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Infectious disease outbreaks have occurred many times in the past decades and are more likely to occur in the future. Recently, Buyuktahtakin et al. (2018) proposed a new epidemics-logistics model ...

This article discusses a study of flu vaccine uptake and hesitancy in a rural community during the 2009–2010 H1N1 pandemic flu season. In it, we explore study participants’ understanding of the rel...

Not all individuals with Influenza like illness (ILI) seek healthcare. Knowing the proportion that do is important to evaluate the actual burden and fatality rate of ILI-relevant diseases, such as seasonal influenza and human infection with avian influenza. A number of studies have investigated the healthcare seeking rate, but the results varied from 0.16 to 0.85. We conducted this analysis for better understanding the healthcare seeking rate for ILI, and providing fundamental data for researchers in relevant fields.In this meta-analysis, a total of 799 articles, published as of 13 December 2016, were retrieved from Pubmed, Embase, Web of Science and Cochrane, and 11 of them were included after screening. The pooled estimates and factors which influence healthcare seeking rates were analysed.The overall pooled healthcare seeking rate was 0.52 (95% CI: 0.46-0.59). The rate was significantly higher during the H1N1 pandemic in 2009 (0.61, 95% CI: 0.51-0.74), in children (0.56, 95% CI: 0.55-0.57) and in patients with documented fever (0.62, 95% CI: 0.53-0.72) than during non-pandemic periods (0.39, 95% CI: 0.33-0.45), in adults (0.45, 95% CI: 0.42-0.48) and in patients without documented fever (0.44, 95% CI: 0.38-0.50). Meta-regression indicated that these three factors could jointly explain 70.1% of the total heterogeneity among published studies.The healthcare seeking rate of ILI patients is needed for estimation of the burden of ILI in the general population based on data from routine ILI sentinel surveillance systems.

During the H1N1 pandemic in Canada, health authorities across the country implemented pandemic plans which emphasized the importance of communicating with the public in an open, clear, and transpar...

In previous research on severe acute respiratory syndrome (SARS) and West Nile virus, empathic responding has been associated with higher perceived threat during a pandemic as well as the implementation of recommended health precautions. The goal of the current study was to investigate the role of empathic responding outside of a Western context by examining the endorsement of specific health precautions during the 2009–2010 H1N1 pandemic in India. Responses to questions about Centers for Disease Control recommended health precautions, perceived threat and empathic responding were collected from 100 individuals living in the city of Dharwad in India’s Karnataka state. Analyses revealed that individuals who responded to the threat of H1N1 with greater empathy were more likely to endorse recommended health behaviours (i.e. vaccination, handwashing and disinfectant use). These effects remained when controlling for gender, perceived threat of H1N1 and other disease-relevant coping responses of denial and wish...

Pregnant women are considered to be susceptible to severe influenza illness and are recommended as a priority group to be targeted for influenza vaccination in countries with vaccination programs. Increased rates of poor birth outcomes have also been temporally associated with influenza infection, especially when pandemics strains emerge. Even though the primary purpose for influenza vaccination during pregnancy is to decrease the risk of influenza infection in the women, other potential benefits include protection of their young infants against influenza illness and possibly improving birth outcomes. The 2009 influenza A/H1N1 pandemic highlighted the importance of influenza vaccination during pregnancy, after pregnant women were identified as a group with heightened morbidity and mortality during the pandemic. A few studies conducted before the 2009/10 season and a large number of reports during and after the 2009 pandemic have assessed the association between maternal influenza vaccination and birth outcomes. Although these studies indicate that influenza vaccination is safe for both the mother and the fetus, there are conflicting data on the effect of vaccination in improving preterm birth rates. We reviewed the 2 published randomized control trials and other observational studies that explored the relationship between maternal influenza vaccination and preterm births.

The article starts from the premise that invasive life has the capacity to produce human communities. Invasive life is conceptualized as a way in which humans categorize proliferating organisms as ‘non‐native’ to a particular territory. The article focuses on the kind of relationship of human beings to invasive life that invokes a sense of ‘being under attack’ on the human side. It is argued that the threat of invasive life produces ‘communities of fate’, which are theorized for the sake of this article in close relation to the concept of ‘communities of practice’. The social dynamics set in motion by such community formation are further analysed in relation to two different case studies: (1) the emergence of the 2009 H1N1 pandemic in Mexico, and (2) the invasive plants eradication campaign of a group of activists in Germany. The article concludes by discussing the merits of analysing social dynamics and community formation in relation to challenges posed by invasive life.

One distinguishing feature of modernity is a shift from fate to risk as a central explanatory principle for uncertainty and danger. Framing the future in terms of risk creates the possibility – and, increasingly, responsibility – for prevention. This study analyses qualitative data from semi-structured interviews with 20 physicians and 43 members of the general public in Japan during the H1N1 influenza pandemic of 2009 to examine how risk and responsibility were imagined, managed, and reorganised through preventative behaviours. I examined respondents’ discussions of a specific preventative recommendation issued in Japan during the 2009 pandemic: prophylactic gargling. I found that Japanese doctors had mixed, often conflicting, opinions about the efficacy of gargling to prevent infection; most felt its usefulness as a recommendation lay in its capacity to give patients the belief that they could mitigate the risk of infection. Doctors who were openly dubious about the effectiveness of gargling in reducing...

This survey study compared pre- and post-pandemic knowledge, attitudes, beliefs, and intended behaviors of pregnant women regarding influenza vaccination (seasonal and/or pandemic) during pregnancy in order to determine key factors influencing their decision to adhere to influenza vaccine recommendations. Only 36% of 662 pre-pandemic respondents knew that influenza was more severe in pregnant women, compared to 62% of the 159 post-pandemic respondents. Of the pre-pandemic respondents, 41% agreed or strongly agreed that that it was safer to wait until after the first 3 months to receive the seasonal influenza vaccine, whereas 23% of the post-pandemic cohort agreed or strongly agreed; 32% of pre-pandemic participants compared to 11% of post-pandemic respondents felt it was best to avoid all vaccines while pregnant. Despite 61% of the pre-pandemic cohort stating that they would have the vaccine while pregnant if their doctor recommended it and 54% citing their doctor/nurse as their primary source of vaccine information, only 20% said their doctor discussed influenza vaccination during their pregnancy, compared to 77% of the post-pandemic respondents who reported having this conversation. Women whose doctors discussed influenza vaccine during pregnancy had higher overall knowledge scores (P < 0.0001; P = 0.005) and were more likely to believe the vaccine is safe in all stages of pregnancy (P < 0.0001; P = 0.001) than those whose doctors did not discuss influenza vaccination. The 2009 H1N1 pandemic experience appeared to change attitudes and behaviours of health care providers and their pregnant patients toward influenza vaccination.

Preventing influenza-like illness (ILI) during pregnancy with antiviral medication use (AVMU) can mitigate serious health risks to mother and foetus. We report on AVMU in pregnant women in Ontario, Canada, and describe characteristics of AVMU during the 2009-2010 H1N1 pandemic. Rates and risk estimates of AVMU were compared across multiple categories and stratified across ILI infection status. Increased AVMU was observed in women with influenza infections, active smokers, those vaccinated against influenza, and those with pre-existing co-morbidities. Decreased AVMU was observed in women with multiple gestations, and those in neighbourhoods of high immigrant concentrations. Our stratified analysis indicated that the observed patterns differed by ILI infection status. We demonstrated that once infected, women across multiple groups were equally likely to use antiviral medications. In this report we also propose possible clinical explanations for the observed differences in AVMU, which will be useful in planning prevention initiatives for future pandemics.

Health Web sites dramatically mushroomed following the arrival of the Internet in the 1990s. However, the accessibility of these Web sites must be continuously assessed to ensure consumers gain easy access to required health information. Accessibility becomes especially critical when information must be disseminated quickly, as in the case of the 2009 H1N1 pandemic. This article will examine the accessibility of three government health Web sites providing information on H1N1. Findings suggest variation in the level of accessibility, with the U.S and Canadian Web sites fulfilling the most accessibility criteria and the Mexican Web site scoring the least. The accessibility assessment provides important preliminary findings for future research into information dissemination during a health emergency and has important implications for health Web page development.

H5N1 is a highly pathogenic avian influenza virus that can cause severe disease and death in humans. H5N1 is spreading rapidly in bird populations and there is great concern that this virus will begin to transmit between people and cause a global crisis. Vaccines are the cornerstone strategy for combating avian influenza but there are complex challenges for pandemic preparedness including the unpredictability of the vaccine target and the manufacturing requirement for rapid deployment. The less-than-optimal response against the 2009 H1N1 pandemic unmasked the limitations associated with influenza vaccine production and in 2010, the President’s Council of Advisors on Science and Technology re-emphasized the need for new recombinant-based vaccines and adjuvants that can shorten production cycles, maximize immunogenicity and satisfy global demand. In this article, the authors review the efforts spent in developing an effective vaccine for H5N1 influenza and summarize clinical studies that highlight the progress made to date.

This study uses the cognitive mediation model as the theoretical framework to examine the influence of motivations, communication, and news elaboration on public knowledge of the H1N1 pandemic and the intention to take precautionary behaviors in Singapore. Using a nationally representative random digit dialing telephone survey of 1,055 adult Singaporeans, the authors' results show that the cognitive mediation model can be applied to health contexts, in which motivations (surveillance gratification, guidance, and need for cognition) were positively associated with news attention, elaboration, and interpersonal communication. News attention, elaboration, and interpersonal communication in turn positively influence public knowledge about the H1N1 influenza. In addition, results show that the motivations have significant indirect effects on behavioral intentions, as partially mediated by communication (media attention and interpersonal communication), elaboration, and knowledge. The authors conclude that the cognitive mediation model can be extended to behavioral outcomes, above and beyond knowledge. Implications for theory and practice for health communication were discussed. Accepted version

The aim of the study was to estimate the risk factors associated with the 2009 H1N1 influenza infection, during pregnancy; to describe complications and obstetric and perinatal outcomes of pregnancies during the H1N1 pandemic in 2009; to identify if there is teratogenicity at birth after antiviral treatment. Medical records of 168 pregnant women treated in Reina Sofia University Hospital (Cordoba, Spain) for suspected influenza A H1N1 from September 2009 to February 2010 were analysed. Using the PCR test, 76 pregnant women were diagnosed with H1N1 + infection, and infection was ruled out in the remaining 92. To manage the pandemic, recommendations of the Centres for Disease Control and Prevention were followed. Results showed that the majority of pregnant women were attended at the hospital between October and December 2009 (91.27%). Most of them were in the third-quarter of pregnancy (42.9%). In our sample, being aged between 29 and 37 years reduces the risk of acquiring infection (odds ratio, OR 0.379, 95% confidence interval, CI 0.188-0.763). However, in pregnant women who have required hospitalisation, the risk of infection increased five-fold (OR = 4.999; 95% CI = 1.178-21.212). No differences were found between obstetric and perinatal outcomes of both affected and unaffected or treated and untreated cohorts. No teratogenicity was observed at birth. It was concluded that maternal age and 3rd trimester pregnancy were found related to the risk of acquiring H1N1. No differences in obstetric outcomes or worse perinatal outcomes were found in patients affected by the pandemic. Early prophylactic treatment may be related to better maternal-fetal results.

Objective: This study assessed the immunogenicity, long-term persistence of immune response and safety of a single dose of an A/California/07/2009 H1N1 pandemic influenza vaccine adjuvanted with AS03 (α-tocopherol and squalene based oil-in-water emulsion Adjuvant System) in subjects ≥ 65 y of age (NCT01114620). Results: At Day 21, the HI immune response met all three European guidance criteria [seroconversion rate (SCR): 60.0%; seroprotection rate (SPR): 64.0%; geometric mean fold rise (GMFR): 10.2] and the US guidance criterion for SCR. At month 6, the HI immune response against the A/California/07/2009 H1N1 strain persisted but at levels lower than that observed at Day 21 (SCR: 38.8%; SPR: 42.9%; HI antibody geometric mean titer: 27.6); the European regulatory guidance criteria for SCR and GMFR were still met. Overall, the vaccine was well-tolerated. Conclusion A single dose of the 3.75µg HA AS03-adjuvanted H1N1 2009 pandemic vaccine induced immune responses against the vaccine strain that met the European regulatory guidance criteria at day 21 in the elderly Japanese population; the immune response persisted at lower levels at month 6. No safety concerns were identified. These results suggest that two vaccine doses might be useful for the elderly population to improve antibody induction and persistence. Methods: In this open-label, single group study, 50 subjects received one dose of the 3.75 µg hemagglutinin (HA) AS03-adjuvanted H1N1 2009 vaccine. Immunogenicity assessments were made before vaccination, 21 days and six months after vaccination using hemagglutination inhibition (HI) and microneutralization assays. Immunogenicity end points were based on US and European regulatory criteria.

This study analyzes US and South Korean news coverage of the H1N1 pandemic to examine cross-cultural variations in attention cycle patterns, cited sources, and news frames. A content analysis was conducted on 630 articles from US and Korean newspapers during the period of April to October 2009. It found that attention cycle patterns, news frames, and sources varied across the two countries according to professional norms, cultural values, social ideologies, and occurrences of relevant events. While US news coverage showed two phases of waxing and waning attention, Korean news coverage showed five phases. The frames used in US news stories placed more emphasis on attribution of responsibility, action, and reassurance. Other framing variations were found as news attention in each country rose and fell. Regarding sources used, Korean news stories relied more on governmental sources, while US news stories used a greater diversity of sources. This study advances research on variations in the attention cycle fo...

In May 2011, the World Health Assembly will receive the report of its International Health Regulations Review Committee examining responses to the outbreak of the 2009 H1N1 pandemic influenza and identifying lessons to be learnt. This will emphasise the need for better risk communication in future. But risk and communication are not objective facts; they are socially mediated cultural products. Responses to crises are not only simply determined by the situation at hand, but also through mental models developed over protracted periods. Accordingly, those responsible for advocating the precautionary approach and encouraging the securitisation of health, that both helped encourage a catastrophist outlook in this instance, are unlikely to be held to account. These elite confusions have come at an enormous cost to society.

Asthma seems to be the more prevalent underlying condition in patients hospitalized for H1N1-related flu.A prospective survey was conducted during the early phase of H1N1 pandemic in France in asthmatic children before vaccination to assess whether severe exacerbations in childhood asthma are associated with influenza-like illness (ILI, the definition of H1N1-related flu in a pandemic). Eight pediatricians in primary care distributed in three localities (Paris, south suburb, and west suburb) conducted the survey (4 weeks/locality from week 36 to 47). At each visit, the pediatrician filled a questionnaire entering the information regarding asthma treatment, severe exacerbation (at least 3 days' use of systemic corticosteroids), and ILI (temperature ≥37.8°C, cough, and/or sore throat, in the absence of a known cause other than influenza) during the past 3 weeks.The survey included 1155 asthmatic children (mean age [SD]: 7.5 years [4.1]); almost all visits were scheduled (99%). A severe exacerbation was recorded in 121 children [10.5%; 95% confidence interval (CI): 8.7-12.2%], which was concomitant with ILI in 20 children (16.5%; 95% CI: 9.9-23.2%), whereas 1034 children did not exhibit any exacerbation. In these latter children, 40 ILI were observed (3.9%; 95% CI: 2.7-5.0%), which constituted a significantly lesser percentage as compared with children with both exacerbation and ILI (p.0001). This result remained significant in each locality. Overall, 60/1155 (5.2%; 95% CI: 3.9-6.5%) asthmatic children had an ILI.Our survey shows that severe exacerbation and ILI are strongly associated during the H1N1 pandemic in asthmatic children.

This paper describes our experience of the novel H1N1 pandemic at Tygerberg Children’s Hospital. Twenty-six children with polymerase chain reaction (PCR)-confrmed H1N1 infection were hospitalised between 1 July 2009 and 30 September 2009. Seventy-three per cent (19/26) had underlying co-morbidities. Cough and/or dyspnoea (92%) and fever (54%) were the main presenting features. Seven children (27%) required intensive care management, with one death. Nosocomial transmission was suspected in 6/26 (23%) children. The H1N1 pandemic caused morbidity especially among low birthweight, premature infants. There is a need for continued vigilance, improved isolation facilities and appropriate immunisation.

Objective This report presents a review of the efficacy and safety of peramivir, a neuraminidase inhibitor that was granted Emergency Use Authorization by the US Food and Drug Administration (FDA) from October 23, 2009 to June 23, 2010 during the 2009 H1N1 pandemic. Methods Literature was accessed via PubMed (January 2000–April 2014) using several search terms: peramivir; BCX-1812; RWJ 270201; H1N1, influenza; antivirals; and neuraminidase inhibitors. The peramivir manufacturers, Shionogi and Co Ltd and BioCryst Pharmaceuticals, were contacted to obtain unpublished data and information presented at recent scientific meetings. Information was obtained from the Centers for Disease Control and Prevention (CDC) and from US FDA websites. English-language and Japanese-language reports in the literature were reviewed and selected based on relevance, along with information from the CDC, US FDA, and the drug manufacturers. Results We obtained eleven clinical trial reports of intravenous peramivir, two of which described comparisons with oseltamivir. Seven of nine other recently reported published studies was a dose–response study. Clinical reports of critically ill patients and pediatric patients infected with pandemic H1N1 described that early treatment significantly decreased mortality. Peramivir administered at 300 mg once daily in adult patients with influenza significantly reduces the time to alleviation of symptoms or fever compared to placebo. It is likely to be as effective as other neuraminidase inhibitors. Conclusion Although peramivir shows efficacy for the treatment of seasonal and pH1N1 influenza, it has not received US FDA approval. Peramivir is used safely and efficiently in hospitalized adult and pediatric patients with suspected or laboratory-confirmed influenza. Peramivir might be a beneficial alternative antiviral treatment for many patients, including those unable to receive inhaled or oral neuraminidase inhibitors, or those requiring nonintravenous drug delivery.