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Background To increase the influenza vaccination rate in Chiburijima Island, we diversified vaccination places from a single clinic to the seven town halls from all the districts. Methods We retrospectively analyzed influenza vaccination coverage, vaccinees' district of residence, and location of vaccination place, from prevaccination screening questionnaires between October 2007 and March 2018. Except for home‐visiting vaccination services, before 2011, influenza vaccination was provided only at a single clinic; after 2012, it was provided at the seven town halls in addition to the clinic. We calculated the vaccination rates among residents of Chiburijima Island, stratified by age groups and districts of residence. Results Estimated influenza vaccination rates for all ages increased from 38% in 2007 to 58% in 2017. There was a 14% increase in coverage in 2010 (the year following the 2009 H1N1 pandemic) and a slight increasing trend after 2012. The vaccination coverage of residents, particularly of people ≥65 years old and living >1 km from the former vaccination place, increased after diversification of the vaccination place. Conclusions Influenza vaccination rate in Chiburijima Island increased by 20% between 2007 and 2017, although the rate among the elderly Japanese people decreased by 4% based on the national data of routine immunization. Shortening the distance to vaccination places might improve the coverage as elderly people are often restricted due to transportation means. Sustained and multifaceted strategies are necessary for better immunization coverage.

The power of social actors to drive or block pharmaceutical uptake has been a concern in sociological debates on pharmaceuticalisation, including in the case of pandemic vaccination. We build on Steven Lukes' three-dimensional view of power to explore the 2009 H1N1 pandemic vaccination in Sweden and Denmark - two similar countries that arrived at conflicting vaccination strategies. Drawing on interviews with members of each country's pandemic steering group and on document analysis, we explore three consecutive stages of pandemic vaccination response: planning, vaccine procurement and the vaccination campaign. The paper makes two contributions to studies of pharmaceuticalisation and pandemics. Conceptually, we advocate the suitability of Lukes' framework over the 'countervailing powers' framework repeatedly used to model power in the pharmaceutical field. Empirically, our study confirms that government-appointed experts steered pandemic planning in both countries, but we show that the state, industry and the WHO also exerted power by enabling and constraining experts' decision-making, including by keeping some information secret. Furthermore, we argue that mass vaccination in Sweden was a pervasive expression of state power, in Lukes' sense, since it rested on keeping latent the tension between many individuals' health interests and the state's interests in protecting social and economic functioning.

This article aims at understanding the challenges of tackling complex policy problems in multilevel governance. In order to better grasp the multilevel regulation of complex policy problems, it is needed to understand how uncertainty and scientific expertise are dealt with. We investigate this via the regulation of pandemics by the EU and the WHO, with the H1N1 pandemic of 2009 as critical case. The analysis of the multilevel practice reveals that the attitude toward uncertainty fundamentally differed between the global (WHO) and the European level. At the global level a classic speaking truth to power approach involved the denial of uncertainty, while at the EU level the assigned role of providing scientific expertise was interpreted as a necessity to openly communicate about uncertainty. While the global approach was heavily criticized, the uncertainty communication at the European level was much appreciated.Este artículo busca comprender los desafíos de abordar problemas políticos complejos en la gobernanza multinivel. Para comprender mejor la regulación multinivel de los problemas políticos complejos, es necesario comprender cómo se aborda la incertidumbre y la experiencia científica. Investigamos esto a través de la regulación de pandemias por parte de la UE y la OMS, con la pandemia H1N1 de 2009 como un caso crítico. El análisis de las prácticas multinivel revela que la actitud hacia la incertidumbre era fundamentalmente diferente entre el nivel global (OMS) y el nivel europeo. A nivel global un método de “decir la verdad al poder” incluía la negación de la incertidumbre, mientras que a nivel europeo el papel asignado de proporcionar experiencia científica se interpretó como algo necesario para comunicarse abiertamente acerca de la incertidumbre. Aunque la aproximación global fue fuertemente criticada, la comunicación de la incertidumbre a nivel europeo fue muy valorada.本文致力理解多层次治理中应对复杂政策问题时面临的挑战。为更好地把握复杂政策问题的多层次监管, 需要明白不确定性和科学技术是如何加以处理的。笔者以2009年HINI流感爆发作为案例, 用欧盟和世界卫生组织(WHO)针对流行病的监管规定对此进行了调查。通过对多层次实践的分析显示, 全球(即WHO)和欧盟对不确定性的态度存在根本差异。在全球层面上, WHO用“对权力说真话”这一经典实践来否定不确定性, 而欧盟则运用科学技术, 将其作为公开交流不确定性的必备手段。结果则是, WHO实践受到严厉批评, 而欧盟对不确定性的公开交流受到赞赏。.

The 2009 H1N1 pandemic and seasonal influenza outbreaks have, at times, overwhelmed capacity in children's hospitals.1 The COVID-19 pandemic is different. Relatively few children have become severely ill when infected with SARS-CoV-2.2 In four weeks from March to April 2020, the Centers for Disease Control and Prevention found 42% reduction in emergency department (ED) visits nationally compared with the prior year and noted the steepest decrease in visits was among children

Influenza pandemics considerably burden affected health systems due to surges in inpatient admissions and associated costs. Previous studies underestimate or overestimate 2009/2010 influenza A/H1N1 pandemic hospital admissions and costs. We robustly estimate overall and age‐specific weekly H1N1 admissions and costs between June 2009 and March 2011 across 170 English hospitals. We calculate H1N1 admissions and costs as the difference between our administrative data of all influenza‐like‐illness patients (seasonal and pandemic alike) and a counterfactual of expected weekly seasonal influenza admissions and costs established using time‐series models on prepandemic (2004–2008) data. We find two waves of H1N1 admissions: one pandemic wave (June 2009–March 2010) with 10,348 admissions costing £20.5 million and one postpandemic wave (November 2010–March 2011) with 11,775 admissions costing £24.8 million. Patients aged 0–4 years old have the highest H1N1 admission rate, and 25‐ to 44‐ and 65+‐year‐olds have the highest costs. Our estimates are up to 4.3 times higher than previous reports, suggesting that the pandemic's burden on hospitals was formerly underassessed. Our findings can help hospitals manage unexpected surges in admissions and resource use due to pandemics.

Background During the A/H1N1 pandemic, patients suffered from impaired consciousness. They were suspected of or diagnosed as having influenza-associated encephalopathy (IAE) in an emergency situation. Their symptoms resembled those of a recently described ‘unique clinical group’, which were reported to have a favorable prognosis. Methods We retrospectively examined 46 patients and divided them into two groups. Group IC contained the 26 patients with persisting impaired consciousness. The remainder of the patients were categorized into group R, consisting of patients with only neurological symptoms without impaired consciousness. Results Male predominance (22 male/four female) was noted in group IC. Patient age ranged from 5 to 12 years old (mean ± SD, 7.7 ± 2.3 years). Impaired consciousness such as delirious behavior or mild reduction of consciousness lasted continuously or intermittently from 5 min to 2.5 days. On electroencephalogram, semi-rhythmic high-voltage slow waves in the parieto-occipital regions and diffuse high-voltage slow waves were observed in eight and in two patients, respectively. In group R, there was no gender predominance. Patient age ranged from 1 to 9 years old (mean ± SD, 4.1 ± 2.5 years). All group R patients were clinically diagnosed with febrile seizure. Conclusions Some of the characteristics in group IC resembled those of the unique clinical group, and are part of a continuous clinical spectrum. Some patients may have favorable outcome without specific treatment.

The 2009 H1N1 pandemic had considerable impact on risk perceptions, vaccination campaigns, and global health governance. In this context, risk communication issues have been probably the most puzzling and the least understood in retrospect. This article reviews the current knowledge on the following issues: risk and pandemic perceptions; vaccination perceptions and practices; rumors and rumor propagation; and health risk communication. It also highlights the research gaps in these areas that remain to be further explored in the future.

Background Obesity was recognized as in independent risk factor for influenza during the 2009 H1N1 influenza pandemic. Objectives We evaluated the association between body mass index (BMI) and influenza-like illness (ILI) during two non-pandemic influenza seasons (2003–2004 and 2004–2005) and during the spring and fall waves of the 2009 H1N1 pandemic. Methods Adults with severe (inpatient) and mild (outpatient) ILI were compared to those without ILI using a case-cohort design. The study was nested among those insured by a single health insurance company, receiving care from a large multispecialty practice. Data were collected from insurance claims and the electronic health record. The primary exposure was obesity (BMI ≥ 30·0 kg/m2). Results Across three seasons, the crude and adjusted ORs for obesity and severe ILI were 1·65 (95% CI 1·31, 2·08) and 1·23 (95% CI 0·97, 1·57), respectively. An association was observed for those aged 20–59 years (adjusted OR 1·92, 95% CI 1·26, 2·90), but not for those 60 and older (adjusted OR 1·08, 95% CI 0·80, 1·46). The adjusted ORs for obesity and severe ILI in 2003–2004, 2004–2005, and during H1N1 were 1·14 (95% CI 0·80, 1·64), 1·24 (95% CI 0·86, 1·79), and 1·76 (95% CI 0·91, 3·42), respectively. Among those with a Charlson Comorbidity Index score of zero, the adjusted ORs for 2003–2004, 2004–2005, and H1N1 were 1·60 (95% CI 0·93, 2·76), 1·43 (95% CI 0·80, 2·56), and 1·90 (95% CI 0·68, 5·27), respectively. Conclusions Our results suggest a small to moderate association between obesity and hospitalized ILI among adults.

Objectives Although ambiguous and uncertain situations, such as those dealing with the threat of widespread viral illness, may have pronounced psychological ramifications, there have been few studies that examined the factors that contributed to such outcomes. The purpose of the present investigation was to examine emotional reactions to a health threat. Design A structural equation model examined the interplay between anxiety and intolerance of uncertainty, as sequentially mediated by appraisals and coping strategies. Methods Adult participants over the age of 18 (N = 1,027) completed online self-report measures during the H1N1 pandemic in 2009. Results Greater intolerance of uncertainty was related to lower appraisals of self- and other control, which predicted low levels of problem-focused coping and greater reports of H1N1-related anxiety. Additionally, individuals with a high intolerance of uncertainty were more likely to perceive the pandemic as threatening and also were more apt to use emotion-focused coping strategies, and both of these factors predicted elevated levels of anxiety. Conclusions Together, these data indicate that threats, such as those related to a potential pandemic, not only have implications for physical health, but also for psychological distress, and that such outcomes vary with a constellation of appraisal and coping factors. Statement of contribution What is already known on this subject? It has been established that the public is often confused by the threat that a potential pandemic virus poses and that they are unsure of what information related to the disease they can trust. Government health agencies often walk the line of minimizing the threat to prevent panic, but simultaneously emphasize the importance of action (vaccination) to prevent a worldwide pandemic. What does this study add? Beyond the physical threat of a pandemic, a significant psychological toll may occur for certain individuals. Anxiety regarding H1N1 is heightened amongst those who cannot tolerate uncertainty. Appraisals of threat, control, and the use of emotion-focused coping mediate the above relationship.

The current study examines the extent to which H1N1 was stigmatized at the height of the 2009 H1N1 pandemic in the U.S. and explores the role that H1N1 stigma played in people's desire for physical distance from others with H1N1. H1N1 was the most stigmatized disease, with participants endorsing greater prejudice towards people with H1N1 than people with cancer or HIV/AIDS. Further, H1N1 stigma partially mediated the relationship between participants' perceptions that H1N1 was threatening and their desire for physical distance from people with H1N1. Therefore, H1N1 stigma played a role in, but was not entirely responsible for, the relationship between perceptions that H1N1 was threatening and desire for distance from others with H1N1.

Background Effectiveness of pandemic plans and community compliance was extensively researched following the H1N1 pandemic. This systematic review examined community response studies to determine whether behavioural responses to the pandemic were related to level of knowledge about the pandemic, perceived severity of the pandemic and level of concern about the pandemic. Methods Literature databases were searched from March 2009 to August 2011 and included cross-sectional or repeated population surveys undertaken during or following the H1N1 pandemic which reported on community response to the pandemic. Studies using population subgroups and other respiratory diseases were excluded, as were mathematical modelling and qualitative studies. Results Nineteen unique studies were included. Fourteen reported pandemic knowledge, 14 reported levels of concern and risk perception and 18 reported pandemic behaviours. Awareness of the pandemic was high, and knowledge was moderate. Levels of concern and risk were low moderate and precautionary behavioural actions lower than intentions. The most commonly reported factors influencing adopting recommended behaviours were increased risk perception and older age, increased pandemic knowledge and being female. Conclusions Important implications for future pandemic planning were identified. A remarkable lack of intercountry variability in responses existed; however, differences between populations within a single country suggest one-size-fits-all plans may be ineffective. Secondly, differences between reported precautionary intentions and preventive behaviours undertaken may be related to people's perceived risk of infection.

Please cite this paper as: Basurto-Davila et al. (2012) Household economic impact and attitudes toward school closures in two cities in Argentina during the 2009 influenza A (H1N1) pandemic. Influenza and Other Respiratory Viruses. DOI: 10.1111/irv.12054. Background School closures were widely implemented in Argentina during the 2009 H1N1 influenza virus pandemic. Objectives To assess the economic impact of school closures on households, their effectiveness in preventing children from engaging in social group activities, and parental attitudes toward them. Methods Three schools that closed for 2 weeks in response to the pandemic were identified in two socioeconomically distinct cities in Argentina. All households with children enrolled in these schools were surveyed. Direct and indirect costs attributable to closures were estimated from the household perspective. Other information collected included children activities during the closures and parental attitudes toward the intervention. Results Completed questionnaires were returned by 45% of surveyed households. Direct and indirect costs due to closures represented 11% of imputed monthly household income in the city with lower socioeconomic status, and 3% in the other city (P = 0·01). Non-childcare expenses and loss of workdays were more common in the city with lower socioeconomic status. Childcare expenses were less common and were experienced by a similar percentage of households in both cities. About three-quarters of respondents in both cities agreed with the closures. The main concern among those who disagreed with closures was their negative impact on education. Children in more than two-thirds of affected households left their home at least once during the closures to spend time in public places. Conclusion School closures may more significantly impact low-income households. Authorities should consider the range of economic impacts of school closures among families when planning their implementation.

Please cite this paper as: Schanzer et al. (2012) Statistical estimates of respiratory admissions attributable to seasonal and pandemic influenza for Canada. Influenza and Other Respiratory Viruses DOI: 10.1111/irv.12011. Background The number of admissions to hospital for which influenza is laboratory confirmed is considered to be a substantial underestimate of the true number of admissions due to an influenza infection. During the 2009 pandemic, testing for influenza in hospitalized patients was a priority, but the ascertainment rate remains uncertain. Methods The discharge abstracts of persons admitted with any respiratory condition were extracted from the Canadian Discharge Abstract Database, for April 2003–March 2010. Stratified, weekly admissions were modeled as a function of viral activity, seasonality, and trend using Poisson regression models. Results An estimated 1 out of every 6·4 admissions attributable to seasonal influenza (2003–April 2009) were coded to J10 (influenza virus identified). During the 2009 pandemic (May–March 2010), the influenza virus was identified in 1 of 1·6 admissions (95% CI, 1·5–1·7) attributed to the pandemic strain. Compared with previous H1N1 seasons (2007/08, 2008/09), the influenza-attributed hospitalization rate for persons

This article examines New York City�s response to the 2009 H1N1 pandemic in the context of the post-9/11 US security regime. While the federal level �all-hazards� approach made for greater depth of support, it also generated unrealistic assumptions at odds with an effective local response. The combination of structurally induced opportunity and actor specific strengths (size, expertise) made for effective local governance by the New York City Department of Health and Mental Hygiene. By underlining the importance of locality as a first line of defence and linking defence function to policy initiative in regard to health governance, this study illustrates the continuing relevance of Weber�s insight into the institutional structure of the city.

Objective: To describe the epidemiological characteristics of the 2009 H1N1 pandemic virus (pH1N1) over the 2009 and 2010 influenza seasons in Australia and New Zealand (NZ) and compare them with expectations based on previous pandemics. Methods: Laboratory-confirmed influenza and influenza-like illness (ILI) data were collected from established general practitioner sentinel surveillance schemes in NZ, Victoria and Western Australia (WA) throughout the 2009 and 2010 winter influenza seasons. Respiratory swabs from a sample of ILI patients were tested for influenza type and subtype. ILI rates and laboratory-confirmed influenza data were analysed by age group and over time. Morbidity, mortality and reproductive number data were collated from the published literature. Results: Peak ILI rates and the percentage of influenza-positive swabs from ILI patients from all sentinel surveillance schemes were considerably lower in 2010 than 2009. Compared to the population, cases of ILI were over-represented in the young. While the age distributions in NZ and WA remained consistent, ILI cases were significantly younger in Victoria in 2009 compared to 2010. In Victoria, laboratory-confirmed pH1N1 comprised up to 97% of influenza-positive swabs in 2009 but only 56–87% in 2010. Mortality and hospitalisations were lower in 2010. The effective reproduction number (R) for pH1N1 was estimated to be 1.2–1.5 in NZ and WA, similar to estimated R values for seasonal influenza. Data from the surveillance systems indicated differences in the epidemiology of pH1N1 compared to expectations based on previous pandemics. In particular, there was no evidence of a second pandemic wave associated with increased mortality, and complete influenza strain replacement did not occur. Implications: Pandemic planning needs to accommodate the potential for influenza viruses to produce pandemics of various infectiousness and degrees of severity.

were collected and tested by RT-PCR of which 22.7% (487) were confirmed A(H1N1)pdm09; H3N2, H1N1, and B were positive in 2.2%, 1.1%, and 7.2%, respectively. The highest rate of A(H1N1)pdm09 cases (57.4%) was detected in the 6-20 year-old age group. Importantly, Bhutan increased from 3 sentinel sites in April 2009 to 11 a year later, and in April 2010 established PCR capability for influenza. Conclusions Despite relative isolation, the A(H1N1)pdm09 reached Bhutan within 3 months of identification in Mexico. The H1N1 pandemic has made Bhutan more prepared for epidemics in the future.

Background Acute respiratory insufficiency characterised critically ill patients during the influenza A (H1N1) pandemic 20092010. Detailed understanding of disease progression and outcome in relati ...

Please cite this paper as: Greene et al. (2012) Patterns in influenza antiviral medication use before and during the 2009 H1N1 pandemic, Vaccine Safety Datalink Project, 2000-2010. Influenza and Other Respiratory Viruses 6(601), e143–e151. Background U.S. recommendations for using influenza antiviral medications changed in response to viral resistance (to reduce adamantane use) and during the 2009 H1N1 pandemic (to focus on protecting high-risk patients). Little information is available on clinician adherence to these recommendations. We characterized population-based outpatient antiviral medication usage, including diagnosis and testing practices, before and during the pandemic. Methods Eight medical care organizations in the Vaccine Safety Datalink Project provided data on influenza antiviral medication dispensings from January 2000 through June 2010. Dispensing rates were explored in relation to changes in recommendations and influenza diagnosis and laboratory testing frequencies. Factors associated with oseltamivir dispensings in pandemic versus pre-pandemic periods were identified using multivariable logistic regression. Results Antiviral use changed coincident with recommendations to avoid adamantanes in 2006, to use alternatives to oseltamivir in 2008, and to use oseltamivir during the pandemic. Of 38,019 oseltamivir dispensings during the pandemic, 31% were to patients not assigned an influenza diagnosis, and 97% were to patients not tested for influenza. Oseltamivir was more likely to be dispensed in pandemic versus pre-pandemic periods to patients

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.

The 2009 influenza A/H1N1 pandemic caused an increase in complications in pregnant women. To be well prepared for a next pandemic, we investigated the obstetric and maternal complications of this pandemic. In our national cohort of 59 pregnant women who were admitted to the hospital, no major complications apart from preterm birth and admission to the neonatal intensive care unit were observed. Although the small size of this study precludes us drawing any definitive conclusions, comparing our results with those in other countries suggests that the influenza A/H1N1 pandemic had a relatively benign course in pregnant women in The Netherlands.

Please cite this paper as: Kim et al. (2012) Is abdominal obesity associated with the 2009 influenza A (H1N1) pandemic in Korean school-aged children? Influenza and Other Respiratory Viruses 6(5), 313–317. Objective Given their medical vulnerabilities, we investigated the epidemiological factors related to H1N1 infection in school-aged children. Methods This study analyzed data collected on 7448 school-aged children in South Korea between 18 November and 8 December 2009. Results We found that H1N1 infection was associated with body mass index (BMI), waist circumference (WC), the use of facemasks, contact history with H1N1-infected persons, and overseas travel history (P

Analysis of a US hospitalization database demonstrated that more influenza patients were hospitalized and the age distribution of hospitalizations was younger during the 2009 (H1N1) influenza A pandemic compared with the three previous influenza seasons. The duration of hospital stay remained stable in all four seasons. A higher proportion of patients was treated with antivirals (P < 0·0001), comprised almost entirely of neuraminidase inhibitors, and the proportion was highest in those with influenza confirmed by diagnostic testing (P < 0·0001). Approximately one-third remained untreated. Young children had the lowest rate of neuraminidase-inhibitor treatment during the 2009 pandemic (P < 0·05).

Of those patients hospitalized in the United States during the 2009 H1N1 influenza pandemic, approximately one-third were under the age of 18 yr (1). The attributed mortality was relatively higher among young children, pregnant women, and individuals with immunosuppression, severe obesity, and other comorbidities when compared to seasonal influenza (2, 3). The virologic and immunologic mechanisms accounting for differences in clinical manifestations and disease outcomes between 2009 H1N1 and seasonal influenza A infections have not yet been fully elucidated. In addition, emerging resistance of the 2009 H1N1 virus to oseltamivir, a NA inhibitor and the mainstay of treatment, has led to pulmonary complications, severe disease, and poor outcomes especially among immunocompromised individuals (4, 5). We report a case of an immunosuppressed pediatric renal transplant patient with mild pneumonia caused by oseltamivir-resistant 2009 H1N1 influenza and successfully treated with zanamivir. This case highlights the complex interplay between pathogen and host, underscores the possible importance of the innate immune system in influenza, and raises questions regarding viral fitness and resistance.

Please cite this paper as: Moghadas et al. (2011) Canada in the face of the 2009 H1N1 pandemic. Influenza and Other Respiratory Viruses 5(2), 83–88. Background Initial public health responses to the 2009 influenza H1N1 pandemic were based on difficult decisions in the face of substantial uncertainty. Policy effectiveness depends critically on such decisions, and future planning for maximum protection of community health requires understanding of the impact of public health responses in observed scenarios. Objectives In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling Team (Pan-InfORM) and the Centre for Disease Modelling (CDM), a focused workshop was organized to: (i) evaluate Canada's response to the spring and autumn waves of the novel H1N1 pandemic; (ii) learn lessons from public health responses, and identify challenges that await public health planners and decision-makers; and (iii) understand how best to integrate resources to overcome these challenges. Main outcome measures We report on key presentations and discussions that took place to achieve the objectives of the workshop. Conclusions Future emerging infectious diseases are likely to bring far greater challenges than those imposed by the 2009 H1N1 pandemic. Canada must address these challenges and enhance its capacity for emergency responses by integrating modelling, surveillance, planning, and decision-making.

On Tuesday, April 21, 2009, the Centers for Disease Control and Prevention (CDC) announced the first U.S. cases of novel H1N1 virus in the United States. Within the next few days, the number of cases would grow, and hospitals saw increasing flu cases as well as a number of “worried well.” This article reviews the immediate response of the Hospital Corporation of America (HCA) system to the novel H1N1 pandemic within the first month after CDC announced confirmation of the first case.