We should not be complacent about our population-based public health response to the first influenza pandemic of the 21stcentury
Identifieur interne : 000777 ( Pmc/Checkpoint ); précédent : 000776; suivant : 000778We should not be complacent about our population-based public health response to the first influenza pandemic of the 21stcentury
Auteurs : Heath A. Kelly [Australie] ; Patricia C. Priest [Nouvelle-Zélande] ; Geoffry N. Mercer [Australie] ; Gary K. Dowse [Australie]Source :
- BMC Public Health [ 1471-2458 ] ; 2011.
Abstract
More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over. Evaluations of the pandemic response are beginning to appear in the public domain.
We argue that, despite the enormous effort made to control the pandemic, it is now time to acknowledge that many of the population-based public health interventions may not have been well considered. Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide. In most countries where they were available, neuraminidase inhibitors were not distributed quickly enough to have had an effect at the population level, although they will have benefited individuals, and prophylaxis within closed communities will have been effective. A pandemic specific vaccine will have protected the people who received it, although in most countries only a small minority was vaccinated, and often a small minority of those most at risk. The pandemic vaccine was generally not available early enough to have influenced the shape of the first pandemic wave and it is likely that any future pandemic vaccine manufactured using current technology will also be available too late, at least in one hemisphere.
Border screening, school closure, widespread anti-viral prophylaxis and a pandemic-specific vaccine were unlikely to have been effective during a pandemic which was less severe than anticipated in the pandemic plans of many countries. These were cornerstones of the population-based public health response. Similar responses would be even less likely to be effective in a more severe pandemic. We agree with the recommendation from the World Health Organisation that pandemic preparedness plans need review.
Url:
DOI: 10.1186/1471-2458-11-78
PubMed: 21291568
PubMed Central: 3048535
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">We should not be complacent about our population-based public health response to the first influenza pandemic of the 21<sup>st</sup>century</title><author><name sortKey="Kelly, Heath A" sort="Kelly, Heath A" uniqKey="Kelly H" first="Heath A" last="Kelly">Heath A. Kelly</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.433799.3</institution-id><institution-id institution-id-type="ISNI">0000000406374986</institution-id><institution>Victorian Infectious Diseases Reference Laboratory,</institution></institution-wrap>Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Melbourne</wicri:regionArea></affiliation></author><author><name sortKey="Priest, Patricia C" sort="Priest, Patricia C" uniqKey="Priest P" first="Patricia C" last="Priest">Patricia C. Priest</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.29980.3a</institution-id><institution-id institution-id-type="ISNI">0000000419367830</institution-id><institution>Department of Preventive and Social Medicine,</institution><institution>University of Otago,</institution></institution-wrap>Dunedin, New Zealand</nlm:aff><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Dunedin</wicri:regionArea></affiliation></author><author><name sortKey="Mercer, Geoffry N" sort="Mercer, Geoffry N" uniqKey="Mercer G" first="Geoffry N" last="Mercer">Geoffry N. Mercer</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.1001.0</institution-id><institution-id institution-id-type="ISNI">0000000121807477</institution-id><institution>National Centre for Epidemiology and Population Health,</institution><institution>Australian National University,</institution></institution-wrap>Canberra, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Canberra</wicri:regionArea></affiliation></author><author><name sortKey="Dowse, Gary K" sort="Dowse, Gary K" uniqKey="Dowse G" first="Gary K" last="Dowse">Gary K. Dowse</name><affiliation wicri:level="1"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.413880.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 0453 2856</institution-id><institution>Communicable Diseases Control Directorate, Department of Health Western Australia,</institution></institution-wrap>Perth, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Perth</wicri:regionArea></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">21291568</idno><idno type="pmc">3048535</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3048535</idno><idno type="RBID">PMC:3048535</idno><idno type="doi">10.1186/1471-2458-11-78</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000102</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000102</idno><idno type="wicri:Area/Pmc/Curation">000102</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Curation">000102</idno><idno type="wicri:Area/Pmc/Checkpoint">000777</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Checkpoint">000777</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">We should not be complacent about our population-based public health response to the first influenza pandemic of the 21<sup>st</sup>century</title><author><name sortKey="Kelly, Heath A" sort="Kelly, Heath A" uniqKey="Kelly H" first="Heath A" last="Kelly">Heath A. Kelly</name><affiliation wicri:level="1"><nlm:aff id="Aff1"><institution-wrap><institution-id institution-id-type="GRID">grid.433799.3</institution-id><institution-id institution-id-type="ISNI">0000000406374986</institution-id><institution>Victorian Infectious Diseases Reference Laboratory,</institution></institution-wrap>Melbourne, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Melbourne</wicri:regionArea></affiliation></author><author><name sortKey="Priest, Patricia C" sort="Priest, Patricia C" uniqKey="Priest P" first="Patricia C" last="Priest">Patricia C. Priest</name><affiliation wicri:level="1"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="GRID">grid.29980.3a</institution-id><institution-id institution-id-type="ISNI">0000000419367830</institution-id><institution>Department of Preventive and Social Medicine,</institution><institution>University of Otago,</institution></institution-wrap>Dunedin, New Zealand</nlm:aff><country xml:lang="fr">Nouvelle-Zélande</country><wicri:regionArea>Dunedin</wicri:regionArea></affiliation></author><author><name sortKey="Mercer, Geoffry N" sort="Mercer, Geoffry N" uniqKey="Mercer G" first="Geoffry N" last="Mercer">Geoffry N. Mercer</name><affiliation wicri:level="1"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.1001.0</institution-id><institution-id institution-id-type="ISNI">0000000121807477</institution-id><institution>National Centre for Epidemiology and Population Health,</institution><institution>Australian National University,</institution></institution-wrap>Canberra, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Canberra</wicri:regionArea></affiliation></author><author><name sortKey="Dowse, Gary K" sort="Dowse, Gary K" uniqKey="Dowse G" first="Gary K" last="Dowse">Gary K. Dowse</name><affiliation wicri:level="1"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="GRID">grid.413880.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 0453 2856</institution-id><institution>Communicable Diseases Control Directorate, Department of Health Western Australia,</institution></institution-wrap>Perth, Australia</nlm:aff><country xml:lang="fr">Australie</country><wicri:regionArea>Perth</wicri:regionArea></affiliation></author></analytic><series><title level="j">BMC Public Health</title><idno type="eISSN">1471-2458</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p>More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over. Evaluations of the pandemic response are beginning to appear in the public domain.</p></sec><sec><title>Discussion</title><p>We argue that, despite the enormous effort made to control the pandemic, it is now time to acknowledge that many of the population-based public health interventions may not have been well considered. Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide. In most countries where they were available, neuraminidase inhibitors were not distributed quickly enough to have had an effect at the population level, although they will have benefited individuals, and prophylaxis within closed communities will have been effective. A pandemic specific vaccine will have protected the people who received it, although in most countries only a small minority was vaccinated, and often a small minority of those most at risk. The pandemic vaccine was generally not available early enough to have influenced the shape of the first pandemic wave and it is likely that any future pandemic vaccine manufactured using current technology will also be available too late, at least in one hemisphere.</p></sec><sec><title>Summary</title><p>Border screening, school closure, widespread anti-viral prophylaxis and a pandemic-specific vaccine were unlikely to have been effective during a pandemic which was less severe than anticipated in the pandemic plans of many countries. These were cornerstones of the population-based public health response. Similar responses would be even less likely to be effective in a more severe pandemic. 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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Public Health</journal-id><journal-id journal-id-type="iso-abbrev">BMC Public Health</journal-id><journal-title-group><journal-title>BMC Public Health</journal-title></journal-title-group><issn pub-type="epub">1471-2458</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">21291568</article-id><article-id pub-id-type="pmc">3048535</article-id><article-id pub-id-type="publisher-id">2809</article-id><article-id pub-id-type="doi">10.1186/1471-2458-11-78</article-id><article-categories><subj-group subj-group-type="heading"><subject>Debate</subject></subj-group></article-categories><title-group><article-title>We should not be complacent about our population-based public health response to the first influenza pandemic of the 21<sup>st</sup>century</article-title></title-group><contrib-group><contrib contrib-type="author" corresp="yes"><name><surname>Kelly</surname><given-names>Heath A</given-names></name><address><email>heath.kelly@mh.org.au</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Priest</surname><given-names>Patricia C</given-names></name><address><email>patricia.priest@otago.ac.nz</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Mercer</surname><given-names>Geoffry N</given-names></name><address><email>geoff.mercer@anu.edu.au</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author"><name><surname>Dowse</surname><given-names>Gary K</given-names></name><address><email>gary.dowse@health.wa.gov.au</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><aff id="Aff1"><label>1</label><institution-wrap><institution-id institution-id-type="GRID">grid.433799.3</institution-id><institution-id institution-id-type="ISNI">0000000406374986</institution-id><institution>Victorian Infectious Diseases Reference Laboratory,</institution></institution-wrap>Melbourne, Australia</aff><aff id="Aff2"><label>2</label><institution-wrap><institution-id institution-id-type="GRID">grid.29980.3a</institution-id><institution-id institution-id-type="ISNI">0000000419367830</institution-id><institution>Department of Preventive and Social Medicine,</institution><institution>University of Otago,</institution></institution-wrap>Dunedin, New Zealand</aff><aff id="Aff3"><label>3</label><institution-wrap><institution-id institution-id-type="GRID">grid.1001.0</institution-id><institution-id institution-id-type="ISNI">0000000121807477</institution-id><institution>National Centre for Epidemiology and Population Health,</institution><institution>Australian National University,</institution></institution-wrap>Canberra, Australia</aff><aff id="Aff4"><label>4</label><institution-wrap><institution-id institution-id-type="GRID">grid.413880.6</institution-id><institution-id institution-id-type="ISNI">0000 0004 0453 2856</institution-id><institution>Communicable Diseases Control Directorate, Department of Health Western Australia,</institution></institution-wrap>Perth, Australia</aff></contrib-group><pub-date pub-type="epub"><day>3</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="pmc-release"><day>3</day><month>2</month><year>2011</year></pub-date><pub-date pub-type="collection"><year>2011</year></pub-date><volume>11</volume><elocation-id>78</elocation-id><history><date date-type="received"><day>15</day><month>10</month><year>2010</year></date><date date-type="accepted"><day>3</day><month>2</month><year>2011</year></date></history><permissions><copyright-statement>© Kelly et al; licensee BioMed Central Ltd. 2011</copyright-statement><license license-type="OpenAccess"><license-p>This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/2.0">http://creativecommons.org/licenses/by/2.0</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract id="Abs1"><sec><title>Background</title><p>More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over. Evaluations of the pandemic response are beginning to appear in the public domain.</p></sec><sec><title>Discussion</title><p>We argue that, despite the enormous effort made to control the pandemic, it is now time to acknowledge that many of the population-based public health interventions may not have been well considered. Prior to the pandemic, there was limited scientific evidence to support border control measures. In particular no border screening measures would have detected prodromal or asymptomatic infections, and asymptomatic infections with pandemic influenza were common. School closures, when they were partial or of short duration, would not have interrupted spread of the virus in school-aged children, the group with the highest rate of infection worldwide. In most countries where they were available, neuraminidase inhibitors were not distributed quickly enough to have had an effect at the population level, although they will have benefited individuals, and prophylaxis within closed communities will have been effective. A pandemic specific vaccine will have protected the people who received it, although in most countries only a small minority was vaccinated, and often a small minority of those most at risk. The pandemic vaccine was generally not available early enough to have influenced the shape of the first pandemic wave and it is likely that any future pandemic vaccine manufactured using current technology will also be available too late, at least in one hemisphere.</p></sec><sec><title>Summary</title><p>Border screening, school closure, widespread anti-viral prophylaxis and a pandemic-specific vaccine were unlikely to have been effective during a pandemic which was less severe than anticipated in the pandemic plans of many countries. These were cornerstones of the population-based public health response. Similar responses would be even less likely to be effective in a more severe pandemic. We agree with the recommendation from the World Health Organisation that pandemic preparedness plans need review.</p></sec></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Influenza</kwd><kwd>Oseltamivir</kwd><kwd>Pandemic Influenza</kwd><kwd>Zanamivir</kwd><kwd>Influenza Infection</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2011</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><affiliations><list><country><li>Australie</li><li>Nouvelle-Zélande</li></country></list><tree><country name="Australie"><noRegion><name sortKey="Kelly, Heath A" sort="Kelly, Heath A" uniqKey="Kelly H" first="Heath A" last="Kelly">Heath A. Kelly</name></noRegion><name sortKey="Dowse, Gary K" sort="Dowse, Gary K" uniqKey="Dowse G" first="Gary K" last="Dowse">Gary K. Dowse</name><name sortKey="Mercer, Geoffry N" sort="Mercer, Geoffry N" uniqKey="Mercer G" first="Geoffry N" last="Mercer">Geoffry N. Mercer</name></country><country name="Nouvelle-Zélande"><noRegion><name sortKey="Priest, Patricia C" sort="Priest, Patricia C" uniqKey="Priest P" first="Patricia C" last="Priest">Patricia C. Priest</name></noRegion></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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