1N1 pandemic seems to be only moderately severe. In the future, a pandemic influenza with high lethality, such as the Spanish influenza in 1918-1919 or even worse, may emerge. In this kind of scenario, lethality rates ranging roughly from 2% to 30% have been proposed. Legal and ethical issues should be discussed before the incident. This article aims to highlight the legal, ethical and professional aspects that might be relevant to anaesthesiologists in the case of a high-lethality infectious disease such as a severe pandemic influenza. The epidemiology, the role of anaesthesiologists and possible threats to the profession and colleagueship within medical specialties relevant to anaesthesiologists are reviewed. During historical plague epidemics, some doctors have behaved like 'deserters'. However, during the Spanish influenza, physicians remained at their jobs, although many perished. In surveys, more than half of the health-care workers have reported their willingness to work in the case of severe pandemics. Physicians have the same human rights as all citizens: they have to be effectively protected against infectious disease. However, they have a duty to treat. Fair and responsible colleagueship among the diverse medical specialties should be promoted. Until disaster threatens humanity, volunteering to work during a pandemic might be the best way to ensure that physicians and other health-care workers stay at their workplace. Broad discussion in society is needed.

Factors affecting preparedness and capacity to manage pandemic influenza: perceptions of healthcare managers.

PubMed

Adini, B; Laor, D; Aharonson-Daniel, L

2014-08-01

Numerous interventions seeking to increase preparedness for pandemic influenza have been implemented, but low compliance of healthcare providers has been reported in many instances. The aim of this study was to identify factors that affect preparedness for pandemic influenza by examining: hospital managers' perceptions of measures implemented to promote preparedness for pandemic influenza; hospital managers' assessments of the readiness and capability of their hospitals to manage pandemic influenza; and the effectiveness of a national pandemic preparedness programme in Israel over time. A quasi-experiment was conducted following implementation of a national pandemic preparedness programme in Israel. A survey assessed hospital managers' perceptions of the effectiveness of the programme, and the preparedness and capacity of their hospitals to manage pandemic influenza. Two independent evaluations of preparedness for biological threats were conducted, based on a validated tool that included 60 objective parameters. Correlations between perceived preparedness and capacity and components of the preparedness programme were analysed using Statistical Package for the Social Sciences Version 17. Stepwise logistic regression was used to determine the components that influence preparedness and capability to manage pandemic influenza. All general hospital managers in Israel were approached twice (first and second evaluations). Ninety-one percent rated themselves as highly/very highly prepared for pandemic influenza, and 87% rated themselves as highly/very highly capable of dealing with pandemic influenza. Strong correlation was found between hospital managers' perceived preparedness and capacity to manage pandemic influenza (rho = 0.761, P = 0.000), and between perceived preparedness and familiarity with the disease (rho = 0.605, P = 0.003). Familiarity with guidelines accounted for 35% of the variance in perceived capability (adjusted R(2) = 0.346, P = 0.002). Inclusion of

A comparison of H1N1 influenza among pediatric inpatients in the pandemic and post pandemic era.

PubMed

Rao, Suchitra; Torok, Michelle R; Bagdure, Dayanand; Cunningham, Maureen A; Williams, Joshua T B; Curtis, Donna J; Wilson, Karen; Dominguez, Samuel R

2015-10-01

The novel influenza A H1N1 (A[H1N1]pdm09) strain emerged in 2009, contributing to significant morbidity and mortality. It is not known whether illness associated with A(H1N1) pdm09 in the post-pandemic era exhibits a similar disease profile. The objectives of this study were to compare the burden of disease of A(H1N1) pdm09 influenza from the 2009 pandemic year to the post-pandemic years (2010-2014), and to explore potential reasons for any differences. We conducted a retrospective cohort study of inpatients admitted to Children's Hospital Colorado with a positive respiratory specimen for influenza from May-December, 2009 and December, 2010-April, 2014. Univariate and multivariate analyses were conducted to compare the demographics and clinical characteristics of patients with H1N1 during the two periods. There were 388 inpatients with influenza A(H1N1) pdm09 in 2009, and 117 during the post-pandemic years. Ninety-four percent of all H1N1 during the post-pandemic era was observed during the 2013-2014 influenza season. Patients with A(H1N1) pdm09 during the post-pandemic year were less likely to have an underlying medical condition (P<0.01). Patients admitted to the ICU during the post-pandemic year had a lower median age (5 vs 8 years, P=0.01) and a lower proportion of patients were intubated, had mental status changes, and ARDS compared with the pandemic years, (P<0.01 for all), with decreased mortality (P=0.02). Patients with influenza A(H1N1) pdm09 during the post-pandemic years appeared to have less severe disease than patients with A(H1N1) pdm09 during the pandemic year. The reasons for this difference are likely multifactorial. Published by Elsevier B.V.

Epidemiological and economic impact of pandemic influenza in Chicago: Priorities for vaccine interventions

PubMed Central

Dorratoltaj, Nargesalsadat; Marathe, Achla; Swarup, Samarth; Eubank, Stephen G.

2017-01-01

The study objective is to estimate the epidemiological and economic impact of vaccine interventions during influenza pandemics in Chicago, and assist in vaccine intervention priorities. Scenarios of delay in vaccine introduction with limited vaccine efficacy and limited supplies are not unlikely in future influenza pandemics, as in the 2009 H1N1 influenza pandemic. We simulated influenza pandemics in Chicago using agent-based transmission dynamic modeling. Population was distributed among high-risk and non-high risk among 0–19, 20–64 and 65+ years subpopulations. Different attack rate scenarios for catastrophic (30.15%), strong (21.96%), and moderate (11.73%) influenza pandemics were compared against vaccine intervention scenarios, at 40% coverage, 40% efficacy, and unit cost of $28.62. Sensitivity analysis for vaccine compliance, vaccine efficacy and vaccine start date was also conducted. Vaccine prioritization criteria include risk of death, total deaths, net benefits, and return on investment. The risk of death is the highest among the high-risk 65+ years subpopulation in the catastrophic influenza pandemic, and highest among the high-risk 0–19 years subpopulation in the strong and moderate influenza pandemics. The proportion of total deaths and net benefits are the highest among the high-risk 20–64 years subpopulation in the catastrophic, strong and moderate influenza pandemics. The return on investment is the highest in the high-risk 0–19 years subpopulation in the catastrophic, strong and moderate influenza pandemics. Based on risk of death and return on investment, high-risk groups of the three age group subpopulations can be prioritized for vaccination, and the vaccine interventions are cost saving for all age and risk groups. The attack rates among the children are higher than among the adults and seniors in the catastrophic, strong, and moderate influenza pandemic scenarios, due to their larger social contact network and homophilous interactions

[Paleopathology and the history of medicine: the example of influenza pandemics].

PubMed

Fangerau, H

2010-11-01

The paper examines the history of former influenza pandemics from the perspective of changing nosographic categories. Special emphasis is put on the so-called Spanish flu of 1918. Due to its high mortality rates this pandemic is often highlighted as a warning sign for what may happen during a future pandemic. After a short introduction into the problematic status of the validity of retrospective diagnoses the history of influenza pandemics is discussed. The pandemic of 1918 is analysed from the perspective of the public health system being connected to and relying on medical and scientific debates. The reasons for this pandemic's rank as the long forgotten pandemic are discussed.

Nonpharmaceutical Interventions for Military Populations During Pandemic Influenza

PubMed Central

Kiliç, Selim; Gray, Gregory C.

2008-01-01

Influenza causes substantial illness and loss of work days among young adults, and outbreaks can affect the preparedness of military units. In an influenza pandemic, people who live in confined settings have greater risk of infection. Military trainees are at particularly high risk. Because of likely unavailability of vaccines and antiviral drugs at the start of a pandemic and for many months thereafter, nonpharmaceutical interventions may be very important. During a pandemic, it seems prudent that military public health officials employ at least several nonpharmaceutical interventions. For example frequent handwashing and respiratory hygiene/cough etiquette should be strongly encouraged among soldiers. Head-to-toe sleeping, a “no-cost” intervention should be for crowded berthing areas. Isolation of patients with influenza and quarantine of their close contacts should be employed. Masks and alcohol-based hand rubs may be employed among those at highest risk. Finally, whenever possible military planners should, reduce crowding and limit the interaction of training cohorts to reduce risk of influenza virus transmission. PMID:18516249

The Cost Effectiveness of Pandemic Influenza Interventions: A Pandemic Severity Based Analysis

PubMed Central

Milne, George J.; Halder, Nilimesh; Kelso, Joel K.

2013-01-01

Background The impact of a newly emerged influenza pandemic will depend on its transmissibility and severity. Understanding how these pandemic features impact on the effectiveness and cost effectiveness of alternative intervention strategies is important for pandemic planning. Methods A cost effectiveness analysis of a comprehensive range of social distancing and antiviral drug strategies intended to mitigate a future pandemic was conducted using a simulation model of a community of ∼30,000 in Australia. Six pandemic severity categories were defined based on case fatality ratio (CFR), using data from the 2009/2010 pandemic to relate hospitalisation rates to CFR. Results Intervention strategies combining school closure with antiviral treatment and prophylaxis are the most cost effective strategies in terms of cost per life year saved (LYS) for all severity categories. The cost component in the cost per LYS ratio varies depending on pandemic severity: for a severe pandemic (CFR of 2.5%) the cost is ∼$9 k per LYS; for a low severity pandemic (CFR of 0.1%) this strategy costs ∼$58 k per LYS; for a pandemic with very low severity similar to the 2009 pandemic (CFR of 0.03%) the cost is ∼$155 per LYS. With high severity pandemics (CFR >0.75%) the most effective attack rate reduction strategies are also the most cost effective. During low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, while for high severity pandemics costs are dominated by hospitalisation costs and productivity losses due to death. Conclusions The most cost effective strategies for mitigating an influenza pandemic involve combining sustained social distancing with the use of antiviral agents. For low severity pandemics the most cost effective strategies involve antiviral treatment, prophylaxis and short durations of school closure; while these are cost effective they are less effective than other strategies in reducing the

Influenza and SARS: the impact of viral pandemics on maritime health.

PubMed

Lim, Poh Lian

2011-01-01

Global travel and transport play a critical role in the spread of infections. We see this clearly in the first two pandemics of the 21st century: SARS and influenza H1N1-2009. Although air travel contributed to dissemination in these two pandemics, the travel restrictions, quarantines, and heightened vigilance which resulted had an impact on maritime health. Seasonal, pandemic, and avian influenza have some important differences with regards to exposure risks, infectivity, and severity. Most of the data for maritime influenza outbreaks focus on seasonal influenza on cruise ships, but influenza among crew members occurs due to close working conditions and is potentially preventable with staff vaccination programs. To date, avian influenza has low human-to-human transmission; infection typically requires close contact with poultry, but presents with severe disease and a high fatality rate. Pandemic (swine) influenza was readily transmitted between people, including young adults, and caused severe illness in high-risk groups including pregnant women, children, and those with co-morbidities and obesity. In contrast, SARS had lower infectivity compared to influenza, and a longer incubation period. These characteristics slowed its propagation enough that outbreak control measures, such as isolation of infected cases and quarantine of exposed but well persons, were effective in terminating this pandemic. No effective vaccine exists for SARS at this time, whereas countries were able to deploy millions of doses of pandemic influenza vaccine within 7 months after the outbreak was first recognized in Mexico. The lack of a protective vaccine and the higher case fatality rate in SARS will mean that stringent quarantine measures may still be required for outbreak control if SARS ever occurs again. Compliance with international health regulations, and the ability to adapt these to maritime health needs, will be important in the shipping industry.

Changing Perceptions: of Pandemic Influenza and Public Health Responses

PubMed Central

2012-01-01

According to the latest World Bank estimates, over the past decade some US $4.3 billion has been pledged by governments to combat the threat of pandemic influenza. Presidents, prime ministers, and even dictators the world over have been keen to demonstrate their commitment to tackling this disease, but this has not always been the case. Indeed, government-led intervention in responding to the threat of pandemic influenza is a relatively recent phenomenon. I explore how human understandings of influenza have altered over the past 500 years and how public policy responses have shifted accordingly. I trace the progress in human understanding of causation from meteorological conditions to the microscopic, and how this has prompted changes in public policy to mitigate the disease's impact. I also examine the latest trend of viewing pandemic influenza as a security threat and how this has changed contemporary governance structures and power dynamics. PMID:22095332

Antibody Persistence in Adults Two Years after Vaccination with an H1N1 2009 Pandemic Influenza Virus-Like Particle Vaccine

PubMed Central

Villasís-Keever, Miguel Ángel; Núñez-Valencia, Adriana; Boscó-Gárate, Ilka; Lozano-Dubernard, Bernardo; Lara-Puente, Horacio; Espitia, Clara; Alpuche-Aranda, Celia; Bonifaz, Laura C.; Arriaga-Pizano, Lourdes; Pastelin-Palacios, Rodolfo; Isibasi, Armando; López-Macías, Constantino

2016-01-01

The influenza virus is a human pathogen that causes epidemics every year, as well as potential pandemic outbreaks, as occurred in 2009. Vaccination has proven to be sufficient in the prevention and containment of viral spreading. In addition to the current egg-based vaccines, new and promising vaccine platforms, such as cell culture-derived vaccines that include virus-like particles (VLPs), have been developed. VLPs have been shown to be both safe and immunogenic against influenza infections. Although antibody persistence has been studied in traditional egg-based influenza vaccines, studies on antibody response durations induced by VLP influenza vaccines in humans are scarce. Here, we show that subjects vaccinated with an insect cell-derived VLP vaccine, in the midst of the 2009 H1N1 influenza pandemic outbreak in Mexico City, showed antibody persistence up to 24 months post-vaccination. Additionally, we found that subjects that reported being revaccinated with a subsequent inactivated influenza virus vaccine showed higher antibody titres to the pandemic influenza virus than those who were not revaccinated. These findings provide insights into the duration of the antibody responses elicited by an insect cell-derived pandemic influenza VLP vaccine and the possible effects of subsequent influenza vaccination on antibody persistence induced by this VLP vaccine in humans. PMID:26919288

Dynamic Regimes of El Niño Southern Oscillation and Influenza Pandemic Timing

PubMed Central

Oluwole, Olusegun Steven Ayodele

2017-01-01

El Niño southern oscillation (ENSO) dynamics has been shown to drive seasonal influenza dynamics. Severe seasonal influenza epidemics and the 2009–2010 pandemic were coincident with chaotic regime of ENSO dynamics. ENSO dynamics from 1876 to 2016 were characterized to determine if influenza pandemics are coupled to chaotic regimes. Time-varying spectra of southern oscillation index (SOI) and sea surface temperature (SST) were compared. SOI and SST were decomposed to components using the algorithm of noise-assisted multivariate empirical mode decomposition. The components were Hilbert transformed to generate instantaneous amplitudes and phases. The trajectories and attractors of components were characterized in polar coordinates and state space. Influenza pandemics were mapped to dynamic regimes of SOI and SST joint recurrence of annual components. State space geometry of El Niños lagged by influenza pandemics were characterized and compared with other El Niños. Timescales of SOI and SST components ranged from sub-annual to multidecadal. The trajectories of SOI and SST components and the joint recurrence of annual components were dissipative toward chaotic attractors. Periodic, quasi-periodic, and chaotic regimes were present in the recurrence of trajectories, but chaos–chaos transitions dominated. Influenza pandemics occurred during chaotic regimes of significantly low transitivity dimension (p < 0.0001). El Niños lagged by influenza pandemics had distinct state space geometry (p < 0.0001). Chaotic dynamics explains the aperiodic timing, and varying duration and strength of El Niños. Coupling of all influenza pandemics of the past 140 years to chaotic regimes of low transitivity indicate that ENSO dynamics drives influenza pandemic dynamics. Forecasts models from ENSO dynamics should compliment surveillance for novel influenza viruses. PMID:29218303

Fitness of Pandemic H1N1 and Seasonal influenza A viruses during Co-infection: Evidence of competitive advantage of pandemic H1N1 influenza versus seasonal influenza.

PubMed

Perez, Daniel Roberto; Sorrell, Erin; Angel, Matthew; Ye, Jianqiang; Hickman, Danielle; Pena, Lindomar; Ramirez-Nieto, Gloria; Kimble, Brian; Araya, Yonas

2009-08-24

On June 11, 2009 the World Health Organization (WHO) declared a new H1N1 influenza pandemic. This pandemic strain is as transmissible as seasonal H1N1 and H3N2 influenza A viruses. Major concerns facing this pandemic are whether the new virus will replace, co-circulate and/or reassort with seasonal H1N1 and/or H3N2 human strains. Using the ferret model, we investigated which of these three possibilities were most likely favored. Our studies showed that the current pandemic virus is more transmissible than, and has a biological advantage over, prototypical seasonal H1 or H3 strains.

Pandemic influenza communication: views from a deliberative forum

PubMed Central

Rogers, Wendy A.; Street, Jackie M.; Braunack‐Mayer, Annette J.; Hiller, Janet E.

2009-01-01

Abstract Objective  To use a deliberative forum to elicit community perspectives on communication about pandemic influenza planning, and to compare these findings with the current Australian national communication strategy. Design  Deliberative forum of 12 persons randomly selected from urban South Australia. Forum members were briefed by experts in infection control, virology, ethics and public policy before deliberating on four key questions: what, how and when should the community be told about pandemic influenza and by whom? Results  The forum recommended provision of detailed and comprehensive information by credible experts, rather than politicians, using a variety of media including television and internet. Recommendations included cumulative communication to build expertise in the community, and specific strategies to include groups such as young people, people with physical or mental disabilities, and rural and remote communities. Information provided should be practical, accurate, and timely, with no ‘holding back’ about the seriousness of a pandemic. The forum expressed confidence in the expert witnesses, despite the acknowledged uncertainty of many of the predictions. Discussion and Conclusion  The deliberative forum’s recommendations were largely consistent with the Australian national pandemic influenza communication strategy and the relevant literature. However, the forum recommended: release of more detailed information than currently proposed in the national strategy; use of non‐political spokespersons; and use of novel communication methods. Their acceptance of uncertainty suggests that policy makers should be open about the limits of knowledge in potentially threatening situations. Our findings show that deliberative forums can provide community perspectives on topics such as communication about pandemic influenza. PMID:19754694

Pandemic influenza preparedness: an ethical framework to guide decision-making

PubMed Central

Thompson, Alison K; Faith, Karen; Gibson, Jennifer L; Upshur, Ross EG

2006-01-01

Background Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. Discussion In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. Summary The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust. PMID:17144926

Pandemic influenza preparedness: an ethical framework to guide decision-making.

PubMed

Thompson, Alison K; Faith, Karen; Gibson, Jennifer L; Upshur, Ross E G

2006-12-04

Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.

Trends in parameterization, economics and host behaviour in influenza pandemic modelling: a review and reporting protocol

PubMed Central

2013-01-01

Background The volume of influenza pandemic modelling studies has increased dramatically in the last decade. Many models incorporate now sophisticated parameterization and validation techniques, economic analyses and the behaviour of individuals. Methods We reviewed trends in these aspects in models for influenza pandemic preparedness that aimed to generate policy insights for epidemic management and were published from 2000 to September 2011, i.e. before and after the 2009 pandemic. Results We find that many influenza pandemics models rely on parameters from previous modelling studies, models are rarely validated using observed data and are seldom applied to low-income countries. Mechanisms for international data sharing would be necessary to facilitate a wider adoption of model validation. The variety of modelling decisions makes it difficult to compare and evaluate models systematically. Conclusions We propose a model Characteristics, Construction, Parameterization and Validation aspects protocol (CCPV protocol) to contribute to the systematisation of the reporting of models with an emphasis on the incorporation of economic aspects and host behaviour. Model reporting, as already exists in many other fields of modelling, would increase confidence in model results, and transparency in their assessment and comparison. PMID:23651557

Registry-Based Surveillance of Influenza-Associated Hospitalisations during the 2009 Influenza Pandemic in Denmark: The Hidden Burden on the Young

PubMed Central

Widgren, Katarina; Nielsen, Jens; Mølbak, Kåre

2010-01-01

Background To follow the impact of the 2009 influenza pandemic in Denmark, influenza surveillance was extended with a system monitoring potentially influenza-associated hospitalisations. Methodology/Principal Findings National administrative data from 2004–2010 from the automatic reporting of all hospital visits and admissions in Denmark (population 5.5 million) were used. In-patient hospitalisations linked to ICD-10 codes for potentially influenza-associated conditions (influenza, viral and bacterial pneumonia, respiratory distress, and febrile convulsion) were aggregated by week and age groups; <5 years, 5–24 years, 25–64 years and ≥65 years. Weekly numbers of influenza-associated hospitalisations were plotted to follow the course of the pandemic. We calculated the total numbers of influenza-associated hospitalisations in each influenza season (week 30 to week 15, the following year). Risk ratios of being admitted with an influenza-associated condition in this season (2009/2010) compared to the previous five seasons (2004/2005–2008/2009) were calculated using binary regression. During the pandemic season, influenza-associated hospitalisations peaked in week 47, 2009. The total number of influenza-associated hospitalisations was 38,273 compared to the median of previous seasons of 35,662 (p = 0.28). The risk ratio of influenza-associated hospitalisations during the pandemic season compared to previous seasons was 1.63 (95%CI 1.49–1.78) for 5–24 year-olds and ranged between 0.98 and 1.08 for the other three age groups. Conclusions The 2009 pandemic influenza did not lead to an overall increase in the number of influenza-associated hospitalisations in Denmark in the 2009/2010 season and could be managed within existing hospital capacity. However, there was a disproportionally large impact on the age group 5–24 years. The influenza-associated hospitalisations during the 2009/2010 pandemic influenza season bore the signature features of historical

Quantifying the transmission potential of pandemic influenza

NASA Astrophysics Data System (ADS)

Chowell, Gerardo; Nishiura, Hiroshi

2008-03-01

This article reviews quantitative methods to estimate the basic reproduction number of pandemic influenza, a key threshold quantity to help determine the intensity of interventions required to control the disease. Although it is difficult to assess the transmission potential of a probable future pandemic, historical epidemiologic data is readily available from previous pandemics, and as a reference quantity for future pandemic planning, mathematical and statistical analyses of historical data are crucial. In particular, because many historical records tend to document only the temporal distribution of cases or deaths (i.e. epidemic curve), our review focuses on methods to maximize the utility of time-evolution data and to clarify the detailed mechanisms of the spread of influenza. First, we highlight structured epidemic models and their parameter estimation method which can quantify the detailed disease dynamics including those we cannot observe directly. Duration-structured epidemic systems are subsequently presented, offering firm understanding of the definition of the basic and effective reproduction numbers. When the initial growth phase of an epidemic is investigated, the distribution of the generation time is key statistical information to appropriately estimate the transmission potential using the intrinsic growth rate. Applications of stochastic processes are also highlighted to estimate the transmission potential using similar data. Critically important characteristics of influenza data are subsequently summarized, followed by our conclusions to suggest potential future methodological improvements.

Pandemic planning in the shipping industry--lessons learnt from the 2009 Influenza Pandemic.

PubMed

Bunyan, Kate

2011-01-01

The events around the 2009 A/H1N1 Influenza Pandemic highlighted the need for better planning to ensure protection of those on vessels, protection for ports of call, and protection of business assets (business continuity). The variety of stakeholders involved in the management of a pandemic made it difficult to achieve a cohesive plan during the event itself. By considering the actions during the last pandemic, and the literature available for the shipping industry on pandemic planning, a pathway to better preparation is suggested.

Experimental vaccines against potentially pandemic and highly pathogenic avian influenza viruses

PubMed Central

Mooney, Alaina J; Tompkins, S Mark

2013-01-01

Influenza A viruses continue to emerge and re-emerge, causing outbreaks, epidemics and occasionally pandemics. While the influenza vaccines licensed for public use are generally effective against seasonal influenza, issues arise with production, immunogenicity, and efficacy in the case of vaccines against pandemic and emerging influenza viruses, and highly pathogenic avian influenza virus in particular. Thus, there is need of improved influenza vaccines and vaccination strategies. This review discusses advances in alternative influenza vaccines, touching briefly on licensed vaccines and vaccine antigens; then reviewing recombinant subunit vaccines, virus-like particle vaccines and DNA vaccines, with the main focus on virus-vectored vaccine approaches. PMID:23440999

Epidemiological isolation causing variable mortality in Island populations during the 1918-1920 influenza pandemic.

PubMed

Shanks, G Dennis; Hussell, Tracy; Brundage, John F

2012-11-01

During the 1918 pandemic period, influenza-related mortality increased worldwide; however, mortality rates varied widely across locations and demographic subgroups. Islands are isolated epidemiological situations that may elucidate why influenza pandemic mortality rates were so variable in apparently similar populations. Our objectives were to determine and compare the patterns of pandemic influenza mortality on islands. We reviewed historical records of mortality associated with the 1918-1920 influenza pandemic in various military and civilian groups on islands. Mortality differed more than 50-fold during pandemic-related epidemics on Pacific islands [range: 0.4% (Hawaii) to 22% (Samoa)], and on some islands, mortality sharply varied among demographic subgroups of island residents such as Saipan: Chamorros [12%] and Caroline Islanders [0.4%]. Among soldiers from island populations who had completed initial military training, influenza-related mortality rates were generally low, for example, Puerto Rico (0.7%) and French Polynesia (0.13%). The findings suggest that among island residents, those who had been exposed to multiple, antigenically diverse respiratory pathogens prior to infection with the 1918 pandemic strain (e.g., less isolated) experienced lower mortality. The continuous circulation of antigenically diverse influenza viruses and other respiratory infectious agents makes widespread high mortality during future influenza pandemics unlikely. © 2012 Blackwell Publishing Ltd.

Circulating avian influenza viruses closely related to the 1918 virus have pandemic potential

PubMed Central

Watanabe, Tokiko; Zhong, Gongxun; Russell, Colin A.; Nakajima, Noriko; Hatta, Masato; Hanson, Anthony; McBride, Ryan; Burke, David F.; Takahashi, Kenta; Fukuyama, Satoshi; Tomita, Yuriko; Maher, Eileen A.; Watanabe, Shinji; Imai, Masaki; Neumann, Gabriele; Hasegawa, Hideki; Paulson, James C.; Smith, Derek J.; Kawaoka, Yoshihiro

2014-01-01

Summary Wild birds harbor a large gene pool of influenza A viruses that have the potential to cause influenza pandemics. Foreseeing and understanding this potential is important for effective surveillance. Our phylogenetic and geographic analyses revealed the global prevalence of avian influenza virus genes whose proteins differ only a few amino acids from the 1918 pandemic influenza virus, suggesting that 1918-like pandemic viruses may emerge in the future. To assess this risk, we generated and characterized a virus composed of avian influenza viral segments with high homology to the 1918 virus. This virus exhibited higher pathogenicity in mice and ferrets than an authentic avian influenza virus. Further, acquisition of seven amino acid substitutions in the viral polymerases and the hemagglutinin surface glycoprotein conferred respiratory droplet transmission to the 1918-like avian virus in ferrets, demonstrating that contemporary avian influenza viruses with 1918 virus-like proteins may have pandemic potential. PMID:24922572

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated with pandemic influenza infection, but not with an adjuvanted pandemic influenza vaccine.

PubMed

Magnus, Per; Gunnes, Nina; Tveito, Kari; Bakken, Inger Johanne; Ghaderi, Sara; Stoltenberg, Camilla; Hornig, Mady; Lipkin, W Ian; Trogstad, Lill; Håberg, Siri E

2015-11-17

Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is associated to infections and it has been suggested that vaccination can trigger the disease. However, little is known about the specific association between clinically manifest influenza/influenza vaccine and CFS/ME. As part of a registry surveillance of adverse effects after mass vaccination in Norway during the 2009 influenza A (H1N1) pandemic, we had the opportunity to estimate and contrast the risk of CFS/ME after infection and vaccination. Using the unique personal identification number assigned to everybody who is registered as resident in Norway, we followed the complete Norwegian population as of October 1, 2009, through national registries of vaccination, communicable diseases, primary health, and specialist health care until December 31, 2012. Hazard ratios (HRs) of CFS/ME, as diagnosed in the specialist health care services (diagnostic code G93.3 in the International Classification of Diseases, Version 10), after influenza infection and/or vaccination were estimated using Cox proportional-hazards regression. The incidence rate of CFS/ME was 2.08 per 100,000 person-months at risk. The adjusted HR of CFS/ME after pandemic vaccination was 0.97 (95% confidence interval [CI]: 0.91-1.04), while it was 2.04 (95% CI: 1.78-2.33) after being diagnosed with influenza infection during the peak pandemic period. Pandemic influenza A (H1N1) infection was associated with a more than two-fold increased risk of CFS/ME. We found no indication of increased risk of CFS/ME after vaccination. Our findings are consistent with a model whereby symptomatic infection, rather than antigenic stimulation may trigger CFS/ME. Copyright © 2015 Elsevier Ltd. All rights reserved.

Pandemic Threat Posed by Avian Influenza A Viruses

PubMed Central

Horimoto, Taisuke; Kawaoka, Yoshihiro

2001-01-01

Influenza pandemics, defined as global outbreaks of the disease due to viruses with new antigenic subtypes, have exacted high death tolls from human populations. The last two pandemics were caused by hybrid viruses, or reassortants, that harbored a combination of avian and human viral genes. Avian influenza viruses are therefore key contributors to the emergence of human influenza pandemics. In 1997, an H5N1 influenza virus was directly transmitted from birds in live poultry markets in Hong Kong to humans. Eighteen people were infected in this outbreak, six of whom died. This avian virus exhibited high virulence in both avian and mammalian species, causing systemic infection in both chickens and mice. Subsequently, another avian virus with the H9N2 subtype was directly transmitted from birds to humans in Hong Kong. Interestingly, the genes encoding the internal proteins of the H9N2 virus are genetically highly related to those of the H5N1 virus, suggesting a unique property of these gene products. The identification of avian viruses in humans underscores the potential of these and similar strains to produce devastating influenza outbreaks in major population centers. Although highly pathogenic avian influenza viruses had been identified before the 1997 outbreak in Hong Kong, their devastating effects had been confined to poultry. With the Hong Kong outbreak, it became clear that the virulence potential of these viruses extended to humans. PMID:11148006

Swine influenza and vaccines: an alternative approach for decision making about pandemic prevention.

PubMed

Basili, Marcello; Ferrini, Silvia; Montomoli, Emanuele

2013-08-01

During the global pandemic of A/H1N1/California/07/2009 (A/H1N1/Cal) influenza, many governments signed contracts with vaccine producers for a universal influenza immunization program and bought hundreds of millions of vaccines doses. We argue that, as Health Ministers assumed the occurrence of the worst possible scenario (generalized pandemic influenza) and followed the strong version of the Precautionary Principle, they undervalued the possibility of mild or weak pandemic wave. An alternative decision rule, based on the non-extensive entropy principle, is introduced, and a different Precautionary Principle characterization is applied. This approach values extreme negative results (catastrophic events) in a different way and predicts more plausible and mild events. It introduces less pessimistic forecasts in the case of uncertain influenza pandemic outbreaks. A simplified application is presented using seasonal data of morbidity and severity among Italian children influenza-like illness for the period 2003-10. Established literature results predict an average attack rate of not less than 15% for the next pandemic influenza [Meltzer M, Cox N, Fukuda K. The economic impact of pandemic influenza in the United States: implications for setting priorities for interventions. Emerg Infect Dis 1999;5:659-71; Meltzer M, Cox N, Fukuda K. Modeling the Economic Impact of Pandemic Influenza in the United States: Implications for Setting Priorities for Intervention. Background paper. Atlanta, GA: CDC, 1999. Available at: http://www.cdc.gov/ncidod/eid/vol5no5/melt_back.htm (7 January 2011, date last accessed))]. The strong version of the Precautionary Principle would suggest using this prediction for vaccination campaigns. On the contrary, the non-extensive maximum entropy principle predicts a lower attack rate, which induces a 20% saving in public funding for vaccines doses. The need for an effective influenza pandemic prevention program, coupled with an efficient use of public

The health care response to pandemic influenza.

PubMed

Barnitz, Laura; Berkwits, Michael

2006-07-18

The threat of an H5N1 influenza virus (avian flu) pandemic is substantial. The success of the current U.S. influenza pandemic response plan depends on effective coordination among state and local public health authorities and individual health care providers. This article is a summary of a public policy paper developed by the American College of Physicians to address issues in the U.S. Department of Health and Human Services Pandemic Influenza Plan that involve physicians. The College's positions call for the following: 1) development of local public health task forces that include physicians representing all specialties and practice settings; 2) physician access to 2-way communication with public health authorities and to information technology tools for diagnosis and syndrome surveillance; 3) clear identification and authorization of agencies to process licensing and registration of volunteer physicians; 4) clear guidelines for overriding standard procedures for confidentiality and consent in the interest of the public's health; 5) clear and fair infection control measures that do not create barriers to care; 6) analysis of and solutions to current problems with seasonal influenza vaccination programs as a way of developing a maximally efficient pandemic flu vaccine program; 7) federal funding to provide pandemic flu vaccine for the entire U.S. population and antiviral drugs for 25% of the population; and 8) planning for health care in alternative, nonhospital settings to prevent a surge in demand for hospital care that exceeds supply. *This paper is an abridged version of a full-text position paper (available at http://www.acponline.org/college/pressroom/as06/pandemic_policy.pdf) written by Laura Barnitz, BJ, MA, and updated and adapted for publication in Annals of Internal Medicine by Michael Berkwits, MD, MSCE. The original position paper was developed for the Health and Public Policy Committee of the American College of Physicians: Jeffrey P. Harris, MD

Understanding estimated worker absenteeism rates during an influenza pandemic.

PubMed

Thanner, Meridith H; Links, Jonathan M; Meltzer, Martin I; Scheulen, James J; Kelen, Gabor D

2011-01-01

Published employee absenteeism estimates during an influenza pandemic range from 10 to 40 percent. The purpose of this study was to estimate daily employee absenteeism through the duration of an influenza pandemic and to determine the relative impact of key variables used to derive the estimates. Using the Centers for Disease Control and Prevention's FluWorkLoss program, the authors estimated the number of absent employees on any given day over the course of a simulated 8-week pandemic wave by using varying attack rates. Employee data from a university with a large academic health system were used. Sensitivity of the program outputs to variation in predictor (inputs) values was assessed. Finally, the authors examined and documented the algorithmic sequence of the program. Using a 35 percent attack rate, a total of 47,270 workdays (or 3.4 percent of all available workdays) would be lost over the course of an 8-week pandemic among a population of 35,026 employees. The highest (peak) daily absenteeism estimate was 5.8 percent (minimum 4.8 percent; maximum 7.4 percent). Sensitivity analysis revealed that varying days missed for nonhospitalized illness had the greatest potential effect on peak absence rate (3.1 to 17.2 percent). Peak absence with 15 and 25 percent attack rates were 2.5 percent and 4.2 percent, respectively. The impact of an influenza pandemic on employee availability may be less than originally thought, even with a high attack rate. These data are generalizable and are not specific to institutions of higher education or medical centers. Thus, these findings provide realistic and useful estimates for influenza pandemic planning for most organizations.

Comparative Characteristics of the 2009 Pandemic Influenza A (H1N1) Virus and 2010-2011 Seasonal Influenza in Pediatric Patients.

PubMed

Nasrallah, Najwan; Shachor-Meyouhas, Yael; Kra-Oz, Zipi; Mashiach, Tania; Szwarcwort-Cohen, Moran; Shafran, Eynat; Kassis, Imad

2016-12-01

In March 2009 the pandemic influenza A (H1N1) strain was identified. The disease initially appeared to be accompanied by complications and high mortality rates. It became an endemic virus during the influenza season in our region, along with the classical seasonal H3N2. To identify the burden of pandemic influenza, its effect in pediatric patients, and complicated hospitalizations, compared to seasonal influenza years after the pandemic. A retrospective observational study was conducted at a tertiary hospital. Data were collected from the medical records of all children who were hospitalized from April 2009 to 2011 with laboratory-confirmed influenza. Of 191 patients with influenza, 100 had the 2009 pandemic influenza, 62 had seasonal influenza, and 29 had H1N1 in 2010-2011. Patients with the 2009 H1N1 were characterized by older age, more co-morbidity conditions and more symptoms including fever, cough and rhinitis on admission. No significant differences in outcomes between the groups were recorded. Of patients hospitalized with pandemic influenza in 2009, 28% had complicated hospitalizations, compared with 17.7% of patients hospitalized with seasonal influenza in 2010-11. Children with pandemic influenza received more oseltamivir (Tamiflu®) (94% vs. 19.4%, P < 0.001) and more antibiotics than the other groups. The type of influenza had no effect on outcome. There were no significant differences between groups in the percentages of in-hospital mortality, admission to intensive care units, prolonged hospitalization (> 9 days), or the development of complications during hospitalization.

Pandemic and post-pandemic influenza A (H1N1) seasons in a tertiary care university hospital-high rate of complications compared to previous influenza seasons.

PubMed

Bauernfeind, S; Bruennler, T; Ehrenstein, B; Langgartner, J; Wenzel, J J; Werner, S; Lubnow, M; Mueller, T; Floerchinger, B; Salzberger, B

2013-02-01

The aim was to study the characteristics and case severity of patients hospitalized for influenza with a pandemic strain at a German tertiary care university hospital in 2009/10 and 2010/11 and to compare them to two previous influenza seasons. An observational study of all patients hospitalized for laboratory-confirmed influenza during the last four influenza seasons at Regensburg University Hospital was undertaken. During the last four seasons, a rising number of patients were admitted due to influenza (4 in 2007/8, 16 in 2008/9, 27 in 2009/10, and 55 in 2010/11). Patients seen in the last two seasons were younger (median age 63 years in 2007/8, 52 years in 2008/9, 42 years in 2009/10, and 48 years in 2010/11) (p = 0.046) and presented with a lower rate of major comorbidities (75 % in 2007/8, 62.5 % in 2008/9, 37 % in 2009/10, and 47.3 % in 2010/11). The pandemic and post-pandemic seasons were characterized by a high rate of seriously ill patients with longer hospitalizations (11 days in 2007/8, 7 days in 2008/9, 22 days in 2009/10 and 2010/11) (p = 0.004) and higher rates of intensive care unit (ICU) admission (25 % in 2007/8, 18.8 % in 2008/9, 66.7 % in 2009/10, and 52.7 % in 2010/11) (p = 0.003) and mechanical ventilation (25 % in 2007/8, 6.3 % in 2008/9, 63 % in 2009/10, and 49.1 % in 2010/11) (p < 0.001). Extracorporeal membrane oxygenation (ECMO) was necessary in 33.3 % of patients in 2009/10 and 25.5 % in 2010/11. We had six fatalities in both pandemic and post-pandemic seasons. Compared to seasonal influenza, we observed even more so in the post-pandemic than the pandemic season a higher number of younger patients, with less serious comorbidities often showing a very severe course.

Securitising health: Australian newspaper coverage of pandemic influenza.

PubMed

Stephenson, Niamh; Jamieson, Michelle

2009-05-01

This paper analyses contemporary Australian newspaper coverage of the threat of pandemic influenza in humans, specifically in the light of recent transformations in biomedical and public health understandings of infectious disease as continuously emerging. Our analysis suggests that the spectre of pandemic influenza is characterised, in newspaper accounts, as invoking a specific form of nation building. The Australian nation is depicted as successfully securing itself in the face of a threat from Asia (and in the absence of an effective international health body). What is described in newspaper accounts reflects a shift in the public health response to infectious disease. This response does not entail a direct focus on protecting either the population or national territory. Instead, it involves the continuous rehearsal of readiness to react to disasters through the networking of government and private agencies responsible for maintaining critical infrastructure. In this way, coverage of pandemic influenza positions health as central to national security, with little reporting of the reasons for or the potential implications of this alliance. Thus, the imperative to 'be prepared' is presented as self-evident.

Differential Immune Profiles in Two Pandemic Influenza A(H1N1)pdm09 Virus Waves at Pandemic Epicenter.

PubMed

Arriaga-Pizano, Lourdes; Ferat-Osorio, Eduardo; Rodríguez-Abrego, Gabriela; Mancilla-Herrera, Ismael; Domínguez-Cerezo, Esteban; Valero-Pacheco, Nuriban; Pérez-Toledo, Marisol; Lozano-Patiño, Fernando; Laredo-Sánchez, Fernando; Malagón-Rangel, José; Nellen-Hummel, Haiko; González-Bonilla, César; Arteaga-Troncoso, Gabriel; Cérbulo-Vázquez, Arturo; Pastelin-Palacios, Rodolfo; Klenerman, Paul; Isibasi, Armando; López-Macías, Constantino

2015-11-01

Severe influenza A(H1N1)pdm2009 virus infection cases are characterized by sustained immune activation during influenza pandemics. Seasonal flu data suggest that immune mediators could be modified by wave-related changes. Our aim was to determine the behavior of soluble and cell-related mediators in two waves at the epicenter of the 2009 influenza pandemic. Leukocyte surface activation markers were studied in serum from peripheral blood samples, collected from the 1(st) (April-May, 2009) and 2(nd) (October 2009-February 2010) pandemic waves. Patients with confirmed influenza A(H1N1)pdm2009 virus infection (H1N1), influenza-like illness (ILI) or healthy donors (H) were analyzed. Serum IL-6, IL-4 and IL-10 levels were elevated in H1N1 patients from the 2(nd) pandemic wave. Additionally, the frequency of helper and cytotoxic T cells was reduced during the 1(st) wave, whereas CD69 expression in helper T cells was increased in the 2(nd) wave for both H1N1 and ILI patients. In contrast, CD62L expression in granulocytes from the ILI group was increased in both waves but in monocytes only in the 2(nd) wave. Triggering Receptor Expressed on Myeloid cells (TREM)-1 expression was elevated only in H1N1 patients at the 1(st) wave. Our results show that during the 2009 influenza pandemic a T cell activation phenotype is observed in a wave-dependent fashion, with an expanded activation in the 2(nd) wave, compared to the 1(st) wave. Conversely, granulocyte and monocyte activation is infection-dependent. This evidence collected at the pandemic epicenter in 2009 could help us understand the differences in the underlying cellular mechanisms that drive the wave-related immune profile behaviors that occur against influenza viruses during pandemics. Copyright © 2015 IMSS. Published by Elsevier Inc. All rights reserved.

Assessing the Ecotoxicologic Hazards of a Pandemic Influenza Medical Response

PubMed Central

Colizza, Vittoria; Schmitt, Heike; Andrews, Johanna; Balcan, Duygu; Huang, Wei E.; Keller, Virginie D.J.; Vespignani, Alessandro; Williams, Richard J.

2011-01-01

Background: The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWTPs) and receiving rivers. Objectives: We assessed the ecotoxicologic risks of a pandemic influenza medical response. Methods: To evaluate this risk, we coupled a global spatially structured epidemic model that simulates the quantities of antivirals and antibiotics used during an influenza pandemic of varying severity and a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers. Results: Consistent with expectations, our model projected a mild pandemic to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, we projected WWTP toxicity to vary between 0–14% and 5–32% potentially affected fraction (PAF), respectively, and river toxicity to vary between 0–14% and 0–30% PAF, respectively, where PAF is the fraction of microbial species predicted to be growth inhibited (lower and upper 95% reference range). Conclusions: The current medical response to pandemic influenza might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. Our results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTPs

Assessing the ecotoxicologic hazards of a pandemic influenza medical response.

PubMed

Singer, Andrew C; Colizza, Vittoria; Schmitt, Heike; Andrews, Johanna; Balcan, Duygu; Huang, Wei E; Keller, Virginie D J; Vespignani, Alessandro; Williams, Richard J

2011-08-01

The global public health community has closely monitored the unfolding of the 2009 H1N1 influenza pandemic to best mitigate its impact on society. However, little attention has been given to the impact of this response on the environment. Antivirals and antibiotics prescribed to treat influenza are excreted into wastewater in a biologically active form, which presents a new and potentially significant ecotoxicologic challenge to microorganisms responsible for wastewater nutrient removal in wastewater treatment plants (WWTPs) and receiving rivers. We assessed the ecotoxicologic risks of a pandemic influenza medical response. To evaluate this risk, we coupled a global spatially structured epidemic model that simulates the quantities of antivirals and antibiotics used during an influenza pandemic of varying severity and a water quality model applied to the Thames catchment to determine predicted environmental concentrations. An additional model was then used to assess the effects of antibiotics on microorganisms in WWTPs and rivers. Consistent with expectations, our model projected a mild pandemic to exhibit a negligible ecotoxicologic hazard. In a moderate and severe pandemic, we projected WWTP toxicity to vary between 0-14% and 5-32% potentially affected fraction (PAF), respectively, and river toxicity to vary between 0-14% and 0-30% PAF, respectively, where PAF is the fraction of microbial species predicted to be growth inhibited (lower and upper 95% reference range). The current medical response to pandemic influenza might result in the discharge of insufficiently treated wastewater into receiving rivers, thereby increasing the risk of eutrophication and contamination of drinking water abstraction points. Widespread drugs in the environment could hasten the generation of drug resistance. Our results highlight the need for empirical data on the effects of antibiotics and antiviral medications on WWTPs and freshwater ecotoxicity.

75 FR 10268 - Pandemic Influenza Vaccines-Amendment

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-05

... DEPARTMENT OF HEALTH AND HUMAN SERVICES Office of the Secretary Pandemic Influenza Vaccines... Preparedness Act for H5N1, H2, H6, H7, H9 and 2009-H1N1 Vaccines: Whereas there are or may be multiple animal... through February 28, 2010 for vaccines against influenza virus strains named in the Declaration other than...

A pandemic influenza modeling and visualization tool

DOE Office of Scientific and Technical Information (OSTI.GOV)

Maciejewski, Ross; Livengood, Philip; Rudolph, Stephen

2011-08-01

The National Strategy for Pandemic Influenza outlines a plan for community response to a potential pandemic. In this outline, state and local communities are charged with enhancing their preparedness. In order to help public health officials better understand these charges, we have developed a modeling and visualization toolkit (PanViz) for analyzing the effect of decision measures implemented during a simulated pandemic influenza scenario. Spread vectors based on the point of origin and distance traveled over time are calculated and the factors of age distribution and population density are taken into effect. Healthcare officials are able to explore the effects ofmore » the pandemic on the population through a spatiotemporal view, moving forward and backward through time and inserting decision points at various days to determine the impact. Linked statistical displays are also shown, providing county level summaries of data in terms of the number of sick, hospitalized and dead as a result of the outbreak. Currently, this tool has been deployed in Indiana State Department of Health planning and preparedness exercises, and as an educational tool for demonstrating the impact of social distancing strategies during the recent H1N1 (swine flu) outbreak.« less

Oseltamivir-resistant pandemic influenza a (H1N1) 2009 viruses in Spain.

PubMed

Ledesma, Juan; Vicente, Diego; Pozo, Francisco; Cilla, Gustavo; Castro, Sonia Pérez; Fernández, Jonathan Suárez; Ruiz, Mercedes Pérez; Navarro, José María; Galán, Juan Carlos; Fernández, Mirian; Reina, Jordi; Larrauri, Amparo; Cuevas, María Teresa; Casas, Inmaculada; Breña, Pilar Pérez

2011-07-01

Pandemic influenza A (H1N1) 2009 virus appeared in Spain on April 25, 2009 for the first time. This new virus was adamantane-resistant but it was sensitive to neuraminidase (NA) inhibitors oseltamivir and zanamivir. To detect oseltamivir-resistant pandemic influenza A (H1N1) 2009 viruses by the Spanish Influenza Surveillance System (SISS) and a possible spread of oseltamivir-resistant viruses in Spain since starting of the pandemic situation. A total of 1229 respiratory samples taken from 413 severe and 766 non-severe patients with confirmed viral detection of pandemic influenza A (H1N1) 2009 viruses from different Spanish regions were analyzed for the specific detection of the H275Y mutation in NA between April 2009 and May 2010. H275Y NA substitution was found in 8 patients infected with pandemic influenza A (H1N1) 2009 viruses collected in November and December 2009 and in January 2010. All oseltamivir-resistant viruses were detected in severe patients (8/413, 1.93%) who previously received treatment with oseltamivir. Six of these patients were immunocompromised. In Spain, the number of oseltamivir-resistant pandemic influenza A (H1N1) 2009 viruses is until now very low. No evidence for any spread of oseltamivir-resistant H1N1 viruses is achieved in our Country. Copyright © 2011 Elsevier B.V. All rights reserved.

Pandemic influenza guidance for corporations.

PubMed

2011-06-01

The purpose of this guidance document is to assist members of the American College of Occupational and Environmental Medicine (ACOEM), and the organizations for which they work, in managing the impact of a pandemic of influenza or other contagious respiratory disease on patients, employees, and business. This guidance document outlines actions to take before and during an influenza pandemic on the basis of two main strategies: (1) reducing the spread of the virus within facilities; and (2) providing medical care and medical surveillance to client/patient populations. Facilities in which ACOEM members serve include government agencies and the military, universities, and corporations, which generally have multiple locations/sites and their own medical staff, with members responsible for medical care and disease control. This guidance is for organizations with outpatient occupational medicine services, to be used as appropriate. Medical centers should also use guidance that addresses additional employee and external patient care needs.1–3 The ACOEM fully supports implementation of occupational influenza programs that conform with guidance from the Centers for Disease Control and Prevention (CDC), with other guidance from the US Department of Health and Human Services (DHHS), and Occupational Safety and Health Administration (OSHA) regulations and guidance.

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

DOE Office of Scientific and Technical Information (OSTI.GOV)

HCTT-CHE

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthenmore » existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.« less

Association of hospitalizations for asthma with seasonal and pandemic influenza.

PubMed

Gerke, Alicia K; Yang, Ming; Tang, Fan; Foster, Eric D; Cavanaugh, Joseph E; Polgreen, Philip M

2014-01-01

Although influenza has been associated with asthma exacerbations, it is not clear the extent to which this association affects health care use in the United States. The first goal of this project was to determine whether, and to what extent, the incidence of asthma hospitalizations is associated with seasonal variation in influenza. Second, we used influenza trends (2000-2008) to help predict asthma admissions during the 2009 H1N1 influenza pandemic. We identified all hospitalizations between 1998 and 2008 in the Nationwide Inpatient Sample from the Healthcare Cost and Utilization Project during which a primary diagnosis of asthma was recorded. Separately, we identified all hospitalizations during which a diagnosis of influenza was recorded. We performed time series regression analyses to investigate the association of monthly asthma admissions with influenza incidence. Finally, we applied these time series regression models using 1998-2008 data, to forecast monthly asthma admissions during the 2009 influenza pandemic. Based on time series regression models, a strong, significant association exists between concurrent influenza activity and incidence of asthma hospitalizations (P-value < 0.0001). Use of influenza data to predict asthma admissions during the 2009 H1N1 pandemic improved the mean squared prediction error by 60.2%. Influenza activity in the population is significantly associated with asthma hospitalizations in the United States, and this association can be exploited to more accurately forecast asthma admissions. Our results suggest that improvements in influenza surveillance, prevention and treatment may decrease hospitalizations of asthma patients. © 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.

Mobilising "vulnerability" in the public health response to pandemic influenza.

PubMed

Stephenson, Niamh; Davis, Mark; Flowers, Paul; MacGregor, Casimir; Waller, Emily

2014-02-01

Analysis of public health's growing interest in "vulnerability" has largely focused on health policy, with little interrogation of how vulnerability is being actively appropriated, countered, ignored or reworked by the publics whose health such policy is designed to protect. Once the assemblage of public health is understood as comprised of different forms of expertise and actors, including publics, addressing this gap matters. We examine the use of vulnerability in the specific context of pandemic influenza preparedness. Pandemic preparedness raises some familiar dilemmas for public health governance: how to engage with publics without fuelling social divisions and disruption; and whether to invoke publics as passive recipients of public health advice or to recognise publics as collective agents responding to the threat of pandemic influenza. Thus, we ask how the mobilisation of vulnerability connects with these dilemmas. To examine vulnerability in pandemic preparedness, two forms of qualitative data are analysed: 1) interviews and focus groups with "vulnerable" and "healthy" people (conducted 2011-12) discussing seasonal and pandemic influenza and; 2) international, Australian national and state level pandemic plans (1999-2013). Vulnerability is variously used in plans as a way to identify groups at particular risk of infection because of pre-existing clinical conditions, and as a free-floating social category that could apply to a broad range of people potentially involved in the social disruption a pandemic might entail. Our interview and focus group data indicate that healthy people rework the free-floating extension of vulnerability, and that people designated vulnerable encounter an absence of any collective responsibility for the threat of pandemic influenza. Our analysis suggests that vulnerability's mobilisation in pandemic preparedness limits the connection between public health governance and its publics: here, the openness and unpredictability of

Influenza Pandemics and Tuberculosis Mortality in 1889 and 1918: Analysis of Historical Data from Switzerland.

PubMed

Zürcher, Kathrin; Zwahlen, Marcel; Ballif, Marie; Rieder, Hans L; Egger, Matthias; Fenner, Lukas

2016-01-01

Tuberculosis (TB) mortality declined in the northern hemisphere over the last 200 years, but peaked during the Russian (1889) and the Spanish (1918) influenza pandemics. We studied the impact of these two pandemics on TB mortality. We retrieved historic data from mortality registers for the city of Bern and countrywide for Switzerland. We used Poisson regression models to quantify the excess pulmonary TB (PTB) mortality attributable to influenza. Yearly PTB mortality rates increased during both influenza pandemics. Monthly influenza and PTB mortality rates peaked during winter and early spring. In Bern, for an increase of 100 influenza deaths (per 100,000 population) monthly PTB mortality rates increased by a factor of 1.5 (95%Cl 1.4-1.6, p<0.001) during the Russian, and 3.6 (95%Cl 0.7-18.0, p = 0.13) during the Spanish pandemic. Nationally, the factor was 2.0 (95%Cl 1.8-2.2, p<0.001) and 1.5 (95%Cl 1.1-1.9, p = 0.004), respectively. We did not observe any excess cancer or extrapulmonary TB mortality (as a negative control) during the influenza pandemics. We demonstrate excess PTB mortality during historic influenza pandemics in Switzerland, which supports a role for influenza vaccination in PTB patients in high TB incidence countries.

The possible macroeconomic impact on the UK of an influenza pandemic.

PubMed

Keogh-Brown, Marcus R; Wren-Lewis, Simon; Edmunds, W John; Beutels, Philippe; Smith, Richard D

2010-11-01

Little is known about the possible impact of an influenza pandemic on a nation's economy. We applied the UK macroeconomic model 'COMPACT' to epidemiological data on previous UK influenza pandemics, and extrapolated a sensitivity analysis to cover more extreme disease scenarios. Analysis suggests that the economic impact of a repeat of the 1957 or 1968 pandemics, allowing for school closures, would be short-lived, constituting a loss of 3.35 and 0.58% of GDP in the first pandemic quarter and year, respectively. A more severe scenario (with more than 1% of the population dying) could yield impacts of 21 and 4.5%, respectively. The economic shockwave would be gravest when absenteeism (through school closures) increases beyond a few weeks, creating policy repercussions for influenza pandemic planning as the most severe economic impact is due to policies to contain the pandemic rather than the pandemic itself.Accounting for changes in consumption patterns made in an attempt to avoid infection worsens the potential impact. Our mild disease scenario then shows first quarter/first year reductions in GDP of 9.5/2.5%, compared with our severe scenario reductions of 29.5/6%. These results clearly indicate the significance of behavioural change over disease parameters. Copyright © 2009 John Wiley & Sons, Ltd.

Enhanced risk of illness during the 1918 influenza pandemic after previous influenza-like illnesses in three military populations.

PubMed

Shanks, G D; Burroughs, S A; Sohn, J D; Waters, N C; Smith, V F; Waller, M; Brundage, J F

2016-07-01

The reasons for the unprecedented mortality during the 1918 influenza pandemic remain poorly understood. We examined morbidity records from three military cohorts from years prior to and during the 1918 pandemic period to assess the effects of previous respiratory illnesses on experiences during the pandemic. Clinical registers and morbidity lists were examined to identify all medical encounters for acute respiratory illnesses in students at two U.S. military officer training academies and Australian soldiers deployed in Europe. Influenza-like illness prior to the major pandemic wave of 1918 predisposed Australian soldiers [relative risk (RR) 1·37, 95% confidence interval (CI) 1·18-1·60, P < 0·0001] and US officer trainees at West Point (RR 3·10, 95% CI 2·13-4·52, P < 0·0001) and Annapolis (RR 2·03, 95% CI 1·65-2·50, P < 0·0001) to increased risks of medically treated illnesses in late 1918. The findings suggest that susceptibility to and/or clinical expressions of the 1918 pandemic influenza virus depended on previous experiences with respiratory infectious agents. The findings are consistent with observations during the 2009 pandemic in Canada and may reflect antibody-dependent enhancement of influenza infection.

Corporate preparedness for pandemic influenza: a survey of pharmaceutical and biotechnology companies in Montgomery County, Maryland.

PubMed

Watkins, Rissah J; Barnett, Daniel J; Links, Jonathan M

2008-09-01

We conducted a survey of corporate preparedness for pandemic influenza among biotechnology and pharmaceutical companies in Montgomery County, Maryland, to determine the level of preparedness for this industry and geographic region. The survey, based on the HHS Business Pandemic Influenza Planning Checklist, established whether a company had a preparedness plan specific to pandemic influenza, the contents of its plan, or its reasons for a lack of a plan. A total of 50 companies participated in the survey. Of these, 40 did not have any type of preparedness plan, 3 were drafting plans, 6 had general preparedness plans that could be applied to an influenza pandemic, and only 1 company had a preparedness plan specifically designed to address pandemic influenza. Biotechnology and pharmaceutical companies in this geographic region are currently not well prepared for pandemic influenza. Public health officials should offer more help, possibly in the form of a model small business preparedness plan, and collaboration between companies should be encouraged to foster sharing of preparedness plans.

Initial Identification and Characterization of an Emerging Zoonotic Influenza Prior to Pandemic Spread

DTIC Science & Technology

2010-11-01

equally closely strains of both H1N2 influenza A virus of swine origin and H3N2 influenza A virus of avian origin. The expected matches for each of...Naval Health Research Center Initial Identification and Characterization of an Emerging Zoonotic Influenza Virus Prior to Pandemic Spread...10.1128/JCM.01336-10 PMCID: PMC3020883 Initial Identification and Characterization of an Emerging Zoonotic Influenza Virus Prior to Pandemic

The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age

PubMed Central

Erkoreka, Anton

2010-01-01

Please cite this paper as: Erkoreka A. (2010) The Spanish influenza pandemic in occidental Europe (1918–1920) and victim age. Influenza and Other Respiratory Viruses 4(2), 81–89. Background  Studies of the Spanish Influenza pandemic (1918–1920) provide interesting information that may improve our preparation for present and future influenza pandemic threats. Methods  We studied archives from France, Italy, Spain and Portugal, obtaining high‐quality data that allowed us to calculate mortality rates associated with the Spanish flu and to characterize the proportional distribution of influenza deaths by age in the capital cities of these countries. Results  French and American troops who fought in the First World War began to be affected from April 1918 onwards by a benign influenza epidemic, which hardly caused any deaths. The first occidental European country in which the pandemic spread to large sectors of the population, causing serious mortality, was Spain. The associated influenza provoked in Madrid a mortality rate of 1·31 per 1000 inhabitants between May and June (1918). In the following months of June and July, the epidemic spread to Portugal, but did not reach the Pyrenees. In September 1918, the influenza pandemic spread with tremendous virulence, presenting itself simultaneously during the month of October in South Western European countries. In Madrid, the 1918 excess mortality due in large part to the influenza pandemic is estimated at 5·27 per 1000. In Paris, the 1918 mortality rate provoked by the influenza and pathologies of the respiratory system was 6·08 per 1000. In South Western European countries, mortality rates oscillated between 10·6 and 12·1 per 1000 inhabitants. A study of the age distribution of deaths due to influenza between 1916 and 1921 reveals that the Spanish influenza principally affected men and women between 15 and 44 years of age. Deaths associated with the seasonal influenza of 1916, 1917 and 1921 represented

Protecting vulnerable populations from pandemic influenza in the United States: a strategic imperative.

PubMed

Hutchins, Sonja S; Truman, Benedict I; Merlin, Toby L; Redd, Stephen C

2009-10-01

Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations.

Pandemic influenza H1N1 2009 infection in Victoria, Australia: no evidence for harm or benefit following receipt of seasonal influenza vaccine in 2009.

PubMed

Kelly, Heath A; Grant, Kristina A; Fielding, James E; Carville, Kylie S; Looker, Clare O; Tran, Thomas; Jacoby, Peter

2011-08-26

Conflicting findings regarding the level of protection offered by seasonal influenza vaccination against pandemic influenza H1N1 have been reported. We performed a test-negative case control study using sentinel patients from general practices in Victoria to estimate seasonal influenza vaccine effectiveness against laboratory proven infection with pandemic influenza. Cases were defined as patients with an influenza-like illness who tested positive for influenza while controls had an influenza-like illness but tested negative. We found no evidence of significant protection from seasonal vaccine against pandemic influenza virus infection in any age group. Age-stratified point estimates, adjusted for pandemic phase, ranged from 44% in persons aged less than 5 years to -103% (odds ratio=2.03) in persons aged 50-64 years. Vaccine effectiveness, adjusted for age group and pandemic phase, was 3% (95% CI -48 to 37) for all patients. Our study confirms the results from our previous interim report, and other studies, that failed to demonstrate benefit or harm from receipt of seasonal influenza vaccine in patients with confirmed infection with pandemic influenza H1N1 2009. Copyright © 2011 Elsevier Ltd. All rights reserved.

Hospital capacity and management preparedness for pandemic influenza in Victoria.

PubMed

Dewar, Ben; Barr, Ian; Robinson, Priscilla

2014-04-01

This study was designed to investigate acute hospital pandemic influenza preparedness in Victoria, Australia, particularly focussing on planning and management efforts. A prospective study was conducted by questionnaire and semi-structured interview of health managers across the Victorian hospital system from July to October 2011. Participants with responsibility for emergency management, planning and operations were selected from every hospital in Victoria with an emergency department to complete a questionnaire (response rate 22/43 = 51%). Each respondent was invited to participate in a phone-based semi-structured interview (response rate 11/22 = 50%). Rural/regional hospitals demonstrated higher levels of clinical (86%) and non-clinical (86%) staff contingency planning than metropolitan hospitals (60% and 40% respectively). Pandemic plans were not being sufficiently tested in exercises or drills, which is likely to undermine their effectiveness. All respondents reported hand hygiene and standard precautions programs in place, although only one-third (33%) of metropolitan respondents and no rural/regional respondents reported being able to meet patient needs with high levels of staff absenteeism. Almost half Victoria's healthcare workers were unvaccinated against influenza. Hospitals across Victoria demonstrated different levels of influenza pandemic preparedness and planning. If a more severe influenza pandemic than that of 2009 arose, Victorian hospitals would struggle with workforce and infrastructure problems, particularly in rural/regional areas. Staff absenteeism threatens to undermine hospital pandemic responses. Various strategies, including education and communication, should be included with in-service training to provide staff with confidence in their ability to work safely during a future pandemic. © 2014 The Authors. ANZJPH © 2014 Public Health Association of Australia.

Macroeconomic impact of pandemic influenza and associated policies in Thailand, South Africa and Uganda.

PubMed

Smith, Richard D; Keogh-Brown, Marcus R

2013-09-01

Research has shown the value of conducting a macroeconomic analysis of the impact of influenza pandemics. However, previous modelling applications focus on high-income countries, and there is a lack of evidence concerning the potential impact of an influenza pandemic on lower- and middle-income countries. To estimate the macroeconomic impact of pandemic influenza in Thailand, South Africa and Uganda with particular reference to pandemic (H1N1) 2009. A single-country whole-economy Computable General Equilibrium (CGE) model was set up for each of the three countries in question and used to estimate the economic impact of declines in labour attributable to morbidity, mortality and school closure. Overall GDP impacts were less than 1% of GDP for all countries and scenarios. Uganda's losses were proportionally larger than those of Thailand and South Africa. Labour-intensive sectors suffer the largest losses. The economic cost of unavoidable absence in the event of an influenza pandemic could be proportionally larger for low-income countries. The cost of mild pandemics, such as pandemic (H1N1) 2009, appears to be small, but could increase for more severe pandemics and/or pandemics with greater behavioural change and avoidable absence. © 2013 Blackwell Publishing Ltd.

Influenza Pandemics and Tuberculosis Mortality in 1889 and 1918: Analysis of Historical Data from Switzerland

PubMed Central

Zürcher, Kathrin; Zwahlen, Marcel; Ballif, Marie; Rieder, Hans L.; Egger, Matthias

2016-01-01

Background Tuberculosis (TB) mortality declined in the northern hemisphere over the last 200 years, but peaked during the Russian (1889) and the Spanish (1918) influenza pandemics. We studied the impact of these two pandemics on TB mortality. Methods We retrieved historic data from mortality registers for the city of Bern and countrywide for Switzerland. We used Poisson regression models to quantify the excess pulmonary TB (PTB) mortality attributable to influenza. Results Yearly PTB mortality rates increased during both influenza pandemics. Monthly influenza and PTB mortality rates peaked during winter and early spring. In Bern, for an increase of 100 influenza deaths (per 100,000 population) monthly PTB mortality rates increased by a factor of 1.5 (95%Cl 1.4–1.6, p<0.001) during the Russian, and 3.6 (95%Cl 0.7–18.0, p = 0.13) during the Spanish pandemic. Nationally, the factor was 2.0 (95%Cl 1.8–2.2, p<0.001) and 1.5 (95%Cl 1.1–1.9, p = 0.004), respectively. We did not observe any excess cancer or extrapulmonary TB mortality (as a negative control) during the influenza pandemics. Conclusions We demonstrate excess PTB mortality during historic influenza pandemics in Switzerland, which supports a role for influenza vaccination in PTB patients in high TB incidence countries. PMID:27706149

Physician's knowledge, attitudes, and practices regarding seasonal influenza, pandemic influenza, and highly pathogenic avian influenza A (H5N1) virus infections of humans in Indonesia.

PubMed

Mangiri, Amalya; Iuliano, A Danielle; Wahyuningrum, Yunita; Praptiningsih, Catharina Y; Lafond, Kathryn E; Storms, Aaron D; Samaan, Gina; Ariawan, Iwan; Soeharno, Nugroho; Kreslake, Jennifer M; Storey, J Douglas; Uyeki, Timothy M

2017-01-01

Indonesia has reported highest number of fatal human cases of highly pathogenic avian influenza (HPAI) A (H5N1) virus infection worldwide since 2005. There are limited data available on seasonal and pandemic influenza in Indonesia. During 2012, we conducted a survey of clinicians in two districts in western Java, Indonesia, to assess knowledge, attitudes, and practices (KAP) of clinical diagnosis, testing, and treatment of patients with seasonal influenza, pandemic influenza, or HPAI H5N1 virus infections. Overall, a very low percentage of physician participants reported ever diagnosing hospitalized patients with seasonal, pandemic, or HPAI H5N1 influenza. Use of influenza testing was low in outpatients and hospitalized patients, and use of antiviral treatment was very low for clinically diagnosed influenza patients. Further research is needed to explore health system barriers for influenza diagnostic testing and availability of antivirals for treatment of influenza in Indonesia. © 2016 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Protecting Vulnerable Populations From Pandemic Influenza in the United States: A Strategic Imperative

PubMed Central

Truman, Benedict I.; Merlin, Toby L.; Redd, Stephen C.

2009-01-01

Protecting vulnerable populations from pandemic influenza is a strategic imperative. The US national strategy for pandemic influenza preparedness and response assigns roles to governments, businesses, civic and community-based organizations, individuals, and families. Because influenza is highly contagious, inadequate preparedness or untimely response in vulnerable populations increases the risk of infection for the general population. Recent public health emergencies have reinforced the importance of preparedness and the challenges of effective response among vulnerable populations. We explore definitions and determinants of vulnerable, at-risk, and special populations and highlight approaches for ensuring that pandemic influenza preparedness includes these populations and enables them to respond appropriately. We also provide an overview of population-specific and cross-cutting articles in this theme issue on influenza preparedness for vulnerable populations. PMID:19797737

People at Risk of Influenza Pandemics: The Evolution of Perception and Behavior.

PubMed

Xu, Jianhua; Peng, Zongchao

2015-01-01

Influenza pandemics can severely impact human health and society. Understanding public perception and behavior toward influenza pandemics is important for minimizing the effects of such events. Public perception and behavior are expected to change over the course of an influenza pandemic, but this idea has received little attention in previous studies. Our study aimed to understand the dynamics of public perception and behavior over the course of the 2009 H1N1 influenza pandemic. Three consecutive cross-sectional surveys were administered among Beijing residents with random-digit dialing techniques in March 2008 and August and November 2009. Effective samples of 507, 508 and 1006 respondents were interviewed in each of the three surveys, respectively. The mean scores of risk perception were low to moderate across the three surveys. The perceived risk of infection of self was significantly lower than that of the community, revealing an optimistic bias. Longitudinally, the perceived risk of contracting H1N1 increased, whereas the perceived risk of being unable to obtain medicine and medical care once influenza permeated the community first increased and then decreased. Responsive actions toward influenza varied. Most respondents took actions that required little extra effort, such as ventilating rooms; these actions did not change over time. Comparatively, a smaller number of respondents took actions for coping with influenza, such as vaccination; however, these actions were taken by an increasing number of respondents over time. The association between risk perception and behavior was unstable. Positive, insignificant, and negative associations were obtained in the three surveys. In conclusion, the evolving patterns of risk perception and responsive behavior over the course of an influenza pandemic are sensitive to how risk and behavior are defined and scoped.

People at Risk of Influenza Pandemics: The Evolution of Perception and Behavior

PubMed Central

Xu, Jianhua; Peng, Zongchao

2015-01-01

Influenza pandemics can severely impact human health and society. Understanding public perception and behavior toward influenza pandemics is important for minimizing the effects of such events. Public perception and behavior are expected to change over the course of an influenza pandemic, but this idea has received little attention in previous studies. Our study aimed to understand the dynamics of public perception and behavior over the course of the 2009 H1N1 influenza pandemic. Three consecutive cross-sectional surveys were administered among Beijing residents with random-digit dialing techniques in March 2008 and August and November 2009. Effective samples of 507, 508 and 1006 respondents were interviewed in each of the three surveys, respectively. The mean scores of risk perception were low to moderate across the three surveys. The perceived risk of infection of self was significantly lower than that of the community, revealing an optimistic bias. Longitudinally, the perceived risk of contracting H1N1 increased, whereas the perceived risk of being unable to obtain medicine and medical care once influenza permeated the community first increased and then decreased. Responsive actions toward influenza varied. Most respondents took actions that required little extra effort, such as ventilating rooms; these actions did not change over time. Comparatively, a smaller number of respondents took actions for coping with influenza, such as vaccination; however, these actions were taken by an increasing number of respondents over time. The association between risk perception and behavior was unstable. Positive, insignificant, and negative associations were obtained in the three surveys. In conclusion, the evolving patterns of risk perception and responsive behavior over the course of an influenza pandemic are sensitive to how risk and behavior are defined and scoped. PMID:26658371

Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis

PubMed Central

2013-01-01

Background A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. Methods A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Results Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and

Vaccination strategies for future influenza pandemics: a severity-based cost effectiveness analysis.

PubMed

Kelso, Joel K; Halder, Nilimesh; Milne, George J

2013-02-11

A critical issue in planning pandemic influenza mitigation strategies is the delay between the arrival of the pandemic in a community and the availability of an effective vaccine. The likely scenario, born out in the 2009 pandemic, is that a newly emerged influenza pandemic will have spread to most parts of the world before a vaccine matched to the pandemic strain is produced. For a severe pandemic, additional rapidly activated intervention measures will be required if high mortality rates are to be avoided. A simulation modelling study was conducted to examine the effectiveness and cost effectiveness of plausible combinations of social distancing, antiviral and vaccination interventions, assuming a delay of 6-months between arrival of an influenza pandemic and first availability of a vaccine. Three different pandemic scenarios were examined; mild, moderate and extreme, based on estimates of transmissibility and pathogenicity of the 2009, 1957 and 1918 influenza pandemics respectively. A range of different durations of social distancing were examined, and the sensitivity of the results to variation in the vaccination delay, ranging from 2 to 6 months, was analysed. Vaccination-only strategies were not cost effective for any pandemic scenario, saving few lives and incurring substantial vaccination costs. Vaccination coupled with long duration social distancing, antiviral treatment and antiviral prophylaxis was cost effective for moderate pandemics and extreme pandemics, where it saved lives while simultaneously reducing the total pandemic cost. Combined social distancing and antiviral interventions without vaccination were significantly less effective, since without vaccination a resurgence in case numbers occurred as soon as social distancing interventions were relaxed. When social distancing interventions were continued until at least the start of the vaccination campaign, attack rates and total costs were significantly lower, and increased rates of vaccination

Child Care and Preschool Pandemic Influenza Planning Checklist

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2006

2006-01-01

A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges that people have little or no immunity to and for which there may be no vaccine. The disease spreads easily person-to-person and causes serious illness. It can sweep across the country and around the world very quickly. It is hard to predict when the…

Finding optimal vaccination strategies for pandemic influenza using genetic algorithms.

PubMed

Patel, Rajan; Longini, Ira M; Halloran, M Elizabeth

2005-05-21

In the event of pandemic influenza, only limited supplies of vaccine may be available. We use stochastic epidemic simulations, genetic algorithms (GA), and random mutation hill climbing (RMHC) to find optimal vaccine distributions to minimize the number of illnesses or deaths in the population, given limited quantities of vaccine. Due to the non-linearity, complexity and stochasticity of the epidemic process, it is not possible to solve for optimal vaccine distributions mathematically. However, we use GA and RMHC to find near optimal vaccine distributions. We model an influenza pandemic that has age-specific illness attack rates similar to the Asian pandemic in 1957-1958 caused by influenza A(H2N2), as well as a distribution similar to the Hong Kong pandemic in 1968-1969 caused by influenza A(H3N2). We find the optimal vaccine distributions given that the number of doses is limited over the range of 10-90% of the population. While GA and RMHC work well in finding optimal vaccine distributions, GA is significantly more efficient than RMHC. We show that the optimal vaccine distribution found by GA and RMHC is up to 84% more effective than random mass vaccination in the mid range of vaccine availability. GA is generalizable to the optimization of stochastic model parameters for other infectious diseases and population structures.

Pandemic influenza preparedness and response in Israel: a unique model of civilian-defense collaboration.

PubMed

Kohn, Sivan; Barnett, Daniel J; Leventhal, Alex; Reznikovich, Shmuel; Oren, Meir; Laor, Danny; Grotto, Itamar; Balicer, Ran D

2010-07-01

In April 2009, the World Health Organization announced the emergence of a novel influenza A(H1N1-09) virus and in June 2009 declared the outbreak a pandemic. The value of military structures in responding to pandemic influenza has become widely acknowledged in recent years. In 2005, the Israeli Government appointed the Ministry of Defense to be in charge of national preparedness and response for a severe pandemic influenza scenario. The Israeli case offers a unique example of civilian-defense partnership where the interface between the governmental, military and civilian spheres has formed a distinctive structure. The Israeli pandemic preparedness protocols represent an example of a collaboration in which aspects of an inherently medical problem can be managed by the defense sector. Although distinctive concepts of the model are not applicable to all countries, it offers a unique forum for governments and international agencies to evaluate this interface within the context of pandemic influenza.

Reactive strategies for containing developing outbreaks of pandemic influenza

PubMed Central

2011-01-01

Background In 2009 and the early part of 2010, the northern hemisphere had to cope with the first waves of the new influenza A (H1N1) pandemic. Despite high-profile vaccination campaigns in many countries, delays in administration of vaccination programs were common, and high vaccination coverage levels were not achieved. This experience suggests the need to explore the epidemiological and economic effectiveness of additional, reactive strategies for combating pandemic influenza. Methods We use a stochastic model of pandemic influenza to investigate realistic strategies that can be used in reaction to developing outbreaks. The model is calibrated to documented illness attack rates and basic reproductive number (R0) estimates, and constructed to represent a typical mid-sized North American city. Results Our model predicts an average illness attack rate of 34.1% in the absence of intervention, with total costs associated with morbidity and mortality of US$81 million for such a city. Attack rates and economic costs can be reduced to 5.4% and US$37 million, respectively, when low-coverage reactive vaccination and limited antiviral use are combined with practical, minimally disruptive social distancing strategies, including short-term, as-needed closure of individual schools, even when vaccine supply-chain-related delays occur. Results improve with increasing vaccination coverage and higher vaccine efficacy. Conclusions Such combination strategies can be substantially more effective than vaccination alone from epidemiological and economic standpoints, and warrant strong consideration by public health authorities when reacting to future outbreaks of pandemic influenza. PMID:21356128

Identification of reassortant pandemic H1N1 influenza virus in Korean pigs.

PubMed

Han, Jae Yeon; Park, Sung Jun; Kim, Hye Kwon; Rho, Semi; Nguyen, Giap Van; Song, Daesub; Kang, Bo Kyu; Moon, Hyung Jun; Yeom, Min Joo; Park, Bong Kyun

2012-05-01

Since the 2009 pandemic human H1N1 influenza A virus emerged in April 2009, novel reassortant strains have been identified throughout the world. This paper describes the detection and isolation of reassortant strains associated with human pandemic influenza H1N1 and swine influenza H1N2 (SIV) viruses in swine populations in South Korea. Two influenza H1N2 reassortants were detected, and subtyped by PCR. The strains were isolated using Madin- Darby canine kidney (MDCK) cells, and genetically characterized by phylogenetic analysis for genetic diversity. They consisted of human, avian, and swine virus genes that were originated from the 2009 pandemic H1N1 virus and a neuraminidase (NA) gene from H1N2 SIV previously isolated in North America. This identification of reassortment events in swine farms raises concern that reassortant strains may continuously circulate within swine populations, calling for the further study and surveillance of pandemic H1N1 among swine.

Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic

PubMed Central

Shanks, G. Dennis; Hussell, Tracy; Brundage, John F.

2012-01-01

Please cite this paper as: Shanks et al. (2012) Epidemiological isolation causing variable mortality in Island populations during the 1918–1920 influenza pandemic. Influenza and Other Respiratory Viruses 6(6), 417–423. Background  During the 1918 pandemic period, influenza‐related mortality increased worldwide; however, mortality rates varied widely across locations and demographic subgroups. Islands are isolated epidemiological situations that may elucidate why influenza pandemic mortality rates were so variable in apparently similar populations. Objectives  Our objectives were to determine and compare the patterns of pandemic influenza mortality on islands. Methods  We reviewed historical records of mortality associated with the 1918–1920 influenza pandemic in various military and civilian groups on islands. Results and Conclusions  Mortality differed more than 50‐fold during pandemic‐related epidemics on Pacific islands [range: 0·4% (Hawaii) to 22% (Samoa)], and on some islands, mortality sharply varied among demographic subgroups of island residents such as Saipan: Chamorros [12%] and Caroline Islanders [0·4%]. Among soldiers from island populations who had completed initial military training, influenza‐related mortality rates were generally low, for example, Puerto Rico (0·7%) and French Polynesia (0·13%). The findings suggest that among island residents, those who had been exposed to multiple, antigenically diverse respiratory pathogens prior to infection with the 1918 pandemic strain (e.g., less isolated) experienced lower mortality. The continuous circulation of antigenically diverse influenza viruses and other respiratory infectious agents makes widespread high mortality during future influenza pandemics unlikely. PMID:22226378

Clinical review: influenza pandemic - physicians and their obligations.

PubMed

Anantham, Devanand; McHugh, Wendy; O'Neill, Stephen; Forrow, Lachlan

2008-01-01

An influenza pandemic threatens to be the most lethal public health crisis to confront the world. Physicians will have critical roles in diagnosis, containment and treatment of influenza, and their commitment to treat despite increased personal risks is essential for a successful public health response. The obligations of the medical profession stem from the unique skills of its practitioners, who are able to provide more effective aid than the general public in a medical emergency. The free choice of profession and the societal contract from which doctors derive substantial benefits affirm this commitment. In hospitals, the duty will fall upon specialties that are most qualified to deal with an influenza pandemic, such as critical care, pulmonology, anesthesiology and emergency medicine. It is unrealistic to expect that this obligation to treat should be burdened with unlimited risks. Instead, risks should be minimized and justified against the effectiveness of interventions. Institutional and public cooperation in logistics, remuneration and psychological/legal support may help remove the barriers to the ability to treat. By stepping forward in duty during such a pandemic, physicians will be able to reaffirm the ethical center of the profession and lead the rest of the healthcare team in overcoming the medical crisis.

Protecting public health and global freight transportation systems during an influenza pandemic.

PubMed

Luke, Thomas C; Rodrigue, Jean-Paul

2008-01-01

The H5N1 influenza threat is resulting in global preparations for the next influenza pandemic. Pandemic influenza planners are prioritizing scarce vaccine, antivirals, and public health support for different segments of society. The freight, bulk goods, and energy transportation network comprise the maritime, rail, air, and trucking industries. It relies on small numbers of specialized workers who cannot be rapidly replaced if lost due to death, illness, or voluntary absenteeism. Because transportation networks link economies, provide critical infrastructures with working material, and supply citizens with necessary commodities, disrupted transportation systems can lead to cascading failures in social and economic systems. However, some pandemic influenza plans have assigned transportation workers a low priority for public health support, vaccine, and antivirals. The science of Transportation Geography demonstrates that transportation networks and workers are concentrated at, or funnel through, a small number of chokepoints and corridors. Chokepoints should be used to rapidly and efficiently vaccinate and prophylax the transportation worker cohort and to implement transmission prevention measures and thereby protect the ability to move goods. Nations, states, the transportation industry and unions, businesses, and other stakeholders must plan, resource, and exercise, and then conduct a transportation health assurance and security campaign for an influenza pandemic.

Department of Defense Implementation Plan for Pandemic Influenza

DTIC Science & Technology

2006-08-01

and Low Intensity Conflict (ASD(SO/LIC)) will provide policy oversight of the DoD Pandemic Influenza bilateral and multilateral international...flexible worksites (e.g., telecommuting ) and flexible work hours (e.g., staggered shifts) in the event of a pandemic. o Ensure development of active...however, special consideration must be given to “social distancing” in the workplace through 74 telecommuting , or other means, as an

Household Transmission of Influenza A(H1N1)pdm09 in the Pandemic and Post-Pandemic Seasons

PubMed Central

Casado, Itziar; Martínez-Baz, Iván; Burgui, Rosana; Irisarri, Fátima; Arriazu, Maite; Elía, Fernando; Navascués, Ana; Ezpeleta, Carmen; Aldaz, Pablo; Castilla, Jesús

2014-01-01

Background The transmission of influenza viruses occurs person to person and is facilitated by contacts within enclosed environments such as households. The aim of this study was to evaluate secondary attack rates and factors associated with household transmission of laboratory-confirmed influenza A(H1N1)pdm09 in the pandemic and post-pandemic seasons. Methods During the 2009–2010 and 2010–2011 influenza seasons, 76 sentinel physicians in Navarra, Spain, took nasopharyngeal and pharyngeal swabs from patients diagnosed with influenza-like illness. A trained nurse telephoned households of those patients who were laboratory-confirmed for influenza A(H1N1)pdm09 to ask about the symptoms, risk factors and vaccination status of each household member. Results In the 405 households with a patient laboratory-confirmed for influenza A(H1N1)pdm09, 977 susceptible contacts were identified; 16% of them (95% CI 14–19%) presented influenza-like illness and were considered as secondary cases. The secondary attack rate was 14% in 2009–2010 and 19% in the 2010–2011 season (p = 0.049), an increase that mainly affected persons with major chronic conditions. In the multivariate logistic regression analysis, the risk of being a secondary case was higher in the 2010–2011 season than in the 2009–2010 season (adjusted odds ratio: 1.72; 95% CI 1.17–2.54), and in children under 5 years, with a decreasing risk in older contacts. Influenza vaccination was associated with lesser incidence of influenza-like illness near to statistical significance (adjusted odds ratio: 0.29; 95% CI 0.08–1.03). Conclusion The secondary attack rate in households was higher in the second season than in the first pandemic season. Children had a greater risk of infection. Preventive measures should be maintained in the second pandemic season, especially in high-risk persons. PMID:25254376

Novel reassortant influenza viruses between pandemic (H1N1) 2009 and other influenza viruses pose a risk to public health.

PubMed

Kong, Weili; Wang, Feibing; Dong, Bin; Ou, Changbo; Meng, Demei; Liu, Jinhua; Fan, Zhen-Chuan

2015-12-01

Influenza A virus (IAV) is characterized by eight single-stranded, negative sense RNA segments, which allows for gene reassortment among different IAV subtypes when they co-infect a single host cell simultaneously. Genetic reassortment is an important way to favor the evolution of influenza virus. Novel reassortant virus may pose a pandemic among humans. In history, three human pandemic influenza viruses were caused by genetic reassortment between avian, human and swine influenza viruses. Since 2009, pandemic (H1N1) 2009 (pdm/09 H1N1) influenza virus composed of two swine influenza virus genes highlighted the genetic reassortment again. Due to wide host species and high transmission of the pdm/09 H1N1 influenza virus, many different avian, human or swine influenza virus subtypes may reassert with it to generate novel reassortant viruses, which may result in a next pandemic among humans. So, it is necessary to understand the potential threat of current reassortant viruses between the pdm/09 H1N1 and other influenza viruses to public health. This study summarized the status of the reassortant viruses between the pdm/09 H1N1 and other influenza viruses of different species origins in natural and experimental conditions. The aim of this summarization is to facilitate us to further understand the potential threats of novel reassortant influenza viruses to public health and to make effective prevention and control strategies for these pathogens. Copyright © 2015 Elsevier Ltd. All rights reserved.

Protection of Racial/Ethnic Minority Populations During an Influenza Pandemic

PubMed Central

Fiscella, Kevin; Levine, Robert S.; Ompad, Danielle C.; McDonald, Marian

2009-01-01

Racial/ethnic minority populations experience worse health outcomes than do other groups during and after disasters. Evidence for a differential impact from pandemic influenza includes both higher rates of underlying health conditions in minority populations, increasing their risk of influenza-related complications, and larger socioeconomic (e.g., access to health care), cultural, educational, and linguistic barriers to adoption of pandemic interventions. Implementation of pandemic interventions could be optimized by (1) culturally competent preparedness and response that address specific needs of racial/ethnic minority populations, (2) improvements in public health and community health safety net systems, (3) social policies that minimize economic burdens and improve compliance with isolation and quarantine, and (4) relevant, practical, and culturally and linguistically tailored communications. PMID:19797739

Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey

PubMed Central

2011-01-01

Background As many respiratory viruses are responsible for influenza like symptoms, accurate measures of the disease burden are not available and estimates are generally based on statistical methods. The objective of this study was to estimate absenteeism rates and hours lost due to seasonal influenza and compare these estimates with estimates of absenteeism attributable to the two H1N1 pandemic waves that occurred in 2009. Methods Key absenteeism variables were extracted from Statistics Canada's monthly labour force survey (LFS). Absenteeism and the proportion of hours lost due to own illness or disability were modelled as a function of trend, seasonality and proxy variables for influenza activity from 1998 to 2009. Results Hours lost due to the H1N1/09 pandemic strain were elevated compared to seasonal influenza, accounting for a loss of 0.2% of potential hours worked annually. In comparison, an estimated 0.08% of hours worked annually were lost due to seasonal influenza illnesses. Absenteeism rates due to influenza were estimated at 12% per year for seasonal influenza over the 1997/98 to 2008/09 seasons, and 13% for the two H1N1/09 pandemic waves. Employees who took time off due to a seasonal influenza infection took an average of 14 hours off. For the pandemic strain, the average absence was 25 hours. Conclusions This study confirms that absenteeism due to seasonal influenza has typically ranged from 5% to 20%, with higher rates associated with multiple circulating strains. Absenteeism rates for the 2009 pandemic were similar to those occurring for seasonal influenza. Employees took more time off due to the pandemic strain than was typical for seasonal influenza. PMID:21486453

Statistical estimates of absenteeism attributable to seasonal and pandemic influenza from the Canadian Labour Force Survey.

PubMed

Schanzer, Dena L; Zheng, Hui; Gilmore, Jason

2011-04-12

As many respiratory viruses are responsible for influenza like symptoms, accurate measures of the disease burden are not available and estimates are generally based on statistical methods. The objective of this study was to estimate absenteeism rates and hours lost due to seasonal influenza and compare these estimates with estimates of absenteeism attributable to the two H1N1 pandemic waves that occurred in 2009. Key absenteeism variables were extracted from Statistics Canada's monthly labour force survey (LFS). Absenteeism and the proportion of hours lost due to own illness or disability were modelled as a function of trend, seasonality and proxy variables for influenza activity from 1998 to 2009. Hours lost due to the H1N1/09 pandemic strain were elevated compared to seasonal influenza, accounting for a loss of 0.2% of potential hours worked annually. In comparison, an estimated 0.08% of hours worked annually were lost due to seasonal influenza illnesses. Absenteeism rates due to influenza were estimated at 12% per year for seasonal influenza over the 1997/98 to 2008/09 seasons, and 13% for the two H1N1/09 pandemic waves. Employees who took time off due to a seasonal influenza infection took an average of 14 hours off. For the pandemic strain, the average absence was 25 hours. This study confirms that absenteeism due to seasonal influenza has typically ranged from 5% to 20%, with higher rates associated with multiple circulating strains. Absenteeism rates for the 2009 pandemic were similar to those occurring for seasonal influenza. Employees took more time off due to the pandemic strain than was typical for seasonal influenza.

Community awareness, use and preference for pandemic influenza vaccines in Pune, India

PubMed Central

Sundaram, Neisha; Purohit, Vidula; Schaetti, Christian; Kudale, Abhay; Joseph, Saju; Weiss, Mitchell G

2015-01-01

Vaccination is a cornerstone of influenza prevention, but limited vaccine uptake was a problem worldwide during the 2009–2010 pandemic. Community acceptance of a vaccine is a critical determinant of its effectiveness, but studies have been confined to high-income countries. We conducted a cross-sectional, mixed-method study in urban and rural Pune, India in 2012–2013. Semi-structured explanatory model interviews were administered to community residents (n = 436) to study awareness, experience and preference between available vaccines for pandemic influenza. Focus group discussions and in-depth interviews complemented the survey. Awareness of pandemic influenza vaccines was low (25%). Some respondents did not consider vaccines relevant for adults, but nearly all (94.7%), when asked, believed that a vaccine would prevent swine flu. Reported vaccine uptake however was 8.3%. Main themes identified as reasons for uptake were having heard of a death from swine flu, health care provider recommendation or affiliation with the health system, influence of peers and information from media. Reasons for non-use were low perceived personal risk, problems with access and cost, inadequate information and a perceived lack of a government mandate endorsing influenza vaccines. A majority indicated a preference for injectable over nasal vaccines, especially in remote rural areas. Hesitancy from a lack of confidence in pandemic influenza vaccines appears to have been less of an issue than access, complacency and other sociocultural considerations. Recent influenza outbreaks in 2015 highlight a need to reconsider policy for routine influenza vaccination while paying attention to sociocultural factors and community preferences for effective vaccine action. PMID:26110454

Difference in immune response in vaccinated and unvaccinated Swedish individuals after the 2009 influenza pandemic

PubMed Central

2014-01-01

Background Previous exposures to flu and subsequent immune responses may impact on 2009/2010 pandemic flu vaccine responses and clinical symptoms upon infection with the 2009 pandemic H1N1 influenza strain. Qualitative and quantitative differences in humoral and cellular immune responses associated with the flu vaccination in 2009/2010 (pandemic H1N1 vaccine) and natural infection have not yet been described in detail. We designed a longitudinal study to examine influenza- (flu-) specific immune responses and the association between pre-existing flu responses, symptoms of influenza-like illness (ILI), impact of pandemic flu infection, and pandemic flu vaccination in a cohort of 2,040 individuals in Sweden in 2009–2010. Methods Cellular flu-specific immune responses were assessed by whole-blood antigen stimulation assay, and humoral responses by a single radial hemolysis test. Results Previous seasonal flu vaccination was associated with significantly lower flu-specific IFN-γ responses (using a whole-blood assay) at study entry. Pandemic flu vaccination induced long-lived T-cell responses (measured by IFN-γ production) to influenza A strains, influenza B strains, and the matrix (M1) antigen. In contrast, individuals with pandemic flu infection (PCR positive) exhibited increased flu-specific T-cell responses shortly after onset of ILI symptoms but the immune response decreased after the flu season (spring 2010). We identified non-pandemic-flu vaccinated participants without ILI symptoms who showed an IFN-γ production profile similar to pandemic-flu infected participants, suggesting exposure without experiencing clinical symptoms. Conclusions Strong and long-lived flu-M1 specific immune responses, defined by IFN-γ production, in individuals after vaccination suggest that M1-responses may contribute to protective cellular immune responses. Silent flu infections appeared to be frequent in 2009/2010. The pandemic flu vaccine induced qualitatively and quantitatively

Market implementation of the MVA platform for pre-pandemic and pandemic influenza vaccines: A quantitative key opinion leader analysis

PubMed Central

Ramezanpour, Bahar; Pronker, Esther S.; Kreijtz, Joost H.C.M.; Osterhaus, Albert D.M.E.; Claassen, E.

2015-01-01

A quantitative method is presented to rank strengths, weaknesses, opportunities, and threats (SWOT) of modified vaccinia virus Ankara (MVA) as a platform for pre-pandemic and pandemic influenza vaccines. Analytic hierarchy process (AHP) was applied to achieve pairwise comparisons among SWOT factors in order to prioritize them. Key opinion leaders (KOLs) in the influenza vaccine field were interviewed to collect a unique dataset to evaluate the market potential of this platform. The purpose of this study, to evaluate commercial potential of the MVA platform for the development of novel generation pandemic influenza vaccines, is accomplished by using a SWOT and AHP combined analytic method. Application of the SWOT–AHP model indicates that its strengths are considered more important by KOLs than its weaknesses, opportunities, and threats. Particularly, the inherent immunogenicity capability of MVA without the requirement of an adjuvant is the most important factor to increase commercial attractiveness of this platform. Concerns regarding vector vaccines and anti-vector immunity are considered its most important weakness, which might lower public health value of this platform. Furthermore, evaluation of the results of this study emphasizes equally important role that threats and opportunities of this platform play. This study further highlights unmet needs in the influenza vaccine market, which could be addressed by the implementation of the MVA platform. Broad use of MVA in clinical trials shows great promise for this vector as vaccine platform for pre-pandemic and pandemic influenza and threats by other respiratory viruses. Moreover, from the results of the clinical trials seem that MVA is particularly attractive for development of vaccines against pathogens for which no, or only insufficiently effective vaccines, are available. PMID:26048779

Healthcare workers' attitudes to working during pandemic influenza: a qualitative study

PubMed Central

Ives, Jonathan; Greenfield, Sheila; Parry, Jayne M; Draper, Heather; Gratus, Christine; Petts, Judith I; Sorell, Tom; Wilson, Sue

2009-01-01

Background Healthcare workers (HCWs) will play a key role in any response to pandemic influenza, and the UK healthcare system's ability to cope during an influenza pandemic will depend, to a large extent, on the number of HCWs who are able and willing to work through the crisis. UK emergency planning will be improved if planners have a better understanding of the reasons UK HCWs may have for their absenteeism, and what might motivate them to work during an influenza pandemic. This paper reports the results of a qualitative study that explored UK HCWs' views (n = 64) about working during an influenza pandemic, in order to identify factors that might influence their willingness and ability to work and to identify potential sources of any perceived duty on HCWs to work. Methods A qualitative study, using focus groups (n = 9) and interviews (n = 5). Results HCWs across a range of roles and grades tended to feel motivated by a sense of obligation to work through an influenza pandemic. A number of significant barriers that may prevent them from doing so were also identified. Perceived barriers to the ability to work included being ill oneself, transport difficulties, and childcare responsibilities. Perceived barriers to the willingness to work included: prioritising the wellbeing of family members; a lack of trust in, and goodwill towards, the NHS; a lack of information about the risks and what is expected of them during the crisis; fear of litigation; and the feeling that employers do not take the needs of staff seriously. Barriers to ability and barriers to willingness, however, are difficult to separate out. Conclusion Although our participants tended to feel a general obligation to work during an influenza pandemic, there are barriers to working, which, if generalisable, may significantly reduce the NHS workforce during a pandemic. The barriers identified are both barriers to willingness and to ability. This suggests that pandemic planning needs to take into account

Antibody responses to influenza viruses in paediatric patients and their contacts at the onset of the 2009 pandemic in Mexico.

PubMed

Miranda-Novales, Guadalupe; Arriaga-Pizano, Lourdes; Herrera-Castillo, Cristina; Pastelin-Palacios, Rodolfo; Valero-Pacheco, Nuriban; Pérez-Toledo, Marisol; Ferat-Osorio, Eduardo; Solórzano-Santos, Fortino; Vázquez-Rosales, Guillermo; Espitia-Pinzón, Clara; Zamudio-Lugo, Irma; Meza-Chávez, Abigail; Klenerman, Paul; Isibasi, Armando; López-Macías, Constantino

2015-03-15

On April 2009, the Mexican Ministry of Health received notification of cases of severe pneumonia mostly affecting young healthy people; this was the beginning of the first influenza pandemic of the 21st century. The nature of the immune response to the influenza A(H1N1)2009 pandemic strain in Mexico at the beginning of the pandemic outbreak has not been completely defined. We describe the serological response to the 2009 pandemic influenza virus in paediatric patients with influenza-like illness, their household contacts (HHCs), and exposed health-care workers (HCWs) at the beginning of the pandemic outbreak in Mexico City. thirty pre-epidemic and 129 epidemic samples were collected and serum antibodies were measured against A(H1N1)2009 pandemic virus and two non-pandemic swine influenza viruses by an haemagglutination inhibition assay . 91% (29/32) of the convalescence samples from confirmed patients had an antibody titre ≥ 10 (GMT 25), 63% (41/65) of the HHCs (GMT 12), 41% of HCWs (GMT 6) and 13% (4/30) of pre-epidemic samples (GMT 6) for the pandemic influenza virus. Of the 32 confirmed cases, 60% had an antibody titre ≥ 40 for the pandemic strain, 53% for the A/swine/Iowa(H1N1) virus (GMT 62) and 43% for the A/swine/Texas(H3N2) virus (GMT 66). The antibody response to 2009 pandemic influenza virus was widespread in convalescence samples from patients with confirmed pandemic influenza infection but the GMT was below the protective titre. There was no evidence that antibodies to the swine influenza viruses had cross-protective effect against the 2009 pandemic influenza virus.

Cost-utility analysis of antiviral use under pandemic influenza using a novel approach - linking pharmacology, epidemiology and heath economics.

PubMed

Wu, D B C; Chaiyakunapruk, N; Pratoomsoot, C; Lee, K K C; Chong, H Y; Nelson, R E; Smith, P F; Kirkpatrick, C M; Kamal, M A; Nieforth, K; Dall, G; Toovey, S; Kong, D C M; Kamauu, A; Rayner, C R

2018-03-01

Simulation models are used widely in pharmacology, epidemiology and health economics (HEs). However, there have been no attempts to incorporate models from these disciplines into a single integrated model. Accordingly, we explored this linkage to evaluate the epidemiological and economic impact of oseltamivir dose optimisation in supporting pandemic influenza planning in the USA. An HE decision analytic model was linked to a pharmacokinetic/pharmacodynamics (PK/PD) - dynamic transmission model simulating the impact of pandemic influenza with low virulence and low transmissibility and, high virulence and high transmissibility. The cost-utility analysis was from the payer and societal perspectives, comparing oseltamivir 75 and 150 mg twice daily (BID) to no treatment over a 1-year time horizon. Model parameters were derived from published studies. Outcomes were measured as cost per quality-adjusted life year (QALY) gained. Sensitivity analyses were performed to examine the integrated model's robustness. Under both pandemic scenarios, compared to no treatment, the use of oseltamivir 75 or 150 mg BID led to a significant reduction of influenza episodes and influenza-related deaths, translating to substantial savings of QALYs. Overall drug costs were offset by the reduction of both direct and indirect costs, making these two interventions cost-saving from both perspectives. The results were sensitive to the proportion of inpatient presentation at the emergency visit and patients' quality of life. Integrating PK/PD-EPI/HE models is achievable. Whilst further refinement of this novel linkage model to more closely mimic the reality is needed, the current study has generated useful insights to support influenza pandemic planning.

The ENSO-pandemic influenza connection: coincident or causal?

NASA Astrophysics Data System (ADS)

Shaman, J. L.; Lipsitch, M.

2011-12-01

The El Niño-Southern Oscillation (ENSO) is a coupled ocean-atmosphere system in the tropical Pacific, which affects weather conditions, including temperatures, precipitation, winds and storm activity, across the planet. ENSO has two extreme phases marked by either warmer (El Niño) or cooler (La Niña) than average sea surface temperatures in the central equatorial Pacific. We find that the 4 most recent human influenza pandemics (1918, 1957, 1968, 2009), all of which were first identified in boreal spring or summer, were preceded by La Niña conditions in the equatorial Pacific. Changes in ENSO have been shown to alter the migration, stopover time, fitness and interspecies mixing of migratory birds, and consequently likely affect their mixing with domestic animals. We hypothesize that La Niña conditions bring divergent influenza subtypes together in some parts of the world and favor the reassortment of influenza through simultaneous multiple infection of individual hosts and the generation of novel pandemic strains. We propose approaches to test this hypothesis using influenza population genetics, virus prevalence in various host species, and avian migration patterns.

Spatial and Temporal Characteristics of the 2009 A/H1N1 Influenza Pandemic in Peru

PubMed Central

Chowell, Gerardo; Viboud, Cécile; Munayco, Cesar V.; Gómez, Jorge; Simonsen, Lone; Miller, Mark A.; Tamerius, James; Fiestas, Victor; Halsey, Eric S.; Laguna-Torres, Victor A.

2011-01-01

Background Highly refined surveillance data on the 2009 A/H1N1 influenza pandemic are crucial to quantify the spatial and temporal characteristics of the pandemic. There is little information about the spatial-temporal dynamics of pandemic influenza in South America. Here we provide a quantitative description of the age-specific morbidity pandemic patterns across administrative areas of Peru. Methods We used daily cases of influenza-like-illness, tests for A/H1N1 influenza virus infections, and laboratory-confirmed A/H1N1 influenza cases reported to the epidemiological surveillance system of Peru's Ministry of Health from May 1 to December 31, 2009. We analyzed the geographic spread of the pandemic waves and their association with the winter school vacation period, demographic factors, and absolute humidity. We also estimated the reproduction number and quantified the association between the winter school vacation period and the age distribution of cases. Results The national pandemic curve revealed a bimodal winter pandemic wave, with the first peak limited to school age children in the Lima metropolitan area, and the second peak more geographically widespread. The reproduction number was estimated at 1.6–2.2 for the Lima metropolitan area and 1.3–1.5 in the rest of Peru. We found a significant association between the timing of the school vacation period and changes in the age distribution of cases, while earlier pandemic onset was correlated with large population size. By contrast there was no association between pandemic dynamics and absolute humidity. Conclusions Our results indicate substantial spatial variation in pandemic patterns across Peru, with two pandemic waves of varying timing and impact by age and region. Moreover, the Peru data suggest a hierarchical transmission pattern of pandemic influenza A/H1N1 driven by large population centers. The higher reproduction number of the first pandemic wave could be explained by high contact rates among school

Pharmaceutical interventions for mitigating an influenza pandemic: modeling the risks and health-economic impacts.

PubMed

Postma, Maarten J; Milne, George; Nelson, E Anthony S; Pyenson, Bruce; Basili, Marcello; Coker, Richard; Oxford, John; Garrison, Louis P

2010-12-01

Model-based analyses built on burden-of-disease and cost-effectiveness theory predict that pharmaceutical interventions may efficiently mitigate both the epidemiologic and economic impact of an influenza pandemic. Pharmaceutical interventions typically encompass the application of (pre)pandemic influenza vaccines, other vaccines (notably pneumococcal), antiviral treatments and other drug treatment (e.g., antibiotics to target potential complications of influenza). However, these models may be too limited to capture the full macro-economic impact of pandemic influenza. The aim of this article is to summarize current health-economic modeling approaches to recognize the strengths and weaknesses of these approaches, and to compare these with more recently proposed alternative methods. We conclude that it is useful, particularly for policy and planning purposes, to extend modeling concepts through the application of alternative approaches, including insurers' risk theories, human capital approaches and sectoral and full macro-economic modeling. This article builds on a roundtable meeting of the Pandemic Influenza Economic Impact Group that was held in Boston, MA, USA, in December 2008.

Distribution of selected healthcare resources for influenza pandemic response in Cambodia

PubMed Central

2013-01-01

Introduction Human influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation. Methods A health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates. Results Gini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province and OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher

Distribution of selected healthcare resources for influenza pandemic response in Cambodia.

PubMed

Schwanke Khilji, Sara U; Rudge, James W; Drake, Tom; Chavez, Irwin; Borin, Khieu; Touch, Sok; Coker, Richard

2013-10-04

Human influenza infection poses a serious public health threat in Cambodia, a country at risk for the emergence and spread of novel influenza viruses with pandemic potential. Prior pandemics demonstrated the adverse impact of influenza on poor communities in developing countries. Investigation of healthcare resource distribution can inform decisions regarding resource mobilization and investment for pandemic mitigation. A health facility survey performed across Cambodia obtained data on availability of healthcare resources important for pandemic influenza response. Focusing on five key resources considered most necessary for treating severe influenza (inpatient beds, doctors, nurses, oseltamivir, and ventilators), resource distributions were analyzed at the Operational District (OD) and Province levels, refining data analysis from earlier studies. Resources were stratified by respondent type (hospital vs. District Health Office [DHO]). A summary index of distribution inequality was calculated using the Gini coefficient. Indices for local spatial autocorrelation were measured at the OD level using geographical information system (GIS) analysis. Finally, a potential link between socioeconomic status and resource distribution was explored by mapping resource densities against poverty rates. Gini coefficient calculation revealed variable inequality in distribution of the five key resources at the Province and OD levels. A greater percentage of the population resides in areas of relative under-supply (28.5%) than over-supply (21.3%). Areas with more resources per capita showed significant clustering in central Cambodia while areas with fewer resources clustered in the northern and western provinces. Hospital-based inpatient beds, doctors, and nurses were most heavily concentrated in areas of the country with the lowest poverty rates; however, beds and nurses in Non-Hospital Medical Facilities (NHMF) showed increasing concentrations at higher levels of poverty. There is

Novel framework for assessing epidemiologic effects of influenza epidemics and pandemics.

PubMed

Reed, Carrie; Biggerstaff, Matthew; Finelli, Lyn; Koonin, Lisa M; Beauvais, Denise; Uzicanin, Amra; Plummer, Andrew; Bresee, Joe; Redd, Stephen C; Jernigan, Daniel B

2013-01-01

The effects of influenza on a population are attributable to the clinical severity of illness and the number of persons infected, which can vary greatly between seasons or pandemics. To create a systematic framework for assessing the public health effects of an emerging pandemic, we reviewed data from past influenza seasons and pandemics to characterize severity and transmissibility (based on ranges of these measures in the United States) and outlined a formal assessment of the potential effects of a novel virus. The assessment was divided into 2 periods. Because early in a pandemic, measurement of severity and transmissibility is uncertain, we used a broad dichotomous scale in the initial assessment to divide the range of historic values. In the refined assessment, as more data became available, we categorized those values more precisely. By organizing and prioritizing data collection, this approach may inform an evidence-based assessment of pandemic effects and guide decision making.

Novel Framework for Assessing Epidemiologic Effects of Influenza Epidemics and Pandemics

PubMed Central

Biggerstaff, Matthew; Finelli, Lyn; Koonin, Lisa M.; Beauvais, Denise; Uzicanin, Amra; Plummer, Andrew; Bresee, Joe; Redd, Stephen C.; Jernigan, Daniel B.

2013-01-01

The effects of influenza on a population are attributable to the clinical severity of illness and the number of persons infected, which can vary greatly between seasons or pandemics. To create a systematic framework for assessing the public health effects of an emerging pandemic, we reviewed data from past influenza seasons and pandemics to characterize severity and transmissibility (based on ranges of these measures in the United States) and outlined a formal assessment of the potential effects of a novel virus. The assessment was divided into 2 periods. Because early in a pandemic, measurement of severity and transmissibility is uncertain, we used a broad dichotomous scale in the initial assessment to divide the range of historic values. In the refined assessment, as more data became available, we categorized those values more precisely. By organizing and prioritizing data collection, this approach may inform an evidence-based assessment of pandemic effects and guide decision making. PMID:23260039

Non-pharmaceutical public health interventions for pandemic influenza: an evaluation of the evidence base.

PubMed

Aledort, Julia E; Lurie, Nicole; Wasserman, Jeffrey; Bozzette, Samuel A

2007-08-15

In an influenza pandemic, the benefit of vaccines and antiviral medications will be constrained by limitations on supplies and effectiveness. Non-pharmaceutical public health interventions will therefore be vital in curtailing disease spread. However, the most comprehensive assessments of the literature to date recognize the generally poor quality of evidence on which to base non-pharmaceutical pandemic planning decisions. In light of the need to prepare for a possible pandemic despite concerns about the poor quality of the literature, combining available evidence with expert opinion about the relative merits of non-pharmaceutical interventions for pandemic influenza may lead to a more informed and widely accepted set of recommendations. We evaluated the evidence base for non-pharmaceutical public health interventions. Then, based on the collective evidence, we identified a set of recommendations for and against interventions that are specific to both the setting in which an intervention may be used and the pandemic phase, and which can be used by policymakers to prepare for a pandemic until scientific evidence can definitively respond to planners' needs. Building on reviews of past pandemics and recent historical inquiries, we evaluated the relative merits of non-pharmaceutical interventions by combining available evidence from the literature with qualitative and quantitative expert opinion. Specifically, we reviewed the recent scientific literature regarding the prevention of human-to-human transmission of pandemic influenza, convened a meeting of experts from multiple disciplines, and elicited expert recommendation about the use of non-pharmaceutical public health interventions in a variety of settings (healthcare facilities; community-based institutions; private households) and pandemic phases (no pandemic; no US pandemic; early localized US pandemic; advanced US pandemic). The literature contained a dearth of evidence on the efficacy or effectiveness of most

Influenza and Pneumonia Mortality in 66 Large Cities in the United States in Years Surrounding the 1918 Pandemic

PubMed Central

Acuna-Soto, Rodolfo; Viboud, Cécile; Chowell, Gerardo

2011-01-01

The 1918 influenza pandemic was a major epidemiological event of the twentieth century resulting in at least twenty million deaths worldwide; however, despite its historical, epidemiological, and biological relevance, it remains poorly understood. Here we examine the relationship between annual pneumonia and influenza death rates in the pre-pandemic (1910–17) and pandemic (1918–20) periods and the scaling of mortality with latitude, longitude and population size, using data from 66 large cities of the United States. The mean pre-pandemic pneumonia death rates were highly associated with pneumonia death rates during the pandemic period (Spearman ρ = 0.64–0.72; P<0.001). By contrast, there was a weak correlation between pre-pandemic and pandemic influenza mortality rates. Pneumonia mortality rates partially explained influenza mortality rates in 1918 (ρ = 0.34, P = 0.005) but not during any other year. Pneumonia death counts followed a linear relationship with population size in all study years, suggesting that pneumonia death rates were homogeneous across the range of population sizes studied. By contrast, influenza death counts followed a power law relationship with a scaling exponent of ∼0.81 (95%CI: 0.71, 0.91) in 1918, suggesting that smaller cities experienced worst outcomes during the pandemic. A linear relationship was observed for all other years. Our study suggests that mortality associated with the 1918–20 influenza pandemic was in part predetermined by pre-pandemic pneumonia death rates in 66 large US cities, perhaps through the impact of the physical and social structure of each city. Smaller cities suffered a disproportionately high per capita influenza mortality burden than larger ones in 1918, while city size did not affect pneumonia mortality rates in the pre-pandemic and pandemic periods. PMID:21886792

Market implementation of the MVA platform for pre-pandemic and pandemic influenza vaccines: A quantitative key opinion leader analysis.

PubMed

Ramezanpour, Bahar; Pronker, Esther S; Kreijtz, Joost H C M; Osterhaus, Albert D M E; Claassen, E

2015-08-20

A quantitative method is presented to rank strengths, weaknesses, opportunities, and threats (SWOT) of modified vaccinia virus Ankara (MVA) as a platform for pre-pandemic and pandemic influenza vaccines. Analytic hierarchy process (AHP) was applied to achieve pairwise comparisons among SWOT factors in order to prioritize them. Key opinion leaders (KOLs) in the influenza vaccine field were interviewed to collect a unique dataset to evaluate the market potential of this platform. The purpose of this study, to evaluate commercial potential of the MVA platform for the development of novel generation pandemic influenza vaccines, is accomplished by using a SWOT and AHP combined analytic method. Application of the SWOT-AHP model indicates that its strengths are considered more important by KOLs than its weaknesses, opportunities, and threats. Particularly, the inherent immunogenicity capability of MVA without the requirement of an adjuvant is the most important factor to increase commercial attractiveness of this platform. Concerns regarding vector vaccines and anti-vector immunity are considered its most important weakness, which might lower public health value of this platform. Furthermore, evaluation of the results of this study emphasizes equally important role that threats and opportunities of this platform play. This study further highlights unmet needs in the influenza vaccine market, which could be addressed by the implementation of the MVA platform. Broad use of MVA in clinical trials shows great promise for this vector as vaccine platform for pre-pandemic and pandemic influenza and threats by other respiratory viruses. Moreover, from the results of the clinical trials seem that MVA is particularly attractive for development of vaccines against pathogens for which no, or only insufficiently effective vaccines, are available. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Mortality associated with influenza in tropics, state of são paulo, Brazil, from 2002 to 2011: the pre-pandemic, pandemic, and post-pandemic periods.

PubMed

Freitas, André Ricardo Ribas; Francisco, Priscila M S Bergamo; Donalisio, Maria Rita

2013-01-01

The impact of the seasonal influenza and 2009 AH1N1 pandemic influenza on mortality is not yet completely understood, particularly in tropical and subtropical countries. The trends of influenza related mortality rate in different age groups and different outcomes on a area in tropical and subtropical climate with more than 41 million people (State of São Paulo, Brazil), were studied from 2002 to 2011 were studied. Serfling-type regression analysis was performed using weekly mortality registries and virological data obtained from sentinel surveillance. The prepandemic years presented a well-defined seasonality during winter and a clear relationship between activity of AH3N2 and increase of mortality in all ages, especially in individuals older than 60 years. The mortality due to pneumonia and influenza and respiratory causes associated with 2009 pandemic influenza in the age groups 0-4 years and older than 60 was lower than the previous years. Among people aged 5-19 and 20-59 years the mortality was 2.6 and 4.4 times higher than that in previous periods, respectively. The mortality in all ages was higher than the average of the previous years but was equal mortality in epidemics of AH3N2. The 2009 pandemic influenza mortality showed significant differences compared to other years, especially considering the age groups most affected.

Pandemic influenza A (H1N1) 2009 vaccination in children: a UK perspective.

PubMed

de Whalley, Philip C S; Pollard, Andrew J

2013-03-01

Pandemic H1N1 influenza infection was common in the UK in 2009 and children were particularly vulnerable. Most cases were mild or subclinical, but there was significant mortality, predominantly in those with pre-existing disease. Despite the rapid development of monovalent pandemic vaccines, and the fast-tracked approval process, these products were not available for large-scale use until the end of the second wave of infection. Vaccine uptake was relatively low, both among children and health-care workers. The monovalent pandemic vaccines and the 2010/2011 trivalent seasonal influenza vaccines were immunogenic and effective, and they probably reduced the impact of the third wave of infection. Vaccines containing novel adjuvants enabled antigen sparing, but safety concerns could limit the future use of these adjuvanted influenza vaccines in children. Public perceptions that the threat of the pandemic was exaggerated by the authorities, and concerns about vaccine safety, might prompt an inadequate response to the next influenza pandemic, potentially compromising public health. © 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

Comparison of five influenza surveillance systems during the 2009 pandemic and their association with media attention

PubMed Central

2013-01-01

Background During the 2009 influenza pandemic period, routine surveillance of influenza-like-illness (ILI) was conducted in The Netherlands by a network of sentinel general practitioners (GPs). In addition during the pandemic period, four other ILI/influenza surveillance systems existed. For pandemic preparedness, we evaluated the performance of the sentinel system and the others to assess which of the four could be useful additions in the future. We also assessed whether performance of the five systems was influenced by media reports during the pandemic period. Methods The trends in ILI consultation rates reported by sentinel GPs from 20 April 2009 through 3 January 2010 were compared with trends in data from the other systems: ILI cases self-reported through the web-based Great Influenza Survey (GIS); influenza-related web searches through Google Flu Trends (GFT); patients admitted to hospital with laboratory-confirmed pandemic influenza, and detections of influenza virus by laboratories. In addition, correlations were determined between ILI consultation rates of the sentinel GPs and data from the four other systems. We also compared the trends of the five surveillance systems with trends in pandemic-related newspaper and television coverage and determined correlation coefficients with and without time lags. Results The four other systems showed similar trends and had strong correlations with the ILI consultation rates reported by sentinel GPs. The number of influenza virus detections was the only system to register a summer peak. Increases in the number of newspaper articles and television broadcasts did not precede increases in activity among the five surveillance systems. Conclusions The sentinel general practice network should remain the basis of influenza surveillance, as it integrates epidemiological and virological information and was able to maintain stability and continuity under pandemic pressure. Hospital and virological data are important during a

Influenza Pandemics in Singapore, a Tropical, Globally Connected City

PubMed Central

Chen, Mark I.; Chan, Siew Pang; Wong, Chia Siong; Cutter, Jeffery; Goh, Kee Tai; Tambyah, Paul Anath

2007-01-01

Tropical cities such as Singapore do not have well-defined influenza seasons but have not been spared from influenza pandemics. The 1918 epidemic in Singapore, which was then already a major global trading hub, occurred in 2 waves, June–July, and October–November, and resulted in >2,870 deaths. The excess mortality rate was higher than that for industrialized nations in the Northern Hemisphere but lower than that for less industrialized countries in Asia and Africa. The 1957 epidemic occurred in May and resulted in widespread illness. The 1968 epidemic occurred in August and lasted a few weeks, again with widespread illness. Tropical cities may be affected early in a pandemic and have higher mortality rates. With the increase in travel and trade, a future pandemic may reach a globally connected city early and spread worldwide. Preparedness and surveillance plans must be developed to include the megacities of the tropical world. PMID:18214178

Connecting the study of wild influenza with the potential for pandemic disease

PubMed Central

Runstadler, Jonathan; Hill, Nichola; Hussein, Islam T.M.; Puryear, Wendy; Keogh, Mandy

2013-01-01

Continuing outbreaks of pathogenic (H5N1) and pandemic (SOIVH1N1) influenza have underscored the need to understand the origin, characteristics, and evolution of novel influenza A virus (IAV) variants that pose a threat to human health. In the last 4–5 years, focus has been placed on the organization of large-scale surveillance programs to examine the phylogenetics of avian influenza virus (AIV) and host-virus relationships in domestic and wild animals. Here we review the current gaps in wild animal and environmental surveillance and the current understanding of genetic signatures in potentially pandemic strains. PMID:23541413

Mortality attributable to pandemic influenza A (H1N1) 2009 in San Luis Potosí, Mexico

PubMed Central

Comas‐García, Andreu; García‐Sepúlveda, Christian A.; Méndez‐de Lira, José J.; Aranda‐Romo, Saray; Hernández‐Salinas, Alba E.; Noyola, Daniel E.

2010-01-01

Please cite this paper as: Comas‐García et al. (2011) Mortality attributable to pandemic influenza A (H1N1) 2009 in San Luis Potosí, Mexico. Influenza and Other Respiratory Viruses 5(2), 76–82. Background  Acute respiratory infections are a leading cause of morbidity and mortality worldwide. Starting in 2009, pandemic influenza A(H1N1) 2009 virus has become one of the leading respiratory pathogens worldwide. However, the overall impact of this virus as a cause of mortality has not been clearly defined. Objectives  To determine the impact of pandemic influenza A(H1N1) 2009 on mortality in a Mexican population. Methods  We assessed the impact of pandemic influenza virus on mortality during the first and second outbreaks in San Luis Potosí, Mexico, and compared it to mortality associated with seasonal influenza and respiratory syncytial virus (RSV) during the previous winter seasons. Results  We estimated that, on average, 8·1% of all deaths that occurred during the 2003–2009 seasons were attributable to influenza and RSV. During the first pandemic influenza A(H1N1) 2009 outbreak, there was an increase in mortality in persons 5–59 years of age, but not during the second outbreak (Fall of 2009). Overall, pandemic influenza A (H1N1) 2009 outbreaks had similar effects on mortality to those associated with seasonal influenza virus epidemics. Conclusions  The impact of influenza A(H1N1) 2009 virus on mortality during the first year of the pandemic was similar to that observed for seasonal influenza. The establishment of real‐time surveillance systems capable of integrating virological, morbidity, and mortality data may result in the timely identification of outbreaks so as to allow for the institution of appropriate control measures to reduce the impact of emerging pathogens on the population. PMID:21306570

Clinical review: Influenza pandemic – physicians and their obligations

PubMed Central

Anantham, Devanand; McHugh, Wendy; O'Neill, Stephen; Forrow, Lachlan

2008-01-01

An influenza pandemic threatens to be the most lethal public health crisis to confront the world. Physicians will have critical roles in diagnosis, containment and treatment of influenza, and their commitment to treat despite increased personal risks is essential for a successful public health response. The obligations of the medical profession stem from the unique skills of its practitioners, who are able to provide more effective aid than the general public in a medical emergency. The free choice of profession and the societal contract from which doctors derive substantial benefits affirm this commitment. In hospitals, the duty will fall upon specialties that are most qualified to deal with an influenza pandemic, such as critical care, pulmonology, anesthesiology and emergency medicine. It is unrealistic to expect that this obligation to treat should be burdened with unlimited risks. Instead, risks should be minimized and justified against the effectiveness of interventions. Institutional and public cooperation in logistics, remuneration and psychological/legal support may help remove the barriers to the ability to treat. By stepping forward in duty during such a pandemic, physicians will be able to reaffirm the ethical center of the profession and lead the rest of the healthcare team in overcoming the medical crisis. PMID:18598380

Existing health inequalities in India: informing preparedness planning for an influenza pandemic

PubMed Central

Kumar, Supriya; Quinn, Sandra C

2012-01-01

On 11 June 2009, the World Health Organization (WHO) declared that the world was in phase 6 of an influenza pandemic. In India, the first case of 2009 H1N1 influenza was reported on 16 May 2009 and by August 2010 (when the pandemic was declared over), 38 730 cases of 2009 H1N1 had been confirmed of which there were 2024 deaths. Here, we propose a conceptual model of the sources of health disparities in an influenza pandemic in India. Guided by a published model of the plausible sources of such disparities in the United States, we reviewed the literature for the determinants of the plausible sources of health disparities during a pandemic in India. We find that factors at multiple social levels could determine inequalities in the risk of exposure and susceptibility to influenza, as well as access to treatment once infected: (1) religion, caste and indigenous identity, as well as education and gender at the individual level; (2) wealth at the household level; and (3) the type of location, ratio of health care practitioners to population served, access to transportation and public spending on health care in the geographic area of residence. Such inequalities could lead to unequal levels of disease and death. Whereas causal factors can only be determined by testing the model when incidence and mortality data, collected in conjunction with socio-economic and geographic factors, become available, we put forth recommendations that policy makers can undertake to ensure that the pandemic preparedness plan includes a focus on social inequalities in India in order to prevent their exacerbation in a pandemic. PMID:22131367

Responding to Vaccine Safety Signals during Pandemic Influenza: A Modeling Study

PubMed Central

Maro, Judith C.; Fryback, Dennis G.; Lieu, Tracy A.; Lee, Grace M.; Martin, David B.

2014-01-01

Background Managing emerging vaccine safety signals during an influenza pandemic is challenging. Federal regulators must balance vaccine risks against benefits while maintaining public confidence in the public health system. Methods We developed a multi-criteria decision analysis model to explore regulatory decision-making in the context of emerging vaccine safety signals during a pandemic. We simulated vaccine safety surveillance system capabilities and used an age-structured compartmental model to develop potential pandemic scenarios. We used an expert-derived multi-attribute utility function to evaluate potential regulatory responses by combining four outcome measures into a single measure of interest: 1) expected vaccination benefit from averted influenza; 2) expected vaccination risk from vaccine-associated febrile seizures; 3) expected vaccination risk from vaccine-associated Guillain-Barre Syndrome; and 4) expected change in vaccine-seeking behavior in future influenza seasons. Results Over multiple scenarios, risk communication, with or without suspension of vaccination of high-risk persons, were the consistently preferred regulatory responses over no action or general suspension when safety signals were detected during a pandemic influenza. On average, the expert panel valued near-term vaccine-related outcomes relative to long-term projected outcomes by 3∶1. However, when decision-makers had minimal ability to influence near-term outcomes, the response was selected primarily by projected impacts on future vaccine-seeking behavior. Conclusions The selected regulatory response depends on how quickly a vaccine safety signal is identified relative to the peak of the pandemic and the initiation of vaccination. Our analysis suggested two areas for future investment: efforts to improve the size and timeliness of the surveillance system and behavioral research to understand changes in vaccine-seeking behavior. PMID:25536228

Pandemic influenza preparedness in Latin America: analysis of national strategic plans.

PubMed

Mensua, Ana; Mounier-Jack, Sandra; Coker, Richard

2009-07-01

The threat of a human pandemic of influenza has prompted the development of national influenza pandemic preparedness plans over the last 4 years. Analyses have been carried out to assess preparedness in Europe, Asia and Africa. We assessed plans to evaluate the national strategic pandemic influenza preparedness in the countries of Latin America. Published national pandemic influenza preparedness plans from Latin American countries were evaluated against criteria drawn from the World Health Organization checklist. Plans were eligible for inclusion if formally published before 16 November 2007. Fifteen national plans were identified and retrieved from the 17 Latin American countries surveyed. Latin American countries demonstrated different degrees of preparedness, and that a high level of completeness of plans was correlated to a country's wealth to a certain extent. Plans were judged strong in addressing surveillance requirements, and provided appropriate communication strategies directed to the general public and health care personnel. However, gaps remained, including the organization of health care services' response; planning and maintenance of essential services; and the provision of containment measures such as the stockpiling of necessary medical supplies including vaccines and antiviral medications. In addition, some inconsistencies and variations which may be important, such as in border control measures and the capacity to contain outbreaks, exist between country plans-issues that could result in confusion in the event of a pandemic. A number of plans remain developmental in nature and, as elsewhere, more emphasis should be placed on strengthening the operability of plans, and in testing them. Whilst taking account of resources constraints, plans should be further developed in a coherent manner with both regional and international imperatives.

Disparities in influenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918

PubMed Central

Grantz, Kyra H.; Rane, Madhura S.; Salje, Henrik; Glass, Gregory E.; Schachterle, Stephen E.; Cummings, Derek A. T.

2016-01-01

Social factors have been shown to create differential burden of influenza across different geographic areas. We explored the relationship between potential aggregate-level social determinants and mortality during the 1918 influenza pandemic in Chicago using a historical dataset of 7,971 influenza and pneumonia deaths. Census tract-level social factors, including rates of illiteracy, homeownership, population, and unemployment, were assessed as predictors of pandemic mortality in Chicago. Poisson models fit with generalized estimating equations (GEEs) were used to estimate the association between social factors and the risk of influenza and pneumonia mortality. The Poisson model showed that influenza and pneumonia mortality increased, on average, by 32.2% for every 10% increase in illiteracy rate adjusted for population density, homeownership, unemployment, and age. We also found a significant association between transmissibility and population density, illiteracy, and unemployment but not homeownership. Lastly, analysis of the point locations of reported influenza and pneumonia deaths revealed fine-scale spatiotemporal clustering. This study shows that living in census tracts with higher illiteracy rates increased the risk of influenza and pneumonia mortality during the 1918 influenza pandemic in Chicago. Our observation that disparities in structural determinants of neighborhood-level health lead to disparities in influenza incidence in this pandemic suggests that disparities and their determinants should remain targets of research and control in future pandemics. PMID:27872284

Pandemic influenza A (H1N1) 2009 vaccine: an update.

PubMed

Goel, M K; Goel, M; Khanna, P; Mittal, K

2011-01-01

The world witnessed a the first influenza pandemic in this century and fourth overall since first flu pandemic was reported during the World War I. The past experiences with influenza viruses and this pandemic of H1N1 place a consider-able strain on health services and resulted in serious illnesses and a large number of deaths. Develop-ing countries were declared more likely to be at risk from the pandemic effects, as they faced the dual problem of highly vulnerable populations and limited resources to respond H1N1. The public health experts agreed that vaccination is the most effective ways to mitigate the negative effects of the pandemic. The vaccines for H1N1 virus have been used in over 40 countries and administered to over 200 million people helped in a great way and on August 10, 2010, World Health Organization (WHO) announced H1N1 to be in postpandemic period. But based on knowledge about past pandemics, the H1N1 (2009) virus is expected to continue to circulate as a seasonal virus and may undergo some agenic-variation. As WHO strongly recommends vaccination, vigilance for regular updating of the composition of influenza vaccines, based on an assessment of the future impact of circulating viruses along with safety surveillance of the vaccines is necessary. This review has been done to take a stock of the currently available H1N1 vaccines and their possible use as public health intervention in the postpandemic period.

Characterizing the Epidemiology of the 2009 Influenza A/H1N1 Pandemic in Mexico

PubMed Central

Chowell, Gerardo; Echevarría-Zuno, Santiago; Viboud, Cécile; Simonsen, Lone; Tamerius, James; Miller, Mark A.; Borja-Aburto, Víctor H.

2011-01-01

Background Mexico's local and national authorities initiated an intense public health response during the early stages of the 2009 A/H1N1 pandemic. In this study we analyzed the epidemiological patterns of the pandemic during April–December 2009 in Mexico and evaluated the impact of nonmedical interventions, school cycles, and demographic factors on influenza transmission. Methods and Findings We used influenza surveillance data compiled by the Mexican Institute for Social Security, representing 40% of the population, to study patterns in influenza-like illness (ILIs) hospitalizations, deaths, and case-fatality rate by pandemic wave and geographical region. We also estimated the reproduction number (R) on the basis of the growth rate of daily cases, and used a transmission model to evaluate the effectiveness of mitigation strategies initiated during the spring pandemic wave. A total of 117,626 ILI cases were identified during April–December 2009, of which 30.6% were tested for influenza, and 23.3% were positive for the influenza A/H1N1 pandemic virus. A three-wave pandemic profile was identified, with an initial wave in April–May (Mexico City area), a second wave in June–July (southeastern states), and a geographically widespread third wave in August–December. The median age of laboratory confirmed ILI cases was ∼18 years overall and increased to ∼31 years during autumn (p<0.0001). The case-fatality ratio among ILI cases was 1.2% overall, and highest (5.5%) among people over 60 years. The regional R estimates were 1.8–2.1, 1.6–1.9, and 1.2–1.3 for the spring, summer, and fall waves, respectively. We estimate that the 18-day period of mandatory school closures and other social distancing measures implemented in the greater Mexico City area was associated with a 29%–37% reduction in influenza transmission in spring 2009. In addition, an increase in R was observed in late May and early June in the southeast states, after mandatory school

Policy perspectives on post pandemic influenza vaccination in Ghana and Malawi.

PubMed

Sambala, Evanson Z; Manderson, Lenore

2017-02-28

In the late 1990s, in the context of renewed concerns of an influenza pandemic, countries such as Ghana and Malawi established plans for the deployment of vaccines and vaccination strategies. A new pandemic was declared in mid-June 2009, and by April 2011, Ghana and Malawi vaccinated 10% of the population. We examine the public health policy perspectives on vaccination as a means to prevent the spread of infection under post pandemic conditions. In-depth interviews were conducted with 46 policymakers (Ghana, n = 24; Malawi, n = 22), identified through snowballing sampling. Interviews were supplemented by field notes and the analysis of policy documents. The use of vaccination to interrupt the pandemic influenza was affected by delays in the procurement, delivery and administration of vaccines, suboptimal vaccination coverage, refusals to be vaccinated, and the politics behind vaccination strategies. More generally, rolling-out of vaccination after the transmission of the influenza virus had abated was influenced by policymakers' own financial incentives, and government and foreign policy conditionality on vaccination. This led to confusion about targeting and coverage, with many policymakers justifying that the vaccination of 10% of the population would establish herd immunity and so reduce future risk. Ghana succeeded in vaccinating 2.3 million of the select groups (100% coverage), while Malawi, despite recourse to force, succeeded only in vaccinating 1.15 million (74% coverage of select groups). For most policymakers, vaccination coverage was perceived as successful, despite that vaccination delays and coverage would not have prevented infection when influenza was at its peak. While the vaccination strategy was problematic and implemented too late to reduce the effects of the 2009 epidemic, policy makers supported the overall goal of pandemic influenza vaccination to interrupt infection. In this context, there was strong support for governments engaging

Simulation to assess the efficacy of US airport entry scrreening of passengers for pandemic influenza

DOE Office of Scientific and Technical Information (OSTI.GOV)

Mcmahon, Benjamin

2009-01-01

We present our methodology and stochastic discrete-event simulation developed to model the screening of passengers for pandemic influenza at the US port-of-entry airports. Our model uniquely combines epidemiology modelling, evolving infected states and conditions of passengers over time, and operational considerations of screening in a single simulation. The simulation begins with international aircraft arrivals to the US. Passengers are then randomly assigned to one of three states -- not infected, infected with pandemic influenza and infected with other respiratory illness. Passengers then pass through various screening layers (i.e. pre-departure screening, en route screening, primary screening and secondary screening) and ultimatelymore » exit the system. We track the status of each passenger over time, with a special emphasis on false negatives (i.e. passengers infected with pandemic influenza, but are not identified as such) as these passengers pose a significant threat as they could unknowingly spread the pandemic influenza virus throughout our nation.« less

Public Response to Community Mitigation Measures for Pandemic Influenza

PubMed Central

Koonin, Lisa M.; Benson, John M.; Cetron, Martin S.; Pollard, William E.; Mitchell, Elizabeth W.; Weldon, Kathleen J.; Herrmann, Melissa J.

2008-01-01

We report the results of a national survey conducted to help public health officials understand the public’s response to community mitigation interventions for a severe outbreak of pandemic influenza. Survey results suggest that if community mitigation measures are instituted, most respondents would comply with recommendations but would be challenged to do so if their income or job were severely compromised. The results also indicate that community mitigation measures could cause problems for persons with lower incomes and for racial and ethnic minorities. Twenty-four percent of respondents said that they would not have anyone available to take care of them if they became sick with pandemic influenza. Given these results, planning and public engagement will be needed to encourage the public to be prepared. PMID:18439361

Critically ill children with pandemic influenza (H1N1) in pediatric intensive care units in Turkey.

PubMed

Kendirli, Tanil; Demirkol, Demet; Yildizdas, Dinçer; Anil, Ayse Berna; Asilioğlu, Nazik; Karapinar, Bülent; Erkek, Nilgün; Sevketoğlu, Esra; Dursun, Oğuz; Arslanköylü, Ali Ertuğ; Bayrakçi, Benan; Bosnak, Mehmet; Köroğlu, Tolga; Horoz, Ozgür Ozden; Citak, Agop; Kesici, Selman; Ates, Can; Karaböcüoğlu, Metin; Ince, Erdal

2012-01-01

To outline the epidemiologic features, clinical presentation, clinical courses, and outcomes in critically ill children with pandemic influenza in pediatric intensive care units. Retrospective, observational, multicenter study. Thirteen tertiary pediatric intensive care units in Turkey. Eighty-three children with confirmed infection attributable to pandemic influenza detected by reverse-transcriptase polymerase chain reaction assay between November 1 and December 31, 2009 who were admitted to critical care units. None. During a 2-month period, 532 children were hospitalized with pandemic influenza and 83 (15.6%) needed critical care. For the 83 patients requiring critical care, the median age was 42 (range, 2-204) months, with 24 (28.9%) and 48 (57.8%) of patients younger than 2 and 5 yrs, respectively. Twenty (24.1%) patients had no underlying illness, but 63 (75.9%) children had an underlying chronic illness. Indications for admission to the pediatric intensive care unit were respiratory failure in 66 (79.5%), neurologic deterioration in six (7.2%), and gastrointestinal symptoms in five (6.0%) patients. Acute lung injury was diagnosed in 23 (27.7%), acute respiratory distress syndrome was diagnosed in 34 (41%), and 51 (61.4%) patients were mechanically ventilated. Oseltamivir was used in 80 (96%) patients. The mortality rate for children with pandemic influenza 2009 was 30.1% compared to an overall mortality rate of 13.7% (p = .0016) among pediatric intensive care unit patients without pandemic influenza during the study period. Also, the mortality rate was 31.7% in patients with comorbidities and 25.0% in previously healthy children (p = .567). The cause of death was primary pandemic influenza infection in 16 (64%), nosocomial infection in four (16%), and primary disease progression in five (20%) patients. The odds ratio for respiratory failure was 14.7 (95% confidence interval, 1.85-111.11), and odds ratio for mechanical ventilation was 27.7 (95% confidence

Key points in evaluating immunogenicity of pandemic influenza vaccines: A lesson from immunogenicity studies of influenza A(H1N1)pdm09 vaccine.

PubMed

Ohfuji, Satoko; Kobayashi, Masayuki; Ide, Yuichiro; Egawa, Yumi; Saito, Tomoko; Kondo, Kyoko; Ito, Kazuya; Kase, Tetsuo; Maeda, Akiko; Fukushima, Wakaba; Hirota, Yoshio

2017-09-18

Immunogenicity studies on pandemic influenza vaccine are necessary to inform rapid development and implementation of a vaccine during a pandemic. Thus, strategies for immunogenicity assessment are required. To identify essential factors to consider when evaluating the immunogenicity of pandemic influenza vaccines using the experience in Japan with the influenza A(H1N1)pdm09 vaccine. We conducted a search of observational studies using PubMed and IchushiWeb. Search terms included "influenza vaccine AND (immunogenicity OR immune response) AND Japan AND (2009 OR pdm09) NOT review," and was limited to studies conducted in humans. A total of 33 articles were identified, of which 16 articles met the inclusion criteria. Immunogenicity of the commercially available influenza A(H1N1)pdm09 vaccine satisfied the international criteria for influenza vaccine immunogenicity in all study populations. The most remarkable immune response was observed in junior high school students, while the lowest immune response was observed in hematological malignancy patients. Similar to immunogenicity studies on seasonal influenza vaccines, factors such as patient background (e.g., age, underlying condition, pre-vaccination titer, body mass index, etc.) and study procedure (e.g., concurrent measurement of pre- and post-vaccination antibody titer, effects of infection during the study period) may have affected the assessment of immunogenicity to the influenza A(H1N1)pdm09 vaccine. In addition, prior vaccination with the seasonal influenza vaccine may inhibit antibody induction by the influenza A(H1N1)pdm09 vaccine. This review discusses factors and strategies that must be considered and addressed during immunogenicity assessments of pandemic influenza vaccines, which may provide useful information for future influenza pandemics. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia

PubMed Central

Song, Joon Y.; Cheong, Hee J.; Heo, Jung Y.; Noh, Ji Y.; Yong, Hwan S.; Kim, Yoon K.; Kang, Eun Y.; Choi, Won S.; Jo, Yu M.; Kim, Woo J.

2011-01-01

Please cite this paper as: Song et al. (2011). Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia. Influenza and Other Respiratory Viruses 5(6), e535–e543. Background  Although influenza virus usually involves the upper respiratory tract, pneumonia was seen more frequently with the 2009 pandemic influenza A/H1N1 than with seasonal influenza. Methods  From September 1, 2009, to January 31, 2010, a specialized clinic for patients (aged ≥15 years) with ILI was operated in Korea University Guro Hospital. RT‐PCR assay was performed to diagnose 2009 pandemic influenza A/H1N1. A retrospective case–case–control study was performed to determine the predictive factors for influenza pneumonia and to discriminate concomitant/secondary bacterial pneumonia from primary influenza pneumonia during the 2009–2010 pandemic. Results  During the study period, the proportions of fatal cases and pneumonia development were 0·12% and 1·59%, respectively. Patients with pneumonic influenza were less likely to have nasal symptoms and extra‐pulmonary symptoms (myalgia, headache, and diarrhea) compared to patients with non‐pneumonic influenza. Crackle was audible in just about half of the patients with pneumonic influenza (38·5% of patients with primary influenza pneumonia and 53·3% of patients with concomitant/secondary bacterial pneumonia). Procalcitonin, C‐reactive protein (CRP), and lactate dehydrogenase were markedly increased in patients with influenza pneumonia. Furthermore, procalcitonin (cutoff value 0·35 ng/ml, sensitivity 81·8%, and specificity 66·7%) and CRP (cutoff value 86·5 mg/IU, sensitivity 81·8%, and specificity 59·3%) were discriminative between patients with concomitant/secondary bacterial pneumonia and patients with primary influenza pneumonia. Conclusions  Considering the subtle manifestations of 2009 pandemic

Detection and isolation of 2009 pandemic influenza A/H1N1 virus in commercial piggery, Lagos Nigeria.

PubMed

Meseko, C A; Odaibo, G N; Olaleye, D O

2014-01-10

WHO declared pandemic of A/H1N1 influenza in 2009 following global spread of the newly emerged strain of the virus from swine. Presently there is a dearth of data on the ecology of pandemic influenza H1N1 required for planning of intervention measures in sub Saharan Africa. Herein we report isolation of 2009 pandemic influenza A/H1N1 in an intensive mega piggery farms operation in South West Nigeria. Sentinel surveillance was carried out in a cohort of intensively reared pigs over a period of two years. Nasal swab specimens were collected at monthly interval from observed clinical cases of influenza like illness in pigs and pig handlers. Samples were analyzed by real time RT-PCR and isolation in chicken embryonated eggs. A total of 227 clinical cases of influenza like illness were observed among pigs out of which 31 (13.7%) were positive for influenza A matrix gene by real time RT-PCR. Virus isolation yielded 29 (12%) isolates out of which 18 (18%) were identified as influenza A/H1N1 by Heamaglutination Inhibition test using H1 antisera. RT-PCR positive samples were subtyped as 2009 pandemic A/H1N1 with subtype specific primers and probes. This is the first report of detection and isolation of pandemic influenza H1N1 from pigs in Nigeria. Continuous circulation of this virus in pigs may cause reassortments with seasonal influenza or mutations and substitutions in the gene that may result in the emergence of novel or pandemic influenza virus of economic and public health importance. Nigeria is considered a geographical hotspot of zoonotic diseases, which necessitate active surveillance and monitoring of emerging pandemic threats. Copyright © 2013 Elsevier B.V. All rights reserved.

Nonpharmaceutical Influenza Mitigation Strategies, US Communities, 1918–1920 Pandemic1

PubMed Central

Stern, Alexandra M.; Navarro, J. Alexander; Michalsen, Joseph R.; Monto, Arnold S.; DiGiovanni, Cleto

2006-01-01

We studied nonpharmaceutical interventions used to mitigate the second, and most deadly, wave of the 1918–1920 influenza pandemic in the United States. We conclude that several small communities implemented potentially successful attempts at preventing the introduction of influenza. PMID:17326953

A model to evaluate mass vaccination against pneumococcus as a countermeasure against pandemic influenza.

PubMed

Crowe, Sonya; Utley, Martin; Walker, Guy; Grove, Peter; Pagel, Christina

2011-07-12

A mathematical model has been developed for the purpose of evaluating vaccination against pneumococcus as a countermeasure against pandemic influenza. As the characteristics of a future pandemic cannot be known in advance, three distinct pandemic scenarios were considered, corresponding to a 1918-like pandemic, a 1957/1968-like pandemic and a 2009-like pandemic. Model estimates for each of these pandemic scenarios are presented for two options of vaccination programme; universal vaccination of the entire UK population and vaccination only of those people considered to be at heightened risk of developing influenza complications. We find that the benefits of each option (in terms of estimated number of deaths and hospital admissions avoided and the courses of antibiotics saved) are high in a 1918-like pandemic and very small in a 2009-like pandemic. Given that the decision regarding deployment of the counter measure would occur prior to knowledge of the flu-strain characteristics being available, we also present the weighted average of the outcomes from the three pandemic scenarios. Based on the historical occurrence of pandemics over the last 100 years, the weighted average of outcomes is an estimated 1400 deaths prevented by the universal vaccination option and 400 deaths saved by the targeted vaccination option (at a cost of approximately 400 million and 50 million courses of vaccine respectively). Finally, the longer term implications of using PPV as a countermeasure against pandemic influenza have been considered by estimating the expected number of courses of vaccine bought and the expected number of deaths and hospital admissions prevented over time under each policy. Copyright © 2011 Elsevier Ltd. All rights reserved.

[Estimation of the excess death associated with influenza pandemics and epidemics in Japan after world war II: relation with pandemics and the vaccination system].

PubMed

Ohmi, Kenichi; Marui, Eiji

2011-10-01

To estimate the excess death associated with influenza pandemics and epidemics in Japan after World War II, and to reexamine the relationship between the excess death and the vaccination system in Japan. Using the Japanese national vital statistics data for 1952-2009, we specified months with influenza epidemics, monthly mortality rates and the seasonal index for 1952-74 and for 1975-2009. Then we calculated excess deaths of each month from the observed number of deaths and the 95% range of expected deaths. Lastly we calculated age-adjusted excess death rates using the 1985 model population of Japan. The total number of excess deaths for 1952-2009 was 687,279 (95% range, 384,149-970,468), 12,058 (95% range, 6,739-17,026) per year. The total number of excess deaths in 6 pandemic years of 1957-58, 58-59, 1968-69, 69-70, 77-78 and 78-79, was 95,904, while that in 51 'non-pandemic' years was 591,376, 6.17 fold larger than pandemic years. The average number of excess deaths for pandemic years was 23,976, nearly equal to that for 'non-pandemic' years, 23,655. At the beginning of pandemics, 1957-58, 1968-69, 1969-70, the proportion of those aged <65 years in excess deaths rose compared with 'non-pandemic' years. In the 1970s and 1980s, when the vaccination program for schoolchildren was mandatory in Japan on the basis of the "Fukumi thesis", age-adjusted average excess mortality rates were relatively low, with an average of 6.17 per hundred thousand. In the 1990s, when group vaccination was discontinued, age-adjusted excess mortality rose up to 9.42, only to drop again to 2.04 when influenza vaccination was made available to the elderly in the 2000s, suggesting that the vaccination of Japanese children prevented excess deaths from influenza pandemics and epidemics. Moreover, in the age group under 65, average excess mortality rates were low in the 1970s and 1980s rather than in the 2000s, which shows that the "Social Defensive" schoolchildren vaccination program in the

The limitations of point of care testing for pandemic influenza: what clinicians and public health professionals need to know.

PubMed

Hatchette, Todd F; Bastien, Nathalie; Berry, Jody; Booth, Tim F; Chernesky, Max; Couillard, Michel; Drews, Steven; Ebsworth, Anthony; Fearon, Margaret; Fonseca, Kevin; Fox, Julie; Gagnon, Jean-Nicolas; Guercio, Steven; Horsman, Greg; Jorowski, Cathy; Kuschak, Theodore; Li, Yan; Majury, Anna; Petric, Martin; Ratnam, Sam; Smieja, Marek; Van Caeseele, Paul

2009-01-01

As the world prepares for the next influenza pandemic, governments have made significant funding commitments to vaccine development and antiviral stockpiling. While these are essential components to pandemic response, rapid and accurate diagnostic testing remains an often neglected cornerstone of pandemic influenza preparedness. Clinicians and Public Health Practitioners need to understand the benefits and drawbacks of different influenza tests in both seasonal and pandemic settings. Culture has been the traditional gold standard for influenza diagnosis but requires from 1-10 days to generate a positive result, compared to nucleic acid detection methods such as real time reverse transcriptase polymerase chain reaction (RT-PCR). Although the currently available rapid antigen detection kits can generate results in less than 30 minutes, their sensitivity is suboptimal and they are not recommended for the detection of novel influenza viruses. Until point-of-care (POC) tests are improved, PILPN recommends that the best option for pandemic influenza preparation is the enhancement of nucleic acid-based testing capabilities across Canada.

[Seasonal and pandemic influenza vaccination: coverage and attitude among private physicians in Germany].

PubMed

Böhmer, M M; Walter, D; Ehrhardt, J; Reiter, S; Krause, G; Wichmann, O

2014-01-01

General practitioners serve as important multipliers for seasonal influenza vaccination in risk groups such as elderly or chronically ill persons, for whom vaccination is recommended in Germany by the Standing Committee on Vaccination (STIKO). Moreover, physicians are a target group for influenza vaccination themselves. Data from 1 590 telephone interviews were analysed. The study population comprised private physicians from 4 different disciplines (general and internal medicine, gynaecology, paediatrics). We assessed seasonal and pandemic vaccination coverage, attitudes and informational needs related to vaccination in general, and opinions about the pandemic situation 2009. Of the interviewed physicians, 61% stated that they have been vaccinated against seasonal influenza regularly. Main reasons for not/only occasionally having received a flu shot were: the belief that seasonal influenza vaccination is not necessary for them (78%) or having forgotten about the vaccination (28%). The interviewed physicians expressed a great demand for active information on STIKO recommendations and certain aspects of the seasonal influenza vaccination. There was a significant association between physicians' own influenza vaccination status and the provision of vaccination information materials, utilisation of a data management system for the vaccination of patients, and active vaccination reminders in the physicians' office. In 2009/10, almost 60% had received a pandemic influenza A(H1N1) vaccination. A major barrier to vaccine uptake was the mistrust in the safety of H1N1 vaccines (stated by 54% of non-vaccinees). Information for the public and physicians by the German public health authorities during the pandemic was rather critically appraised by the respondents. Compared to other subgroups of health-care workers, among private physicians seasonal and pandemic vaccine uptake was rather high. The physicians' need for more information on vaccination topics can be met by

2015 Pandemic Influenza Readiness Assessment Among US Public Health Emergency Preparedness Awardees.

PubMed

Fitzgerald, Thomas J; Moulia, Danielle L; Graitcer, Samuel B; Vagi, Sara J; Dopson, Stephanie A

2017-09-01

To assess how US Public Health Emergency Preparedness (PHEP) awardees plan to respond to an influenza pandemic with vaccination. The Centers for Disease Control and Prevention developed the Pandemic Influenza Readiness Assessment, an online survey sent to PHEP directors, to analyze, in part, the readiness of PHEP awardees to vaccinate 80% of the populations of their jurisdictions with 2 doses of pandemic influenza vaccine, separated by 21 days, within 16 weeks of vaccine availability. Thirty-eight of 60 (63.3%) awardees reported being able to vaccinate their populations within 16 weeks; 38 (63.3%) planned to allocate more than 20% of their pandemic vaccine supply to points of dispensing (PODs). Thirty-four of 58 (58.6%) reported staffing as a challenge to vaccinating 80% of their populations; 28 of 60 (46.7%) reported preparedness workforce decreases, and 22 (36.7%) reported immunization workforce decreases between January 2012 and July 2015. Awardees relied on PODs to vaccinate segments of their jurisdictions despite workforce decreases. Planners must ensure readiness for POD sites to vaccinate, but should also leverage complementary sites and providers to augment public health response.

Adjuvant solution for pandemic influenza vaccine production.

PubMed

Clegg, Christopher H; Roque, Richard; Van Hoeven, Neal; Perrone, Lucy; Baldwin, Susan L; Rininger, Joseph A; Bowen, Richard A; Reed, Steven G

2012-10-23

Extensive preparation is underway to mitigate the next pandemic influenza outbreak. New vaccine technologies intended to supplant egg-based production methods are being developed, with recombinant hemagglutinin (rHA) as the most advanced program for preventing seasonal and avian H5N1 Influenza. Increased efforts are being focused on adjuvants that can broaden vaccine immunogenicity against emerging viruses and maximize vaccine supply on a worldwide scale. Here, we test protection against avian flu by using H5N1-derived rHA and GLA-SE, a two-part adjuvant system containing glucopyranosyl lipid adjuvant (GLA), a formulated synthetic Toll-like receptor 4 agonist, and a stable emulsion (SE) of oil in water, which is similar to the best-in-class adjuvants being developed for pandemic flu. Notably, a single submicrogram dose of rH5 adjuvanted with GLA-SE protects mice and ferrets against a high titer challenge with H5N1 virus. GLA-SE, relative to emulsion alone, accelerated induction of the primary immune response and broadened its durability against heterosubtypic H5N1 virus challenge. Mechanistically, GLA-SE augments protection via induction of a Th1-mediated antibody response. Innate signaling pathways that amplify priming of Th1 CD4 T cells will likely improve vaccine performance against future outbreaks of lethal pandemic flu.

77 FR 6625 - Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and Health Care...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-08

... DEPARTMENT OF VETERANS AFFAIRS Meeting the Challenge of Pandemic Influenza: Ethical Guidance for... its National Center for Ethics in Health Care (NCEHC) invites interested parties to comment on a guidance document entitled ``Meeting the Challenge of Pandemic Influenza: Ethical Guidance for Leaders and...

A knowledge representation of local pandemic influenza planning models.

PubMed

Islam, Runa; Brandeau, Margaret L; Das, Amar K

2007-10-11

Planning for pandemic flu outbreak at the small-government level can be aided through the use of mathematical policy models. Formulating and analyzing policy models, however, can be a time- and expertise-expensive process. We believe that a knowledge-based system for facilitating the instantiation of locale- and problem-specific policy models can reduce some of these costs. In this work, we present the ontology we have developed for pandemic influenza policy models.

Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures

PubMed Central

2006-01-01

The World Health Organization's recommended pandemic influenza interventions, based on limited data, vary by transmission pattern, pandemic phase, and illness severity and extent. In the pandemic alert period, recommendations include isolation of patients and quarantine of contacts, accompanied by antiviral therapy. During the pandemic period, the focus shifts to delaying spread and reducing effects through population-based measures. Ill persons should remain home when they first become symptomatic, but forced isolation and quarantine are ineffective and impractical. If the pandemic is severe, social distancing measures such as school closures should be considered. Nonessential domestic travel to affected areas should be deferred. Hand and respiratory hygiene should be routine; mask use should be based on setting and risk, and contaminated household surfaces should be disinfected. Additional research and field assessments during pandemics are essential to update recommendations. Legal authority and procedures for implementing interventions should be understood in advance and should respect cultural differences and human rights. PMID:16494723

Colleges and Universities Pandemic Influenza Planning Checklist

ERIC Educational Resources Information Center

Centers for Disease Control and Prevention, 2006

2006-01-01

In the event of an influenza pandemic, colleges and universities will play an integral role in protecting the health and safety of students, employees and their families. The Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention (CDC) have developed this checklist as a framework to assist colleges and…

Whole genome characterization of human influenza A(H1N1)pdm09 viruses isolated from Kenya during the 2009 pandemic.

PubMed

Gachara, George; Symekher, Samuel; Otieno, Michael; Magana, Japheth; Opot, Benjamin; Bulimo, Wallace

2016-06-01

An influenza pandemic caused by a novel influenza virus A(H1N1)pdm09 spread worldwide in 2009 and is estimated to have caused between 151,700 and 575,400 deaths globally. While whole genome data on new virus enables a deeper insight in the pathogenesis, epidemiology, and drug sensitivities of the circulating viruses, there are relatively limited complete genetic sequences available for this virus from African countries. We describe herein the full genome analysis of influenza A(H1N1)pdm09 viruses isolated in Kenya between June 2009 and August 2010. A total of 40 influenza A(H1N1)pdm09 viruses isolated during the pandemic were selected. The segments from each isolate were amplified and directly sequenced. The resulting sequences of individual gene segments were concatenated and used for subsequent analysis. These were used to infer phylogenetic relationships and also to reconstruct the time of most recent ancestor, time of introduction into the country, rates of substitution and to estimate a time-resolved phylogeny. The Kenyan complete genome sequences clustered with globally distributed clade 2 and clade 7 sequences but local clade 2 viruses did not circulate beyond the introductory foci while clade 7 viruses disseminated country wide. The time of the most recent common ancestor was estimated between April and June 2009, and distinct clusters circulated during the pandemic. The complete genome had an estimated rate of nucleotide substitution of 4.9×10(-3) substitutions/site/year and greater diversity in surface expressed proteins was observed. We show that two clades of influenza A(H1N1)pdm09 virus were introduced into Kenya from the UK and the pandemic was sustained as a result of importations. Several closely related but distinct clusters co-circulated locally during the peak pandemic phase but only one cluster dominated in the late phase of the pandemic suggesting that it possessed greater adaptability. Copyright © 2016 Elsevier B.V. All rights reserved.

Optimizing Distribution of Pandemic Influenza Antiviral Drugs

PubMed Central

Huang, Hsin-Chan; Morton, David P.; Johnson, Gregory P.; Gutfraind, Alexander; Galvani, Alison P.; Clements, Bruce; Meyers, Lauren A.

2015-01-01

We provide a data-driven method for optimizing pharmacy-based distribution of antiviral drugs during an influenza pandemic in terms of overall access for a target population and apply it to the state of Texas, USA. We found that during the 2009 influenza pandemic, the Texas Department of State Health Services achieved an estimated statewide access of 88% (proportion of population willing to travel to the nearest dispensing point). However, access reached only 34.5% of US postal code (ZIP code) areas containing <1,000 underinsured persons. Optimized distribution networks increased expected access to 91% overall and 60% in hard-to-reach regions, and 2 or 3 major pharmacy chains achieved near maximal coverage in well-populated areas. Independent pharmacies were essential for reaching ZIP code areas containing <1,000 underinsured persons. This model was developed during a collaboration between academic researchers and public health officials and is available as a decision support tool for Texas Department of State Health Services at a Web-based interface. PMID:25625858

Two Years after Pandemic Influenza A/2009/H1N1: What Have We Learned?

PubMed Central

Cheng, Vincent C. C.; To, Kelvin K. W.; Tse, Herman; Hung, Ivan F. N.

2012-01-01

Summary: The world had been anticipating another influenza pandemic since the last one in 1968. The pandemic influenza A H1N1 2009 virus (A/2009/H1N1) finally arrived, causing the first pandemic influenza of the new millennium, which has affected over 214 countries and caused over 18,449 deaths. Because of the persistent threat from the A/H5N1 virus since 1997 and the outbreak of the severe acute respiratory syndrome (SARS) coronavirus in 2003, medical and scientific communities have been more prepared in mindset and infrastructure. This preparedness has allowed for rapid and effective research on the epidemiological, clinical, pathological, immunological, virological, and other basic scientific aspects of the disease, with impacts on its control. A PubMed search using the keywords “pandemic influenza virus H1N1 2009” yielded over 2,500 publications, which markedly exceeded the number published on previous pandemics. Only representative works with relevance to clinical microbiology and infectious diseases are reviewed in this article. A significant increase in the understanding of this virus and the disease within such a short amount of time has allowed for the timely development of diagnostic tests, treatments, and preventive measures. These findings could prove useful for future randomized controlled clinical trials and the epidemiological control of future pandemics. PMID:22491771

Were Equatorial Regions Less Affected by the 2009 Influenza Pandemic? The Brazilian Experience

PubMed Central

Schuck-Paim, Cynthia; Viboud, Cécile; Simonsen, Lone; Miller, Mark A.; Moura, Fernanda E. A.; Fernandes, Roberto M.; Carvalho, Marcia L.; Alonso, Wladimir J.

2012-01-01

Although it is in the Tropics where nearly half of the world population lives and infectious disease burden is highest, little is known about the impact of influenza pandemics in this area. We investigated the mortality impact of the 2009 influenza pandemic relative to mortality rates from various outcomes in pre-pandemic years throughout a wide range of latitudes encompassing the entire tropical, and part of the subtropical, zone of the Southern Hemisphere (+5°N to −35°S) by focusing on a country with relatively uniform health care, disease surveillance, immunization and mitigation policies: Brazil. To this end, we analyzed laboratory-confirmed deaths and vital statistics mortality beyond pre-pandemic levels for each Brazilian state. Pneumonia, influenza and respiratory mortality were significantly higher during the pandemic, affecting predominantly adults aged 25 to 65 years. Overall, there were 2,273 and 2,787 additional P&I- and respiratory deaths during the pandemic, corresponding to a 5.2% and 2.7% increase, respectively, over average pre-pandemic annual mortality. However, there was a marked spatial structure in mortality that was independent of socio-demographic indicators and inversely related with income: mortality was progressively lower towards equatorial regions, where low or no difference from pre-pandemic mortality levels was identified. Additionally, the onset of pandemic-associated mortality was progressively delayed in equatorial states. Unexpectedly, there was no additional mortality from circulatory causes. Comparing disease burden reliably across regions is critical in those areas marked by competing health priorities and limited resources. Our results suggest, however, that tropical regions of the Southern Hemisphere may have been disproportionally less affected by the pandemic, and that climate may have played a key role in this regard. These findings have a direct bearing on global estimates of pandemic burden and the assessment of the

Resilience Training for Hospital Workers in Anticipation of an Influenza Pandemic

ERIC Educational Resources Information Center

Aiello, Andria; Khayeri, Michelle Young-Eun; Raja, Shreyshree; Peladeau, Nathalie; Romano, Donna; Leszcz, Molyn; Maunder, Robert G.; Rose, Marci; Adam, Mary Anne; Pain, Clare; Moore, Andrea; Savage, Diane; Schulman, Rabbi Bernard

2011-01-01

Background: Well before the H1N1 influenza, health care organizations worldwide prepared for a pandemic of unpredictable impact. Planners anticipated the possibility of a pandemic involving high mortality, high health care demands, rates of absenteeism rising up to 20-30% among health care workers, rationing of health care, and extraordinary…

Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence.

PubMed

Wever, Peter C; van Bergen, Leo

2014-09-01

The Meuse-Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1.2 million U.S. troops. With over 26,000 deaths among American soldiers, the offensive is considered "America's deadliest battle". The Meuse-Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45,000 American soldiers making it questionable which battle should be regarded "America's deadliest". The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918. © 2014 The Authors. Influenza and Other Respiratory Viruses Published by John Wiley & Sons Ltd.

Ethics for pandemics beyond influenza: Ebola, drug-resistant tuberculosis, and anticipating future ethical challenges in pandemic preparedness and response.

PubMed

Smith, Maxwell J; Silva, Diego S

2015-01-01

The unprecedented outbreak of Ebola virus disease (EVD) in West Africa has raised several novel ethical issues for global outbreak preparedness. It has also illustrated that familiar ethical issues in infectious disease management endure despite considerable efforts to understand and mitigate such issues in the wake of past outbreaks. To improve future global outbreak preparedness and response, we must examine these shortcomings and reflect upon the current state of ethical preparedness. To this end, we focus our efforts in this article on the examination of one substantial area: ethical guidance in pandemic plans. We argue that, due in part to their focus on considerations arising specifically in relation to pandemics of influenza origin, pandemic plans and their existing ethical guidance are ill-equipped to anticipate and facilitate the navigation of unique ethical challenges that may arise in other infectious disease pandemics. We proceed by outlining three reasons why this is so, and situate our analysis in the context of the EVD outbreak and the threat posed by drug-resistant tuberculosis: (1) different infectious diseases have distinct characteristics that challenge anticipated or existing modes of pandemic prevention, preparedness, response, and recovery, (2) clear, transparent, context-specific ethical reasoning and justification within current influenza pandemic plans are lacking, and (3) current plans neglect the context of how other significant pandemics may manifest. We conclude the article with several options for reflecting upon and ultimately addressing ethical issues that may emerge with different infectious disease pandemics.

Accounting for personal and professional choices for pandemic influenza vaccination amongst English healthcare workers.

PubMed

Marcu, Afrodita; Rubinstein, Helena; Michie, Susan; Yardley, Lucy

2015-05-05

Healthcare workers (HCWs) are encouraged to get vaccinated during influenza pandemics to reduce their own, and patients', risk of infection, and to encourage their patients to get immunised. Despite extensive research on HCWs' receipt of vaccination, little is known about how HCWs articulate pandemic influenza vaccination advice to patients. To explore HCWs' uptake of the A/H1N1 vaccine during the pandemic of 2009-2010, their recommendations to patients at the time, and their anticipated choices around influenza vaccination under different pandemic scenarios. We conducted semi-structured interviews and focus groups with eight vaccinated and seventeen non-vaccinated HCWs from primary care practices in England. The data was analysed using thematic analysis. The HCWs constructed their receipt of vaccination as a personal choice informed by personal health history and perceptions of vaccine safety, while they viewed patients' vaccination as choices made following informed consent and medical guidelines. Some HCWs received the A/H1N1 vaccine under the influence of their local practice organizational norms and values. While non-vaccinated HCWs regarded patients' vaccination as patients' choice, some vaccinated HCWs saw it also as a public health issue. The non-vaccinated HCWs emphasised that they would not allow their personal choices to influence the advice they gave to patients, whereas some vaccinated HCWs believed that by getting vaccinated themselves they could provide a reassuring example to patients, particularly those who have concerns about influenza vaccination. All HCWs indicated they would accept vaccination under the severe pandemic scenario. However, most non-vaccinated HCWs expressed reticence to vaccinate under the mild pandemic scenario. Providing evidence-based arguments about the safety of new vaccines and the priority of public health over personal choice, and creating strong social norms for influenza vaccination as part of the organizational culture

No evidence of 1918 influenza pandemic origin in Chinese laborers/soldiers in France.

PubMed

Shanks, G Dennis

2016-01-01

Laborers and soldiers from China and Southeast Asia recruited during the First World War by Britain and France have been suggested as the origin of the 1918 influenza pandemic in Western Europe. This study aimed to review the available data to better understand the sources and origins of the 1918 influenza pandemic, and clarify whether, in fact, there was an Asian connection to its onset. We reviewed official mortality lists from the Commonwealth War Graves Commission and the French Ministry of Defence for all-cause (Britain) and pneumonia/influenza (France) mortality, respectively. The results indicated that influenza mortality (estimated 1/1000) in Chinese and Southeast Asian laborers and soldiers lagged other co-located military units by several weeks. This finding does not support a Southeast Asian importation of lethal influenza to Europe in 1918. Copyright © 2015. Published by Elsevier Taiwan LLC.

Measures against transmission of pandemic H1N1 influenza in Japan in 2009: simulation model.

PubMed

Yasuda, H; Suzuki, K

2009-11-05

The first outbreak of pandemic H1N1 influenza in Japan was contained in the Kansai region in May 2009 by social distancing measures. Modelling methods are needed to estimate the validity of these measures before their implementation on a large scale. We estimated the transmission coefficient from outbreaks of pandemic H1N1 influenza among school children in Japan in summer 2009; using this transmission coefficient, we simulated the spread of pandemic H1N1 influenza in a virtual community called the virtual Chuo Line which models an area to the west of metropolitan Tokyo. Measures evaluated in our simulation included: isolation at home, school closure, post-exposure prophylaxis and mass vaccinations of school children. We showed that post-exposure prophylaxis combined with isolation at home and school closure significantly decreases the total number of cases in the community and can mitigate the spread of pandemic H1N1 influenza, even when there is a delay in the availability of vaccine.

Lessons from the 1918 Influenza Pandemic: Using Historical Examples to Inform the Department of Defense’s Response to the Next Pandemic

DTIC Science & Technology

2013-04-01

international containment as near as possible to the origin of an outbreak. Conclusion: The influenza pandemic of 1918 was the most rapidly lethal...fighting strength. Troop ships from the US delivered 1,700 new influenza cases to Brest , France in September 1918.26 These sick soldiers, far from...the population of the US during the pandemic because distrust and terror follow fear. 47 Fear led people to question the origin of the

Information technology systems for critical care triage and medical response during an influenza pandemic: a review of current systems.

PubMed

Bandayrel, Kristofer; Lapinsky, Stephen; Christian, Michael

2013-06-01

To assess local, state, federal, and global pandemic influenza preparedness by identifying pandemic plans at the local, state, federal, and global levels, and to identify any information technology (IT) systems in these plans to support critical care triage during an influenza pandemic in the Canadian province of Ontario. The authors used advanced MEDLINE and Google search strategies and conducted a comprehensive review of key pandemic influenza Web sites. Descriptive data extraction and analysis for IT systems were conducted on all of the included pandemic plans. A total of 155 pandemic influenza plans were reviewed: 29 local, 62 state, 63 federal, and 1 global. We found 70 plans that examined IT systems (10 local, 33 state, 26 federal, 1 global), and 85 that did not (19 local, 29 state, 37 federal). Of the 70 plans, 64 described surveillance systems (10 local, 32 state, 21 federal, 1 global), 2 described patient data collection systems (1 state, 1 federal); 4 described other types of IT systems (4 federal), and none were intended for triage. Although several pandemic plans have been drafted, the majority are high-level general documents that do not describe IT systems. The plans that discuss IT systems focus strongly on surveillance, which fails to recognize the needs of a health care system responding to an influenza pandemic. The best examples of the types of IT systems to guide decision making during a pandemic were found in the Kansas and the Czech Republic pandemic plans, because these systems were designed to collect both patient and surveillance data. Although Ontario has yet to develop such an IT system, several IT systems are in place that could be leveraged to support critical care triage and medical response during an influenza pandemic.

Behavioural intentions in response to an influenza pandemic.

PubMed

Kok, Gerjo; Jonkers, Ruud; Gelissen, Roger; Meertens, Ree; Schaalma, Herman; de Zwart, Onno

2010-03-30

Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur. A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample. Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient. Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react.

Spatial-temporal excess mortality patterns of the 1918–1919 influenza pandemic in Spain

PubMed Central

2014-01-01

Background The impact of socio-demographic factors and baseline health on the mortality burden of seasonal and pandemic influenza remains debated. Here we analyzed the spatial-temporal mortality patterns of the 1918 influenza pandemic in Spain, one of the countries of Europe that experienced the highest mortality burden. Methods We analyzed monthly death rates from respiratory diseases and all-causes across 49 provinces of Spain, including the Canary and Balearic Islands, during the period January-1915 to June-1919. We estimated the influenza-related excess death rates and risk of death relative to baseline mortality by pandemic wave and province. We then explored the association between pandemic excess mortality rates and health and socio-demographic factors, which included population size and age structure, population density, infant mortality rates, baseline death rates, and urbanization. Results Our analysis revealed high geographic heterogeneity in pandemic mortality impact. We identified 3 pandemic waves of varying timing and intensity covering the period from Jan-1918 to Jun-1919, with the highest pandemic-related excess mortality rates occurring during the months of October-November 1918 across all Spanish provinces. Cumulative excess mortality rates followed a south–north gradient after controlling for demographic factors, with the North experiencing highest excess mortality rates. A model that included latitude, population density, and the proportion of children living in provinces explained about 40% of the geographic variability in cumulative excess death rates during 1918–19, but different factors explained mortality variation in each wave. Conclusions A substantial fraction of the variability in excess mortality rates across Spanish provinces remained unexplained, which suggests that other unidentified factors such as comorbidities, climate and background immunity may have affected the 1918–19 pandemic mortality rates. Further archeo

[An influenza pandemic in Russia as a part of a global spread of the influenza A(H1N1)pdm09 in 2009-2011].

PubMed

Karpova, L S; Pelikh, M Iu; Stoliarov, K A; Popovtseva, N M; Stoliarova, T P

2012-01-01

The comparison of the first and second waves of the pandemic influenza A(H1N1)pdm09 in the world and Russia was performed on the basis of weekly reports of Regional offices for Europe and on the data of the Federal Center for Influenza on a weekly incidence of influenza and acute respiratory viral infections, hospitalization, and mortality from the influenza in the age groups of population in 49 cities of the Russian Federation. The first wave of the pandemic, which continued in the countries of the world all summer, was of mixed etiology and, in spite of the availability of imported cases, has not caused a steep increase in Russia. The second wave of the pandemic in the countries of the Southern hemisphere was less intense. In the countries of the Northern hemisphere (in autumn 2009), on the contrary, it was more intensive, which was associated with different seasonality of influenza in these hemispheres. In Russia, the second wave (2011) was of a lesser intensity as compared to the first with respect to the duration in the country and in urban areas, the incidence in the entire population, including schoolchildren and adults, the rate of hospitalization and case fatality rate reduction of laboratory-confirmed influenza infection. The duration of the last pandemic of 2009 was the same as in 1957 and 1968, and longer than in 1977. The morbidity was one-half less than in the pandemic of 1957 and 1968, and was approaching the pandemic 1977. At the same time, the incidence in children 3-6 and 7-14 years was higher than in previous pandemics.

US school/academic institution disaster and pandemic preparedness and seasonal influenza vaccination among school nurses.

PubMed

Rebmann, Terri; Elliott, Michael B; Reddick, Dave; D Swick, Zachary

2012-09-01

School pandemic preparedness is essential, but has not been evaluated. An online survey was sent to school nurses (from state school nurse associations and/or state departments of education) between May and July 2011. Overall school pandemic preparedness scores were calculated by assigning 1 point for each item in the school's pandemic plan; the maximum score was 11. Linear regression was used to describe factors associated with higher school pandemic preparedness scores. Nurse influenza vaccine uptake was assessed as well. A total of 1,997 nurses from 26 states completed the survey. Almost three-quarters (73.7%; n = 1,472) reported receiving the seasonal influenza vaccine during the 2010-11 season. Very few (2.2%; n = 43) reported that their school/district had a mandatory influenza vaccination policy. Pandemic preparedness scores ranged from 0 to 10 points, with an average score of 4.3. Determinants of school pandemic preparedness were as follows: planning to be a point of dispensing during a future pandemic (P < .001), having experienced multiple student or employee hospitalizations and/or deaths related to H1N1 during the pandemic (P = .01 or <.05, respectively), having a lead nurse complete the survey (P < .001), and having the school nurse study participant be a member of the school disaster planning committee (P < .001). US schools must continue to address gaps in pandemic planning. Copyright © 2012 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Death from 1918 pandemic influenza during the First World War: a perspective from personal and anecdotal evidence

PubMed Central

Wever, Peter C; van Bergen, Leo

2014-01-01

The Meuse-Argonne offensive, a decisive battle during the First World War, is the largest frontline commitment in American military history involving 1·2 million U.S. troops. With over 26 000 deaths among American soldiers, the offensive is considered “America's deadliest battle”. The Meuse-Argonne offensive coincided with the highly fatal second wave of the influenza pandemic in 1918. In Europe and in U.S. Army training camps, 1918 pandemic influenza killed around 45 000 American soldiers making it questionable which battle should be regarded “America's deadliest”. The origin of the influenza pandemic has been inextricably linked with the men who occupied the military camps and trenches during the First World War. The disease had a profound impact, both for the military apparatus and for the individual soldier. It struck all the armies and might have claimed toward 100 000 fatalities among soldiers overall during the conflict while rendering millions ineffective. Yet, it remains unclear whether 1918 pandemic influenza had an impact on the course of the First World War. Still, even until this day, virological and bacteriological analysis of preserved archived remains of soldiers that succumbed to 1918 pandemic influenza has important implications for preparedness for future pandemics. These aspects are reviewed here in a context of citations, images, and documents illustrating the tragic events of 1918. PMID:24975798

Mortality burden of the 2009 A/H1N1 influenza pandemic in France: comparison to seasonal influenza and the A/H3N2 pandemic.

PubMed

Lemaitre, Magali; Carrat, Fabrice; Rey, Grégoire; Miller, Mark; Simonsen, Lone; Viboud, Cécile

2012-01-01

The mortality burden of the 2009 A/H1N1 pandemic remains unclear in many countries due to delays in reporting of death statistics. We estimate the age- and cause-specific excess mortality impact of the pandemic in France, relative to that of other countries and past epidemic and pandemic seasons. We applied Serfling and Poisson excess mortality approaches to model weekly age- and cause-specific mortality rates from June 1969 through May 2010 in France. Indicators of influenza activity, time trends, and seasonal terms were included in the models. We also reviewed the literature for country-specific estimates of 2009 pandemic excess mortality rates to characterize geographical differences in the burden of this pandemic. The 2009 A/H1N1 pandemic was associated with 1.0 (95% Confidence Intervals (CI) 0.2-1.9) excess respiratory deaths per 100,000 population in France, compared to rates per 100,000 of 44 (95% CI 43-45) for the A/H3N2 pandemic and 2.9 (95% CI 2.3-3.7) for average inter-pandemic seasons. The 2009 A/H1N1 pandemic had a 10.6-fold higher impact than inter-pandemic seasons in people aged 5-24 years and 3.8-fold lower impact among people over 65 years. The 2009 pandemic in France had low mortality impact in most age groups, relative to past influenza seasons, except in school-age children and young adults. The historical A/H3N2 pandemic was associated with much larger mortality impact than the 2009 pandemic, across all age groups and outcomes. Our 2009 pandemic excess mortality estimates for France fall within the range of previous estimates for high-income regions. Based on the analysis of several mortality outcomes and comparison with laboratory-confirmed 2009/H1N1 deaths, we conclude that cardio-respiratory and all-cause mortality lack precision to accurately measure the impact of this pandemic in high-income settings and that use of more specific mortality outcomes is important to obtain reliable age-specific estimates.

Risk factors for death from pandemic influenza in 1918–1919: a case–control study

PubMed Central

Summers, Jennifer A; Stanley, James; Baker, Michael G; Wilson, Nick

2014-01-01

Background Despite the persisting threat from future influenza pandemics, much is still unknown about the risk factors for death from such events, and especially for the 1918–1919 influenza pandemic. Methods A case–control study was performed to explore possible risk factors for death from pandemic influenza among New Zealand military personnel in the Northern Hemisphere in 1918–1919 (n = 218 cases, n = 221 controls). Data were compiled from a Roll-of-Honour dataset, a dataset of nearly all military personnel involved in the war and archived individual records. Results In the fully adjusted multivariable model, the following were significantly associated with increased risk of death from pandemic influenza: age (25–29 years), pre-pandemic hospitalisations for a chronic condition (e.g. tuberculosis), relatively early year of military deployment, a relatively short time from enlistment to foreign service, and having a larger chest size (e.g. adjusted odds ratio for 90–99 cm versus <90 cm was 2·45; 95% CI=1·47–4·10). There were no significant associations in the fully adjusted model with military rank, occupational class at enlistment, and rurality at enlistment. Conclusions This is one of the first published case–control studies of mortality risk factors for the 1918–1919 influenza pandemic. Some of the findings are consistent with previous research on risk factors (such as chronic conditions and age groups), but others appear more novel (e.g., larger chest size). As all such historical analyses have limitations, there is a need for additional studies in other settings as archival World War One records become digitalised. PMID:24490663

A neighborhood susceptibility index for planning of local physical interventions in response to pandemic influenza outbreaks

PubMed Central

Timpka, Toomas; Eriksson, Henrik; Strömgren, Magnus; Eriksson, Olle; Ekberg, Joakim; Grimvall, Anders; Nyce, James; Gursky, Elin; Holm, Einar

2010-01-01

The global spread of a novel A (H1N1) influenza virus in 2009 has highlighted the possibility of a devastating pandemic similar to the ‘Spanish flu’ of 1917–1918. Responding to such pandemics requires careful planning for the early phases where there is no availability of pandemic vaccine. We set out to compute a Neighborhood Influenza Susceptibility Index (NISI) describing the vulnerability of local communities of different geo-socio-physical structure to a pandemic influenza outbreak. We used a spatially explicit geo-physical model of Linköping municipality (pop. 136,240) in Sweden, and employed an ontology-modeling tool to define simulation models and transmission settings. We found considerable differences in NISI between neighborhoods corresponding to primary care areas with regard to early progress of the outbreak, as well as in terms of the total accumulated share of infected residents counted after the outbreak. The NISI can be used in local preparations of physical response measures during pandemics. PMID:21347087

Healthcare workers as parents: attitudes toward vaccinating their children against pandemic influenza A/H1N1.

PubMed

Torun, Sebahat D; Torun, Fuat; Catak, Binali

2010-10-10

Both the health care workers (HCWs) and children are target groups for pandemic influenza vaccination. The coverage of the target populations is an important determinant for impact of mass vaccination. The objective of this study is to determine the attitudes of HCWs as parents, toward vaccinating their children with pandemic influenza A/H1N1 vaccine. A cross-sectional questionnaire survey was conducted with health care workers (HCWs) in a public hospital during December 2009 in Istanbul. All persons employed in the hospital with or without a health-care occupation are accepted as HCW. The HCWs who are parents of children 6 months to 18 years of age were included in the study. Pearson's chi-square test and logistic regression analysis was applied for the statistical analyses. A total of 389 HCWs who were parents of children aged 6 months-18 years participated study. Among all participants 27.0% (n = 105) reported that themselves had been vaccinated against pandemic influenza A/H1N1. Two third (66.1%) of the parents answered that they will not vaccinate their children, 21.1% already vaccinated and 12.9% were still undecided. Concern about side effect was most reported reason among who had been not vaccinated their children and among undecided parents. The second reason for refusing the pandemic vaccine was concerns efficacy of the vaccine. Media was the only source of information about pandemic influenza in nearly one third of HCWs. Agreement with vaccine safety, self receipt of pandemic influenza A/H1N1 vaccine, and trust in Ministry of Health were found to be associated with the positive attitude toward vaccinating their children against pandemic influenza A/H1N1. Persuading parents to accept a new vaccine seems not be easy even if they are HCWs. In order to overcome the barriers among HCWs related to pandemic vaccines, determination of their misinformation, attitudes and behaviors regarding the pandemic influenza vaccination is necessary. Efforts for orienting

Healthcare workers as parents: attitudes toward vaccinating their children against pandemic influenza A/H1N1

PubMed Central

2010-01-01

Background Both the health care workers (HCWs) and children are target groups for pandemic influenza vaccination. The coverage of the target populations is an important determinant for impact of mass vaccination. The objective of this study is to determine the attitudes of HCWs as parents, toward vaccinating their children with pandemic influenza A/H1N1 vaccine. Methods A cross-sectional questionnaire survey was conducted with health care workers (HCWs) in a public hospital during December 2009 in Istanbul. All persons employed in the hospital with or without a health-care occupation are accepted as HCW. The HCWs who are parents of children 6 months to 18 years of age were included in the study. Pearson's chi-square test and logistic regression analysis was applied for the statistical analyses. Results A total of 389 HCWs who were parents of children aged 6 months-18 years participated study. Among all participants 27.0% (n = 105) reported that themselves had been vaccinated against pandemic influenza A/H1N1. Two third (66.1%) of the parents answered that they will not vaccinate their children, 21.1% already vaccinated and 12.9% were still undecided. Concern about side effect was most reported reason among who had been not vaccinated their children and among undecided parents. The second reason for refusing the pandemic vaccine was concerns efficacy of the vaccine. Media was the only source of information about pandemic influenza in nearly one third of HCWs. Agreement with vaccine safety, self receipt of pandemic influenza A/H1N1 vaccine, and trust in Ministry of Health were found to be associated with the positive attitude toward vaccinating their children against pandemic influenza A/H1N1. Conclusions Persuading parents to accept a new vaccine seems not be easy even if they are HCWs. In order to overcome the barriers among HCWs related to pandemic vaccines, determination of their misinformation, attitudes and behaviors regarding the pandemic influenza vaccination

Ferrets as Models for Influenza Virus Transmission Studies and Pandemic Risk Assessments

PubMed Central

Barclay, Wendy; Barr, Ian; Fouchier, Ron A.M.; Matsuyama, Ryota; Nishiura, Hiroshi; Peiris, Malik; Russell, Charles J.; Subbarao, Kanta; Zhu, Huachen

2018-01-01

The ferret transmission model is extensively used to assess the pandemic potential of emerging influenza viruses, yet experimental conditions and reported results vary among laboratories. Such variation can be a critical consideration when contextualizing results from independent risk-assessment studies of novel and emerging influenza viruses. To streamline interpretation of data generated in different laboratories, we provide a consensus on experimental parameters that define risk-assessment experiments of influenza virus transmissibility, including disclosure of variables known or suspected to contribute to experimental variability in this model, and advocate adoption of more standardized practices. We also discuss current limitations of the ferret transmission model and highlight continued refinements and advances to this model ongoing in laboratories. Understanding, disclosing, and standardizing the critical parameters of ferret transmission studies will improve the comparability and reproducibility of pandemic influenza risk assessment and increase the statistical power and, perhaps, accuracy of this model. PMID:29774862

ICU-treated influenza A(H1N1) pdm09 infections more severe post pandemic than during 2009 pandemic: a retrospective analysis.

PubMed

Ylipalosaari, Pekka; Ala-Kokko, Tero I; Laurila, Jouko; Ahvenjärvi, Lauri; Syrjälä, Hannu

2017-11-21

We compared in a single mixed intensive care unit (ICU) patients with influenza A(H1N1) pdm09 between pandemic and postpandemic periods. Retrospective analysis of prospectively collected data in 2009-2016. Data are expressed as median (25th-75th percentile) or number (percentile). Seventy-six influenza A(H1N1) pdm09 patients were admitted to the ICU: 16 during the pandemic period and 60 during the postpandemic period. Postpandemic patients were significantly older (60 years vs. 43 years, p < 0.001) and less likely to have epilepsy or other neurological diseases compared with pandemic patients (5 [8.3%] vs. 6 [38%], respectively; p = 0.009). Postpandemic patients were more likely than pandemic patients to have cardiovascular disease (24 [40%] vs. 1 [6%], respectively; p = 0.015), and they had higher scores on APACHE II (17 [13-22] vs. 14 [10-17], p = 0.002) and SAPS II (40 [31-51] vs. 31 [25-35], p = 0.002) upon admission to the ICU. Postpandemic patients had higher maximal SOFA score (9 [5-12] vs. 5 [4-9], respectively; p = 0.03) during their ICU stay. Postpandemic patients had more often septic shock (40 [66.7%] vs. 8 [50.0%], p = 0.042), and longer median hospital stays (15.0 vs. 8.0 days, respectively; p = 0.006). During 2015-2016, only 18% of the ICU- treated patients had received seasonal influenza vaccination. Postpandemic ICU-treated A(H1N1) pdm09 influenza patients were older and developed more often septic shock and had longer hospital stays than influenza patients during the 2009 pandemic.

Lessons from pandemic influenza A(H1N1): the research-based vaccine industry's perspective.

PubMed

Abelin, Atika; Colegate, Tony; Gardner, Stephen; Hehme, Norbert; Palache, Abraham

2011-02-01

As A(H1N1) influenza enters the post-pandemic phase, health authorities around the world are reviewing the response to the pandemic. To ensure this process enhances future preparations, it is essential that perspectives are included from all relevant stakeholders, including vaccine manufacturers. This paper outlines the contribution of R&D-based influenza vaccine producers to the pandemic response, and explores lessons that can be learned to improve future preparedness. The emergence of 2009 A(H1N1) influenza led to unprecedented collaboration between global health authorities, scientists and manufacturers, resulting in the most comprehensive pandemic response ever undertaken, with a number of vaccines approved for use three months after the pandemic declaration. This response was only possible because of the extensive preparations undertaken during the last decade. During this period, manufacturers greatly increased influenza vaccine production capacity, and estimates suggest a further doubling of capacity by 2014. Producers also introduced cell-culture technology, while adjuvant and whole virion technologies significantly reduced pandemic vaccine antigen content. This substantially increased pandemic vaccine production capacity, which in July 2009 WHO estimated reached 4.9 billion doses per annum. Manufacturers also worked with health authorities to establish risk management plans for robust vaccine surveillance during the pandemic. Individual producers pledged significant donations of vaccine doses and tiered-pricing approaches for developing country supply. Based on the pandemic experience, a number of improvements would strengthen future preparedness. Technical improvements to rapidly select optimal vaccine viruses, and processes to speed up vaccine standardization, could accelerate and extend vaccine availability. Establishing vaccine supply agreements beforehand would avoid the need for complex discussions during a period of intense time pressure. Enhancing

Early estimation of pandemic influenza Antiviral and Vaccine Effectiveness (EAVE): use of a unique community and laboratory national data-linked cohort study.

PubMed

Simpson, Colin R; Lone, Nazir; McMenamin, Jim; Gunson, Rory; Robertson, Chris; Ritchie, Lewis D; Sheikh, Aziz

2015-10-01

After the introduction of any new pandemic influenza, population-level surveillance and rapid assessment of the effectiveness of a new vaccination will be required to ensure that it is targeted to those at increased risk of serious illness or death from influenza. We aimed to build a pandemic influenza reporting platform that will determine, once a new pandemic is under way: the uptake and effectiveness of any new pandemic vaccine or any protective effect conferred by antiviral drugs once available; the clinical attack rate of pandemic influenza; and the existence of protection provided by previous exposure to, and vaccination from, A/H1N1 pandemic or seasonal influenza/identification of susceptible groups. An observational cohort and test-negative study design will be used (post pandemic). A national linkage of patient-level general practice data from 41 Practice Team Information general practices, hospitalisation and death certification, virological swab and serology-linked data. We will study a nationally representative sample of the Scottish population comprising 300,000 patients. Confirmation of influenza using reverse transcription polymerase chain reaction and, in a subset of the population, serology. Future available pandemic influenza vaccination and antivirals will be evaluated. To build a reporting platform tailored towards the evaluation of pandemic influenza vaccination. This system will rapidly measure vaccine effectiveness (VE), adjusting for confounders, estimated by determining laboratory-confirmed influenza; influenza-related morbidity and mortality, including general practice influenza-like illnesses (ILIs); and hospitalisation and death from influenza and pneumonia. Once a validated haemagglutination inhibition assay has been developed (and prior to the introduction of any vaccination), cross-reactivity with previous exposure to A/H1N1 or A/H1N1 vaccination, other pandemic influenza or other seasonal influenza vaccination or exposure will be

The 2009 pandemic in Mexico: Experience and lessons regarding national preparedness policies for seasonal and epidemic influenza.

PubMed

Cordova-Villalobos, Jose A; Macias, Alejandro E; Hernandez-Avila, Mauricio; Dominguez-Cherit, Guillermo; Lopez-Gatell, Hugo; Alpuche-Aranda, Celia; Ponce de León-Rosales, Samuel

2017-01-01

Influenza is a viral respiratory disease capable of causing epidemics that represent a threat for global security. Mexico was the first country to notify the WHO of an outbreak of what later became the first influenza pandemic of the 21st Century, caused by the virus A(H1N1)2009. Before this event Mexico had a national pandemic influenza preparedness plan, which included seasonal influenza vaccination, stockpiles of personal protection equipment and strategic drugs, and risk communication strategies. During the epidemic, the national public health laboratory network and case surveillance systems were strengthened together with surge capacities for intensive care and delivery of antiviral drugs. Risk communication was conducted for people to comply with implemented measures regarding social distancing (workplace and school closures, household quarantine). This report describes the Mexican experience during the 2009 influenza pandemic and the lessons that this experience provides to public health preparedness for future pandemics.

Modeling uncertainties in workforce disruptions from influenza pandemics using dynamic input-output analysis.

PubMed

El Haimar, Amine; Santos, Joost R

2014-03-01

Influenza pandemic is a serious disaster that can pose significant disruptions to the workforce and associated economic sectors. This article examines the impact of influenza pandemic on workforce availability within an interdependent set of economic sectors. We introduce a simulation model based on the dynamic input-output model to capture the propagation of pandemic consequences through the National Capital Region (NCR). The analysis conducted in this article is based on the 2009 H1N1 pandemic data. Two metrics were used to assess the impacts of the influenza pandemic on the economic sectors: (i) inoperability, which measures the percentage gap between the as-planned output and the actual output of a sector, and (ii) economic loss, which quantifies the associated monetary value of the degraded output. The inoperability and economic loss metrics generate two different rankings of the critical economic sectors. Results show that most of the critical sectors in terms of inoperability are sectors that are related to hospitals and health-care providers. On the other hand, most of the sectors that are critically ranked in terms of economic loss are sectors with significant total production outputs in the NCR such as federal government agencies. Therefore, policy recommendations relating to potential mitigation and recovery strategies should take into account the balance between the inoperability and economic loss metrics. © 2013 Society for Risk Analysis.

Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis.

PubMed

Saunders-Hastings, Patrick; Reisman, Jane; Krewski, Daniel

2016-01-01

Influenza pandemics occur when a novel influenza strain, to which humans are immunologically naïve, emerges to cause infection and illness on a global scale. Differences in the viral properties of pandemic strains, relative to seasonal ones, can alter the effectiveness of interventions typically implemented to control seasonal influenza burden. As a result, annual control activities may not be sufficient to contain an influenza pandemic. This study seeks to inform pandemic policy and planning initiatives by reviewing the effectiveness of previous interventions to reduce pandemic influenza transmission and infection. Results will inform the planning and design of more focused in-depth systematic reviews for specific types of interventions, thus providing the most comprehensive and current understanding of the potential for alternative interventions to mitigate the burden of pandemic influenza. A systematic review and narrative synthesis of existing systematic reviews and meta-analyses examining intervention effectiveness in containing pandemic influenza transmission was conducted using information collected from five databases (PubMed, Medline, Cochrane, Embase, and Cinahl/EBSCO). Two independent reviewers conducted study screening and quality assessment, extracting data related to intervention impact and effectiveness. Most included reviews were of moderate to high quality. Although the degree of statistical heterogeneity precluded meta-analysis, the present systematic review examines the wide variety of interventions that can impact influenza transmission in different ways. While it appears that pandemic influenza vaccination provides significant protection against infection, there was insufficient evidence to conclude that antiviral prophylaxis, seasonal influenza cross-protection, or a range of non-pharmaceutical strategies would provide appreciable protection when implemented in isolation. It is likely that an optimal intervention strategy will employ a

Health system resource gaps and associated mortality from pandemic influenza across six Asian territories.

PubMed

Rudge, James W; Hanvoravongchai, Piya; Krumkamp, Ralf; Chavez, Irwin; Adisasmito, Wiku; Chau, Pham Ngoc; Phommasak, Bounlay; Putthasri, Weerasak; Shih, Chin-Shui; Stein, Mart; Timen, Aura; Touch, Sok; Reintjes, Ralf; Coker, Richard

2012-01-01

Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a "mild-to-moderate" pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as "avoidable" mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards minimizing avoidable deaths.

Fitness of Pandemic H1N1 and Seasonal influenza A viruses during Co-infection

PubMed Central

Perez, Daniel Roberto; Sorrell, Erin; Angel, Matthew; Ye, Jianqiang; Hickman, Danielle; Pena, Lindomar; Ramirez-Nieto, Gloria; Kimble, Brian; Araya, Yonas

2009-01-01

On June 11, 2009 the World Health Organization (WHO) declared a new H1N1 influenza pandemic. This pandemic strain is as transmissible as seasonal H1N1 and H3N2 influenza A viruses. Major concerns facing this pandemic are whether the new virus will replace, co-circulate and/or reassort with seasonal H1N1 and/or H3N2 human strains. Using the ferret model, we investigated which of these three possibilities were most likely favored. Our studies showed that the current pandemic virus is more transmissible than, and has a biological advantage over, prototypical seasonal H1 or H3 strains. PMID:20029606

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

DOE Office of Scientific and Technical Information (OSTI.GOV)

ORAU's Oak Ridge Institute for Science Education

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do justmore » that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.« less

Evaluation of Three Live Attenuated H2 Pandemic Influenza Vaccine Candidates in Mice and Ferrets

PubMed Central

Chen, Grace L.; Lamirande, Elaine W.; Cheng, Xing; Torres-Velez, Fernando; Orandle, Marlene; Jin, Hong; Kemble, George

2014-01-01

ABSTRACT H2 influenza viruses have not circulated in humans since 1968, and therefore a significant portion of the population would be susceptible to infection should H2 influenza viruses reemerge. H2 influenza viruses continue to circulate in avian reservoirs worldwide, and these reservoirs are a potential source from which these viruses could emerge. Three reassortant cold-adapted (ca) H2 pandemic influenza vaccine candidates with hemagglutinin (HA) and neuraminidase (NA) genes derived from the wild-type A/Japan/305/1957 (H2N2) (Jap/57), A/mallard/6750/1978 (H2N2) (mal/78), or A/swine/MO/4296424/2006 (H2N3) (sw/06) viruses and the internal protein gene segments from the A/Ann Arbor/6/60 ca virus were generated by plasmid-based reverse genetics (Jap/57 ca, mal/78 ca, and sw/06 ca, respectively). The vaccine candidates exhibited the in vitro phenotypes of temperature sensitivity and cold adaptation and were restricted in replication in the respiratory tract of ferrets. In mice and ferrets, the vaccines elicited neutralizing antibodies and conferred protection against homologous wild-type virus challenge. Of the three candidates, the sw/06 ca vaccine elicited cross-reactive antibodies and provided significant protection against the greatest number of heterologous viruses. These observations suggest that the sw/06 ca vaccine should be further evaluated in a clinical trial as an H2 pandemic influenza vaccine candidate. IMPORTANCE Influenza pandemics arise when novel influenza viruses are introduced into a population with little prior immunity to the new virus and often result in higher rates of illness and death than annual seasonal influenza epidemics. An influenza H2 subtype virus caused a pandemic in 1957, and H2 viruses circulated in humans till 1968. H2 influenza viruses continue to circulate in birds, and the development of an H2 influenza vaccine candidate is therefore considered a priority in preparing for future pandemics. However, we cannot predict whether a

Economic analysis of pandemic influenza mitigation strategies for five pandemic severity categories

PubMed Central

2013-01-01

Background The threat of emergence of a human-to-human transmissible strain of highly pathogenic influenza A(H5N1) is very real, and is reinforced by recent results showing that genetically modified A(H5N1) may be readily transmitted between ferrets. Public health authorities are hesitant in introducing social distancing interventions due to societal disruption and productivity losses. This study estimates the effectiveness and total cost (from a societal perspective, with a lifespan time horizon) of a comprehensive range of social distancing and antiviral drug strategies, under a range of pandemic severity categories. Methods An economic analysis was conducted using a simulation model of a community of ~30,000 in Australia. Data from the 2009 pandemic was used to derive relationships between the Case Fatality Rate (CFR) and hospitalization rates for each of five pandemic severity categories, with CFR ranging from 0.1% to 2.5%. Results For a pandemic with basic reproduction number R0 = 1.8, adopting no interventions resulted in total costs ranging from $441 per person for a pandemic at category 1 (CFR 0.1%) to $8,550 per person at category 5 (CFR 2.5%). For severe pandemics of category 3 (CFR 0.75%) and greater, a strategy combining antiviral treatment and prophylaxis, extended school closure and community contact reduction resulted in the lowest total cost of any strategy, costing $1,584 per person at category 5. This strategy was highly effective, reducing the attack rate to 5%. With low severity pandemics costs are dominated by productivity losses due to illness and social distancing interventions, whereas higher severity pandemic costs are dominated by healthcare costs and costs arising from productivity losses due to death. Conclusions For pandemics in high severity categories the strategies with the lowest total cost to society involve rigorous, sustained social distancing, which are considered unacceptable for low severity pandemics due to societal

Anti-pandemic influenza A (H1N1) virus potential of catechin and gallic acid.

PubMed

You, Huey-Ling; Huang, Chao-Chun; Chen, Chung-Jen; Chang, Cheng-Chin; Liao, Pei-Lin; Huang, Sheng-Teng

2018-05-01

The pandemic influenza A (H1N1) virus has spread worldwide and infected a large proportion of the human population. Discovery of new and effective drugs for the treatment of influenza is a crucial issue for the global medical community. According to our previous study, TSL-1, a fraction of the aqueous extract from the tender leaf of Toonasinensis, has demonstrated antiviral activities against pandemic influenza A (H1N1) through the down-regulation of adhesion molecules and chemokine to prevent viral attachment. The aim of the present study was to identify the active compounds in TSL-1 which exert anti-influenza A (H1N1) virus effects. XTT assay was used to detect the cell viability. Meanwhile, the inhibitory effect on the pandemic influenza A (H1N1) virus was analyzed by observing plaque formation, qRT-PCR, neuraminidase activity, and immunofluorescence staining of influenza A-specific glycoprotein. Both catechin and gallic acid were found to be potent inhibitors in terms of influenza virus mRNA replication and MDCK plaque formation. Additionally, both compounds inhibited neuraminidase activities and viral glycoprotein. The 50% effective inhibition concentration (EC 50 ) of catechin and gallic acid for the influenza A (H1N1) virus were 18.4 μg/mL and 2.6 μg/mL, respectively; whereas the 50% cytotoxic concentrations (CC 50 ) of catechin and gallic acid were >100 μg/mL and 22.1 μg/mL, respectively. Thus, the selectivity indexes (SI) of catechin and gallic acid were >5.6 and 22.1, respectively. The present study demonstrates that catechin might be a safe reagent for long-term use to prevent influenza A (H1N1) virus infection; whereas gallic acid might be a sensitive reagent to inhibit influenza virus infection. We conclude that these two phyto-chemicals in TSL-1 are responsible for exerting anti-pandemic influenza A (H1N1) virus effects. Copyright © 2017. Published by Elsevier Taiwan LLC.

Determinants of virulence of influenza A virus

PubMed Central

Schrauwen, Eefje J.A.; de Graaf, Miranda; Herfst, Sander; Rimmelzwaan, Guus F.; Osterhaus, Albert D.M.E.; Fouchier, Ron A.M.

2013-01-01

Influenza A viruses cause yearly seasonal epidemics and occasional global pandemics in humans. In the last century, four human influenza A virus pandemics have occured. Ocasionally, influenza A viruses that circulate in other species, cross the species barrier and infect humans. Virus re-assortment (i.e. mixing of gene segments of multiple viruses) and the accumulation of mutations contribute to the emergence of new influenza A virus variants. Fortunately, most of these variants do not have the ability to spread among humans and subsequently cause a pandemic. In this review we focus on the threat of animal influenza A viruses which have shown the ability to infect humans. In addition, genetic factors which could alter the virulence of influenza A viruses are discussed. Identification and characterization of these factors may provide insights into genetic traits which change virulence and help us to understand which genetic determinants are of importance for the pandemic potential of animal influenza A viruses. PMID:24078062

Patterns of early transmission of pandemic influenza in London – link with deprivation

PubMed Central

Balasegaram, Sooria; Ogilvie, Flora; Glasswell, Amy; Anderson, Charlotte; Cleary, Vivien; Turbitt, Deborah; McCloskey, Brian

2012-01-01

Please cite this paper as: Balasegaram et al. (2012) Patterns of early transmission of pandemic influenza in London – link with deprivation. Influenza and Other Respiratory Viruses 6(3), e35–e41. Background  During the early containment phase in England from April to June 2009, the national strategy for H1N1 pandemic influenza involved case investigation and treatment, and tracing and prophylaxis of contacts. Objective  To describe the relationship between early transmission of H1N1 pandemic influenza in London and age and socio‐economic status. Methods  Epidemiological data on cases of pandemic flu in London reported to the London Flu Response Centre were analysed to determine patterns of transmission. Results  There were 3487 reported cases (2202 confirmed, 1272 presumed and 14 probable) from 20 April to 28 June 2009, during the ‘containment’ period. The highest report rate of 206 per 100 000 (95% CI 195–218) was seen in primary school–age children (5−11 years) followed by 129 (95% CI 119–139) in secondary school–age children (12–18 years). Reports of cases were initially concentrated in affluent areas but overall showed a clear trend with deprivation and risk ratio of 2·32 (95% CI 1·94–2·78) between the most deprived and the least deprived. Conclusion  Early transmissions were highest amongst school‐aged children but linked with socio‐economic deprivation across all age groups. PMID:22236079

Pandemic A/H1N1 influenza: transmission of the first cases in Spain.

PubMed

Català, Laura; Rius, Cristina; García de Olalla, Patricia; Nelson, Jeanne L; Alvarez, Josep; Minguell, Sofía; Camps, Neus; Sala, María Rosa; Arias, Carlos; Barrabeig, Irene; Carol, Mónica; Torra, Roser; Cardeñosa, Neus; Pumarola, Tomas; Caylà, Joan A

2012-02-01

Pandemic A/H1N1 influenza emerged in Mexico at the end of March 2009. Since then, it is still important to provide evidences that contributed to the international spread of the virus and to ascertain the attack rate of this new strain of influenza among the first cases in Spain that led to identify the first transmission in Europe. Three pandemic A/H1N1 influenza groups related to an overseas flight were studied: 71 student group, 94 remaining passengers, and 68 contacts of confirmed cases. The attack rate with their 95% confidence interval (CI) among the student group and contacts was calculated. On April 26th, when the first cases were notified, strong preventive measures were implemented among the student group and the contacts of the confirmed cases. On 27th April, the first pandemic A/H1N1 influenza cases confirmed in Spain were three students that came back from Mexico by airplane. A student generated the first native case in Spain and one of the first cases in Europe. Similar attack rates were found between the student group (14.1%; CI: 12.1-16.1) and their contacts (13.2%; CI: 4.4-22.0), but no cases among remaining passengers were detected, suggesting low transmission risk during air travel. The first cases of pandemic A/H1N1 influenza in Spain were imported by airplane from Mexico. Preventive efforts to reduce the impact of the influenza influenced that primary and secondary rates were lower than first estimations by WHO. Copyright © 2011 Elsevier España, S.L. All rights reserved.

Possible Increased Pathogenicity of Pandemic (H1N1) 2009 Influenza Virus upon Reassortment

PubMed Central

Schrauwen, Eefje J.A.; Herfst, Sander; Chutinimitkul, Salin; Bestebroer, Theo M.; Rimmelzwaan, Guus F.; Osterhaus, Albert D.M.E.; Kuiken, Thijs

2011-01-01

Since emergence of the pandemic (H1N1) 2009 virus in April 2009, three influenza A viruses—seasonal (H3N2), seasonal (H1N1), and pandemic (H1N1) 2009—have circulated in humans. Genetic reassortment between these viruses could result in enhanced pathogenicity. We compared 4 reassortant viruses with favorable in vitro replication properties with the wild-type pandemic (H1N1) 2009 virus with respect to replication kinetics in vitro and pathogenicity and transmission in ferrets. Pandemic (H1N1) 2009 viruses containing basic polymerase 2 alone or in combination with acidic polymerase of seasonal (H1N1) virus were attenuated in ferrets. In contrast, pandemic (H1N1) 2009 with neuraminidase of seasonal (H3N2) virus resulted in increased virus replication and more severe pulmonary lesions. The data show that pandemic (H1N1) 2009 virus has the potential to reassort with seasonal influenza viruses, which may result in increased pathogenicity while it maintains the capacity of transmission through aerosols or respiratory droplets. PMID:21291589

Influenza Infection Control Practices in Labor and Delivery Units During the 2009 H1N1 Influenza Pandemic

PubMed Central

Williams, Jennifer L.; Mersereau, Patricia W.; Ruch-Ross, Holly; Zapata, Lauren B.; Ruhl, Catherine

2015-01-01

Objective To assess the presence and usefulness of written policies and practices on infection control consistent with the Center for Disease Control and Prevention’s (CDC) guidance in hospital labor and delivery (L&D) units during the 2009 H1N1 influenza pandemic. Setting Online survey. Participants Of 11,845 eligible nurses, 2,641 (22%) participated. This analysis includes a subset of 1,866 nurses who worked exclusively in L&D units. Methods A cross-sectional descriptive evaluation was sent to 12,612 members from the Association of Women’s Health, Obstetric, and Neonatal Nurses (AWHONN) who reported working in labor, delivery, postpartum, or newborn care settings during the 2009 H1N1 influenza pandemic. Results Respondents (73.8%) reported that CDC guidance was very useful for infection control in L&D settings during the pandemic. We assessed the presence of the following infection control written policies, consistent with CDC’s guidance in hospital L&D units, during the 2009 H1N1 influenza pandemic and their rate of implementation most of the time: questioning women upon arrival about recent flu-like symptoms (89.4%, 89.9%), immediate initiation of antiviral medicines if flu suspected or confirmed (65.2%, 49%), isolating ill women from healthy women immediately (90.7%, 84.7%), ask ill women to wear masks during L&D (67%, 57.7%), immediately separating healthy newborns from ill mothers (50.9%, 42.4%), and bathing healthy infants when stable (58.4%, 56.9%). Reported written policies for five of the six practices increased during the pandemic. Five of six written policies remained above baseline after the pandemic. Conclusions Respondents considered CDC guidance very useful. The presence of written policies is important for the implementation of infection control practices by L&D nurses. PMID:24020478

Are we prepared to help low-resource communities cope with a severe influenza pandemic?

PubMed

Starbuck, Eric S; von Bernuth, Rudolph; Bolles, Kathryn; Koepsell, Jeanne

2013-11-01

Recent research involving lab-modified H5N1 influenza viruses with increased transmissibility and the ongoing evolution of the virus in nature should remind us of the continuing importance of preparedness for a severe influenza pandemic. Current vaccine technology and antiviral supply remain inadequate, and in a severe pandemic, most low-resource communities will fail to receive adequate medical supplies. However, with suitable guidance, these communities can take appropriate actions without substantial outside resources to reduce influenza transmission and care for the ill. Such guidance should be completed, and support provided to developing countries to adapt it for their settings and prepare for implementation. © 2012 John Wiley & Sons Ltd.

Pandemic Flu

MedlinePlus

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Behavioural intentions in response to an influenza pandemic

PubMed Central

2010-01-01

Background Little is known regarding which behavioural responses can be expected if an influenza pandemic were to occur. Methods A survey comprising questions based on risk perception theories, in particular PMT, was conducted with a Dutch sample. Results Although fear that an influenza pandemic may occur was high, participants do not feel well informed. General practitioners and local health authorities were considered trustworthy sources of information and the information considered most urgent pertained to which protective measures should be taken. Participants reported an intention to comply with recommendations regarding protective measures. However, response and self efficacy were low. Maladaptive behaviours can be expected. Increasing numbers of ill individuals and school closures are also expected to lead to a decreased work force. Participants indicated wanting antiviral drugs even if the supply were to be insufficient. Conclusions Messages regarding health protective behaviours from local health authorities should anticipate the balance between overreacting and underreacting. Also, when protective recommendations from health professionals conflict with company policies, it is unclear how employees will react. PMID:20353568

Health System Resource Gaps and Associated Mortality from Pandemic Influenza across Six Asian Territories

PubMed Central

Rudge, James W.; Hanvoravongchai, Piya; Krumkamp, Ralf; Chavez, Irwin; Adisasmito, Wiku; Ngoc Chau, Pham; Phommasak, Bounlay; Putthasri, Weerasak; Shih, Chin-Shui; Stein, Mart; Timen, Aura; Touch, Sok; Reintjes, Ralf; Coker, Richard

2012-01-01

Background Southeast Asia has been the focus of considerable investment in pandemic influenza preparedness. Given the wide variation in socio-economic conditions, health system capacity across the region is likely to impact to varying degrees on pandemic mitigation operations. We aimed to estimate and compare the resource gaps, and potential mortalities associated with those gaps, for responding to pandemic influenza within and between six territories in Asia. Methods and Findings We collected health system resource data from Cambodia, Indonesia (Jakarta and Bali), Lao PDR, Taiwan, Thailand and Vietnam. We applied a mathematical transmission model to simulate a “mild-to-moderate” pandemic influenza scenario to estimate resource needs, gaps, and attributable mortalities at province level within each territory. The results show that wide variations exist in resource capacities between and within the six territories, with substantial mortalities predicted as a result of resource gaps (referred to here as “avoidable” mortalities), particularly in poorer areas. Severe nationwide shortages of mechanical ventilators were estimated to be a major cause of avoidable mortalities in all territories except Taiwan. Other resources (oseltamivir, hospital beds and human resources) are inequitably distributed within countries. Estimates of resource gaps and avoidable mortalities were highly sensitive to model parameters defining the transmissibility and clinical severity of the pandemic scenario. However, geographic patterns observed within and across territories remained similar for the range of parameter values explored. Conclusions The findings have important implications for where (both geographically and in terms of which resource types) investment is most needed, and the potential impact of resource mobilization for mitigating the disease burden of an influenza pandemic. Effective mobilization of resources across administrative boundaries could go some way towards

Comparison of Patients Hospitalized With Pandemic 2009 Influenza A (H1N1) Virus Infection During the First Two Pandemic Waves in Wisconsin

PubMed Central

Truelove, Shaun A.; Chitnis, Amit S.; Heffernan, Richard T.; Karon, Amy E.; Haupt, Thomas E.

2011-01-01

Background. Wisconsin was severely affected by pandemic waves of 2009 influenza A H1N1 infection during the period 15 April through 30 August 2009 (wave 1) and 31 August 2009 through 2 January 2010 (wave 2). Methods. To evaluate differences in epidemiologic features and outcomes during these pandemic waves, we examined prospective surveillance data on Wisconsin residents who were hospitalized ≥24 h with or died of pandemic H1N1 infection. Results. Rates of hospitalizations and deaths from pandemic H1N1 infection in Wisconsin increased 4- and 5-fold, respectively, from wave 1 to wave 2; outside Milwaukee, hospitalization and death rates increased 10- and 8-fold, respectively. Hospitalization rates were highest among racial and ethnic minorities and children during wave 1 and increased most during wave 2 among non-Hispanic whites and adults. Times to hospital admission and antiviral treatment improved between waves, but the overall hospital course remained similar, with no change in hospitalization duration, intensive care unit admission, requirement for mechanical ventilation, or mortality. Conclusions. We report broader geographic spread and marked demographic differences during pandemic wave 2, compared with wave 1, although clinical outcomes were similar. Our findings emphasize the importance of using comprehensive surveillance data to detect changing characteristics and impacts during an influenza pandemic and of vigorously promoting influenza vaccination and other prevention efforts. PMID:21278213

The health and economic impact of vaccination with 7-valent pneumococcal vaccine (PCV7) during an annual influenza epidemic and influenza pandemic in China.

PubMed

Caldwell, Ronald; Roberts, Craig S; An, Zhijie; Chen, Chieh-I; Wang, Bruce

2015-07-24

China has experienced several severe outbreaks of influenza over the past century: 1918, 1957, 1968, and 2009. Influenza itself can be deadly; however, the increase in mortality during an influenza outbreak is also attributable to secondary bacterial infections, specifically pneumococcal disease. Given the history of pandemic outbreaks and the associated morbidity and mortality, we investigated the cost-effectiveness of a PCV7 vaccination program in China from the context of typical and pandemic influenza seasons. A decision-analytic model was employed to evaluate the impact of a 7-valent pneumococcal vaccine (PCV7) infant vaccination program on the incidence, mortality, and cost associated with pneumococcal disease during a typical influenza season (15% flu incidence) and influenza pandemic (30% flu incidence) in China. The model incorporated Chinese data where available and included both direct and indirect (herd) effects on the unvaccinated population, assuming a point in time following the initial introduction of the vaccine where the impact of the indirect effects has reached a steady state, approximately seven years following the implementation of the vaccine program. Pneumococcal disease incidence, mortality, and costs were evaluated over a one year time horizon. Healthcare costs were calculated using a payer perspective and included vaccination program costs and direct medical expenditures from pneumococcal disease. The model predicted that routine PCV7 vaccination of infants in China would prevent 5,053,453 cases of pneumococcal disease and 76,714 deaths in a single year during a normal influenza season.The estimated incremental-cost-effectiveness ratios were ¥12,281 (US$1,900) per life-year saved and ¥13,737 (US$2,125) per quality-adjusted-life-year gained. During an influenza pandemic, the model estimated that routine vaccination with PCV7 would prevent 8,469,506 cases of pneumococcal disease and 707,526 deaths, and would be cost-saving. Routine

Will the community nurse continue to function during H1N1 influenza pandemic: a cross-sectional study of Hong Kong community nurses?

PubMed

Wong, Eliza L Y; Wong, Samuel Y S; Kung, Kenny; Cheung, Annie W L; Gao, Tiffany T; Griffiths, Sian

2010-04-30

Healthcare workers have been identified as one of the high risk groups for being infected with influenza during influenza pandemic. Potential levels of absenteeism among healthcare workers in hospital settings are high. However, there was no study to explore the attitudes of healthcare workers in community setting towards the preparedness to the novel H1N1 influenza pandemic. The aim of this study was to explore the willingness of community nurses in Hong Kong to work during H1N1 influenza pandemic. A cross-sectional survey was conducted among all 401 community nurses employed by the Hospital Authority in Hong Kong when the WHO pandemic alert level was 6. The response rate of this study was 66.6%. 76.9% participants reported being "not willing" (33.3%) or "not sure" (43.6%) to take care of patients during H1N1 influenza pandemic. The self-reported reasons for being unwilling to report to duty during H1N1 influenza pandemic were psychological stress (55.0%) and fear of being infected H1N1 influenza (29.2%). The reported unwillingness to report to duty was marginally significantly associated with the request for further training of using infection control clinical guideline (OR: 0.057; CI: 0.25-1.02). Those who reported unwillingness or not being sure about taking care of the patients during H1N1 influenza pandemic were more depressed (p < 0.001) and found work more emotionally stressful (p < 0.001). Interventions to provide infection control training and address community nurses' psychological needs might increase their willingness to provide care to patients in the community during H1N1 influenza pandemic. This would help to ensure an effective and appropriate health system response during the H1N1 influenza pandemic.

Will the community nurse continue to function during H1N1 influenza pandemic: a cross-sectional study of Hong Kong community nurses?

PubMed Central

2010-01-01

Background Healthcare workers have been identified as one of the high risk groups for being infected with influenza during influenza pandemic. Potential levels of absenteeism among healthcare workers in hospital settings are high. However, there was no study to explore the attitudes of healthcare workers in community setting towards the preparedness to the novel H1N1 influenza pandemic. The aim of this study was to explore the willingness of community nurses in Hong Kong to work during H1N1 influenza pandemic. Methods A cross-sectional survey was conducted among all 401 community nurses employed by the Hospital Authority in Hong Kong when the WHO pandemic alert level was 6. Results The response rate of this study was 66.6%. 76.9% participants reported being "not willing" (33.3%) or "not sure" (43.6%) to take care of patients during H1N1 influenza pandemic. The self-reported reasons for being unwilling to report to duty during H1N1 influenza pandemic were psychological stress (55.0%) and fear of being infected H1N1 influenza (29.2%). The reported unwillingness to report to duty was marginally significantly associated with the request for further training of using infection control clinical guideline (OR: 0.057; CI: 0.25-1.02). Those who reported unwillingness or not being sure about taking care of the patients during H1N1 influenza pandemic were more depressed (p < 0.001) and found work more emotionally stressful (p < 0.001). Conclusions Interventions to provide infection control training and address community nurses' psychological needs might increase their willingness to provide care to patients in the community during H1N1 influenza pandemic. This would help to ensure an effective and appropriate health system response during the H1N1 influenza pandemic. PMID:20433691

Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and Beyond

PubMed Central

Koonin, Lisa M.; Kohl, Katrin S.; Cetron, Martin

2012-01-01

Shortly after the influenza A (H1N1) 2009 pandemic began, the U.S. government provided guidance to state and local authorities to assist decision-making for the use of nonpharmaceutical strategies to minimize influenza spread. This guidance included recommendations for flexible decision-making based on outbreak severity, and it allowed for uncertainty and course correction as the pandemic progressed. These recommendations build on a foundation of local, collaborative planning and posit a series of questions regarding epidemiology, the impact on the health-care system, and locally determined feasibility and acceptability of nonpharmaceutical strategies. This article describes -recommendations and key questions for decision makers. PMID:23115381

Genetic Characterization of Influenza A (H1N1) Pandemic 2009 Virus Isolates from Mumbai.

PubMed

Gohil, Devanshi; Kothari, Sweta; Shinde, Pramod; Meharunkar, Rhuta; Warke, Rajas; Chowdhary, Abhay; Deshmukh, Ranjana

2017-08-01

Pandemic influenza A (H1N1) 2009 virus was first detected in India in May 2009 which subsequently became endemic in many parts of the country. Influenza A viruses have the ability to evade the immune response through its ability of antigenic variations. The study aims to characterize influenza A (H1N1) pdm 09 viruses circulating in Mumbai during the pandemic and post-pandemic period. Nasopharyngeal swabs positive for influenza A (H1N1) pdm 09 viruses were inoculated on Madin-Darby canine kidney cell line for virus isolation. Molecular and phylogenetic analysis of influenza A (H1N1) pdm 09 isolates was conducted to understand the evolution and genetic diversity of the strains. Nucleotide and amino acid sequences of the HA gene of Mumbai isolates when compared to A/California/07/2009-vaccine strain revealed 14 specific amino acid differences located at the antigenic sites. Amino acid variations in HA and NA gene resulted in changes in the N-linked glycosylation motif which may lead to immune evasion. Phylogenetic analysis of the isolates revealed their evolutionary position with vaccine strain A/California/07/2009 but had undergone changes gradually. The findings in the present study confirm genetic variability of influenza viruses and highlight the importance of continuous surveillance during influenza outbreaks.

National Strategy for Pandemic Influenza Implementation Plan

DTIC Science & Technology

2006-05-01

future and threaten an unprotected human population. The economic and societal disruption of an influenza pandemic could be significant. Absenteeism ...levels of staff absent for a few weeks on either side of the peak. Absenteeism will increase not only because of personal illness or incapacitation...due to their own illness, illness in a family member, or as a result of public health guidance to limit contact with others. Absenteeism across

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives.

PubMed

Silva, Diego S; Gibson, Jennifer L; Robertson, Ann; Bensimon, Cécile M; Sahni, Sachin; Maunula, Laena; Smith, Maxwell J

2012-03-26

Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans.

Priority setting of ICU resources in an influenza pandemic: a qualitative study of the Canadian public's perspectives

PubMed Central

2012-01-01

Background Pandemic influenza may exacerbate existing scarcity of life-saving medical resources. As a result, decision-makers may be faced with making tough choices about who will receive care and who will have to wait or go without. Although previous studies have explored ethical issues in priority setting from the perspective of clinicians and policymakers, there has been little investigation into how the public views priority setting during a pandemic influenza, in particular related to intensive care resources. Methods To bridge this gap, we conducted three public town hall meetings across Canada to explore Canadian's perspectives on this ethical challenge. Town hall discussions group discussions were digitally recorded, transcribed, and analyzed using thematic analysis. Results Six interrelated themes emerged from the town hall discussions related to: ethical and empirical starting points for deliberation; criteria for setting priorities; pre-crisis planning; in-crisis decision-making; the need for public deliberation and input; and participants' deliberative struggle with the ethical issues. Conclusions Our findings underscore the importance of public consultation in pandemic planning for sustaining public trust in a public health emergency. Participants appreciated the empirical and ethical uncertainty of decision-making in an influenza pandemic and demonstrated nuanced ethical reasoning about priority setting of intensive care resources in an influenza pandemic. Policymakers may benefit from a better understanding the public's empirical and ethical 'starting points' in developing effective pandemic plans. PMID:22449119

"It's as bad as anything can be": Patients, identity, and the influenza pandemic.

PubMed

Bristow, Nancy K

2010-04-01

Americans were stunned when pandemic influenza hit the United States in 1918. Recent advances in bacteriology and public health allowed Americans to imagine a future free of infectious disease, even as their familiarity with influenza tempered their fears of it. They soon realized this influenza was something unprecedented, as it shocked them with its pace, virulence, mortality patterns, and symptoms. Patients endured and frequently succumbed to a miserable illness, their suffering often made worse by the chaotic circumstances the epidemic produced in families and communities and shaped in significant and sometimes discriminatory ways by their gender, class, and race. While the nation's public culture soon forgot the epidemic, it lived on in lives changed irrevocably by its consequences. As they face present and future influenza pandemics, Americans can learn from this earlier experience, guarding against identity-based discrimination and acknowledging and remembering the grief and loss fellow citizens suffered.

Pandemic influenza A (H1N1) 2009 in the English- and Dutch-speaking Caribbean: an epidemiological overview.

PubMed

Boisson, E V; Des Vignes, F; Quesnel, S

2013-07-01

To describe epidemiological trends of pandemic influenza A (H1N1) in the English and Dutch-speaking Caribbean during the pandemic period. Data on laboratory-confirmed cases and deaths associated with pandemic influenza A (H1N1) contained in two regional databases at the Caribbean Epidemiology Centre (CAREC) were analysed. The data sources were epidemiological and laboratory reports from English and Dutch-speaking countries and the CAREC laboratory information system (LABIS). In the English- and Dutch-speaking Caribbean, pandemic influenza A (H1N1) was the predominant circulating influenza virus type during the pandemic period. There were three distinct phases: a first pandemic wave during mid-April to end of August 2009 (734 cases), a second pandemic wave during September-December 2009 (570 cases) and a phase of low transmission during January to mid-August 2010 (55 cases). The majority of cases (76%) were aged less than 30 years, with children of school age being most affected. Most cases (89%) presented with symptoms of the respiratory tract and smaller proportions (20-40%) presented with gastrointestinal and other symptoms. No cases tested were resistant to oseltamivir. A quarter of cases required hospitalization and the case fatality rate was 1.8%. The epidemiological characteristics of the pandemic in the English- and Dutch-speaking Caribbean were consistent with that in other parts of the world. It is important that post pandemic surveillance (epidemiological and virological) for respiratory illnesses continues to be enhanced in order to give a better understanding of seasonality and changing trends in respiratory illnesses and their aetiologic agents.

Clinical presentations of pandemic 2009 influenza A (H1N1) virus infection in hospitalized Thai children.

PubMed

Lochindarat, Sorasak; Bunnag, Thanyanat

2011-08-01

A novel influenza A (H1N1) virus of swine origin caused human infection and acute respiratory illness in Mexico during the spring of 2009. After that, the virus spread globally, resulting in the influenza pandemic. To observe the clinical manifestations of the 2009 pandemic influenza A (H1N1) and the epidemic waves of hospitalized children for a period of one year. A prospective observational study of children under eighteen years old, confirmed having the 2009 pandemic influenza (H1N1) infection by real-time reverse-transcription-polymerase-chain-reaction (RT-PCR), admitted at Queen Sirikit National Institute of Child Health, Bangkok, Thailand during one year, from 1st June 2009 to 31st May 2010. A total of 83 pandemic influenza infected children were admitted during a one-year period. There were two waves of epidemic outbreak, the first wave from June to August 2009 and the second wave from January to February 2010. There were 47 cases of males (56.6%), with the highest attack rates among children 1-5 years of age (48.2%). The youngest case was a 29-day old girl. The correct provisional diagnosis of pandemic influenza infection are 39.5%, the other initial diagnosis are pneumonia, bronchiolitis, tonsillitis, encephalitis, and dengue infection. Most patients coming for care had typical, influenza-like symptoms with fever (98.8%), cough (92.6%) and rhinorrhea (74.1%). Systemic symptoms are frequent. Gastrointestinal symptoms (including vomiting (46.9%) and diarrhea (24.7%)) occur more commonly than seasonal influenza. Pneumonia is the most common complication (43.2%); other complications include bronchiolitis, hemoptysis, acute respiratory distress syndrome (ARDS) and encephalitis. In one case, a seven year old girl suffered from ARDS, sepsis, multi-organ dysfunction syndrome and ventilator associated pneumonia, but survived with some neurological sequelae. Radiographic findings included diffuse interstitial, alveolar infiltrates and some in lobar distributions

Exploring national surveillance for health-related workplace absenteeism: lessons learned from the 2009 influenza A pandemic.

PubMed

Groenewold, Matthew R; Konicki, Doris L; Luckhaupt, Sara E; Gomaa, Ahmed; Koonin, Lisa M

2013-04-01

During the 2009 influenza A (H1N1) virus pandemic, the Centers for Disease Control and Prevention did a pilot study to test the feasibility of using national surveillance of workplace absenteeism to assess the pandemic's impact on the workplace to plan for preparedness and continuity of operations and to contribute to health awareness during the emergency response. Population-based and sentinel worksite approaches were used. Monthly measures of the 1-week prevalence of health-related absenteeism among full-time workers were estimated using nationally representative data from the Current Population Survey. Enhanced passive surveillance of absenteeism was conducted using weekly data from a convenience sample of sentinel worksites. Nationally, the pandemic's impact on workplace absenteeism was small. Estimates of 1-week absenteeism prevalence did not exceed 3.7%. However, peak workplace absenteeism was correlated with the highest occurrence of both influenza-like illness and influenza-positive laboratory tests. Systems for monitoring workplace absenteeism should be included in pandemic preparedness planning.

Mortality risk factors during the 1918-1919 influenza pandemic in the Australian army.

PubMed

Shanks, G Dennis; Mackenzie, Alison; McLaughlin, Ruth; Waller, Michael; Dennis, Peter; Lee, Seung-Eun; Brundage, John F

2010-06-15

Understanding the risk of mortality during the 1918-1919 influenza pandemic could inform preparations for a future pandemic. Prospectively collected demographic, hospitalization, and death data from all individuals who served in the Australian Imperial Force from 1914 through 1919 in Europe and the Middle East were abstracted from archived records. Analyses were conducted to determine mortality risk factors. Hospitalization with a respiratory illness during the spring-summer of 1918 protected soldiers from death (odds ratio, 0.37 [95% confidence interval, 0.25-0.53]; P < .001) but not from hospitalization during the fall-winter of 1918-1919. During the fall-winter of 1918-1919, there was a strong inverse relationship between risk of dying of pneumonia-influenza and time in military service. The pneumonia-influenza death rate among men who enlisted in 1918 (6.33 deaths per 100 person-years) was 9 times higher than that among the 1917 enlistment cohort (0.72 deaths per 100 person-years) and >14 times higher than that among the 1916 cohort (0.43 deaths per 100 person-years), 1915 cohort (0.29 deaths per 100 person-years), and 1914 cohort (0.28 deaths per 100 person-years). There was a strong inverse relationship between length of service in the Australian Imperial Force and mortality risk from pneumonia-influenza during the fall-winter of 1918-1919. The protective effect of increased service likely reflected increased acquired immunity to influenza viruses and endemic bacterial strains that caused secondary pneumonia and most of the deaths during the 1918-1919 influenza pandemic.

Pandemic Influenza Preparedness and Response Among Public-Housing Residents, Single-Parent Families, and Low-Income Populations

PubMed Central

Truman, Benedict I.; Hutchins, Sonja; Richard, Roland; Brown, Clive; Guillory, Joyce A.; Rashid, Jamila

2009-01-01

During the early stages of an influenza pandemic, a pandemic vaccine likely will not be available. Therefore, interventions to mitigate pandemic influenza transmission in communities will be an important component of the response to a pandemic. Public-housing residents, single-parent families, and low-income populations may have difficulty complying with community-wide interventions. To enable compliance with community interventions, stakeholders recommended the following: (1) community mobilization and partnerships, (2) culturally specific emergency communications planning, (3) culturally specific education and training programs, (4) evidence-based measurement and evaluation efforts, (5) strategic planning policies, (6) inclusion of community members as partners, and (7) policy and program changes to minimize morbidity and mortality. PMID:19797740

Public-Private Partnerships: Critical to Combatting the Next Pandemic Influenza in the State of Kansas

DTIC Science & Technology

2011-06-10

Influenza A (H5N1), also known as Avian Flu or Bird Flu because it primarily affects chickens , turkeys, guinea fowls, migratory waterfowl, and other avian...difficult to predict. The 1918 "Spanish Flu ," the deadliest pandemic in history, is estimated to have killed more than 50 million people worldwide...overlooks influenza. As Dorothy Pettit and Janice Bailie suggested in their book, A Cruel Wind: Pandemic Flu in America, the general population in

Impact of School Cycles and Environmental Forcing on the Timing of Pandemic Influenza Activity in Mexican States, May-December 2009.

PubMed

Tamerius, James; Viboud, Cécile; Shaman, Jeffrey; Chowell, Gerardo

2015-08-01

While a relationship between environmental forcing and influenza transmission has been established in inter-pandemic seasons, the drivers of pandemic influenza remain debated. In particular, school effects may predominate in pandemic seasons marked by an atypical concentration of cases among children. For the 2009 A/H1N1 pandemic, Mexico is a particularly interesting case study due to its broad geographic extent encompassing temperate and tropical regions, well-documented regional variation in the occurrence of pandemic outbreaks, and coincidence of several school breaks during the pandemic period. Here we fit a series of transmission models to daily laboratory-confirmed influenza data in 32 Mexican states using MCMC approaches, considering a meta-population framework or the absence of spatial coupling between states. We use these models to explore the effect of environmental, school-related and travel factors on the generation of spatially-heterogeneous pandemic waves. We find that the spatial structure of the pandemic is best understood by the interplay between regional differences in specific humidity (explaining the occurrence of pandemic activity towards the end of the school term in late May-June 2009 in more humid southeastern states), school vacations (preventing influenza transmission during July-August in all states), and regional differences in residual susceptibility (resulting in large outbreaks in early fall 2009 in central and northern Mexico that had yet to experience fully-developed outbreaks). Our results are in line with the concept that very high levels of specific humidity, as present during summer in southeastern Mexico, favor influenza transmission, and that school cycles are a strong determinant of pandemic wave timing.

Multiple control strategies for prevention of avian influenza pandemic.

PubMed

Ullah, Roman; Zaman, Gul; Islam, Saeed

2014-01-01

We present the prevention of avian influenza pandemic by adjusting multiple control functions in the human-to-human transmittable avian influenza model. First we show the existence of the optimal control problem; then by using both analytical and numerical techniques, we investigate the cost-effective control effects for the prevention of transmission of disease. To do this, we use three control functions, the effort to reduce the number of contacts with human infected with mutant avian influenza, the antiviral treatment of infected individuals, and the effort to reduce the number of infected birds. We completely characterized the optimal control and compute numerical solution of the optimality system by using an iterative method.

Willingness of Hong Kong healthcare workers to accept pre-pandemic influenza vaccination at different WHO alert levels: two questionnaire surveys

PubMed Central

Chor, Josette S Y; Ngai, Karry LK; Goggins, William B; Wong, Martin C S; Wong, Samuel Y S; Lee, Nelson; Leung, Ting-fan; Rainer, Timothy H; Griffiths, Sian

2009-01-01

Objective To assess the acceptability of pre-pandemic influenza vaccination among healthcare workers in public hospitals in Hong Kong and the effect of escalation in the World Health Organization’s alert level for an influenza pandemic. Design Repeated cross sectional studies using self administered, anonymous questionnaires Setting Surveys at 31 hospital departments of internal medicine, paediatrics, and emergency medicine under the Hong Kong Hospital Authority from January to March 2009 and in May 2009 Participants 2255 healthcare workers completed the questionnaires in the two studies. They were doctors, nurses, or allied health professionals working in the public hospital system. Main outcome measures Stated willingness to accept pre-pandemic influenza vaccination (influenza A subtypes H5N1 or H1N1) and its associating factors. Results The overall willingness to accept pre-pandemic H5N1 vaccine was only 28.4% in the first survey, conducted at WHO influenza pandemic alert phase 3. No significant changes in the level of willingness to accept pre-pandemic H5N1 vaccine were observed despite the escalation to alert phase 5. The willingness to accept pre-pandemic H1N1 vaccine was 47.9% among healthcare workers when the WHO alert level was at phase 5. The most common reasons for an intention to accept were “wish to be protected” and “following health authority’s advice.” The major barriers identified were fear of side effects and doubts about efficacy. More than half of the respondents thought nurses should be the first priority group to receive the vaccines. The strongest positive associating factors were history of seasonal influenza vaccination and perceived risk of contracting the infection. Conclusions The willingness to accept pre-pandemic influenza vaccination was low, and no significant effect was observed with the change in WHO alert level. Further studies are required to elucidate the root cause of the low intention to accept pre-pandemic

Evidence-based medicine and the governance of pandemic influenza.

PubMed

Kamradt-Scott, Adam

2012-01-01

The conventional response of governments to protect their populations against the threat of influenza has been to ensure adequate vaccine production and/or access to supplies of vaccines and antiviral medications. This focus has, in turn, shaped the global governance structures around pandemic influenza, with collective efforts centred on facilitating virus sharing, maintaining and increasing vaccine production, and ensuring access to pharmaceuticals - responses that remain unattainable for many low- and middle-income countries (LMICs) in the short to medium term. This paper argues that this emphasis on pharmacological responses reflects a particular view of biomedicine that pays inadequate attention to the weak capacity of many health systems. In more recent years, this dynamic has been further exacerbated by the influence of evidence-based medicine (EBM) that preferences certain types of biomedical knowledge and practice. This paper explores the role that EBM has played in shaping the global governance of pandemic influenza, and how it has served to reinforce and reify the authority of particular groups of actors, including policy-makers, elected officials and the medical community. The paper concludes that only by unpacking these structures and revealing the political authority in play can alternative policy responses more appropriate to LMICs be considered.

Investing in Immunity: Prepandemic Immunization to Combat Future Influenza Pandemics.

PubMed

Goodman, Jesse L

2016-02-15

We are unlikely, with current technologies, to have sufficient pandemic influenza vaccine ready in time to impact the first wave of the next pandemic. Emerging data show that prior immunization with an immunologically distinct hemagglutinin of the same subtype offers the potential to "prime" recipients for rapid protection with a booster dose, years later, of a vaccine then manufactured to match the pandemic strain. This article proposes making prepandemic priming vaccine(s) available for voluntary use, particularly to those at high risk of early occupational exposure, such as first responders and healthcare workers, and to others maintaining critical infrastructure. In addition to providing faster protection and potentially reducing social disruption, being able, early in a pandemic, to immunize those who had received prepandemic vaccine with one dose of the pandemic vaccine, rather than the 2 doses typically required, would reduce the total doses of pandemic vaccine then needed, extending vaccine supplies. Published by Oxford University Press for the Infectious Diseases Society of America 2015. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Inspecting the Mechanism: A Longitudinal Analysis of Socioeconomic Status Differences in Perceived Influenza Risks, Vaccination Intentions and Vaccination Behaviors during the 2009-2010 Influenza Pandemic

PubMed Central

Maurer, Jürgen

2015-01-01

Background Influenza vaccination is strongly associated with socioeconomic status, but there is only limited evidence on the respective roles of socioeconomic differences in vaccination intentions vs. corresponding differences in follow through on initial vaccination plans for subsequent socioeconomic differences in vaccine uptake. Methods Nonparametric mean smoothing, linear regression and Probit models were used to analyze longitudinal survey data on perceived influenza risks, behavioral vaccination intentions and vaccination behavior of adults during the 2009-10 influenza A/H1N1 (“Swine Flu”) pandemic in the United States. Perceived influenza risks and behavioral vaccination intentions were elicited prior to the availability of H1N1 vaccine using a probability scale question format. H1N1 vaccine uptake was assessed at the end of the pandemic. Results Education, income and health insurance coverage displayed positive associations with behavioral intentions to get vaccinated for pandemic influenza while employment was negatively associated with stated H1N1 vaccination intentions. Education and health insurance coverage also displayed significant positive associations with pandemic vaccine uptake. Moreover, behavioral vaccination intentions showed a strong and statistically significant positive partial association with later H1N1 vaccination. Incorporating vaccination intentions in a statistical model for H1N1 vaccine uptake further highlighted higher levels of follow through on initial vaccination plans among persons with higher education levels and health insurance. Limitations Sampling bias, misreporting in self-reported data, and limited generalizability to non-pandemic influenza are potential limitations of the analysis. Conclusions Closing the socioeconomic gap in influenza vaccination requires multi-pronged strategies that not only increase vaccination intentions by improving knowledge, attitudes and beliefs but also facilitate follow through on initial

Willingness to volunteer during an influenza pandemic: perspectives from students and staff at a large Canadian university.

PubMed

Rosychuk, Rhonda J; Bailey, Tracey; Haines, Christina; Lake, Robert; Herman, Benjamin; Yonge, Olive; Marrie, Thomas J

2008-03-01

A future influenza pandemic will require greater demand on numerous essential services and a reduced capacity to meet that demand. Recruitment of volunteers is an important issue for pre-pandemic planning. To identify factors and attitudes towards volunteerism in the event of a pandemic of influenza. A 42-item web-questionnaire was administered to all faculty, staff and students at the University of Alberta. Respondents indicated their willingness to volunteer. Responses were dichotomized and logistic regression models were developed to capture the association between willingness to volunteer and (i) demographic and information source variables, (ii) risk perception and general knowledge, and (iii) volunteering attitudes and priority access variables. Many factors predicted willingness to volunteer and several involved interactions with other variables. Individuals who were older, relied on University Health Centre information and who had past volunteerism experience were generally more likely to be willing to volunteer. Those willing to volunteer were more likely to think spread could be prevented by covering mouth when coughing/sneezing, and treatment would include drinking fluids. Those who thought influenza would be treated by antibiotics were less willing to volunteer. Likely volunteers thought that healthcare students should be encouraged to volunteer if there was a healthcare worker shortage. This study provides guidance for those who are preparing universities to deal with pandemic influenza. The results suggest factors that might be important in the recruitment of volunteers during an influenza pandemic and these factors might be relevant for other sectors as well.

[Technical report on the 2009 influenza A (H1N1) pandemic].

PubMed

2010-01-01

Since its appearance in April 2009, the influenza A (H1N1) pandemic has been a subject of continued attention by national and international health authorities, as well as in the communication media. It has been six months since the first cases were published and the winter season has just ended in the southern hemisphere. Therefore, we now have quite extensive knowledge on the behaviour of the disease, its severity and the way it manifests itself in the child/adolescent population. The Spanish Paediatric Association commissioned its Evidence Based Medicine Working Group to prepare a technical report on the influenza pandemic. This report has been prepared following the highly structured working methodology proposed by the so-called Evidence Based Medicine (EBM). This methodology requires formulating clinical questions, carrying out a systematic review of the literature looking for research works that could answer them, the critical reading of these, evaluating their methodology quality and clinical importance and finally, establishing recommendations based on those studies considered valid and important as well as on good clinical judgement. The present report approaches all aspects of the influenza pandemic considered to be of interest: extent of the disease, clinical and laboratory diagnosis, physical prevention measures, vaccination and pharmacological treatment. The target population of the report are children and adolescents. Many of the considerations made may also be applied to other age groups. The primary objective of this report is to establish a group of recommendations which may serve as a generic framework for the prevention, diagnosis and treatment of the pandemic influenza in children and adolescents. The final targets of the report are paediatricians and also general/family doctors and nurses who look after children and adolescents. Copyright (c) 2009 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Macroeconomic impact of a mild influenza pandemic and associated policies in Thailand, South Africa and Uganda: a computable general equilibrium analysis.

PubMed

Smith, Richard D; Keogh-Brown, Marcus R

2013-11-01

Previous research has demonstrated the value of macroeconomic analysis of the impact of influenza pandemics. However, previous modelling applications focus on high-income countries and there is a lack of evidence concerning the potential impact of an influenza pandemic on lower- and middle-income countries. To estimate the macroeconomic impact of pandemic influenza in Thailand, South Africa and Uganda with particular reference to pandemic (H1N1) 2009. A single-country whole-economy computable general equilibrium (CGE) model was set up for each of the three countries in question and used to estimate the economic impact of declines in labour attributable to morbidity, mortality and school closure. Overall GDP impacts were less than 1% of GDP for all countries and scenarios. Uganda's losses were proportionally larger than those of Thailand and South Africa. Labour-intensive sectors suffer the largest losses. The economic cost of unavoidable absence in the event of an influenza pandemic could be proportionally larger for low-income countries. The cost of mild pandemics, such as pandemic (H1N1) 2009, appears to be small, but could increase for more severe pandemics and/or pandemics with greater behavioural change and avoidable absence. © 2013 John Wiley & Sons Ltd.

Pandemic controllability: a concept to guide a proportionate and flexible operational response to future influenza pandemics.

PubMed

McCaw, J M; Glass, K; Mercer, G N; McVernon, J

2014-03-01

The 2009 H1N1 influenza pandemic posed challenges for governments worldwide. Strategies designed to limit community transmission, such as antiviral deployment, were largely ineffective due to both feasibility constraints and the generally mild nature of disease, resulting in incomplete case ascertainment. Reviews of national pandemic plans have identified pandemic impact, primarily linked to measures of transmissibility and severity, as a key concept to incorporate into the next generation of plans. While an assessment of impact provides the rationale under which interventions may be warranted, it does not directly provide an assessment on whether particular interventions may be effective. Such considerations motivate our introduction of the concept of pandemic controllability. For case-targeted interventions, such as antiviral treatment and post-exposure prophylaxis, we identify the visibility and transmissibility of a pandemic as the key drivers of controllability. Taking a case-study approach, we suggest that high-impact pandemics, for which control is most desirable, are likely uncontrollable with case-targeted interventions. Strategies that do not rely on the identification of cases may prove relatively more effective. By introducing a pragmatic framework for relating the assessment of impact to the ability to mitigate an epidemic (controllability), we hope to address a present omission identified in pandemic response plans.

Synthetic generation of influenza vaccine viruses for rapid response to pandemics.

PubMed

Dormitzer, Philip R; Suphaphiphat, Pirada; Gibson, Daniel G; Wentworth, David E; Stockwell, Timothy B; Algire, Mikkel A; Alperovich, Nina; Barro, Mario; Brown, David M; Craig, Stewart; Dattilo, Brian M; Denisova, Evgeniya A; De Souza, Ivna; Eickmann, Markus; Dugan, Vivien G; Ferrari, Annette; Gomila, Raul C; Han, Liqun; Judge, Casey; Mane, Sarthak; Matrosovich, Mikhail; Merryman, Chuck; Palladino, Giuseppe; Palmer, Gene A; Spencer, Terika; Strecker, Thomas; Trusheim, Heidi; Uhlendorff, Jennifer; Wen, Yingxia; Yee, Anthony C; Zaveri, Jayshree; Zhou, Bin; Becker, Stephan; Donabedian, Armen; Mason, Peter W; Glass, John I; Rappuoli, Rino; Venter, J Craig

2013-05-15

During the 2009 H1N1 influenza pandemic, vaccines for the virus became available in large quantities only after human infections peaked. To accelerate vaccine availability for future pandemics, we developed a synthetic approach that very rapidly generated vaccine viruses from sequence data. Beginning with hemagglutinin (HA) and neuraminidase (NA) gene sequences, we combined an enzymatic, cell-free gene assembly technique with enzymatic error correction to allow rapid, accurate gene synthesis. We then used these synthetic HA and NA genes to transfect Madin-Darby canine kidney (MDCK) cells that were qualified for vaccine manufacture with viral RNA expression constructs encoding HA and NA and plasmid DNAs encoding viral backbone genes. Viruses for use in vaccines were rescued from these MDCK cells. We performed this rescue with improved vaccine virus backbones, increasing the yield of the essential vaccine antigen, HA. Generation of synthetic vaccine seeds, together with more efficient vaccine release assays, would accelerate responses to influenza pandemics through a system of instantaneous electronic data exchange followed by real-time, geographically dispersed vaccine production.

Managing boundaries between professional and lay nursing following the influenza pandemic, 1918-1919: insights for professional resilience today?

PubMed

Wood, Pamela J

2017-03-01

To examine lay-professional nursing boundaries, using challenges to the New Zealand nursing profession following the 1918-1919 influenza pandemic as the example. The influenza pandemic of 1918-1919 had an overwhelming international impact on communities and the nursing profession. After the pandemic, the expectation for communities to be able to nurse the sick reflects today's increasing reliance on families to care for people at home. It similarly raised questions about the profession's role and professional boundaries in relation to volunteer or lay nursing. In New Zealand, the postpandemic challenge to build community lay nursing capacity tested these boundaries. Historical research. Analysis of historical primary sources of official reports, newspaper accounts, articles in New Zealand's professional nursing journal Kai Tiaki and the memoir of Hester Maclean, the country's chief nurse. Interpretation of findings in relation to secondary sources examining similar historical tensions between professional and lay nursing, and to the more recent notion of professional resilience. Maclean guarded nursing's professional boundaries by maintaining considerable control over community instruction in nursing and by strenuously resisting the suggestion that this should be done in hospitals where professional nurses trained. This historical example shows how the nursing profession faced the perceived threat to its professional boundaries. It also shows how competing goals of building community lay nursing capacity and protecting professional boundaries can be effectively managed. In the context of a global nursing shortage, limited healthcare budgets and a consequently increasing reliance on households to provide care for family members, this historical research shows nurses today that similar issues have been faced and effectively managed in the past. © 2016 John Wiley & Sons Ltd.

The pandemic potential of avian influenza A(H7N9) virus: a review.

PubMed

Tanner, W D; Toth, D J A; Gundlapalli, A V

2015-12-01

In March 2013 the first cases of human avian influenza A(H7N9) were reported to the World Health Organization. Since that time, over 650 cases have been reported. Infections are associated with considerable morbidity and mortality, particularly within certain demographic groups. This rapid increase in cases over a brief time period is alarming and has raised concerns about the pandemic potential of the H7N9 virus. Three major factors influence the pandemic potential of an influenza virus: (1) its ability to cause human disease, (2) the immunity of the population to the virus, and (3) the transmission potential of the virus. This paper reviews what is currently known about each of these factors with respect to avian influenza A(H7N9). Currently, sustained human-to-human transmission of H7N9 has not been reported; however, population immunity to the virus is considered very low, and the virus has significant ability to cause human disease. Several statistical and geographical modelling studies have estimated and predicted the spread of the H7N9 virus in humans and avian species, and some have identified potential risk factors associated with disease transmission. Additionally, assessment tools have been developed to evaluate the pandemic potential of H7N9 and other influenza viruses. These tools could also hypothetically be used to monitor changes in the pandemic potential of a particular virus over time.

Origins of the 2009 H1N1 influenza pandemic in swine in Mexico

PubMed Central

Mena, Ignacio; Nelson, Martha I; Quezada-Monroy, Francisco; Dutta, Jayeeta; Cortes-Fernández, Refugio; Lara-Puente, J Horacio; Castro-Peralta, Felipa; Cunha, Luis F; Trovão, Nídia S; Lozano-Dubernard, Bernardo; Rambaut, Andrew; van Bakel, Harm; García-Sastre, Adolfo

2016-01-01

Asia is considered an important source of influenza A virus (IAV) pandemics, owing to large, diverse viral reservoirs in poultry and swine. However, the zoonotic origins of the 2009 A/H1N1 influenza pandemic virus (pdmH1N1) remain unclear, due to conflicting evidence from swine and humans. There is strong evidence that the first human outbreak of pdmH1N1 occurred in Mexico in early 2009. However, no related swine viruses have been detected in Mexico or any part of the Americas, and to date the most closely related ancestor viruses were identified in Asian swine. Here, we use 58 new whole-genome sequences from IAVs collected in Mexican swine to establish that the swine virus responsible for the 2009 pandemic evolved in central Mexico. This finding highlights how the 2009 pandemic arose from a region not considered a pandemic risk, owing to an expansion of IAV diversity in swine resulting from long-distance live swine trade. DOI: http://dx.doi.org/10.7554/eLife.16777.001 PMID:27350259

Capacity Building in Response to Pandemic Influenza Threats: Lao PDR Case Study

PubMed Central

Phommasack, Bounlay; Moen, Ann; Vongphrachanh, Phengta; Tsuyuoka, Reiko; Cox, Nancy; Khamphaphongphanh, Bouaphanh; Phonekeo, Darouny; Kasai, Takeshi; Ketmayoon, Pakapak; Lewis, Hannah; Kounnavong, Bounheuang; Khanthamaly, Viengphone; Corwin, Andrew

2012-01-01

The Lao People's Democratic Republic (PDR) committed to pandemic detection and response preparations when faced with the threat of avian influenza. Since 2006, the National Center for Laboratory and Epidemiology of Lao PDR has developed credible laboratory, surveillance, and epidemiological (human) capacity and as a result was designated a World Health Organization National Influenza Center in 2010. The Lao PDR experience in building influenza capacities provides a case study of the considerable crossover effect of such investments to augment the capacity to combat emerging and re-emerging diseases other than influenza. PMID:23222137

Adaptation of Pandemic H1N1 Influenza Viruses in Mice▿

PubMed Central

Ilyushina, Natalia A.; Khalenkov, Alexey M.; Seiler, Jon P.; Forrest, Heather L.; Bovin, Nicolai V.; Marjuki, Henju; Barman, Subrata; Webster, Robert G.; Webby, Richard J.

2010-01-01

The molecular mechanism by which pandemic 2009 influenza A viruses were able to sufficiently adapt to humans is largely unknown. Subsequent human infections with novel H1N1 influenza viruses prompted an investigation of the molecular determinants of the host range and pathogenicity of pandemic influenza viruses in mammals. To address this problem, we assessed the genetic basis for increased virulence of A/CA/04/09 (H1N1) and A/TN/1-560/09 (H1N1) isolates, which are not lethal for mice, in a new mammalian host by promoting their mouse adaptation. The resulting mouse lung-adapted variants showed significantly enhanced growth characteristics in eggs, extended extrapulmonary tissue tropism, and pathogenicity in mice. All mouse-adapted viruses except A/TN/1-560/09-MA2 grew faster and to higher titers in cells than the original strains. We found that 10 amino acid changes in the ribonucleoprotein (RNP) complex (PB2 E158G/A, PA L295P, NP D101G, and NP H289Y) and hemagglutinin (HA) glycoprotein (K119N, G155E, S183P, R221K, and D222G) controlled enhanced mouse virulence of pandemic isolates. HA mutations acquired during adaptation affected viral receptor specificity by enhancing binding to α2,3 together with decreasing binding to α2,6 sialyl receptors. PB2 E158G/A and PA L295P amino acid substitutions were responsible for the significant enhancement of transcription and replication activity of the mouse-adapted H1N1 variants. Taken together, our findings suggest that changes optimizing receptor specificity and interaction of viral polymerase components with host cellular factors are the major mechanisms that contribute to the optimal competitive advantage of pandemic influenza viruses in mice. These modulators of virulence, therefore, may have been the driving components of early evolution, which paved the way for novel 2009 viruses in mammals. PMID:20592084

School illness absenteeism during 2009 influenza A (H1N1) pandemic--South Dakota, 2009-2010.

PubMed

Kightlinger, Lon; Horan, Vickie

2013-05-01

Schools are important amplification settings of influenza virus transmission. We demonstrated correlation of school absenteeism (due to any illness) with other influenza A (H1N1) activity surveillance data during the 2009 pandemic. We collected nonspecific illness student absenteeism data from August 17, 2009 through April 3, 2010 from 187 voluntarily participating South Dakota schools using weekly online surveys. Relative risks (RR) were calculated as the ratio of the probability of absenteeism during elevated weeks versus the probability of absenteeism during the baseline weeks (RR = 1.89). We used Pearson correlation to associate absenteeism with laboratory-confirmed influenza cases, influenza cases diagnosed by rapid tests, influenza-associated hospitalizations and deaths reported in South Dakota during the 2009 H1N1 pandemic period. School-absenteeism data correlated strongly with data from these other influenza surveillance sources.

Outbreaks of pandemic (H1N1) 2009 and seasonal influenza A (H3N2) on cruise ship.

PubMed

Ward, Kate A; Armstrong, Paul; McAnulty, Jeremy M; Iwasenko, Jenna M; Dwyer, Dominic E

2010-11-01

To determine the extent and pattern of influenza transmission and effectiveness of containment measures, we investigated dual outbreaks of pandemic (H1N1) 2009 and influenza A (H3N2) that had occurred on a cruise ship in May 2009. Of 1,970 passengers and 734 crew members, 82 (3.0%) were infected with pandemic (H1N1) 2009 virus, 98 (3.6%) with influenza A (H3N2) virus, and 2 (0.1%) with both. Among 45 children who visited the ship's childcare center, infection rate for pandemic (H1N1) 2009 was higher than that for influenza A (H3N2) viruses. Disembarked passengers reported a high level of compliance with isolation and quarantine recommendations. We found 4 subsequent cases epidemiologically linked to passengers but no evidence of sustained transmission to the community or passengers on the next cruise. Among this population of generally healthy passengers, children seemed more susceptible to pandemic (H1N1) 2009 than to influenza (H3N2) viruses. Intensive disease control measures successfully contained these outbreaks.

Estimating the incidence reporting rates of new influenza pandemics at an early stage using travel data from the source country.

PubMed

Chong, K C; Fong, H F; Zee, C Y

2014-05-01

During the surveillance of influenza pandemics, underreported data are a public health challenge that complicates the understanding of pandemic threats and can undermine mitigation efforts. We propose a method to estimate incidence reporting rates at early stages of new influenza pandemics using 2009 pandemic H1N1 as an example. Routine surveillance data and statistics of travellers arriving from Mexico were used. Our method incorporates changes in reporting rates such as linearly increasing trends due to the enhanced surveillance. From our results, the reporting rate was estimated at 0·46% during early stages of the pandemic in Mexico. We estimated cumulative incidence in the Mexican population to be 0·7% compared to 0·003% reported by officials in Mexico at the end of April. This method could be useful in estimation of actual cases during new influenza pandemics for policy makers to better determine appropriate control measures.

Continued dominance of pandemic A(H1N1) 2009 influenza in Victoria, Australia in 2010

PubMed Central

Grant, Kristina; Franklin, Lucinda; Kaczmarek, Marlena; Hurt, Aeron; Kostecki, Renata; Kelly, Heath

2011-01-01

The 2010 Victorian influenza season was characterized by normal seasonal influenza activity and the dominance of the pandemic A(H1N1) 2009 strain. General Practice Sentinel Surveillance rates peaked at 9.4 ILI cases per 1000 consultations in week 36 for metropolitan practices, and at 10.5 ILI cases per 1000 in the following week for rural practices. Of the 678 ILI cases, 23% were vaccinated, a significantly higher percentage than in previous years. A significantly higher percentage of ILI patients were swabbed in 2010 compared to 2003–2008, but similar to 2009, with a similar percentage being positive for influenza as in previous years. Vaccination rates increased with patient age. Melbourne Medical Deputising Service rates peaked in week 35 at 19.1 ILI cases per 1000 consultations. Of the 1914 cases of influenza notified to the Department of Health, Victoria, 1812 (95%) were influenza A infections – 1001 (55%) pandemic A(H1N1) 2009, 4 (< 1%) A(H3N2) and 807 (45%) not subtyped; 88 (5%) were influenza B; and 14 (< 1%) were influenza A and B co-infections. The World Health Organization Collaborating Centre for Reference and Research on Influenza tested 403 isolates of which 261 were positive for influenza, 250 of which were influenza A and 11 were influenza B. Ninety-two per cent of the influenza A viruses were pandemic A(H1N1) 2009, and following antigenic analysis all of these were found to be similar to the current vaccine strain. Three viruses (0.9%) were found to be oseltamivir resistant due to an H275Y mutation in the neuraminidase gene. PMID:23908889

Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet

PubMed Central

Schuck‐Paim, Cynthia; Shanks, G. Dennis; Almeida, Francisco E. A.; Alonso, Wladimir J.

2012-01-01

Please cite this paper as: Schuck‐Paim et al. (2012) Exceptionally high mortality rate of the 1918 influenza pandemic in the Brazilian naval fleet. Influenza and Other Respiratory Viruses DOI: 10.1111/j.1750‐2659.2012.00341.x. Background  The naval experience with the 1918 pandemic during World War I remains underexplored despite its key role on the pandemic’s global diffusion and the epidemiological interest of isolated and relatively homogeneous populations. The pandemic outbreak in the Brazilian naval fleet is of particular interest both because of its severity and the fact that it was the only Latin American military force deployed to war. Objectives  To study the mortality patterns of the pandemic in the Brazilian fleet sent to patrol the West African coast in 1918. Method  We investigated mortality across vessels, ranks, and occupations based on official population and mortality records from the Brazilian Navy Archives. Results  The outbreak that swept this fleet included the highest influenza mortality rate on any naval ship reported to date. Nearly 10% of the crews died, with death rates reaching 13–14% on two destroyers. While overall mortality was lower for officers, stokers and engineer officers were significantly more likely to die from the pandemic, possibly due to the pulmonary damage from constant exposure to the smoke and coal dust from the boilers. Conclusions  The fatality patterns observed provide valuable data on the conditions that can exacerbate the impact of a pandemic. While the putative lack of exposure to a first pandemic wave may have played a role in the excessive mortality observed in this fleet, our results indicate that strenuous labor conditions, dehydration, and exposure to coal dust were major risk factors. The unequal death rates among vessels remain an open question. PMID:22336427

Department of Defense influenza and other respiratory disease surveillance during the 2009 pandemic

PubMed Central

2011-01-01

The Armed Forces Health Surveillance Center’s Division of Global Emerging Infections Surveillance and Response System (AFHSC-GEIS) supports and oversees surveillance for emerging infectious diseases, including respiratory diseases, of importance to the U.S. Department of Defense (DoD). AFHSC-GEIS accomplishes this mission by providing funding and oversight to a global network of partners for respiratory disease surveillance. This report details the system’s surveillance activities during 2009, with a focus on efforts in responding to the novel H1N1 Influenza A (A/H1N1) pandemic and contributions to global public health. Active surveillance networks established by AFHSC-GEIS partners resulted in the initial detection of novel A/H1N1 influenza in the U.S. and several other countries, and viruses isolated from these activities were used as seed strains for the 2009 pandemic influenza vaccine. Partners also provided diagnostic laboratory training and capacity building to host nations to assist with the novel A/H1N1 pandemic global response, adapted a Food and Drug Administration-approved assay for use on a ruggedized polymerase chain reaction platform for diagnosing novel A/H1N1 in remote settings, and provided estimates of seasonal vaccine effectiveness against novel A/H1N1 illness. Regular reporting of the system’s worldwide surveillance findings to the global public health community enabled leaders to make informed decisions on disease mitigation measures and controls for the 2009 A/H1N1 influenza pandemic. AFHSC-GEIS’s support of a global network contributes to DoD’s force health protection, while supporting global public health. PMID:21388566

Breastfeeding--anti-viral potential and relevance to the influenza virus pandemic.

PubMed

Prameela, K K

2011-06-01

Essential nutritive and immunological ingredients abundantly present in breastmilk make it the choice infant nutrition. The uniqueness of mother's milk, in contrast to most therapeutics and immunizations, lies in its potential to adapt itself to the requirements of the infant so that timely immune defenses are tapped from its constituents by immune regulation, modulation and immune acceleration to stimulate novel substances; these render it pertinent as defense when faced with challenging organisms. While it is appreciated that immunity can be transferred from mother to infant through breastmilk following maternal influenza vaccination, the immense benefits conferred by breastfeeding per se during influenza pandemics may not be fully valued. This is substantiated by debates and ambiguities for continued breastfeeding in the face of maternal influenza infections. This article emphasises the utmost importance of breastfeeding in viral pandemics in the light of the changing immunological strategies used by viruses at different times and the urgent need for such opportune defenses. The prolific interaction of its constituents is frequently understated as enormous advantages to the suckling infant.

Pandemic influenza and health system resource gaps in Bali: an analysis through a resource transmission dynamics model.

PubMed

Adisasmito, Wiku; Hunter, Benjamin M; Krumkamp, Ralf; Latief, Kamal; Rudge, James W; Hanvoravongchai, Piya; Coker, Richard J

2015-03-01

The failure to contain pandemic influenza A(H1N1) 2009 in Mexico has shifted global attention from containment to mitigation. Limited surveillance and reporting have, however, prevented detailed assessment of mitigation during the pandemic, particularly in low- and middle-income countries. To assess pandemic influenza case management capabilities in a resource-limited setting, the authors used a health system questionnaire and density-dependent, deterministic transmission model for Bali, Indonesia, determining resource gaps. The majority of health resources were focused in and around the provincial capital, Denpasar; however, gaps are found in every district for nursing staff, surgical masks, and N95 masks. A relatively low pathogenicity pandemic influenza virus would see an overall surplus for physicians, antivirals, and antimicrobials; however, a more pathogenic virus would lead to gaps in every resource except antimicrobials. Resources could be allocated more evenly across Bali. These, however, are in short supply universally and therefore redistribution would not fill resource gaps. © 2011 APJPH.

[Survey about responsiveness of third-level hospitals to a medical disaster: after the pandemic influenza in Mexico].

PubMed

Serna-Ojeda, Juan Carlos; Castañón-González, Jorge Alberto; Macías, Alejandro E; Mansilla-Olivares, Armando; Domínguez-Cherit, Guillermo; Polanco-González, Carlos

2012-01-01

The recent pandemic influenza AH1N1 virus made it clear that planning for medical disaster response is critical. To know the responsiveness of a sample of highly specialized hospitals in Mexico to a medical disaster, with the previous pandemic influenza AH1N1 as reference. A survey was conducted among the Medical Directors of a sample of highly specialized hospitals, covering: previous experience with the pandemic influenza, space considerations, material resources, staff, logistics, and current general perspectives. Descriptive statistics were used for analysis. A 95% response was obtained from the institutions (19 hospitals). Of these, 47.4% considered that the medical institution was not ready to respond to pandemic influenza. The median surge capacity for the Intensive Care Unit beds was 30% (range 0 to 32 beds). The least reserve in medication was found in the antivirals (26.3%). Only 47.4% considered having enough intensive care nurses and 57.9% enough respiratory technicians; 42.1% would not have an easy access to resources in an emergency. Prevention is key in responsiveness to medical disasters, and therefore the basic steps for planning strategies must be considered.

Sunspot activity and influenza pandemics: a statistical assessment of the purported association.

PubMed

Towers, S

2017-10-01

Since 1978, a series of papers in the literature have claimed to find a significant association between sunspot activity and the timing of influenza pandemics. This paper examines these analyses, and attempts to recreate the three most recent statistical analyses by Ertel (1994), Tapping et al. (2001), and Yeung (2006), which all have purported to find a significant relationship between sunspot numbers and pandemic influenza. As will be discussed, each analysis had errors in the data. In addition, in each analysis arbitrary selections or assumptions were also made, and the authors did not assess the robustness of their analyses to changes in those arbitrary assumptions. Varying the arbitrary assumptions to other, equally valid, assumptions negates the claims of significance. Indeed, an arbitrary selection made in one of the analyses appears to have resulted in almost maximal apparent significance; changing it only slightly yields a null result. This analysis applies statistically rigorous methodology to examine the purported sunspot/pandemic link, using more statistically powerful un-binned analysis methods, rather than relying on arbitrarily binned data. The analyses are repeated using both the Wolf and Group sunspot numbers. In all cases, no statistically significant evidence of any association was found. However, while the focus in this particular analysis was on the purported relationship of influenza pandemics to sunspot activity, the faults found in the past analyses are common pitfalls; inattention to analysis reproducibility and robustness assessment are common problems in the sciences, that are unfortunately not noted often enough in review.

Burden of pediatric influenza A virus infection post swine-flu H1N1 pandemic in Egypt.

PubMed

Khattab, Adel; Shaheen, Malak; Kamel, Terez; El Faramay, Amel; El Rahman, Safaa Abd; Nabil, Dalia; Gouda, Mohamed

2013-09-01

To screen children with influenza like illness or with symptoms of acute respiratory tract infections for influenza A virus infection - post swine flu pandemic era - using rapid influenza diagnostic tests. During two years (2010 & 2011), 1 200 children with influenza like illness or acute respiratory tract infections (according to World Health Organization criteria) were recruited. Their ages ranged from 2-60 months. Nasopharyngeal aspirates specimens were collected from all children for rapid influenza A diagnostic test. Influenza A virus rapid test was positive in 47.5% of the children; the majority (89.6%) were presented with lower respiratory tract infections. Respiratory rate and temperature were significantly higher among positive rapid influenza test patients. Influenza A virus infection is still a major cause of respiratory tract infections in Egyptian children. It should be considered in all cases with cough and febrile episodes and influenza like symptoms even post swine flu pandemic. Copyright © 2013 Hainan Medical College. Published by Elsevier B.V. All rights reserved.

Continual Reintroduction of Human Pandemic H1N1 Influenza A Viruses into Swine in the United States, 2009 to 2014

PubMed Central

Stratton, Jered; Killian, Mary Lea; Janas-Martindale, Alicia; Vincent, Amy L.

2015-01-01

ABSTRACT The diversity of influenza A viruses in swine (swIAVs) presents an important pandemic threat. Knowledge of the human-swine interface is particularly important for understanding how viruses with pandemic potential evolve in swine hosts. Through phylogenetic analysis of contemporary swIAVs in the United States, we demonstrate that human-to-swine transmission of pandemic H1N1 (pH1N1) viruses has occurred continuously in the years following the 2009 H1N1 pandemic and has been an important contributor to the genetic diversity of U.S. swIAVs. Although pandemic H1 and N1 segments had been largely removed from the U.S. swine population by 2013 via reassortment with other swIAVs, these antigens reemerged following multiple human-to-swine transmission events during the 2013-2014 seasonal epidemic. These findings indicate that the six internal gene segments from pH1N1 viruses are likely to be sustained long term in the U.S. swine population, with periodic reemergence of pandemic hemagglutinin (HA) and neuraminidase (NA) segments in association with seasonal pH1N1 epidemics in humans. Vaccinating U.S. swine workers may reduce infection of both humans and swine and in turn limit the role of humans as sources of influenza virus diversity in pigs. IMPORTANCE Swine are important hosts in the evolution of influenza A viruses with pandemic potential. Here, we analyze influenza virus sequence data generated by the U.S. Department of Agriculture's national surveillance system to identify the central role of humans in the reemergence of pandemic H1N1 (pH1N1) influenza viruses in U.S. swine herds in 2014. These findings emphasize the important role of humans as continuous sources of influenza virus diversity in swine and indicate that influenza viruses with pandemic HA and NA segments are likely to continue to reemerge in U.S. swine in association with seasonal pH1N1 epidemics in humans. PMID:25833052

Continual Reintroduction of Human Pandemic H1N1 Influenza A Viruses into Swine in the United States, 2009 to 2014.

PubMed

Nelson, Martha I; Stratton, Jered; Killian, Mary Lea; Janas-Martindale, Alicia; Vincent, Amy L

2015-06-01

The diversity of influenza A viruses in swine (swIAVs) presents an important pandemic threat. Knowledge of the human-swine interface is particularly important for understanding how viruses with pandemic potential evolve in swine hosts. Through phylogenetic analysis of contemporary swIAVs in the United States, we demonstrate that human-to-swine transmission of pandemic H1N1 (pH1N1) viruses has occurred continuously in the years following the 2009 H1N1 pandemic and has been an important contributor to the genetic diversity of U.S. swIAVs. Although pandemic H1 and N1 segments had been largely removed from the U.S. swine population by 2013 via reassortment with other swIAVs, these antigens reemerged following multiple human-to-swine transmission events during the 2013-2014 seasonal epidemic. These findings indicate that the six internal gene segments from pH1N1 viruses are likely to be sustained long term in the U.S. swine population, with periodic reemergence of pandemic hemagglutinin (HA) and neuraminidase (NA) segments in association with seasonal pH1N1 epidemics in humans. Vaccinating U.S. swine workers may reduce infection of both humans and swine and in turn limit the role of humans as sources of influenza virus diversity in pigs. Swine are important hosts in the evolution of influenza A viruses with pandemic potential. Here, we analyze influenza virus sequence data generated by the U.S. Department of Agriculture's national surveillance system to identify the central role of humans in the reemergence of pandemic H1N1 (pH1N1) influenza viruses in U.S. swine herds in 2014. These findings emphasize the important role of humans as continuous sources of influenza virus diversity in swine and indicate that influenza viruses with pandemic HA and NA segments are likely to continue to reemerge in U.S. swine in association with seasonal pH1N1 epidemics in humans. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

A Candidate H1N1 Pandemic Influenza Vaccine Elicits Protective Immunity in Mice

PubMed Central

Steitz, Julia; Barlow, Peter G.; Hossain, Jaber; Kim, Eun; Okada, Kaori; Kenniston, Tom; Rea, Sheri; Donis, Ruben O.; Gambotto, Andrea

2010-01-01

Background In 2009 a new pandemic disease appeared and spread globally. The recent emergence of the pandemic influenza virus H1N1 first isolated in Mexico and USA raised concerns about vaccine availability. We here report our development of an adenovirus-based influenza H1N1 vaccine tested for immunogenicity and efficacy to confer protection in animal model. Methods We generated two adenovirus(Ad5)-based influenza vaccine candidates encoding the wildtype or a codon-optimized hemagglutinin antigen (HA) from the recently emerged swine influenza isolate A/California/04/2009 (H1N1)pdm. After verification of antigen expression, immunogenicity of the vaccine candidates were tested in a mouse model using dose escalations for subcutaneous immunization. Sera of immunized animals were tested in microneutalization and hemagglutination inhibition assays for the presence of HA-specific antibodies. HA-specific T-cells were measured in IFNγ Elispot assays. The efficiency of the influenza vaccine candidates were evaluated in a challenge model by measuring viral titer in lung and nasal turbinate 3 days after inoculation of a homologous H1N1 virus. Conclusions/Significance A single immunization resulted in robust cellular and humoral immune response. Remarkably, the intensity of the immune response was substantially enhanced with codon-optimized antigen, indicating the benefit of manipulating the genetic code of HA antigens in the context of recombinant influenza vaccine design. These results highlight the value of advanced technologies in vaccine development and deployment in response to infections with pandemic potential. Our study emphasizes the potential of an adenoviral-based influenza vaccine platform with the benefits of speed of manufacture and efficacy of a single dose immunization. PMID:20463955

No effect of 2008/09 seasonal influenza vaccination on the risk of pandemic H1N1 2009 influenza infection in England.

PubMed

Pebody, Richard; Andrews, Nick; Waight, Pauline; Malkani, Rashmi; McCartney, Christine; Ellis, Joanna; Miller, Elizabeth

2011-03-21

This study reports effectiveness of trivalent influenza vaccine (TIV) against confirmed pandemic influenza infection in England using a retrospective test-negative case-control study. Cases and controls were frequency matched by age, swabbing-week and region. On univariable and multivariable analysis adjusted for underlying clinical risk factors, cases were no more or less likely than controls to be vaccinated with 2008-09 or 2007-08 season TIV. Adjusted vaccine effectiveness for the former was -6% (-43% to 22%). Vaccine effectiveness did not differ significantly by age-group or hospitalisation status. There was no evidence prior vaccination with TIV significantly altered subsequent risk of pandemic influenza H1N1 2009 infection. Copyright © 2011 Elsevier Ltd. All rights reserved.

Willingness to volunteer during an influenza pandemic: perspectives from students and staff at a large Canadian university

PubMed Central

Rosychuk, Rhonda J.; Bailey, Tracey; Haines, Christina; Lake, Robert; Herman, Benjamin; Yonge, Olive; Marrie, Thomas J.

2008-01-01

Background  A future influenza pandemic will require greater demand on numerous essential services and a reduced capacity to meet that demand. Recruitment of volunteers is an important issue for pre‐pandemic planning. Objectives  To identify factors and attitudes towards volunteerism in the event of a pandemic of influenza. Participants/methods  A 42‐item web‐questionnaire was administered to all faculty, staff and students at the University of Alberta. Respondents indicated their willingness to volunteer. Responses were dichotomized and logistic regression models were developed to capture the association between willingness to volunteer and (i) demographic and information source variables, (ii) risk perception and general knowledge, and (iii) volunteering attitudes and priority access variables. Results  Many factors predicted willingness to volunteer and several involved interactions with other variables. Individuals who were older, relied on University Health Centre information and who had past volunteerism experience were generally more likely to be willing to volunteer. Those willing to volunteer were more likely to think spread could be prevented by covering mouth when coughing/sneezing, and treatment would include drinking fluids. Those who thought influenza would be treated by antibiotics were less willing to volunteer. Likely volunteers thought that healthcare students should be encouraged to volunteer if there was a healthcare worker shortage. Conclusion  This study provides guidance for those who are preparing universities to deal with pandemic influenza. The results suggest factors that might be important in the recruitment of volunteers during an influenza pandemic and these factors might be relevant for other sectors as well. PMID:19453473

Continual re-introduction of human pandemic H1N1 influenza A viruses into US swine, 2009-2014

USDA-ARS?s Scientific Manuscript database

Human-to-swine transmission of pandemic H1N1 influenza viruses (pH1N1) increased the genetic diversity of influenza A viruses in swine (swIAVs) globally and is linked to the emergence of new pandemic threats, including H3N2v variants. Through phylogenetic analysis of contemporary swIAVs in the Unit...

Safety and efficacy of a novel live attenuated influenza vaccine against pandemic H1N1 in swine

USDA-ARS?s Scientific Manuscript database

On June 11, 2009 the World Health Organization (WHO) declared that the outbreaks caused by novel swine-origin influenza A (H1N1) virus had reached pandemic proportions. The pandemic H1N1 (H1N1pdm) is the predominant influenza strain in the human population. It has also crossed the species barriers a...

Global mortality estimates for the 2009 Influenza Pandemic from the GLaMOR project: a modeling study.

PubMed

Simonsen, Lone; Spreeuwenberg, Peter; Lustig, Roger; Taylor, Robert J; Fleming, Douglas M; Kroneman, Madelon; Van Kerkhove, Maria D; Mounts, Anthony W; Paget, W John

2013-11-01

Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries. We obtained weekly virology and underlying cause-of-death mortality time series for 2005-2009 for 20 countries covering ∼35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%-85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000-249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in persons <65 y. Limitations include lack of representation of low-income countries among single-country estimates and an inability to study subsequent pandemic waves (2010-2012). We estimate that 2009 global pandemic respiratory mortality was ∼10-fold higher than the World Health Organization's laboratory-confirmed mortality count. Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons <65 y of age occurred, so that many more life-years were lost. The burden varied greatly among countries, corroborating early reports of far greater pandemic severity in the Americas than in Australia, New Zealand, and Europe. A collaborative network

Fully human broadly neutralizing monoclonal antibodies against influenza A viruses generated from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient

DOE Office of Scientific and Technical Information (OSTI.GOV)

Hu, Weibin; Chen, Aizhong; Miao, Yi

Whether the 2009 pandemic H1N1 influenza vaccine can induce heterosubtypic cross-protective anti-hemagglutinin (HA) neutralizing antibodies is an important issue. We obtained a panel of fully human monoclonal antibodies from the memory B cells of a 2009 pandemic H1N1 influenza vaccine recipient. Most of the monoclonal antibodies targeted the HA protein but not the HA1 fragment. Among the analyzed antibodies, seven mAbs exhibited neutralizing activity against several influenza A viruses of different subtypes. The conserved linear epitope targeted by the neutralizing mAbs (FIEGGWTGMVDGWYGYHH) is part of the fusion peptide on HA2. Our work suggests that a heterosubtypic neutralizing antibody response primarilymore » targeting the HA stem region exists in recipients of the 2009 pandemic H1N1 influenza vaccine. The HA stem region contains various conserved neutralizing epitopes with the fusion peptide as an important one. This work may aid in the design of a universal influenza A virus vaccine.« less

Adaptive Mutations That Occurred during Circulation in Humans of H1N1 Influenza Virus in the 2009 Pandemic Enhance Virulence in Mice.

PubMed

Otte, A; Sauter, M; Daxer, M A; McHardy, A C; Klingel, K; Gabriel, G

2015-07-01

During the 2009 H1N1 influenza pandemic, infection attack rates were particularly high among young individuals who suffered from pneumonia with occasional death. Moreover, previously reported determinants of mammalian adaptation and pathogenicity were not present in 2009 pandemic H1N1 influenza A viruses. Thus, it was proposed that unknown viral factors might have contributed to disease severity in humans. In this study, we performed a comparative analysis of two clinical 2009 pandemic H1N1 strains that belong to the very early and later phases of the pandemic. We identified mutations in the viral hemagglutinin (HA) and the nucleoprotein (NP) that occurred during pandemic progression and mediate increased virulence in mice. Lethal disease outcome correlated with elevated viral replication in the alveolar epithelium, increased proinflammatory cytokine and chemokine responses, pneumonia, and lymphopenia in mice. These findings show that viral mutations that have occurred during pandemic circulation among humans are associated with severe disease in mice. In this study, novel determinants of 2009 pandemic H1N1 influenza pathogenicity were identified in the viral hemagglutinin (HA) and the nucleoprotein (NP) genes. In contrast to highly pathogenic avian influenza viruses, increased virulence in mice did not correlate with enhanced polymerase activity but with reduced activity. Lethal 2009 pandemic H1N1 infection in mice correlated with lymphopenia and severe pneumonia. These studies suggest that molecular mechanisms that mediate 2009 pandemic H1N1 influenza pathogenicity are distinct from those that mediate avian influenza virus pathogenicity in mice. Copyright © 2015, American Society for Microbiology. All Rights Reserved.

Influenza vaccination in the Americas: Progress and challenges after the 2009 A(H1N1) influenza pandemic

PubMed Central

Ropero-Álvarez, Alba María; El Omeiri, Nathalie; Kurtis, Hannah Jane; Danovaro-Holliday, M. Carolina; Ruiz-Matus, Cuauhtémoc

2016-01-01

ABSTRACT Background: There has been considerable uptake of seasonal influenza vaccines in the Americas compared to other regions. We describe the current influenza vaccination target groups, recent progress in vaccine uptake and in generating evidence on influenza seasonality and vaccine effectiveness for immunization programs. We also discuss persistent challenges, 5 years after the A(H1N1) 2009 influenza pandemic. Methods: We compiled and summarized data annually reported by countries to the Pan American Health Organization/World Health Organization (PAHO/WHO) through the WHO/UNICEF joint report form on immunization, information obtained through PAHO's Revolving Fund for Vaccine Procurement and communications with managers of national Expanded Programs on Immunization (EPI). Results: Since 2008, 25 countries/territories in the Americas have introduced new target groups for vaccination or expanded the age ranges of existing target groups. As of 2014, 40 (89%) out of 45 countries/territories have policies established for seasonal influenza vaccination. Currently, 29 (64%) countries/territories target pregnant women for vaccination, the highest priority group according to WHO´s Stategic Advisory Group of Experts and PAHO/WHO's Technical Advisory Group on Vaccine-preventable Diseases, compared to only 7 (16%) in 2008. Among 23 countries reporting coverage data, on average, 75% of adults ≥60 years, 45% of children aged 6–23 months, 32% of children aged 5–2 years, 59% of pregnant women, 78% of healthcare workers, and 90% of individuals with chronic conditions were vaccinated during the 2013–14 Northern Hemisphere or 2014 Southern Hemisphere influenza vaccination activities. Difficulties however persist in the estimation of vaccination coverage, especially for pregnant women and persons with chronic conditions. Since 2007, 6 tropical countries have changed their vaccine formulation from the Northern to the Southern Hemisphere formulation and the timing of

Influenza vaccination in the Americas: Progress and challenges after the 2009 A(H1N1) influenza pandemic.

PubMed

Ropero-Álvarez, Alba María; El Omeiri, Nathalie; Kurtis, Hannah Jane; Danovaro-Holliday, M Carolina; Ruiz-Matus, Cuauhtémoc

2016-08-02

There has been considerable uptake of seasonal influenza vaccines in the Americas compared to other regions. We describe the current influenza vaccination target groups, recent progress in vaccine uptake and in generating evidence on influenza seasonality and vaccine effectiveness for immunization programs. We also discuss persistent challenges, 5 years after the A(H1N1) 2009 influenza pandemic. We compiled and summarized data annually reported by countries to the Pan American Health Organization/World Health Organization (PAHO/WHO) through the WHO/UNICEF joint report form on immunization, information obtained through PAHO's Revolving Fund for Vaccine Procurement and communications with managers of national Expanded Programs on Immunization (EPI). Since 2008, 25 countries/territories in the Americas have introduced new target groups for vaccination or expanded the age ranges of existing target groups. As of 2014, 40 (89%) out of 45 countries/territories have policies established for seasonal influenza vaccination. Currently, 29 (64%) countries/territories target pregnant women for vaccination, the highest priority group according to WHO´s Stategic Advisory Group of Experts and PAHO/WHO's Technical Advisory Group on Vaccine-preventable Diseases, compared to only 7 (16%) in 2008. Among 23 countries reporting coverage data, on average, 75% of adults ≥60 years, 45% of children aged 6-23 months, 32% of children aged 5-2 years, 59% of pregnant women, 78% of healthcare workers, and 90% of individuals with chronic conditions were vaccinated during the 2013-14 Northern Hemisphere or 2014 Southern Hemisphere influenza vaccination activities. Difficulties however persist in the estimation of vaccination coverage, especially for pregnant women and persons with chronic conditions. Since 2007, 6 tropical countries have changed their vaccine formulation from the Northern to the Southern Hemisphere formulation and the timing of their campaigns to April-May following the

Protecting Home Health Care Workers: A Challenge to Pandemic Influenza Preparedness Planning

PubMed Central

McPhaul, Kathleen; Phillips, Sally; Gershon, Robyn; Lipscomb, Jane

2009-01-01

The home health care sector is a critical element in a pandemic influenza emergency response. Roughly 85% of the 1.5 million workers delivering in-home care to 7.6 million clients are low-wage paraprofessionals, mostly women, and disproportionately members of racial and ethnic minorities. Home health care workers' ability and willingness to respond during a pandemic depends on appropriate communication, training, and adequate protections, including influenza vaccination and respiratory protection. Preparedness planning should also include support for child care and transportation and help home health care workers protect their income and access to health care. We summarize findings from a national stakeholder meeting, which highlighted the need to integrate home health care employers, workers, community advocates, and labor unions into the planning process. PMID:19461108

Clinical and Virological Factors Associated with Viremia in Pandemic Influenza A/H1N1/2009 Virus Infection

PubMed Central

Tse, Herman; To, Kelvin K. W.; Wen, Xi; Chen, Honglin; Chan, Kwok-Hung; Tsoi, Hoi-Wah; Li, Iris W. S.; Yuen, Kwok-Yung

2011-01-01

Background Positive detection of viral RNA in blood and other non-respiratory specimens occurs in severe human influenza A/H5N1 viral infection but is not known to occur commonly in seasonal human influenza infection. Recently, viral RNA was detected in the blood of patients suffering from severe pandemic influenza A/H1N1/2009 viral infection, although the significance of viremia had not been previously studied. Our study aims to explore the clinical and virological factors associated with pandemic influenza A/H1N1/2009 viremia and to determine its clinical significance. Methodology/Principal Findings Clinical data of patients admitted to hospitals in Hong Kong between May 2009 and April 2010 and tested positive for pandemic influenza A/H1N1/2009 was collected. Viral RNA was detected by reverse-transcription polymerase chain reactions (RT-PCR) targeting the matrix (M) and HA genes of pandemic influenza A/H1N1/2009 virus from the following specimens: nasopharyngeal aspirate (NPA), endotracheal aspirate (ETA), blood, stool and rectal swab. Stool and/ or rectal swab was obtained only if the patient complained of any gastrointestinal symptoms. A total of 139 patients were included in the study, with viral RNA being detected in the blood of 14 patients by RT-PCR. The occurrence of viremia was strongly associated with a severe clinical presentation and a higher mortality rate, although the latter association was not statistically significant. D222G/N quasispecies were observed in 90% of the blood samples. Conclusion Presence of pandemic influenza A/H1N1/2009 viremia is an indicator of disease severity and strongly associated with D222G/N mutation in the viral hemagglutinin protein. PMID:21980333

A qualitative study of pandemic influenza preparedness among small and medium-sized businesses in New York City.

PubMed

Burton, Deron C; Confield, Evan; Gasner, Mary Rose; Weisfuse, Isaac

2011-10-01

Small businesses need to engage in continuity planning to assure delivery of goods and services and to sustain the economy during an influenza pandemic. This is especially true in New York City, where 98 per cent of businesses have fewer than 100 employees. It was an objective therefore, to determine pandemic influenza business continuity practices and strategies suitable for small and medium-sized NYC businesses. The study design used focus groups, and the participants were owners and managers of businesses with fewer than 500 employees in New York City. The main outcome measures looked for were the degree of pandemic preparedness, and the feasibility of currently proposed business continuity strategies. Most participants reported that their businesses had no pandemic influenza plan. Agreement with feasibility of specific business continuity strategies was influenced by the type of business represented, cost of the strategy, and business size. It was concluded that recommendations for pandemic-related business continuity plans for small and medium-sized businesses should be tailored to the type and size of business and should highlight the broad utility of the proposed strategies to address a range of business stressors.

Oseltamivir use and outcomes during the 2009 influenza A H1N1 pandemic in Taiwan

PubMed Central

2013-01-01

Background The Taiwan CDC provided free oseltamivir to all patients with influenza infections confirmed by rapid testing or who had clinical warning symptoms during the 2009 H1N1 influenza pandemic in Taiwan. However, oseltamivir utilization patterns, cost, and outcomes among oseltamivir-treated patients remained unclear. Method A population-level, observational cohort study was conducted using the Taiwan National Health Insurance Database from January to December 2009 to describe the use of oseltamivir. Result Prescription trend over weeks increased after a change in government policy and responded to the influenza virus activity. The overall prescription rate was 22.33 per 1000 persons, with the highest prescription rate of 116.5 for those aged 7–12 years, followed by 69.0 for those aged 13–18 years, while the lowest rate was 1.7 for those aged ≥ 65 years. As influenza virus activity increased, the number of prescriptions for those aged ≤18 years rose significantly, whereas no substantial change was observed for those aged ≥65 years. There were also regional variations in terms of oseltamivir utilization and influenza complication rates. Conclusions Oseltamivir was widely used in the 2009 H1N1 influenza pandemic in Taiwan, particularly in those aged 7–18 years. The number of prescriptions for oseltamivir increased with a change in government policy and with increasing cases of pandemic influenza. Further study is needed to examine whether there is an over- or under-use of anti-influenza drugs in different age groups or regions and to examine the current policy of public use of anti-influenza drugs to reduce influenza-associated morbidity and mortality. PMID:23849163

Outbreaks of Pandemic (H1N1) 2009 and Seasonal Influenza A (H3N2) on Cruise Ship

PubMed Central

Ward, Kate A.; Armstrong, Paul; Iwasenko, Jenna M.; Dwyer, Dominic E.

2010-01-01

To determine the extent and pattern of influenza transmission and effectiveness of containment measures, we investigated dual outbreaks of pandemic (H1N1) 2009 and influenza A (H3N2) that had occurred on a cruise ship in May 2009. Of 1,970 passengers and 734 crew members, 82 (3.0%) were infected with pandemic (H1N1) 2009 virus, 98 (3.6%) with influenza A (H3N2) virus, and 2 (0.1%) with both. Among 45 children who visited the ship’s childcare center, infection rate for pandemic (H1N1) 2009 was higher than that for influenza A (H3N2) viruses. Disembarked passengers reported a high level of compliance with isolation and quarantine recommendations. We found 4 subsequent cases epidemiologically linked to passengers but no evidence of sustained transmission to the community or passengers on the next cruise. Among this population of generally healthy passengers, children seemed more susceptible to pandemic (H1N1) 2009 than to influenza (H3N2) viruses. Intensive disease control measures successfully contained these outbreaks. PMID:21029531

A duplex real-time RT-PCR assay for detecting H5N1 avian influenza virus and pandemic H1N1 influenza virus.

PubMed

Kang, Xiao-ping; Jiang, Tao; Li, Yong-qiang; Lin, Fang; Liu, Hong; Chang, Guo-hui; Zhu, Qing-yu; Qin, E-de; Qin, Cheng-feng; Yang, Yin-hui

2010-06-02

A duplex real-time reverse transcriptase polymerase chain reaction (RT-PCR) assay was improved for simultaneous detection of highly pathogenic H5N1 avian influenza virus and pandemic H1N1 (2009) influenza virus, which is suitable for early diagnosis of influenza-like patients and for epidemiological surveillance. The sensitivity of this duplex real-time RT-PCR assay was 0.02 TCID50 (50% tissue culture infective dose) for H5N1 and 0.2 TCID50 for the pandemic H1N1, which was the same as that of each single-target RT-PCR for pandemic H1N1 and even more sensitive for H5N1 with the same primers and probes. No cross reactivity of detecting other subtype influenza viruses or respiratory tract viruses was observed. Two hundred and thirty-six clinical specimens were tested by comparing with single real-time RT-PCR and result from the duplex assay was 100% consistent with the results of single real-time RT-PCR and sequence analysis.

The El Niño–Southern Oscillation (ENSO)–pandemic Influenza connection: Coincident or causal?

PubMed Central

Shaman, Jeffrey; Lipsitch, Marc

2013-01-01

We find that the four most recent human influenza pandemics (1918, 1957, 1968, and 2009), all of which were first identified in boreal spring or summer, were preceded by La Niña conditions in the equatorial Pacific. Changes in the phase of the El Niño–Southern Oscillation have been shown to alter the migration, stopover time, fitness, and interspecies mixing of migratory birds, and consequently, likely affect their mixing with domestic animals. We hypothesize that La Niña conditions bring divergent influenza subtypes together in some parts of the world and favor the reassortment of influenza through simultaneous multiple infection of individual hosts and the generation of novel pandemic strains. We propose approaches to test this hypothesis using influenza population genetics, virus prevalence in various host species, and avian migration patterns. PMID:22308322

Planning and response to the influenza A (H1N1) pandemic: ethics, equity and justice.

PubMed

Devnani, Mahesh; Gupta, Anil Kumar; Devnani, Bharti

2011-01-01

This paper aims to highlight three ethical considerations related to influenza pandemic planning and response: ethical allocation of scarce resources; obligations and duties of healthcare workers to treat patients, and the balance between conflicting individual and community interests. Among these, perhaps the most challenging question facing bioethics is how to allocate scarce, life-saving resources given the devastating social and economic ramifications of a pandemic. In such situations, the identification of clear overall goals for pandemic planning is essential in making difficult choices. The dilemma between the duty to save patients and the right to protect the healthcare personnel's own life and health is a key issue. During the course of a pandemic, civil liberties may also be threatened, requiring limits on individual freedom to protect individuals as well as entire communities. Yet, individual liberty should be restricted with great care, and only when alternative approaches are not effective. Pandemic influenza planning and response should be a cooperative and shared responsibility that balances community and individual interests.

Severe pandemic 2009 H1N1 influenza disease due to pathogenic immune complexes

PubMed Central

Monsalvo, Ana Clara; Batalle, Juan P.; Lopez, M. Florencia; Krause, Jens C.; Klemenc, Jennifer; Zea, Johanna; Maskin, Bernardo; Bugna, Jimena; Rubinstein, Carlos; Aguilar, Leandro; Dalurzo, Liliana; Libster, Romina; Savy, Vilma; Baumeister, Elsa; Aguilar, Liliana; Cabral, Graciela; Font, Julia; Solari, Liliana; Weller, Kevin P.; Johnson, Joyce; Echavarria, Marcela; Edwards, Kathryn M.; Chappell, James D.; Crowe, James E.; Williams, John V.; Melendi, Guillermina A.; Polack, Fernando P.

2010-01-01

Pandemic influenza viruses often cause severe disease in middle-aged adults without preexistent co-morbidities. The mechanism of illness associated with severe disease in this age group is not well understood1–10. Here, we demonstrate preexisting serum antibody that cross-reacts with, but does not protect against 2009 H1N1 influenza virus in middle-aged adults. Non-protective antibody is associated with immune complex(IC)-mediated disease after infection. High titers of serum antibody of low avidity for H1-2009 antigen, and low avidity pulmonary ICs against the same protein were detected in severely ill patients. Moreover, C4d deposition - a sensitive marker of complement activation mediated by ICs- was present in lung sections of fatal cases. Archived lung sections from adults with confirmed fatal influenza 1957 H2N2 infection revealed a similar mechanism of illness. These observations provide a novel biological mechanism for the unusual age distribution of severe cases during influenza pandemics. PMID:21131958

Pandemic influenza and critical infrastructure dependencies: possible impact on hospitals.

PubMed

Itzwerth, Ralf L; Macintyre, C Raina; Shah, Smita; Plant, Aileen J

2006-11-20

Hospitals will be particularly challenged when pandemic influenza spreads. Within the health sector in general, existing pandemic plans focus on health interventions to control outbreaks. The critical relationship between the health sector and other sectors is not well understood and addressed. Hospitals depend on critical infrastructure external to the organisation itself. Existing plans do not adequately consider the complexity and interdependency of systems upon which hospitals rely. The failure of one such system can trigger a failure of another, causing cascading breakdowns. Health is only one of the many systems that struggle at maximum capacity during "normal" times, as current business models operate with no or minimal "excess" staff and have become irreducible operations. This makes interconnected systems highly vulnerable to acute disruptions, such as a pandemic. Companies use continuity plans and highly regulated business continuity management to overcome process interruptions. This methodology can be applied to hospitals to minimise the impact of a pandemic.

A history of the 1918 Spanish influenza pandemic and its impact on Iran.

PubMed

Azizi, Mohammad Hossein; Raees Jalali, Ghanbar Ali; Azizi, Farzaneh

2010-05-01

Approximately ninety two years ago, the worst influenza pandemic or "Spanish flu" occurred in 1918, at the end of the First World War (WWI, 1914-1918) which resulted in the deaths of millions of people worldwide. The death toll exceeded the total number of victims of WWI. The 1918 Spanish flu was a deadly, major global event that affected many countries, including Iran. In Iran, it was accompanied by a high mortality rate estimated to be more than one million. However, detailed information on the impact of this outbreak in Iran is scarce. The present paper describes a brief history of the influenza pandemics in the world as well as the spread of the 1918 Spanish flu to Iran.

Relevance of workplace social mixing during influenza pandemics: an experimental modelling study of workplace cultures.

PubMed

Timpka, T; Eriksson, H; Holm, E; Strömgren, M; Ekberg, J; Spreco, A; Dahlström, Ö

2016-07-01

Workplaces are one of the most important regular meeting places in society. The aim of this study was to use simulation experiments to examine the impact of different workplace cultures on influenza dissemination during pandemics. The impact is investigated by experiments with defined social-mixing patterns at workplaces using semi-virtual models based on authentic sociodemographic and geographical data from a North European community (population 136 000). A simulated pandemic outbreak was found to affect 33% of the total population in the community with the reference academic-creative workplace culture; virus transmission at the workplace accounted for 10·6% of the cases. A model with a prevailing industrial-administrative workplace culture generated 11% lower incidence than the reference model, while the model with a self-employed workplace culture (also corresponding to a hypothetical scenario with all workplaces closed) produced 20% fewer cases. The model representing an academic-creative workplace culture with restricted workplace interaction generated 12% lower cumulative incidence compared to the reference model. The results display important theoretical associations between workplace social-mixing cultures and community-level incidence rates during influenza pandemics. Social interaction patterns at workplaces should be taken into consideration when analysing virus transmission patterns during influenza pandemics.

Qualitative motivators and barriers to pandemic vs. seasonal influenza vaccination among healthcare workers: a content analysis.

PubMed

Prematunge, Chatura; Corace, Kimberly; McCarthy, Anne; Nair, Rama C; Roth, Virginia; Suh, Kathryn N; Garber, Gary

2014-12-12

Influenza is a major concern across healthcare environments. Annual vaccination of healthcare workers (HCW) remains a key mode of influenza prevention in healthcare settings. Yet influenza vaccine coverage among HCWs continues to be below recommended targets, in pandemic and non-pandemic settings. Thus, the primary objective of this analysis is to identify motivators and barriers to pandemic (panINFLU) and seasonal influenza vaccination (sINFLU) through the qualitative analysis of HCW provided reasons driving HCW's personal vaccination decisions. Data were collected from a multi-professional sample of HCWs via a cross-sectional survey study, conducted at a tertiary-care hospital in Ontario, Canada. HCW provided and ranked qualitative reasons for personal (1) panINFLU (pH1N1) and (2) sINFLU (2008/2009 season) vaccine uptake and avoidance were used to identify key vaccination motivators and barriers through content analysis methodology. Most HCW vaccination motivators and barriers were found to be similar for panINFLU and sINFLU vaccines. Personal motivators had the greatest impact on vaccination (panINFLU 29.9% and sINFLU 33.9%). Other motivators included preventing influenza in loved ones, patients, and community, and awareness of HCW role in influenza transmission. In contrast, concerns of vaccine safety and limited HCW knowledge of influenza vaccines (panINFLU 46.2% and sINFLU 37.3%). HCW vaccination during the pandemic was motivated by panINFLU related fear, epidemiology, and workplace pro-vaccination policies. HCW perceptions of accelerated panINFLU vaccine development and vaccine safety compromises, negative views of external sources (i.e. media, pharmaceutical companies, and regulatory agencies) and pandemic management strategies were barriers specific to panINFLU vaccine. HCW panINFLU and sINFLU vaccine coverage can increase if future vaccination programs (1) highlight personal vaccination benefits (2) emphasize the impact HCW non-vaccination on family

Public Health Policy and Experience of the 2009 H1N1 Influenza Pandemic in Pune, India

PubMed Central

Purohit, Vidula; Kudale, Abhay; Sundaram, Neisha; Joseph, Saju; Schaetti, Christian; Weiss, Mitchell G.

2018-01-01

Background: Prior experience and the persisting threat of influenza pandemic indicate the need for global and local preparedness and public health response capacity. The pandemic of 2009 highlighted the importance of such planning and the value of prior efforts at all levels. Our review of the public health response to this pandemic in Pune, India, considers the challenges of integrating global and national strategies in local programmes and lessons learned for influenza pandemic preparedness. Methods: Global, national and local pandemic preparedness and response plans have been reviewed. In-depth interviews were undertaken with district health policy-makers and administrators who coordinated the pandemic response in Pune. Results: In the absence of a comprehensive district-level pandemic preparedness plan, the response had to be improvised. Media reporting of the influenza pandemic and inaccurate information that was reported at times contributed to anxiety in the general public and to widespread fear and panic. Additional challenges included inadequate public health services and reluctance of private healthcare providers to treat people with flu-like symptoms. Policy-makers developed a response strategy that they referred to as the Pune plan, which relied on powers sanctioned by the Epidemic Act of 1897 and resources made available by the union health ministry, state health department and a government diagnostic laboratory in Pune. Conclusion: The World Health Organization’s (WHO’s) global strategy for pandemic control focuses on national planning, but state-level and local experience in a large nation like India shows how national planning may be adapted and implemented. The priority of local experience and requirements does not negate the need for higher level planning. It does, however, indicate the importance of local adaptability as an essential feature of the planning process. Experience and the implicit Pune plan that emerged are relevant for pandemic

Pandemic Influenza: An Analysis of State Preparedness and Response Plans

DTIC Science & Technology

2007-09-24

RL32752, Continuity of Operations (COOP) in the Executive Branch: Issues in the 109th Congress, by R. Eric Petersen, and White House Homeland Security...23 Holmberg, S.D., Layton , C.M., Ghneim, G.S., and Wagener, D.K., “State Plans for Containment of Pandemic Influenza,” Emerging Infectious Diseases

Evolutionary pattern of pandemic influenza (H1N1) 2009 virus in the late phases of the 2009 pandemic.

PubMed Central

Valli, Maria Beatrice; Meschi, Silvia; Selleri, Marina; Zaccaro, Paola; Ippolito, Giuseppe; Capobianchi, Maria Rosaria; Menzo, Stefano

2010-01-01

Influenza A( H1N1)v has spread rapidly in all parts of the globe in 2009 as a true pandemic, although fortunately a clinically mild one. The relevant evolutionary steps for the new virus to adapt to human populations occurred very early during the pandemic, before the end of April. Of the several resulting clades or clusters, clade 7 appeared later and proved more successful, substituting all other early clades before the bulk of the worldwide infections occurred. PMID:20228856

Preparing ICUs for pandemics.

PubMed

Gabriel, Lucinda E K; Webb, Steve A R

2013-10-01

Influenza pandemics occur intermittently and represent an existential global infectious diseases threat. The purpose of this review is to describe clinical and research preparedness for future pandemics. Pandemic influenza typically results in large numbers of individuals with life-threatening pneumonia requiring treatment in ICUs. Clinical preparedness of ICUs relates to planning to provide increased 'surge' capacity to meet increased demand and requires consideration of staffing, equipment and consumables, bed-space availability and management systems. Research preparedness is also necessary, as timely clinical research has the potential to change the trajectory of a pandemic. The clinical research response during the 2009 H1N1 influenza pandemic was suboptimal. Better planning is necessary to optimize both clinical and research responses to future pandemics.

Knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season: questionnaire study.

PubMed

Rurik, Imre; Langmár, Zoltán; Márton, Hajnalka; Kovács, Eszter; Szigethy, Endre; Ilyés, István

2011-04-15

To evaluate the knowledge, motivation, and attitudes of Hungarian family physicians toward pandemic influenza vaccination in the 2009/10 influenza season. A questionnaire with 20 questions was developed and sent to 232 family physicians in 3 largest Hungarian cities: Budapest, Debrecen, and Miskolc. The study was conducted in December 2009 and January 2010. A hundred and ninety eight (85%) physicians answered the questionnaire adequately. Respondents believed that the influenza outbreak represented less of a threat to their practices than to Hungary or the world as a whole. They mostly agreed that vaccination was important and were frequently dissatisfied with the support from health authorities. The proportion of vaccinated patients ranged between 2% and 53%, without differences according to geographical region, age, sex, and duration of physicians' employment in family practice. Physicians who were satisfied with the payment for procedures and underwent vaccination themselves were more active in vaccination. Health authorities should provide clear and evidence-based professional support to family physicians and should encourage them to get vaccinated against pandemic influenza, while insurance funds have to establish appropriate reimbursement system.

Economic evaluation of influenza pandemic mitigation strategies in the us using a stochastic microsimulation transmission model

PubMed Central

Sander, Beate; Nizam, Azhar; Garrison, Louis P.; Postma, Maarten J.; Halloran, M. Elizabeth; Longini, Ira M.

2013-01-01

Objectives To project the potential economic impact of pandemic influenza mitigation strategies from a societal perspective in the United States. Methods We use a stochastic agent-based model to simulate pandemic influenza in the community. We compare 17 strategies: targeted antiviral prophylaxis (TAP) alone and in combination with school closure as well as prevaccination. Results In the absence of intervention, we predict a 50% attack rate with an economic impact of $187 per capita as loss to society. Full TAP is the most effective single strategy, reducing number of cases by 54% at the lowest cost to society ($127 per capita). Prevaccination reduces number of cases by 48% and is the second least costly alternative ($140 per capita). Adding school closure to full TAP or prevaccination further improves health outcomes, but increases total cost to society by approximately $2700 per capita. Conclusion Full targeted antiviral prophylaxis is an effective and cost-saving measure for mitigating pandemic influenza. PMID:18671770

From containment to community: Trigger points from the London pandemic (H1N1) 2009 influenza incident response.

PubMed

Balasegaram, S; Glasswell, A; Cleary, V; Turbitt, D; McCloskey, B

2011-02-01

In the UK, during the first wave of pandemic (H1N1) 2009 influenza, a national 'containment' strategy was employed from 25 April to 2 July 2009, with case finding, treatment of cases, contact tracing and prophylaxis of close contacts. The aim of the strategy was to delay the introduction and spread of pandemic flu in the UK, provide a better understanding of the course of the novel disease, and thereby allow more time for the development of treatment and vaccination options. Descriptive study of the management of the containment phase of pandemic (H1N1) 2009 influenza. Analysis of data reported to the London Flu Response Centre (LFRC). The average number of telephone calls and faxes per day from health professionals before 15 June 2009 was 188, but this started to rise from 363 on 12 June, to 674 on 15 June, and peaked on 22 June at 2206 calls. The number of cases confirmed [by pandemic (H1N1) 2009 influenza specific H1 and N1 polymerase chain reaction] in London rose to a peak of 200 cases per day. There were widespread school outbreaks reporting large numbers of absences with influenza-like illnesses. Activity in the LFRC intensified to a point where London was declared a 'hot spot' for pandemic (H1N1) 2009 influenza on 19 June 2009 because of sustained community transmission. The local incident response was modified to the 'outbreak management phase' of the containment phase. The sharp rise in the number of telephone calls and the rise in school outbreaks appeared to be trigger points for community transmission. These indicators should inform decisions on modifying public health strategy in pandemic situations. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Content analysis of press coverage during the H1N1 influenza pandemic in Germany 2009-2010.

PubMed

Husemann, Sabine; Fischer, Florian

2015-04-15

The H1N1 influenza pandemic occurred in Germany between April 2009 and August 2010. Pandemics often lead to uncertainty amongst the public and so risk communication on health-related issues is one of the key areas of action for health authorities and other healthcare institutions. The mass media may contribute to risk communication, so this study analysed press coverage during the H1N1 pandemic in Germany. A comprehensive analysis of the press coverage during the H1N1 pandemic was conducted in two steps. First, a temporal analysis was carried out of newspaper articles over the entire course of the pandemic, a total of 15,353 articles. The newspaper articles were obtained from the database Nexis. The total number of articles about the influenza pandemic during each individual week was plotted against the number of incident influenza cases during that week. Second, a quantitative content analysis of 140 newspaper articles from selected dates was conducted. This study indicates that media awareness seems to be strongly related to the actual situation in the pandemic, because changes in the number of infected people were associated with nearly identical changes in the number of newspaper articles. Few articles contained information on the agent of the influenza or support measures. Information on vaccination was included in 32.9% of all articles. Almost half of the articles (48.6%) used case reports. Fear appeals were used in only 10.7% of the newspaper articles; 32.9% of the articles contained the message characteristic "self-efficacy". The newspaper articles that were analysed in the content analysis included different information and message characteristics. The extent of information provided differed during the pandemic. As current research indicates, the use of message characteristics such as fear appeals and self-efficacy, which were also included in the analysed newspaper articles, can help to make health messages effective.

Field performance of clinical case definitions for influenza screening during the 2009 pandemic.

PubMed

Chen, Shey-Ying; Chen, Yee-Chun; Chiang, Wen-Chu; Kung, Hsiang-Chi; King, Chwan-Chuen; Lai, Mei-Shu; Chie, Wei-Chu; Chen, Shyr-Chyr; Chen, Wen-Jone; Chang, Shan-Chwen

2012-11-01

The aim of this study was to assess the performance of 3 different influenza-like illness (ILI) case definitions, adopted by the European (European-CDC), USA (USA-CDC), and Taiwan Centers for Disease Prevention and Control (Taiwan-CDC), as screening tools for influenza during the 2009 H1N1 pandemic. From August 15 to 30, 2009, all emergency department patients with clinical symptoms or at epidemiologic risk for influenza were enrolled in an observational cohort study. Influenza diagnosis was established by positive rapid influenza diagnostic test or virus isolation. Sensitivity, specificity, positive predictive value, and negative predictive value of the European-, USA, and Taiwan-CDC ILI case definitions for screening were determined. A total of 870 patients were screened during the study period. Rapid influenza diagnostic test was positive in 315 patients, 273 (85.6%) of whom had fever duration less than 72 hours. Virus isolation identified 4 more patients with influenza A initially negative by rapid influenza diagnostic test. The mean (SD) age of these 319 patients was 24.3 (18.1) years. Of the 870 screened patients, 670 (77.0%), 476 (54.7%), and 325 (37.4%) met the European-, USA-, and Taiwan-CDC ILI case definition, respectively. Screening sensitivity was 95%, 77.7%, and 57.7% and specificity was 33.4%, 58.6%, and 74.4%, respectively. Differences in sensitivity and specificity between any 2 of the 3 groups were statistically significant (P < .05). First-line physicians should recognize the advantage and limitation of different ILI case definitions in influenza screening, especially confronted by pandemic or highly pathogenic avian influenza in the future. Copyright © 2012 Elsevier Inc. All rights reserved.

Humoral and cellular responses to a non-adjuvanted monovalent H1N1 pandemic influenza vaccine in hospital employees

PubMed Central

2013-01-01

Background The efficacy of the H1N1 influenza vaccine relies on the induction of both humoral and cellular responses. This study evaluated the humoral and cellular responses to a monovalent non-adjuvanted pandemic influenza A/H1N1 vaccine in occupationally exposed subjects who were previously vaccinated with a seasonal vaccine. Methods Sixty healthy workers from a respiratory disease hospital were recruited. Sera and peripheral blood mononuclear cells (PBMCs) were obtained prior to and 1 month after vaccination with a non-adjuvanted monovalent 2009 H1N1 vaccine (Influenza A (H1N1) 2009 Monovalent Vaccine Panenza, Sanofi Pasteur). Antibody titers against the pandemic A/H1N1 influenza virus were measured via hemagglutination inhibition (HI) and microneutralization assays. Antibodies against the seasonal HA1 were assessed by ELISA. The frequency of IFN-γ-producing cells as well as CD4+ and CD8+ T cell proliferation specific to the pandemic virus A/H1N peptides, seasonal H1N1 peptides and seasonal H3N2 peptides were assessed using ELISPOT and flow cytometry. Results At baseline, 6.7% of the subjects had seroprotective antibody titers. The seroconversion rate was 48.3%, and the seroprotection rate was 66.7%. The geometric mean titers (GMTs) were significantly increased (from 6.8 to 64.9, p < 0.05). Forty-nine percent of the subjects had basal levels of specific IFN-γ-producing T cells to the pandemic A/H1N1 peptides that were unchanged post-vaccination. CD4+ T cell proliferation in response to specific pandemic A/H1N1 virus peptides was also unchanged; in contrast, the antigen-specific proliferation of CD8+ T cells significantly increased post-vaccination. Conclusion Our results indicate that a cellular immune response that is cross-reactive to pandemic influenza antigens may be present in populations exposed to the circulating seasonal influenza virus prior to pandemic or seasonal vaccination. Additionally, we found that the pandemic vaccine induced a

Pandemic potential of H7N9 influenza viruses

PubMed Central

Watanabe, Tokiko; Watanabe, Shinji; Maher, Eileen A.; Neumann, Gabriele; Kawaoka, Yoshihiro

2014-01-01

Avian influenza viruses rarely infect humans, but the recently emerged avian H7N9 influenza viruses have caused sporadic infections in humans in China, resulting in 440 confirmed cases with 122 fatalities as of May 16, 2014. In addition, epidemiologic surveys suggest that there have been asymptomatic or mild human infections with H7N9 viruses. These viruses replicate efficiently in mammals, show limited transmissibility in ferrets and guinea pigs, and possess mammalian-adapting amino acid changes that likely contribute to their ability to infect mammals. Here, we summarize the characteristic features of the novel H7N9 viruses and assess their pandemic potential. PMID:25264312

Global Emerging Infection Surveillance and Response (GEIS)- Avian Influenza Pandemic Influenza (AI/PI) Program

DTIC Science & Technology

2010-10-01

work in Nairobi, Kericho, and Kisumu, including the National Influenza Center (NIC), the arbovirus reference laboratory, the antimalarial resistance...and establish the pattern of antimalarial resistance across Kenya. Outbreak investigation and response continues. AFI expanded into regions around...important scientific activity since it aids in the detection of viral antigenic shift and drift which are responsible for pandemics and epidemics

Regional patterns of mortality during the 1918 influenza pandemic in Newfoundland.

PubMed

Sattenspiel, Lisa

2011-07-22

The Spanish Influenza pandemic reached the island of Newfoundland in the summer of 1918 and by the time it disappeared, nearly 2000 of its 250,000 residents died. The pandemic spread in several waves, including a mild outbreak during the summer of 1918 (Wave I), a major, deadly outbreak in the succeeding fall and spring (Wave II), and a small echo wave in 1920. All parts of the island experienced the epidemic, but the effects varied across districts, both in timing and in severity. Overall P&I mortality rates across districts during the entire epidemic (1918-1920) ranged from 28.6 to 109.3 deaths per 10,000 population, with the island as a whole experiencing a mortality rate of 74.5 per 10,000. This island-wide mortality rate was 4.5 times higher than the P&I mortality rate for the 3 years immediately preceding the epidemic. Estimates of the reproduction number, R, range from 1.2 to 2.4 for Wave I and from 2.4 to 9.3 for Wave II. The pandemic experience on Newfoundland illustrates the high degree of regional variability in incidence and severity that epidemics can exhibit. In addition, compared to other world regions, the island's pandemic peaked relatively late and exhibited an unusual bimodal peak during Wave II, emphasizing that local and regional conditions can have major influences on timing, location, and rate of spread. This suggests the need to for greater understanding of how local factors influence epidemic spread so that more effective control strategies can be developed for populations experiencing future influenza pandemics. Copyright © 2011 Elsevier Ltd. All rights reserved.

Structural Basis of Preexisting Immunity to the 2009 H1N1 Pandemic Influenza Virus

DOE Office of Scientific and Technical Information (OSTI.GOV)

Xu, Rui; Ekiert, Damian C.; Krause, Jens C.

The 2009 H1N1 swine flu is the first influenza pandemic in decades. The crystal structure of the hemagglutinin from the A/California/04/2009 H1N1 virus shows that its antigenic structure, particularly within the Sa antigenic site, is extremely similar to those of human H1N1 viruses circulating early in the 20th century. The cocrystal structure of the 1918 hemagglutinin with 2D1, an antibody from a survivor of the 1918 Spanish flu that neutralizes both 1918 and 2009 H1N1 viruses, reveals an epitope that is conserved in both pandemic viruses. Thus, antigenic similarity between the 2009 and 1918-like viruses provides an explanation for themore » age-related immunity to the current influenza pandemic.« less

Inspecting the Mechanism: A Longitudinal Analysis of Socioeconomic Status Differences in Perceived Influenza Risks, Vaccination Intentions, and Vaccination Behaviors during the 2009-2010 Influenza Pandemic.

PubMed

Maurer, Jürgen

2016-10-01

Influenza vaccination is strongly associated with socioeconomic status, but there is only limited evidence on the respective roles of socioeconomic differences in vaccination intentions versus corresponding differences in follow-through on initial vaccination plans for subsequent socioeconomic differences in vaccine uptake. Nonparametric mean smoothing, linear regression, and probit models were used to analyze longitudinal survey data on perceived influenza risks, behavioral vaccination intentions, and vaccination behavior of adults during the 2009-2010 influenza A/H1N1 ("swine flu") pandemic in the United States. Perceived influenza risks and behavioral vaccination intentions were elicited prior to the availability of H1N1 vaccine using a probability scale question format. H1N1 vaccine uptake was assessed at the end of the pandemic. Education, income, and health insurance coverage displayed positive associations with behavioral intentions to get vaccinated for pandemic influenza while employment was negatively associated with stated H1N1 vaccination intentions. Education and health insurance coverage also displayed significant positive associations with pandemic vaccine uptake. Moreover, behavioral vaccination intentions showed a strong and statistically significant positive partial association with later H1N1 vaccination. Incorporating vaccination intentions in a statistical model for H1N1 vaccine uptake further highlighted higher levels of follow-through on initial vaccination plans among persons with higher education levels and health insurance. Sampling bias, misreporting in self-reported data, and limited generalizability to nonpandemic influenza are potential limitations of the analysis. Closing the socioeconomic gap in influenza vaccination requires multipronged strategies that not only increase vaccination intentions by improving knowledge, attitudes, and beliefs but also facilitate follow-through on initial vaccination plans by improving behavioral

Use of a pandemic preparedness drill to increase rates of influenza vaccination among healthcare workers.

PubMed

Kuntz, Jennifer L; Holley, Stephanie; Helms, Charles M; Cavanaugh, Joseph E; Vande Berg, Jeff; Herwaldt, Loreen A; Polgreen, Philip M

2008-02-01

To determine the effect of a pandemic influenza preparedness drill on the rate of influenza vaccination among healthcare workers (HCWs). Before-after intervention trial. The University of Iowa Hospitals and Clinics (UIHC), a large, academic medical center, during 2005. Staff members at UIHC. UIHC conducted a pandemic influenza preparedness drill that included a goal of vaccinating a large number of HCWs in 6 days without disrupting patient care. Peer vaccination and mobile vaccination teams were used to vaccinate HCWs, educational tools were distributed to encourage HCWs to be vaccinated, and resources were allocated on the basis of daily vaccination reports. Logit models were used to compare vaccination rates achieved during the 2005 vaccination drill with the vaccination rates achieved during the 2003 vaccination campaign. UIHC vaccinated 54% of HCWs (2,934 of 5,467) who provided direct patient care in 6 days. In 2 additional weeks, this rate increased to 66% (3,625 of 5,467). Overall, 66% of resident physicians (311 of 470) and 63% of nursing staff (1,429 of 2,255) were vaccinated. Vaccination rates in 2005 were significantly higher than the hospitalwide rate of 41% (5,741 of 14,086) in 2003. UIHC dramatically increased the influenza vaccination rate among HCWs by conducting a pandemic influenza preparedness drill. Additionally, the drill allowed us to conduct a bioemergency drill in a realistic scenario, use innovative methods for vaccine delivery, and secure administrative support for future influenza vaccination campaigns. Our study demonstrates how a drill can be used to improve vaccination rates significantly.

Diagnostic testing for pandemic influenza in Singapore: a novel dual-gene quantitative real-time RT-PCR for the detection of influenza A/H1N1/2009.

PubMed

Lee, Hong Kai; Lee, Chun Kiat; Loh, Tze Ping; Tang, Julian Wei-Tze; Chiu, Lily; Tambyah, Paul A; Sethi, Sunil K; Koay, Evelyn Siew-Chuan

2010-09-01

With the relative global lack of immunity to the pandemic influenza A/H1N1/2009 virus that emerged in April 2009 as well as the sustained susceptibility to infection, rapid and accurate diagnostic assays are essential to detect this novel influenza A variant. Among the molecular diagnostic methods that have been developed to date, most are in tandem monoplex assays targeting either different regions of a single viral gene segment or different viral gene segments. We describe a dual-gene (duplex) quantitative real-time RT-PCR method selectively targeting pandemic influenza A/H1N1/2009. The assay design includes a primer-probe set specific to only the hemagglutinin (HA) gene of this novel influenza A variant and a second set capable of detecting the nucleoprotein (NP) gene of all swine-origin influenza A virus. In silico analysis of the specific HA oligonucleotide sequence used in the assay showed that it targeted only the swine-origin pandemic strain; there was also no cross-reactivity against a wide spectrum of noninfluenza respiratory viruses. The assay has a diagnostic sensitivity and specificity of 97.7% and 100%, respectively, a lower detection limit of 50 viral gene copies/PCR, and can be adapted to either a qualitative or quantitative mode. It was first applied to 3512 patients with influenza-like illnesses at a tertiary hospital in Singapore, during the containment phase of the pandemic (May to July 2009).

Technology transfer of oil-in-water emulsion adjuvant manufacturing for pandemic influenza vaccine production in Romania.

PubMed

Fox, Christopher B; Huynh, Chuong; O'Hara, Michael K; Onu, Adrian

2013-03-15

Many developing countries lack or have inadequate pandemic influenza vaccine manufacturing capacity. In the 2009 H1N1 pandemic, this led to delayed and inadequate vaccine coverage in the developing world. Thus, bolstering developing country influenza vaccine manufacturing capacity is urgently needed. The Cantacuzino Institute in Bucharest, Romania has been producing seasonal influenza vaccine since the 1970s, and has the capacity to produce ∼5 million doses of monovalent vaccine in the event of an influenza pandemic. Inclusion of an adjuvant in the vaccine could enable antigen dose sparing, expanding vaccine coverage and potentially allowing universal vaccination of the Romanian population and possibly neighboring countries. However, adjuvant formulation and manufacturing know-how are difficult to access. This manuscript describes the successful transfer of oil-in-water emulsion adjuvant manufacturing and quality control technologies from the Infectious Disease Research Institute in Seattle, USA to the Cantacuzino Institute. By describing the challenges and accomplishments of the project, it is hoped that the knowledge and experience gained will benefit other institutes involved in similar technology transfer projects designed to facilitate increased vaccine manufacturing capacity in developing countries. Copyright © 2012 Elsevier Ltd. All rights reserved.

Identification of influenza A pandemic (H1N1) 2009 variants during the first 2009 influenza outbreak in Mexico City.

PubMed

Zepeda, Hector M; Perea-Araujo, Lizbeth; Zarate-Segura, Paola B; Vázquez-Pérez, Joel A; Miliar-García, Angel; Garibay-Orijel, Claudio; Domínguez-López, Aarón; Badillo-Corona, Jesús A; López-Orduña, Eduardo; García-González, Octavio P; Villaseñor-Ruíz, Ignacio; Ahued-Ortega, Armando; Aguilar-Faisal, Leopoldo; Bravo, Jorge; Lara-Padilla, Eleazar; García-Cavazos, Ricardo J

2010-05-01

In March 2009, public health surveillance detected increased numbers of influenza-like illness presenting to hospitals in Mexico City. The aetiological agent was subsequently determined to be a novel influenza A (H1N1) triple reassortant, which has spread worldwide. As a consequence the World Health Organisation has declared the first Influenza pandemic of the 21st century. To describe clinically and molecularly the first outbreak of influenza A pH1N1 (2009) during 1-5 May to establish a baseline of epidemiological data for pH1N1. Also, to monitor for the emergence of antiviral resistance, and mutations affecting virulence and transmissibility. Samples were collected from 751 patients with influenza-like symptoms throughout Mexico City and were tested for influenza A pH1N1 (2009) using real-time PCR. In the samples that were positive for influenza A pH1N1 (2009) fragments from the haemagglutinin (H1) and neuraminidase (N1) genes were sequenced. A total of 203/751 (27%) patients were positive for the pandemic H1N1 (2009) virus (53% male and 47% female). The 0-12-year-old group was the most affected 85/751 (42%). Sequence analysis showed five new variants of the pandemic H1N1 (2009) virus for NA: G249E (GQ292900), M269I (GQ292892), Y274H (GQ292913), T332A (GQ292933), N344K (GQ292882), and four variants for HA: N461K (GQ293006), K505R (GQ292989), I435V (GQ292995), I527N (GQ292997). We have provided a baseline of epidemiological data from the first outbreak of influenza A pH1N1 (2009) during 1-5 May in Mexico City. The sequencing of partial fragments of the HA and NA genes did not show the presence of previously described mutations affecting known sites of antiviral resistance in seasonal influenza A such as the H275Y (oseltamivir resistance), R293 or N295 etc. Copyright 2010 Elsevier B.V. All rights reserved.

Global Mortality Estimates for the 2009 Influenza Pandemic from the GLaMOR Project: A Modeling Study

PubMed Central

Simonsen, Lone; Spreeuwenberg, Peter; Lustig, Roger; Taylor, Robert J.; Fleming, Douglas M.; Kroneman, Madelon; Van Kerkhove, Maria D.; Mounts, Anthony W.; Paget, W. John

2013-01-01

Background Assessing the mortality impact of the 2009 influenza A H1N1 virus (H1N1pdm09) is essential for optimizing public health responses to future pandemics. The World Health Organization reported 18,631 laboratory-confirmed pandemic deaths, but the total pandemic mortality burden was substantially higher. We estimated the 2009 pandemic mortality burden through statistical modeling of mortality data from multiple countries. Methods and Findings We obtained weekly virology and underlying cause-of-death mortality time series for 2005–2009 for 20 countries covering ∼35% of the world population. We applied a multivariate linear regression model to estimate pandemic respiratory mortality in each collaborating country. We then used these results plus ten country indicators in a multiple imputation model to project the mortality burden in all world countries. Between 123,000 and 203,000 pandemic respiratory deaths were estimated globally for the last 9 mo of 2009. The majority (62%–85%) were attributed to persons under 65 y of age. We observed a striking regional heterogeneity, with almost 20-fold higher mortality in some countries in the Americas than in Europe. The model attributed 148,000–249,000 respiratory deaths to influenza in an average pre-pandemic season, with only 19% in persons <65 y. Limitations include lack of representation of low-income countries among single-country estimates and an inability to study subsequent pandemic waves (2010–2012). Conclusions We estimate that 2009 global pandemic respiratory mortality was ∼10-fold higher than the World Health Organization's laboratory-confirmed mortality count. Although the pandemic mortality estimate was similar in magnitude to that of seasonal influenza, a marked shift toward mortality among persons <65 y of age occurred, so that many more life-years were lost. The burden varied greatly among countries, corroborating early reports of far greater pandemic severity in the Americas than in

AF03-adjuvanted and non-adjuvanted pandemic influenza A (H1N1) 2009 vaccines induce strong antibody responses in seasonal influenza vaccine-primed and unprimed mice.

PubMed

Caillet, Catherine; Piras, Fabienne; Bernard, Marie-Clotilde; de Montfort, Aymeric; Boudet, Florence; Vogel, Frederick R; Hoffenbach, Agnès; Moste, Catherine; Kusters, Inca

2010-04-19

Pandemic influenza vaccines have been manufactured using the A/California/07/2009 (H1N1) strain as recommended by the World Health Organization. We evaluated in mice the immunogenicity of pandemic (H1N1) 2009 vaccine and the impact of prior vaccination against seasonal trivalent influenza vaccines (TIV) on antibody responses against pandemic (H1N1) 2009. In naïve mice, a single dose of unadjuvanted H1N1 vaccine (3 microg of HA) was shown to elicit hemagglutination inhibition (HI) antibody titers >40, a titer associated with protection in humans against seasonal influenza. A second vaccine dose of pandemic (H1N1) 2009 vaccine strongly increased these titers, which were consistently higher in mice previously primed with TIV than in naïve mice. At a low immunization dose (0.3 microg of HA), the AF03-adjuvanted vaccine elicited higher HI antibody titers than the corresponding unadjuvanted vaccines in both naïve and TIV-primed animals, suggesting a potential for antigen dose-sparing. These results are in accordance with the use in humans of a split-virion inactivated pandemic (H1N1) 2009 vaccine formulated with or without AF03 adjuvant to protect children and young adults against influenza A (H1N1) 2009 infection. Copyright 2010 Elsevier Ltd. All rights reserved.

Predictors of fatality in pandemic influenza A (H1N1) virus infection among adults

PubMed Central

2014-01-01

Background The fatality attributed to pandemic influenza A H1N1 was not clear in the literature. We described the predictors for fatality related to pandemic influenza A H1N1 infection among hospitalized adult patients. Methods This is a multicenter study performed during the pandemic influenza A H1N1 [A(H1N1)pdm09] outbreak which occurred in 2009 and 2010. Analysis was performed among laboratory confirmed patients. Multivariate analysis was performed for the predictors of fatality. Results In the second wave of the pandemic, 848 adult patients were hospitalized because of suspected influenza, 45 out of 848 (5.3%) died, with 75% of fatalities occurring within the first 2 weeks of hospitalization. Among the 241 laboratory confirmed A(H1N1)pdm09 patients, the case fatality rate was 9%. In a multivariate logistic regression model that was performed for the fatalities within 14 days after admission, early use of neuraminidase inhibitors was found to be protective (Odds ratio: 0.17, confidence interval: 0.03-0.77, p = 0.022), nosocomial infections (OR: 5.7, CI: 1.84-18, p = 0.013), presence of malignant disease (OR: 3.8, CI: 0.66-22.01, p = 0.133) significantly increased the likelihood of fatality. Conclusions Early detection of the infection, allowing opportunity for the early use of neuraminidase inhibitors, was found to be important for prevention of fatality. Nosocomial bacterial infections and underlying malignant diseases increased the rate of fatality. PMID:24916566

Public perceptions of pandemic influenza resource allocation: a deliberative forum using Grid/Group analysis.

PubMed

Docter, Stynke P; Street, Jackie; Braunack-Mayer, Annette J; van der Wilt, Gert-Jan

2011-08-01

The emergence of virulent avian influenza A subtypes with potential to evolve into novel human subtypes prompted directives from the World Health Organisation recommending that countries prepare for a pandemic. In response the Australian government developed the Australian Health Management Plan for Pandemic Influenza (AHMPPI), which includes strategies to contain and/or manage a pandemic. To implement these strategies successfully, community compliance is necessary. Our qualitative study investigated, through a deliberative forum, the extent to which the antiviral drug and vaccine allocation of the AHMPPI corresponds with community views about the priority groups. We used Mary Douglas' Grid/Group analysis to analyse the results, which suggested that the AHMPPI's allocation strategy corresponds well with community views with both based on a hierarchical structure. There are some differences concerning community involvement in the decision process and information provision to the public, for which our study provides recommendations.

Bulls, Bears, and Birds: Preparing the Financial Industry for an Avian Influenza Pandemic.

PubMed

Maldin, Beth; Inglesby, Thomas V; Nuzzo, Jennifer B; Lien, Onora; Gronvall, Gigi Kwik; Toner, Eric; O'Toole, Tara

2005-01-01

Bulls, Bears, and Birds: Preparing the Financial Industry for an Avian Influenza Pandemic was a half day symposium on avian influenza for senior leaders and decision makers from the financial sector with responsibility for business continuity, health, and security. The event brought together experts and leaders from the medical, public health, business continuity, and financial communities to appraise financial industry leaders on the threat of avian influenza and to offer suggestions regarding what the financial industry could do to prepare and respond.

Analysis of 2009 pandemic influenza A/H1N1 outcomes in 19 European countries: association with completeness of national strategic plans

PubMed Central

Meeyai, Aronrag; Cooper, Ben S; Coker, Richard

2013-01-01

Objective To describe changes in reported influenza activity associated with the 2009 H1N1 pandemic in European countries and determine whether there is a correlation between these changes and completeness of national strategic pandemic preparedness. Design A retrospective correlational study. Setting Countries were included if their national strategic plans had previously been analysed and if weekly influenza-like illness (ILI) data from sentinel networks between week 21, 2006 and week 20, 2010 were more than 50% complete. Outcome measures For each country we calculated three outcomes: the percentage change in ILI peak height during the pandemic relative to the prepandemic mean; the timing of the ILI peak and the percentage change in total cases relative to the prepandemic mean. Correlations between these outcomes and completeness of a country's national strategic pandemic preparedness plan were assessed using the Pearson product–moment correlation coefficient. Results Nineteen countries were included. The ILI peak occurred earlier than the mean seasonal peak in 17 countries. In 14 countries the pandemic peak was higher than the seasonal peak, though the difference was large only in Norway, the UK and Greece. Nine countries experienced more total ILI cases during the pandemic compared with the mean for prepandemic years. Five countries experienced two distinct pandemic peaks. There was no clear pattern of correlation between overall completeness of national strategic plans and pandemic influenza outcome measures and no evidence of association between these outcomes and components of pandemic plans that might plausibly affect influenza outcomes (public health interventions, vaccination, antiviral use, public communication). Amongst the 17 countries with a clear pandemic peak, only the correlation between planning for essential services and change in total ILI cases significantly differed from zero: correlation coefficient (95% CI) 0.50 (0.02, 0.79). Conclusions

Integrating pharmacies into public health program planning for pandemic influenza vaccine response.

PubMed

Fitzgerald, Thomas J; Kang, Yoonjae; Bridges, Carolyn B; Talbert, Todd; Vagi, Sara J; Lamont, Brock; Graitcer, Samuel B

2016-11-04