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Introduction There is very little data available on the impact that respiratory viral infections (RVI) have on neonatal morbidity and mortality in the UK. Aims Define the epidemiology and impact of RVIs in a UK NICU population. Methods We conducted a retrospective case review of all NICU patients, at two large tertiary centres, with multiplex PCR confirmed RVIs between 2007 and 2013. Additionally, suspect/proven RVIs were identified in a local population (Nottingham area, 2 large teaching hospitals). Results 15,907 respiratory samples were analysed by PCR with 7941 positive (50%) of which 52% were in children. 806 samples from NICU patients (76334 inpatient days) yielded 158 (19.6%) positives in 90 babies (median gestation 29 weeks, IQR 26–34). There were no differences in the number of RVIs between Spring/Summer (n = 46) and Autumn/Winter (n = 44) periods. 71% of babies positive for RVIs had rhinovirus, 8% RSV and 6% H1N1. Almost half of all infected babies required escalation of respiratory support especially those Discussion This is the largest UK series detailing RVIs in NICU patients. Although RVIs are uncommon, our study demonstrates significant associated morbidity, especially with rhinovirus, and significant mortality during the H1N1 pandemic. Subclinical RVIs can occur in the NICU1 and coupled with our data suggests we need to explore better ways of minimising the impact of RVIs in this vulnerable population. Reference Bennett, et al. J Peds 2012;161(5):814–18

BACKGROUND: Many schools throughout the United States reported an increase in dismissals due to the 2009 influenza A H1N1 pandemic (pH1N1). During the fall months of 2009, more than 567 school dismissals were reported from the state of Michigan. In December 2009, the Michigan Department of Community Health, in collaboration with the United States Centers for Disease Control and Prevention, conducted a survey to describe the knowledge, attitudes, and practices (KAPs) of households with school-aged children and classroom teachers regarding the recommended use of nonpharmaceutical interventions (NPIs) to slow the spread of influenza. METHODS: A random sample of eight elementary schools (kindergarten through 5th grade) was selected from each of the eight public health preparedness regions in the state. Within each selected school, a single classroom was randomly identified from each grade (K-5), and household caregivers of the classroom students and their respective teachers were asked to participate in the survey. RESULTS: In total, 26% (2,188/8,280) of household caregivers and 45% (163/360) of teachers from 48 schools (of the 64 sampled) responded to the survey. Of the 48 participating schools, 27% (13) experienced a school dismissal during the 2009 fall term. Eighty-seven percent (1,806/2,082) of caregivers and 80% (122/152) of teachers thought that the 2009 influenza A H1N1 pandemic was severe, and >90% of both groups indicated that they told their children/students to use NPIs, such as washing hands more often and covering coughs with tissues, to prevent infection with influenza. CONCLUSIONS: Knowledge and instruction on the use of NPIs appeared to be high among household caregivers and teachers responding to the survey. Nevertheless, public health officials should continue to explain the public health rationale for NPIs to reduce pandemic influenza. Ensuring this information is communicated to household caregivers and teachers through trusted sources is essential.

PURPOSE: The purpose of this study was to evaluate the effects of lifestyle behaviors and health habits on the risk for acquiring pandemic influenza (H1N1) virus infection. MATERIALS AND METHODS: We conducted a case-control study in a secondary care hospital in South Korea between November 2009 and August 2010. We enrolled patients with H1N1 infection, as confirmed by a positive result of the real-time reverse transcriptase polymerase chain reaction assay; for each patient, we enrolled 4 age- and gender-matched controls with no history of H1N1 infection or severe acute respiratory illness during the H1N1 pandemic in South Korea (1:4 match). RESULTS: During the study period, 33 cases and 132 age- and gender-matched controls were enrolled. The case group had a higher percentage of current smokers (p

Background Multiple observational studies have associated antiviral treatment of patients hospitalized with influenza with improved outcome, including reduced mortality. During the 2009–2010 H1N1 pandemic increased use of antiviral treatment of hospital patients was reported. We have carried out prospective surveillance for influenza in patients in a large network of Canadian hospitals since 2006. We wished to assess trends in antiviral use in the two seasons (2010–2011 and 2011–2012) since the end of the pandemic. Findings Adults (>16 years) testing positive for influenza at the time of or during admission to participating Canadian hospitals were prospectively reviewed. In 2009–2010 there were 1132 confirmed cases, 1107 in 2010–2011 and 631 in 2011–2012. Information on antiviral therapy was available in >95% in each year. Rising to 89.6% in 2009, the proportion of adult patients treated with antiviral therapy fell to 79.9% and 65.7% in the two subsequent seasons (p 98% of cases in each year. The median time from onset of symptoms to initiation of antiviral therapy was three days. The treatment proportion fell across all age groups, co-morbid conditions and disease severity. Conclusion Despite evidence for benefit of antiviral therapy, and clinical practice guidelines recommending treatment of this population, antiviral therapy of Canadian adults hospitalized with influenza has progressively fallen in the two seasons since the end of the 2009–2010 influenza pandemic.

This commentary discusses the pathology and pathogenesis of the 2009 H1N1 influenza A pandemic.

When H5N1 avian influenza emerged in 1997, much of the world began planning for an eventual pandemic. Most planners expected the pandemic to begin in Asia and believed the virus would be highly lethal. In the United States, planning efforts for pandemic influenza escalated again in November 2005, with the publication of the National Strategy for Pandemic Influenza.1 The H1N1 pandemic that emerged in the spring of 2009 did not conform to prior planning assumptions. It began in Mexico rather than Asia and to date has not been as lethal as first feared. Since 2005, global influenza surveillance has vastly . . .

In this issue Allam1 raises concern about perceived over-reaction to the emergence of the novel influenza H1N1 strain, stating that the response of the World Health Organization (WHO) and mass media conclusions overestimated and exaggerated the problem, and provoked unnecessary alarm among the general population, rather than transmitting calm and a sense of safety. (see letter, page 862) . His first argument is that the rapid escalation of pandemic phases and communications by WHO gave the impression of an escalation in virulence of the virus rather than simply reflecting an increase in the extent of the spread. The WHO’s pre-specified definitions of pandemic phases are entirely based on the extent of geographic spread and make no reference to severity.2 WHO’s communications at the time of declaring different pandemic phases have consistently emphasised that most cases are mild. On the declaration of phase 6, it was stated that “On present evidence, the overwhelming majority of patients experience mild symptoms and make a rapid and full recovery—often in the absence of any form of medical treatment … we do not expect to see a sudden and dramatic jump in the number of severe or fatal infections.”3 This is not consistent with the assertion that …

The World Health Organization has convened a group of international experts to advise it on the Middle East respiratory syndrome coronavirus. The committee, convened under the WHO’s international health regulations, is made up of experts including immunologists, virologists, and epidemiologists and held its first telephone conference on Tuesday 9 July, when it reviewed current information about the disease. This is the first time that an international committee of experts, independent of WHO, has met since the H1N1 pandemic in 2009. Keiji Fukuda, WHO’s assistant director general for health, security, and environment, told a press conference on 4 July that it was unlikely that the committee, convened to investigate the causes of the disease and how it is likely to evolve, would make recommendations on 9 July, but he …

Influenza A H1N1 is a novel influenza virus that is of swine source. Clinical manifestations of this virus vary from mild respiratory symptoms to fatal respiratory or/and cardiovascular complications. The new influenza A H1N1 pandemic was first identified in April 2009 in the United States and Mexico, and then spread globally. In September 10 2010, the World Health Organization announced that the influenza A H1N1 pandemic had moved into the post-pandemic period and is no longer considered a dangerous global disease. On the 15th of August 2010, the Ministry of Health in Saudi Arabia declared that the cases of influenza A H1N1 in 2010 have drastically declined to 874 cases with no deaths or serious complications.

OBJECTIVE: To investigate recent respiratory and influenza-like illnesses (ILIs) in acute myocardial infarction patients compared with patients hospitalised for acute non-vascular surgical conditions during the second wave of the 2009 influenza A H1N1 pandemic. DESIGN: Case-control study. SETTING: Coronary care unit, acute cardiology and acute surgical admission wards in a major teaching hospital in London, UK. PARTICIPANTS: 134 participants (70 cases and 64 controls) aged ≥40 years hospitalised for acute myocardial infarction and acute surgical conditions between 21 September 2009 and 28 February 2010, frequency-matched for gender, 5-year age-band and admission week. PRIMARY EXPOSURE: ILI (defined as feeling feverish with either a cough or sore throat) within the last month. SECONDARY EXPOSURES: Acute respiratory illness within the last month not meeting ILI criteria; nasopharyngeal and throat swab positive for influenza virus. RESULTS: 29 of 134 (21.6%) participants reported respiratory illness within the last month, of whom 13 (9.7%) had illnesses meeting ILI criteria. The most frequently reported category for timing of respiratory symptom onset was 8-14 days before admission (31% of illnesses). Cases were more likely than controls to report ILI-adjusted OR 3.17 (95% CI 0.61 to 16.47)-as well as other key respiratory symptoms, and were less likely to have received influenza vaccination-adjusted OR 0.46 (95% CI 0.19 to 1.12)-although the differences were not statistically significant. No swabs were positive for influenza virus. CONCLUSIONS: Point estimates suggested that recent ILI was more common in patients hospitalised with acute myocardial infarction than with acute surgical conditions during the second wave of the influenza A H1N1 pandemic, and influenza vaccination was associated with cardioprotection, although the findings were not statistically significant. The study was underpowered, partly because the age groups typically affected by acute myocardial infarction had low rates of infection with the pandemic influenza strain compared with seasonal influenza.

The purpose of this paper is to analyse the commercial non-sanitary interests of the management of the pandemic influenza preparedness in the Global North and how this preparedness for the pandemic could be an additional burden for the countries of the Global South. Moreover, this paper examines the complexity of scientifi c outreach to society through the media in the case of serious epidemic outbreaks. Este artigo tem por objetivo analisar os interesses comerciais não relacionados à saúde pública que surgiram durante a condução da pandemia da gripe A (H1N1) no hemisfério Norte. Também busca refletir como a preparação para esta pandemia poderia se tornar um peso para os países do Hemisfério Sul. Além disso, este trabalho examina a complexidade da divulgação científica pelos meios de comunicação em casos de surtos epidêmicos graves.

The decision of the United Kingdom’s coalition government to cancel the traditional publicity campaign about the dangers of flu the year after the H1N1 pandemic in 2009-10 is likely to have contributed to a rise in numbers of deaths and admissions to hospital the following year, researchers say. The only “notable difference” between the pandemic year of 2009-10 and the year immediately after was the action of the government, say investigators, one of whom is Liam Donaldson, the chief medical officer for England in the first year of the pandemic, who stepped down from the post when the coalition came to power in May 2010. They describe the government’s approach to flu that year as “laissez-faire,” particularly the cancellation of the public awareness campaign by the health secretary for England, Andrew Lansley. Their analysis of flu activity in England, published in Eurosurveillance (2012;17:pii=20139; www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20139), shows that during the winter of 2010-11 …

Objective Pregnant women were identified at greater risk and given priority for 2009 H1N1 vaccination during the 2009 through 2010 H1N1 pandemic. We identified factors associated with acceptance or refusal of 2009 H1N1 vaccination during pregnancy. Study Design We conducted an in-person survey of postpartum women on the labor and delivery service from June 17 through Aug. 13, 2010, at 4 New York hospitals. Results Of 1325 survey respondents, 34.2% received 2009 H1N1 vaccination during pregnancy. A provider recommendation was most strongly associated with vaccine acceptance (odds ratio [OR], 19.4; 95% confidence interval [CI], 12.7–31.1). Also more likely to take vaccine were women indicating the vaccine was safe for the fetus (OR, 12.4; 95% CI, 8.3–19.0) and those who previously took seasonal flu vaccination (OR, 7.9; 95% CI, 5.8–10.7). Race, education, income, and age were less important in accepting vaccine. Conclusion Greater emphasis on vaccine safety and provider recommendation is needed to increase the number of women vaccinated during pregnancy.

BackgroundA school absenteeism surveillance system was implemented in the province of Quebec, Canada during the second wave of the 2009 H1N1 pandemic. This paper compares this surveillance approach with other available indicators.MethodAll (3432) elementary and high schools from Quebec were included. Each school was required to report through a web-based system any day where the proportion of students absent for influenza-like illness (ILI) exceeded 10% of current school enrolment.ResultsBetween October 18 and December 12 2009, 35.6% of all schools met the 10% absenteeism threshold. This proportion was greater in elementary compared to high schools (40% vs 19%) and in smaller compared to larger schools (44% vs 22%). The maximum absenteeism rate was reached the first day of reporting or within the next two days in 55% and 31% of schools respectively. The first reports and subsequent peak in school absenteeism provincially preceded the peak in paediatric hospitalization by two and one weeks, respectively. Trends in school surveillance otherwise mirrored other indicators.ConclusionDuring a pandemic, school outbreak surveillance based on a 10% threshold appears insufficient to trigger timely intervention within a given affected school. However, school surveillance appears well-correlated and slightly anticipatory compared to other population indicators. As such, school absenteeism warrants further evaluation as an adjunct surveillance indicator whose overall utility will depend upon specified objectives, and other existing capacity for monitoring and response.

BackgroundThe H1N1 pandemic in 2009 and the H5N1 pandemic in 2005 demonstrated that the drugs approved to treat influenza A viruses have low efficacy. This provided a stimulus for new studies of influenza A viruses in the context of the methods used in drug design developed over the past 100 years. Finding new universal drugs is the ultimate goal but its long time horizon is incompatible with emergency situations created by reoccurring influenza outbreaks. Therefore, we propose a computer-aided method for finding efficacious drugs and drug complexes based on the use of the DrugBank database.Methods(1) We start by assembling a panel of target proteins. (2) We then assemble a panel of drugs. (3) This is followed by a selection of benchmark binding pockets based on the panel of target proteins and the panel of drugs. (4) We generate a set of computational features, which measure the efficacy of a drug. (5) We propose a universal program to search for drugs and drug complexes. (6) A case study we report here illustrates how to use this universal program for finding an optimal drug and a drug complex for a given target. (7) Validation of the Azirchromycin and Aspirin complex is provided mathematically. (8) Finally, we propose a simple strategy to validate our computational prediction that the Azirchromycin and Aspirin complex should prove clinically effective.ResultA set of computable features are mined and then based on these features, a universal program for finding the potential drug &drug complexes is proposed. Using this universal program, the Azirchromycin and Aspirin complex is selected and its efficacy is predicted mathematically. For clinical validation of this finding, future work is still required.

Background Though recommended by many and mandated by some, influenza vaccination rates among health care workers, even in pandemics, remain below optimal levels. The objective of this study was to assess vaccination uptake, attitudes, and distinguishing characteristics (including doctor-nurse differences) of health care workers who did and did not receive the pandemic H1N1 influenza vaccine in late 2009. Methodology/Principal Findings In early 2010 we mailed a self-administered survey to 800 physicians and 800 nurses currently licensed and practicing in Minnesota. 1,073 individuals responded (cooperation rate: 69%). 85% and 62% of Minnesota physicians and nurses, respectively, reported being vaccinated. Accurately estimating the risk of vaccine side effects (OR 2.0; 95% CI 1.5–2.7), agreeing with a professional obligation to be vaccinated (OR 10.1; 95% CI 7.1–14.2), an ethical obligation to follow public health authorities' recommendations (OR 9.9; 95% CI 6.6–14.9), and laws mandating pandemic vaccination (OR 3.1; 95% CI 2.3–4.1) were all independently associated with receiving the H1N1 influenza vaccine. Conclusions/Significance While a majority of health care workers in one midwestern state reported receiving the pandemic H1N1 vaccine, physicians and nurses differed significantly in vaccination uptake. Several key attitudes and perceptions may influence health care workers' decisions regarding vaccination. These data inform how states might optimally enlist health care workers' support in achieving vaccination goals during a pandemic.

Onset of narcolepsy in China (1998–2010) is seasonal, with a 6.7-fold increase from November (least frequent) to April (peak frequency).

Objectives (1) To characterize the epidemiology of H1N1-related hospitalizations in Massachusetts; and (2) to compare characteristics of those hospitalized during periods of seasonal influenza activity and during the H1N1 pandemic. Methods Authors applied maximum and minimum criteria to the Massachusetts Hospital Discharge Database to identify H1N1-related hospitalizations. They constructed annual line graphs describing mean frequencies of influenza-like illness(ILI)-related discharges between 2005-2008, and compared these rates to early waves of H1N1 in 2009. Results During spring and summer 2009, there were significantly higher rates of ILI-related hospital discharges in Massachusetts compared to 2005-2008. Out of 359,344 total discharges between April 26-September 30,2009, H1N1-related hospitalizations ranged from 601 to 10,967 cases. Minimum criteria confirmed that H1N1 affected a younger population (50% were

Introduction Screening for influenza in arriving airline passengers and follow-up of people seated near passengers with suspected infection was used in New Zealand during the containment stage of the H1N1 pandemic in 2009. However, there is little evidence for in-flight transmission of influenza in modern commercial aircraft. This investigation aimed to assess the risks of such transmission from a school group of infected passengers who arrived in New Zealand on 25 April 2009. Methods We interviewed and obtained nasopharyngeal swabs and/or serological specimens from the school group. Passengers in the same section of the aircraft were interviewed and nasopharyngeal swabs collected from those who were symptomatic. Results All 24 members of the school group were interviewed and had nasopharyngeal swabs and/or serological specimens collected. We obtained interview information from 97 out of 102 other passengers in the rear section of the aircraft. Nine laboratory-confirmed symptomatic cases of H1N1 infection occurred in the school group. Two other passengers seated within two rows of the infected passengers developed confirmed infection, 12 and 48 h following the flight, implying an infection risk of 3.5% for the 57 susceptible passengers in those rows. Follow-up by public health workers located 93.1% of passengers, but only 52.2% within 72 h of arrival. Conclusions This investigation suggests a small but definite risk of pandemic influenza transmission during modern commercial air travel. This risk was concentrated close to infected symptomatic passengers. It is slow and difficult to follow-up and screen exposed passengers once they have left the airport.

BackgroundPandemic influenza poses a great challenge to healthcare systems. Vaccinating medical teams and the population against pandemic influenza is the global recommended strategy to contain spread of the disease. As part of the efforts made to overcome the H1N1 pandemic, the Israeli Ministry of Health (MOH) initiated a general vaccination program for medical teams and the total country population. Due to low compliance rates of the medical staff, the MOH conducted regional conferences aimed at providing knowledge and encouraging staff to be vaccinated.ObjectivesTo evaluate the effect of the regional conferences on the compliance rates amongst medical providers to be vaccinated against H1N1.MethodsMedical providers from the primary health care services were invited to conferences that were conducted in 3 regions. Attitudes of the teams regarding compliance to be vaccinated were assessed pre and post the conferences. Additionally, the actual rates of vaccinations were recorded over the period of vaccination program. Actual compliance rates before and after the conferences were compared to detect differences as well as the relationship between teams' attitudes and actual vaccinations.ResultsVaccination rates of medical providers remained low during the full vaccination period. Among the non-vaccinated, 24% to 29% reported before the conference that they agree to be vaccinated versus 57% to 62% following the conference. Analysis of the actual vaccination data among the medical providers did not demonstrate a change in compliance following the conferences and an overall decrease was noted after the first two weeks of the vaccinated project.ConclusionsA statistically significant relationship was not found between reported attitudes of medical providers regarding readiness to be vaccinated and their actual vaccination. The MOH intervention did not achieve the expected result and did not raise compliance to be vaccinated.

BackgroundEffective function of the community care system is important during a pandemic. Self-protective behavior might help stop the spread of the disease during a pandemic and prevent system dysfunction because of personnel morbidity.ObjectiveTo compare the immunization rate and reported self-protective behavior of healthcare workers between hospitals and community care clinics during the peak of the winter A/H1N1 pandemic in Israel.MethodsA questionnaire was completed by 1,147 healthcare workers in 21 hospitals and 40 primary care clinics in Israel between 26 November 2009 and 10 December 2009 (the peak of the winter A/H1N1 flu outbreak).ResultsThe rate of vaccination against A/H1N1 among hospital workers (27.9%) was significantly higher compared with primary care clinics workers (19.3%) (OR = 0.691 (0.821–0.582)).

This study investigated the relationship between school session status and H1N1 influenza prevalence. Weekly means of Influenza-like-Illness (ILI) rates over the period May 1 to October 31,2009 were compared between areas where schools were and were not in session in the United States. Rates were substantially and significantly higher in areas where schools were in session. This result held separately in spring and fall and was robust to various controls.

The European Union parliament has branded as “disproportionate” some of the public health measures that governments took during the H1N1 pandemic two years ago. MEPs have also called on European Union countries to overhaul their prevention plans to make them more effective, coherent, and flexible. In a strongly worded resolution the parliament urges the World Health Organization to revise the definition of a pandemic to take account not just of its geographical spread but also of its severity. The resolution and accompanying report were drafted by the French Green MEP Michele Rivasi. After they were approved on 8 March in Strasbourg she said, “This report …

The European parliament has launched a strong attack on the World Health Organization, accusing it of distorting the term “pandemic” during the H1N1 outbreak in 2009-10 and triggering a worldwide false alarm. That, in turn, gave rise to inappropriate and disproportionate public health decisions by European Union countries, members of the parliament claim. The criticism comes in a report drafted by the French Green MEP Michele Rivasi evaluating management of H1N1 flu in 2009-10 in the European Union. The report was overwhelmingly adopted by the parliament’s public health committee on 25 January, with 58 votes in favour of the report, just two against, and one abstention. It calls …

The head of an international investigative panel looking into the World Health Organization’s handling of the H1N1 influenza pandemic has promised the inquiry will present a “critical” and transparent report. Harvey Fineberg, chairman of the external review committee, told members of WHO’s governing board that the report will deal with all the criticisms levelled at the agency, such as how it defined a pandemic, and identify lessons for strengthening preparedness and scope for a future response to a pandemic. He said the report will reflect all views, …

In response to the global spread of the H1N1 influenza virus after first being detected in North America in April 2009, WHO declared the first influenza pandemic in more than four decades on June 11 of the same year. In Korea, the arrival of the 2009 H1N1 pandemic influenza triggered an integrated response that was mainly based on the 2006 Pandemic Influenza Preparedness and Response Plan. At least 270 fatal cases, 764 laboratory-thousand confirmed cases, and 3.6 million courses of antiviral agent use were reported to the end of August 2010 in this country. Even if government tried to control and mitigate the impact of pandemic by using public health and medical countermeasures, there were several issues found during the H1N1 pandemic responses. The main difficulty was the delayed and insufficient supply of pandemic vaccine. Therefore the mass vaccination campaign was begun after the peak of pandemic and its mitigation effect on the pandemic disease burden was diminished. The amount of stockpiled antiviral agents by government was not enough in the early phase of pandemic. The rapid antigen test for the H1N1 influenza showed low sensitivity, about 50%. Many infected people were seeking to be diagnosed with rRT-PCR test, which is expensive and not useful for the decision of antiviral use because of late test report. The communications among government, medical societies, general people and mass media were also not satisfactory. Lessons learned from the national response to the H1N1 pandemic made the government to launch the TEPIK in October 2010. TEPIK will incorporate those lessons into the future pandemic preparedness planning. The mission of TEPIK is to ensure the safety of the nation and people from the threat of pandemic influenza. TEPIK focuses to establish government-academic-institute-industry collaborative system with three main strategies; to expedite sharing of RD to establish the preparedness and response of RD and to secure the innovative and leading response technology against pandemic influenza. TEPIK has 34 research projects in eight research areas, which include vaccine; therapeutics; diagnostics; basic/mechanism; clinical/ policy; surveillance/epidemiology; innovative researches; and infrastructures. Research subjects in each research area will be stated in this presentation.

A new paper reports that the emergence of a more virulent strain of A/H1N1 pandemic influenza can occur by spontaneous mutations and re-assortment with seasonal viruses.

Background Surveys are popular methods to measure public perceptions in emergencies but can be costly and time consuming. We suggest and evaluate a complementary “infoveillance” approach using Twitter during the 2009 H1N1 pandemic. Our study aimed to: 1) monitor the use of the terms “H1N1” versus “swine flu” over time; 2) conduct a content analysis of “tweets”; and 3) validate Twitter as a real-time content, sentiment, and public attention trend-tracking tool. Methodology/Principal Findings Between May 1 and December 31, 2009, we archived over 2 million Twitter posts containing keywords “swine flu,” “swineflu,” and/or “H1N1.” using Infovigil, an infoveillance system. Tweets using “H1N1” increased from 8.8% to 40.5% (R 2 = .788; p

Objective: To describe characteristics and outcomes of paediatric patients in a paediatric intensive care unit (PICU) during H1N1 pandemic. Patients and Methods: We included in the study 34 consecutive patients, admitted to the PICU from 01-11-2009 to 28-02-2010. Demographic data, symptoms, comorbid conditions, illness progression, treatments, and clinical outcomes were collected from all patients. Results: 19 (55.9%) patients were male and 15 (44.1%) were female. 29.4% of the patients were positive for H1N1 by viral polymerase chain reaction (PCR) on endobronchial secretions. Subjects with H1N1 infection were older than children who were admitted to the paediatric intensive care unit for other causes (7.9±5.1 years vs. 3.9±3.7 years, P< 0.05). Duration of intensive care stay and mechanical ventilation was longer in children with H1N1 infection (34.7±28.7 vs. 11.8±17.5 days, P< 0.05 and 32.5±27.7 vs. 10.3±18.6 days, P< 0.05, respectively). 80% of the children with H1N1 infection had known comordid disorders compared to the 33.3% of the rest of the subjects (P< 0.05). Children with H1N1 infection presented an increased complications rate (70% vs. 16.7%, P< 0.005) and had 4.8 times increased likelihood to present complications compared with the children who were admitted to the paediatric intensive care unit for other causes. Mortality rate was higher in children with H1N1 infection, but the difference between the two groups was not statistically significant. Conclusions: Critical illness from H1N1 infection in children who require admission to paediatric intensive care unit, was associated with increased complications rate, and prolonged duration of mechanical ventilation and hospitalization.

The World Health Organization’s management of the swine flu pandemic last year was thwarted by a confusing number of definitions of a pandemic and delays in producing and distributing vaccines, says an investigative panel. Harvey Fineberg, chairman of the external review committee looking into WHO’s handling of the pandemic, told reporters, “There are multiple ways people have elected to define and describe what they mean by a pandemic.” Dr Fineberg said that once the committee’s investigation is complete it will consider making recommendations for the future, in terms that included, “at the minimum, clarity, consistency, and practicality.” In testimony Margaret Chan, WHO’s director general, admitted that the …

The World Health Organization announced on 10 August that H1N1 influenza had “largely run its course” and had entered the post-pandemic phase. A total of 18 500 deaths from HIN1 have so far been confirmed worldwide. Announcing the end of the pandemic, Margaret Chan, WHO’s director general, said that downgrading the pandemic “does not mean that the virus has gone away” but that it was expected “to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to …

The origin of H1N1pdm constitutes an unresolved mystery, as its most recently observed ancestors were isolated in pigs nearly a decade before it emerged in humans. One theory suggests imperfect surveillance of swine viruses caused the virus to be missed in swine herds. Other hypotheses point to the possibility of laboratory error or an avian intermediary. We show substitution bias classification identifies the host where a virus has been evolving. Comparing the evolution of H1N1pdm ancestors with other influenza viruses, we show the evolutionary history in unsampled years is similar to the evolution of other swine viruses, presenting evidence it emerged from unsampled herds.

The chairman of the external expert review committee examining the World Health Organization’s management of the H1N1 pandemic said on 2 July that the panel will probe deeper into allegations that the drug industry may have unduly influenced key outcomes. Speaking at the end of the second round of hearings at WHO headquarters Harvey Fineberg, the head of the 27 member review committee, told reporters that, “Part of [our] concern is dealing with the accusations of undue influence by pharmaceutical companies on the decisions.” Asked if that included looking into …

The United Kingdom’s response to the 2009 H1N1 flu pandemic, which cost £1.2bn (€1.5bn; $1.8bn), was highly satisfactory and good value for money, concludes an independent review. But any purchasing for future pandemics should allow greater flexibility, it adds. The review, by Deirdrie Hine, a former chief medical officer for Wales, says that preparations, including stockpiling drugs and plans to buy up to 132 million doses of vaccine, were “soundly based in terms of value for money, reflecting the inherently low cost of vaccination in relation to the value of lives saved.” Around £1bn was spent on pharmaceuticals, including antivirals, antibiotics, and vaccines. More than 30 million doses of vaccine are believed to be left over, as the swine flu pandemic virus proved far milder in its effects than expected. Dame Deirdrie said that lessons needed to be learnt …

The next flu pandemic could be more severe than the H1N1 pandemic of 2009, health experts have warned. Maria Zambon, director of the Health Protection Agency’s Centre for Infections, borrowed from Benjamin Franklin when she suggested that the emergence of new pandemics was as certain in this world as “death and taxes.” Professor Zambon was summing up the Health Protection Agency’s Pandemic Influenza Conference held in London on 21 and 22 June, which explored the world’s response to a 21st century pandemic. Earlier in the conference Nancy Cox, …