Researchers Urge World Not to Become Complacent About Influenza

More than a year after an influenza pandemic was declared in June 2009, the World Health Organization declared the pandemic to be over, and valuations of the pandemic response are beginning to appear in the public domain. Heath A Kelly, of the Victorian Infectious Diseases Reference Laboratory in Melbourne, Australia, and colleagues, assert 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." Their commentary was published in BMC Public Health.

They add that, "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."

The researchers summarize that 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. They note, "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 Organization that pandemic preparedness plans need review."

Reference: Kelly HA, Priest PC, Mercer GN and Dowse GK. We should not be complacent about our population-based public health response to the first influenza pandemic of the 21st century. BMC Public Health 2011, 11:78doi:10.1186/1471-2458-11-78.