Research Article: Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling

Date Published: June 1, 2010

Publisher: Public Library of Science

Author(s): Maria D. Van Kerkhove, Tommi Asikainen, Niels G. Becker, Steven Bjorge, Jean-Claude Desenclos, Thais dos Santos, Christophe Fraser, Gabriel M. Leung, Marc Lipsitch, Ira M. Longini, Emma S. McBryde, Cathy E. Roth, David K. Shay, Derek J. Smith, Jacco Wallinga, Peter J. White, Neil M. Ferguson, Steven Riley

Abstract: In light of the 2009 influenza pandemic and potential future pandemics, Maria Van Kerkhove and colleagues anticipate six public health challenges and the data needed to support sound public health decision making.

Partial Text: The emergence and global spread of a novel strain of human influenza A/H1N1 during 2009 (pandemic [H1N1] 2009 influenza, or H1N1pdm) has highlighted the importance of data from both detailed outbreak investigations and population surveillance for the support of public health decision making. For example, public health organizations in several countries undertook detailed case investigations to build databases of the first few hundred cases, which include laboratory confirmation status, age, relative severity, exposure history, onset of symptoms, and contact history (for example, the UK First Few Hundred project [1]). Descriptive analyses of such data allowed decision-makers to conclude rapidly that the disease caused by the novel strain was relatively mild for the majority of confirmed cases and that it was being transmitted efficiently between children. Therefore, most countries decided that stringent interventions at the community level (such as proactive school closures) were not appropriate, because their benefits were limited when compared with the high overall cost to society. Population surveillance was also crucial in the early stages of the pandemic. Indeed, the two independent influenza cases [2] that provided the viral isolates used to discern the presence of a novel strain were obtained through a sentinel surveillance system designed for exactly that purpose [3].

While there have been recommendations focusing on how to maintain and enhance population-level surveillance when in most countries case numbers have far exceeded routine testing capacity [12],[18], here we suggest specific nonroutine data that will help public health policy makers to address six public health challenges that we anticipate will continue for the next 12 to 18 months. Because of inherent biases in the routine reporting of cases of differing levels of severity, sufficiently powered representative serological surveys will be useful in the short and medium term to help quantify the degree of susceptibility in the population and to help characterize individual-level severity. Systematic reporting of the incidence of ARI and SARI will help to characterize the speed of growth of the epidemic and hence allow the detection of significant changes in underlying transmissibility. Specific data gathering processes are also required to accurately define the clinical spectrum of severe disease, measure excess mortality in a timely fashion, and help to rapidly detect possible vaccine escape, antiviral resistant strains, and other mutant strains.



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