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Lessons from the European Experience with A(H1N1) 2009

Lessons from the European Experience with A(H1N1) 2009. Angus Nicoll CBE European Centre for Disease Prevention and Control 3 rd meeting of the National Influenza Centres in the Western Pacific and South East Asian Regions, Beijing. H3N8. H2N2. H2N2. H1N1. Pandemic H1N1. H3N2. 2015.

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Lessons from the European Experience with A(H1N1) 2009

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  1. Lessons from the European Experience with A(H1N1) 2009 Angus Nicoll CBE European Centre for Disease Prevention and Control 3rd meeting of the National Influenza Centres in the Western Pacific and South East Asian Regions, Beijing

  2. H3N8 H2N2 H2N2 H1N1 PandemicH1N1 H3N2 2015 2010 1915 1925 1955 1965 1975 1985 1995 2005 1895 1905 H1N1 H9* Recorded new avian influenzas 1999 H5 1997 2003 H7 1980 1996 2002 1955 1965 1975 1985 1995 2005 Pandemics of influenza Recorded human pandemic influenza(early sub-types inferred) 2009 Pandemic influenza H1N1 1889 Russian influenza H2N2 1968 Hong Kong influenza H3N2 1918 Spanish influenza H1N1 1900 Old Hong Kong influenza H3N8 1957 Asian influenza H2N2 Animated slide: Press space bar Reproduced and adapted (2009) with permission of Dr Masato Tashiro, Director, Center for Influenza Virus Research, National Institute of Infectious Diseases (NIID), Japan.

  3. A pandemic strain emerging in the Americas. Immediate virus sharing so rapid diagnostic and vaccines. Pandemic (H1N1) currently not that pathogenic. Some seeming residual immunity in a major large risk group (older people). No known pathogenicity markers. Initially susceptible to oseltamivir. Good data and information coming out of North America. Arriving in Europe in the summer. Mild presentation in most. The situation could be a lot worse for Europe! (Situation circa summer 2009) A pandemic emerging in SE Asia Delayed virus sharing Based on a more pathogenic strain, e.g. A(H5N1) No residual immunity Heightened pathogenicity Inbuilt antiviral resistance Minimal data until transmission reached Europe Arriving in the late autumn or winter Contrast with what might have happened — and might still happen! Severe presentation immediately

  4. Some ‘Lessons Learnt ‘ points • Five years preparation paid off – for those who did it • But need to operationalise and adapt the plans for this pandemic • The ‘acid tests’ have been crucial e.g. can you distribute antivirals quickly and efficiently ?http://ecdc.europa.eu/en/healthtopics/Pages/Pandemic_Influenza_Assessment_Tools.aspx • Built around a regularly updated risk assessment http://ecdc.europa.eu/en/healthtopics/Documents/0907_Influenza_AH1N1_Risk_Assessment.pdf • Planning projections has to be adjusted http://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Planning_Assumptions_for_the_First_Wave_of_Pandemic_A(H1N1)_2009_in_Europe.pdf • Surveillance has had to be adjusted http://ecdc.europa.eu/en/publications/Publications/0908_MER_Surveillance_and_Studies_in_a_Pandemic_Meeting_Report.pdf • Personal interventions - are justified • Societal Public Health Interventions – mostly not justified http://ecdc.europa.eu/en/publications/Publications/0906_TER_Public_Health_Measures_for_Influenza_Pandemics.pdfhttp://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Managing_schools_during_the_current_pandemic_(H1N1)_2009.pdf • Containment vs. Mitigation – beware of policy decisions http://ecdc.europa.eu/en/healthtopics/Documents/0906_Influenza_AH1N1_Mitigation_and_Delaying_Strategies_for_the_Influenza_in_Europe.pdf • Beware of stating numbers – deaths are difficult • The health care sector is a vulnerable point

  5. Idealised national curve for planning, Europe 2009: Reality is never so smooth and simple Initiation Acceleration Peak Declining 25% aths 20% 15% Proportion of total cases, consultations, hospitalisations or de 10% 5% 0% 1 2 3 4 5 6 7 8 9 10 11 12 Week Single-wave profile showing proportion of new clinical cases, consultations, hospitalisations or deaths by week. Based on London, second wave 1918. Animated slide: Please wait Source: Department of Health, UK

  6. One possible European scenario — summer 2009 Initiation Acceleration Peak Declining 25% 20% 15% Proportion of total cases, consultations, hospitalisations or deaths 10% 5% 0% Apr Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Month In reality, the initiation phase can be prolonged, especially in the summer months. What cannot be determined is when acceleration takes place. Animated slide: Press key

  7. Switch to deaths

  8. Some ‘Lessons Learnt ‘ points • Five years preparation paid off – for those who did it • But need to operationalise and adapt the plans for this pandemic • The ‘acid tests’ have been crucial e.g. can you distribute antivirals quickly and efficiently ?http://ecdc.europa.eu/en/healthtopics/Pages/Pandemic_Influenza_Assessment_Tools.aspx • Built around a regularly updated risk assessment http://ecdc.europa.eu/en/healthtopics/Documents/0907_Influenza_AH1N1_Risk_Assessment.pdf • Planning projections has to be adjusted http://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Planning_Assumptions_for_the_First_Wave_of_Pandemic_A(H1N1)_2009_in_Europe.pdf • Surveillance has had to be adjusted http://ecdc.europa.eu/en/publications/Publications/0908_MER_Surveillance_and_Studies_in_a_Pandemic_Meeting_Report.pdf • Personal interventions - are justified • Societal Public Health Interventions – mostly not justified http://ecdc.europa.eu/en/publications/Publications/0906_TER_Public_Health_Measures_for_Influenza_Pandemics.pdfhttp://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Managing_schools_during_the_current_pandemic_(H1N1)_2009.pdf • Containment vs. Mitigation – beware of policy decisions http://ecdc.europa.eu/en/healthtopics/Documents/0906_Influenza_AH1N1_Mitigation_and_Delaying_Strategies_for_the_Influenza_in_Europe.pdf • Beware of stating numbers – deaths are difficult • The health care sector is a vulnerable point

  9. RCGP (England and Wales) ILI consultation rate per 100,000 2008/09 and recent seasons.

  10. Some revised planning assumptions for the pandemic – first wave A(H1N1) 2009These represent a reasonable worst case applying to one European country (the United Kingdom) with data available as of July 2009They should not be used for predictionsSource: UK http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_102892

  11. Some ‘Lessons Learnt ‘ points • Five years preparation paid off – for those who did it • But need to operationalise and adapt the plans for this pandemic • The ‘acid tests’ have been crucial e.g. can you distribute antivirals quickly and efficiently ?http://ecdc.europa.eu/en/healthtopics/Pages/Pandemic_Influenza_Assessment_Tools.aspx • Built around a regularly updated risk assessment http://ecdc.europa.eu/en/healthtopics/Documents/0907_Influenza_AH1N1_Risk_Assessment.pdf • Planning projections has to be adjusted http://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Planning_Assumptions_for_the_First_Wave_of_Pandemic_A(H1N1)_2009_in_Europe.pdf • Surveillance has had to be adjusted http://ecdc.europa.eu/en/publications/Publications/0908_MER_Surveillance_and_Studies_in_a_Pandemic_Meeting_Report.pdf • Personal interventions - are justified • Societal Public Health Interventions – mostly not justified http://ecdc.europa.eu/en/publications/Publications/0906_TER_Public_Health_Measures_for_Influenza_Pandemics.pdfhttp://ecdc.europa.eu/en/healthtopics/Documents/0908_InfluenzaA_H1N1_Managing_schools_during_the_current_pandemic_(H1N1)_2009.pdf • Containment vs. Mitigation – beware of policy decisions http://ecdc.europa.eu/en/healthtopics/Documents/0906_Influenza_AH1N1_Mitigation_and_Delaying_Strategies_for_the_Influenza_in_Europe.pdf • Beware of stating numbers – deaths are difficult • The health care sector is a vulnerable point

  12. Daily and Weekly hospitalisations with suspected pandemic influenza in England, by age group. Weekly number (rate per 100,000 population) of new hospitalisations Daily rate per 100,000 population of new hospitalisations.

  13. Hospitalised patientsEngland At 12 August 0800

  14. Hospitalisation ratiosper 100,000 population of that age At 12 August 0800

  15. Some ‘Lessons Learnt ‘ points • Five years preparation paid off – for those who did it • But need to operationalise and adapt the plans for this pandemic • The ‘acid tests’ have been crucial e.g. can you distribute antivirals quickly and efficiently • Built around a regularly updated risk assessment • Planning projections has to be adjusted • Surveillance has had to be adjusted Personal interventions - are justified • Societal Public Health Interventions – mostly not justified • Containment vs. Mitigation – beware of policy decisions • Beware of stating numbers – deaths are difficult • The health care sector is a vulnerable point

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