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Challenges of the 2009 H1N1 Pandemic Influenza:

Challenges of the 2009 H1N1 Pandemic Influenza:. Charles Penn Global Influenza Programme World Health Organization Geneva. Influenza Pandemics 20th Century. Credit: US National Museum of Health and Medicine. 1918: “Spanish Flu”. 1957: “Asian Flu”. 1968: “Hong Kong Flu”.

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Challenges of the 2009 H1N1 Pandemic Influenza:

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  1. Challenges of the 2009 H1N1 Pandemic Influenza: Charles Penn Global Influenza Programme World Health Organization Geneva

  2. Influenza Pandemics 20th Century Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 20-40 million deaths 1-4 million deaths 1-4 million deaths A(H1N1) A(H2N2) A(H3N2)

  3. Definition of "pandemic" • Many definitions: • "Epidemic over a wide geographic area and affecting a large proportion of the population" • "Worldwide epidemic" • Context of influenza virus: • New strain • Antigenic "shift" (new subtype) • Transmissible human to human • Cause illness

  4. Outline • History of the pandemic • Current status (epidemiology) • Clinical presentation and impact • Vaccines & antivirals

  5. Pandemic H1N1 2009 Timeline 4 April: outbreak of ILI in Veracruz March April May June August September July October 15-17 April: clusters of severe pneumonia in Mexico

  6. Age-related distribution of deaths from severe pneumonia compared to influenza seasons 2006-08(Mexico, 24 March- 29 April 2009) During 5-weeks period, 2155 cases of severe pneumonia with 821 hospitalizations + 100 deaths: 87% of deaths and 71% of severe pneumonia cases aged 5- 59 yrs

  7. Pandemic H1N1 2009 Timeline 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 April May June August March September July October 15-17 April: clusters of severe pneumonia in Mexico 27 April: Canada and Spain report H1N1 cases 23 April: H1N1 confirmed in several patients in MX

  8. Pandemic H1N1 2009 Timeline 21 April: 2 cases of H1N1 confirmed in California, USA 27 April: WHO phase 4 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June August March September July October

  9. Pandemic H1N1 2009 Timeline 27 April: WHO phase 4 29 April: WHO phase 5 Increasing activity throughout Northern Hemisphere 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries April May June August March September July October WK 24: SA H3N2 peak

  10. Disease presentation and progression Uncomplicated self limiting illness Exacerbation of Underlying conditions Severe lower respiratory Tract infection: Viral pneumonitis ARDS Bacterial pneumonia

  11. Age-Specific (population based) hospitalization rates (Australia, Chile, Argentina, New Zealand)

  12. Within Vaccine Area, Four Particular Priorities • Facilitate rapid development and manufacture of pandemic vaccine • Provide guidance on use of pandemic vaccine • Monitor vaccine safety • Open or increase vaccine access for developing & middle income countries

  13. Update on Donations • 13 donor governments* • 5 donor manufacturers** • 190 M vaccine doses pledged • 74.5 M syringes pledged • US$ 46M pledged for operations *Australia, Belgium, Brazil, Canada, France, Germany, Italy, Japan, New Zealand, Singapore, Switzerland, Thailand, UK, USA (and the Bill and Melinda Gates Foundation) **Becton-Dickinson, CSL, GSK, MedIummune, Sanofi Pasteur, Temptime

  14. Role of Antivirals Monitoring effectiveness Guidelines for use Equitable Access

  15. Final comments • Never enough information • World looks to WHO for leadership • Evidence-based responses • Be prepared to go where others don't • Unintended consequences • Tide of media interest, public opinion • Better prepared than ever before BUT... • Virus still spread faster than we could act • News and opinion travels faster and further than ever before

  16. Some successes • Rapid isolation and characterisation of new virus • Vaccine developed and available in 6 months • New antivirals since last pandemic which are effective • Reducing severity of illness, hospitalisation, death • Advances in healthcare (especially CC/ICU) • Clinical networks effective in real time • From science to public health to critical care

  17. THANK YOU

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