Elizabeth Cooney: December 17, 2010
Almost 10 years after the Sept. 11 terrorist attacks and the anthrax mystery mailings, state public health departments have become better prepared to face emergencies, but a new report from a national health policy group says gains made by Massachusetts and many other states may be in danger. The state’s emergency preparedness chief said the findings do not reflect current capacity.
The Trust for America’s Health and the Robert Wood Johnson Foundation compiled scores for the 50 states based on how well they prevent, identify, and respond to new disease outbreaks, threats of bioterrorism, and natural disasters. Massachusetts, regarded as the birthplace of public health, scored six out of a possible 10 points. Only two states -- Iowa and Montana -- scored lower, with five points.
Like many other states, Massachusetts has seen cuts to its public health budget, from fiscal 2008-2009 to 2009-2010, which the report’s authors link to poorer readiness. The state also fell short on how it communicated with staff during emergency exercises, developing incident reports within 60 days, and rapidly identifying and submitting results of testing for foodborne diseases caused by e. coli contamination.
“That was a snapshot of our capacity at that time but it doesn’t really reflect the changes to programs we made since then,” Mary Clark, director of the Massachusetts Emergency Preparedness Bureau, said in an interview. The report looked at 2007 and 2008, which she says is outdated.
The four issues on which the state did not meet the report’s standards were based on incomplete information or have been rectified, she said. Although the state’s public health budget has been cut, the legislature has funded emergency preparedness separately. The state now meets the two criteria for staff notification and incident reporting. And a better system is now in place for reporting foodborne illness test results to the US Centers for Disease Control and Prevention.
Rhode Island also scored six out of 10 points. Maine did slightly better with a score of seven out of 10. Connecticut, New Hampshire, and Vermont led New England with eight out of 10 points. Only Maine and New Hampshire had stable or increased funding for public health.
Clark said she sees a continued commitment to public health preparedness in Massachusetts and other states, as shown by their response to the H1N1 flu pandemic last year.
“It wasn’t as severe as it could have been. Despite the issues around vaccine availability and timeliness, Massachusetts, for example, had one of the highest rates of vaccination of all of the states in the US,” she said. “The ability to do that was based on emergency preparedness work done at the local and state level in the years since 2001.”
http://www.boston.com/news/health/blog/2010/12/mass_emergency.html
Showing posts with label H1N1. Show all posts
Showing posts with label H1N1. Show all posts
Sunday, 19 December 2010
Sunday, 5 September 2010
BIOTERRORISM: Swine flu yielded valuable lessons for future
Carol Campbell and Yojana Sharma
25 August 2010
The pandemic scare highlighted the global shortage of vaccine
As the WHO declared the end of the swine flu pandemic earlier this month, the high financial cost incurred in preparing defences against the disease has left many countries wondering whether it was money that could have been better spent, given that the disease failed to spread as widely as feared.
But experts say that while the cost of vaccines and anti-virals was high, the lessons learned and the monitoring systems put in place will protect humanity from inevitable future virus outbreaks.
Frew Benson, South Africa's chief director of communicable diseases, said the country spent 115 million rand (US$15.6 million) on vaccine but has only used about US$3.4 million worth. The remaining vaccine will, until it expires, remain part of the country's strategic stock against the epidemic, Benson said.
There also remains a huge stockpile of antivirals. Benson said 100,000 courses were imported for South Africa but only 25,000 have been used so far. The cost of wasted expired vaccine and antivirals will be shouldered by purchasing governments.
"This country was lucky, for some reason this epidemic didn't hit us as hard as other countries in Africa. West Africa is battling far more with A(H1N1) than we are here," said Benson.
Lucille Blumberg, head of epidemiology at South Africa's National Institute for Communicable Diseases, said it was not all wasted — laboratories had been upgraded and skills improved across Africa to cope with the epidemic.
"Yes, there was excessive use of resources in South Africa during the epidemic," she told SciDev.Net. "But this was inevitable."
"There was a time, at the height of the epidemic, when laboratories couldn't cope," she said. "In hindsight we didn't need to test and treat every case, but at that stage we didn't know what we were dealing with — or how dangerous it was."
Rick Bright, scientific director of the global vaccine development programme at Seattle-based nongovernmental organisation PATH, said that a network of influenza centres around the world had been strengthened and regional labs expanded, including in Africa where there are now major laboratories in Madagascar, Senegal and South Africa.
This is particularly important for flu, which does not display specific external symptoms and can be diagnosed only through laboratory testing.
"H1N1 taught us a lot by intensifying attention without the occurrence of fatalities. It was a dry-run for a larger more lethal flu pandemic," said Bright, who has been reviewing the needs of low-income countries for the Influenza VII conference, to be held in Hong Kong in September.
He said the pandemic scare highlighted the global shortage of vaccine, and the need for countries to be able to manufacture antivirals and vaccines within their own countries.
"Stockpiling is not a solution, because no one knows what the next mutation of the influenza virus will be," Bright said.
"Maintaining a stockpile has major costs and you have to continually test the vaccine for potency and that also has costs," said Kathleen Neuzil, Senior Advisor for Immunizations at PATH. The H5N1 vaccine, for example, is more stable in bulk form, but once it is in syringes and vials it can lose its potency within a year.
"The emergence of H1N1 showed the limitations of a stockpile concept, particularly for low-income countries," said Katherine Neuzil, director of PATH's global vaccine work. "You don't have time to put in place a stockpile if the virus mutates."
"In terms of preparedness, we are in much better shape than ten, five, or even two years ago, especially in terms of the degree of surveillance, and the number of countries involved in surveillance," Neuzil said.
http://www.scidev.net/en/news/swine-flu-yielded-valuable-lessons-for-future-say-experts.html
25 August 2010
The pandemic scare highlighted the global shortage of vaccine
As the WHO declared the end of the swine flu pandemic earlier this month, the high financial cost incurred in preparing defences against the disease has left many countries wondering whether it was money that could have been better spent, given that the disease failed to spread as widely as feared.
But experts say that while the cost of vaccines and anti-virals was high, the lessons learned and the monitoring systems put in place will protect humanity from inevitable future virus outbreaks.
Frew Benson, South Africa's chief director of communicable diseases, said the country spent 115 million rand (US$15.6 million) on vaccine but has only used about US$3.4 million worth. The remaining vaccine will, until it expires, remain part of the country's strategic stock against the epidemic, Benson said.
There also remains a huge stockpile of antivirals. Benson said 100,000 courses were imported for South Africa but only 25,000 have been used so far. The cost of wasted expired vaccine and antivirals will be shouldered by purchasing governments.
"This country was lucky, for some reason this epidemic didn't hit us as hard as other countries in Africa. West Africa is battling far more with A(H1N1) than we are here," said Benson.
Lucille Blumberg, head of epidemiology at South Africa's National Institute for Communicable Diseases, said it was not all wasted — laboratories had been upgraded and skills improved across Africa to cope with the epidemic.
"Yes, there was excessive use of resources in South Africa during the epidemic," she told SciDev.Net. "But this was inevitable."
"There was a time, at the height of the epidemic, when laboratories couldn't cope," she said. "In hindsight we didn't need to test and treat every case, but at that stage we didn't know what we were dealing with — or how dangerous it was."
Rick Bright, scientific director of the global vaccine development programme at Seattle-based nongovernmental organisation PATH, said that a network of influenza centres around the world had been strengthened and regional labs expanded, including in Africa where there are now major laboratories in Madagascar, Senegal and South Africa.
This is particularly important for flu, which does not display specific external symptoms and can be diagnosed only through laboratory testing.
"H1N1 taught us a lot by intensifying attention without the occurrence of fatalities. It was a dry-run for a larger more lethal flu pandemic," said Bright, who has been reviewing the needs of low-income countries for the Influenza VII conference, to be held in Hong Kong in September.
He said the pandemic scare highlighted the global shortage of vaccine, and the need for countries to be able to manufacture antivirals and vaccines within their own countries.
"Stockpiling is not a solution, because no one knows what the next mutation of the influenza virus will be," Bright said.
"Maintaining a stockpile has major costs and you have to continually test the vaccine for potency and that also has costs," said Kathleen Neuzil, Senior Advisor for Immunizations at PATH. The H5N1 vaccine, for example, is more stable in bulk form, but once it is in syringes and vials it can lose its potency within a year.
"The emergence of H1N1 showed the limitations of a stockpile concept, particularly for low-income countries," said Katherine Neuzil, director of PATH's global vaccine work. "You don't have time to put in place a stockpile if the virus mutates."
"In terms of preparedness, we are in much better shape than ten, five, or even two years ago, especially in terms of the degree of surveillance, and the number of countries involved in surveillance," Neuzil said.
http://www.scidev.net/en/news/swine-flu-yielded-valuable-lessons-for-future-say-experts.html
Tuesday, 20 July 2010
BIOTERRORISM: H1N1 and 1918 virus
KSDK -- The vaccine for last year's pandemic H1N1 influenza also appears to protect against the 1918 Spanish influenza virus, which killed approximately 50 million world-wide, according to new research published in the online journal Nature Communications.
The findings assuage fears that the 1918 virus, which sparked the most devastating pandemic of the 20th century, could be used as a lethal bioterrorist agent, said Robert Belshe, M.D., director of Saint Louis University's Center for Vaccine Developments and a study author.
"Scientists reconstructed the formerly extinct 1918 influenza virus to better understand the most deadly influenza pandemic ever. However, some people raised concerns that the virus could accidentally be released or could maliciously be used as a weapon of bioterrorism," Belshe said.
"Our data indicates the H1N1 influenza vaccine likely protects against infections and illness from the 1918 virus. It's really important news for those who work with the 1918 virus in laboratories, who now know they likely will be protected from the more deadly virus if they get the H1N1 influenza vaccine."
The research also reinforces the idea that the 2009 H1N1 influenza is a milder strain of the 1918 influenza.
"The 1918 virus has basically come back. Fortunately it's much more mild this time. This finding also helps explain why older people, who have immunity to the 1918 influenza, are relatively protected against the H1N1 influenza," added Sharon Frey, M.D., clinical director of Saint Louis University Center for Vaccine Development and a study author.
Researchers studied the effect of the H1N1 influenza vaccine in both mice and humans. They vaccinated mice with the H1N1 influenza vaccine and found mice produced antibodies that cross reacted with the 1918 virus and fully protected them from the more lethal 1918 pandemic virus.
Likewise, people who were vaccinated against the H1N1 influenza mounted a significant antibody response to the 1918 influenza.
The researchers noted that because of the spread of the 2009 H1N1 influenza virus around the world and the large number of people who already have been vaccinated against H1N1, a large proportion of the population probably already has cross-protective antibodies against the 1918 virus.
"It's perhaps one of the few good things about getting the H1N1 influenza. Of course, getting the vaccination spares you from illness and also likely will protect you from the much more lethal 1918 influenza," Belshe said.
"Our findings should considerably reduce concerns about the consequences of an accidental or intended release of the deadly Spanish 1918 flu virus. In addition, going forward, those working in labs with the 1918 influenza virus might get the H1N1 vaccine for protection," Frey added.
http://www.ksdk.com/news/local/story.aspx?storyid=204280&catid=9
The findings assuage fears that the 1918 virus, which sparked the most devastating pandemic of the 20th century, could be used as a lethal bioterrorist agent, said Robert Belshe, M.D., director of Saint Louis University's Center for Vaccine Developments and a study author.
"Scientists reconstructed the formerly extinct 1918 influenza virus to better understand the most deadly influenza pandemic ever. However, some people raised concerns that the virus could accidentally be released or could maliciously be used as a weapon of bioterrorism," Belshe said.
"Our data indicates the H1N1 influenza vaccine likely protects against infections and illness from the 1918 virus. It's really important news for those who work with the 1918 virus in laboratories, who now know they likely will be protected from the more deadly virus if they get the H1N1 influenza vaccine."
The research also reinforces the idea that the 2009 H1N1 influenza is a milder strain of the 1918 influenza.
"The 1918 virus has basically come back. Fortunately it's much more mild this time. This finding also helps explain why older people, who have immunity to the 1918 influenza, are relatively protected against the H1N1 influenza," added Sharon Frey, M.D., clinical director of Saint Louis University Center for Vaccine Development and a study author.
Researchers studied the effect of the H1N1 influenza vaccine in both mice and humans. They vaccinated mice with the H1N1 influenza vaccine and found mice produced antibodies that cross reacted with the 1918 virus and fully protected them from the more lethal 1918 pandemic virus.
Likewise, people who were vaccinated against the H1N1 influenza mounted a significant antibody response to the 1918 influenza.
The researchers noted that because of the spread of the 2009 H1N1 influenza virus around the world and the large number of people who already have been vaccinated against H1N1, a large proportion of the population probably already has cross-protective antibodies against the 1918 virus.
"It's perhaps one of the few good things about getting the H1N1 influenza. Of course, getting the vaccination spares you from illness and also likely will protect you from the much more lethal 1918 influenza," Belshe said.
"Our findings should considerably reduce concerns about the consequences of an accidental or intended release of the deadly Spanish 1918 flu virus. In addition, going forward, those working in labs with the 1918 influenza virus might get the H1N1 vaccine for protection," Frey added.
http://www.ksdk.com/news/local/story.aspx?storyid=204280&catid=9
Monday, 19 July 2010
BIOTERRORISM: Inabilty to respond to threat
EGYPT: Did the government overreact to H1N1? CAIRO, 18 July 2010 (IRIN) - While a review is underway of how the World Health Organization (WHO) and national authorities handled last year's outbreak of the H1N1 virus, also referred to as swine flu, medical experts in Egypt have criticized their government for overreacting to the pandemic, provoking unjustified fear and wasting millions of dollars-worth of much-needed public funds. "Egypt is probably the only country in the world that acted in such an insane way towards the virus," Saed Aun, a former preventive medicine advisor to the Egyptian health ministry, told IRIN. "The Egyptian government applied the wrong policies in dealing with the crisis." When H1N1 was first detected in a university dormitory in April 2009, the Egyptian Cabinet in May decided to cull all the nation's more than 350,000 pigs obstensibly to avert the spread of the virus, although the link between H1N1 and pigs had not been officially established. [http://www.irinnews.org/Report.aspx?ReportId=84344] Apart from the enormous loss to pig farmers [http://www.irinnews.org/Report.aspx?ReportId=86742], the culling led to an accumulation of rubbish on the streets of the capital as pigs had been eating much of it previously. [http://www.irinnews.org/Report.aspx?ReportId=87853] In Cairo, the livelihoods of unofficial rubbish collectors - known as 'Zabalin' to Egyptians - and pig farmers were very much intertwined as the former collected organic waste from the capital's streets and sold it to farmers to feed their pigs. The cull hit the livelihoods of 70,000 former pig farmers and 'Zaballin' and their families in the Cairo area, according to local NGO Association for the Protection of the Environment. "The waste was a good source of profit for the rubbish collectors," said Israel Ayad, a pig farmer and unofficial spokesman for the rubbish collectors. "Why should they collect rubbish after the pigs are gone?" In reference to the health hazards posed by the piles of rotting waste in the capital, Chairman of the Doctors' Association Hamdy al-Sayed described the situation as a "national scandal". The government later said the cull was not related to H1N1 but was simply a general health measure. Schools hit hardest Experts say Egypt's schools were the biggest losers in the government's handling of the pandemic. In addition to the intermittent closures of some schools, the ministries of health and education ordered all schools to halve the sizes of their classrooms, which led to many children being able to attend only three days a week. [http://www.irinnews.org/Report.aspx?ReportId=86695] "The state of confusion surrounding the appearance of the virus harmed the educational process greatly," Nadia Youssef, an educational specialist at Cairo University, said. "The problem was that the virus appeared during the first months of the academic year. Some schools were closed down while parts of the curricula were removed, affecting the educational record of the students badly." Health officials in Egypt are divided over whether they can expect any more waves of H1N1 infections. [http://www.irinnews.org/Report.aspx?ReportId=88149] The country's 55 hospitals and health centres capable of dealing with H1N1 cases say they are ready to receive any new patients and have large stocks of vaccines. Fathi Shabana, head of Imbaba Fever Hospital, said his hospital had 60,000 doses of the H1N1 vaccine in preparation for winter, which is considered to begin in November. However, Mustafa Orkhan, head of the Swine Flu Centre, a local NGO which gives tips on H1N1, said he did not expect any more outbreaks of the virus in Egypt. "Egypt is safe as far as this virus is concerned," he said. Controversial vaccinations The issue of H1N1 vaccinations is at the heart of public and expert debate on the pandemic and how it has been handled. The government spent 30 million Egyptian pounds (US$5.4 million) to buy 1.9 million doses of the vaccine, having failed to secure the 5 million doses it was seeking to purchase. Later, a plan to inoculate 1.2 million schoolchildren went awry as hundreds of thousands of parents refused to send their children to schools to get the vaccine after rumours spread that the vaccines could cause physical deformities. [http://www.irinnews.org/Report.aspx?ReportId=87647] Now, the health ministry still has some 500,000 doses of the vaccine in its stocks. Some of these will be used to inoculate around 70,000 people travelling to Saudi Arabia in November to perform the annual Hajj pilgrimage, but the inoculation is optional. The remaining vaccines will expire in May 2011. "These vaccines will of course be thrown out after they expire," Aun said. "This is yet one more indication of the failure of the government to deal with the crisis wisely." Health officials said 16,356 Egyptians had contracted the H1N1 virus to date and 280 people had died - most of whom had other health problems. Globally, more than 15,000 people died as a result of the virus since April 2009 but the WHO had predicted two to four million deaths.
Thursday, 3 June 2010
BIOTERRORISM: Planning for diosasters is incompetent
The announcement that less than one-third of Torontonians received the H1N1 vaccine is taking health experts by surprise and creating alarm over potential system-wide deficiencies with the country’s pandemic planning.
It’s also raising questions over the lack of solid data on vaccination rates across the country and the accuracy of immunization estimates being used by some cities and provinces.
On Tuesday, Toronto Public Health released a report that showed 28 per cent of Toronto residents received the H1N1 vaccine. That’s far below national estimates from the Public Health Agency of Canada that indicate nearly half of the country’s population received the shot. And it’s lower than the 40 per cent that Ontario typically immunizes against seasonal flu.
“I’m surprised that it appears to be significantly lower than that,” said Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital.
As policy-makers and health experts evaluate the response to the H1N1 pandemic, Toronto’s relatively low vaccination rate signals serious problems that need to be addressed across the system, said Earl Brown, professor in the biochemistry, microbiology and immunology department at the University of Ottawa.
Vaccine programs in Toronto and elsewhere were dogged by inconsistent communication from the government over the availability of the vaccine and who should receive it first, as well as problems with vaccine supply and the prominence of anti-vaccine advocates who spread myths about immunization risks, Prof. Brown said.
“When the experts start equivocating, then the public really had to throw up their hands sometimes,” he said.
Alberta’s chief medical officer of health said the province immunized about 33 per cent of its population and agreed that missteps were made and that pandemic planning needs major improvements.
http://www.theglobeandmail.com/news/national/low-h1n1-vaccination-rate-alarms-health-experts/article1583841/
It’s also raising questions over the lack of solid data on vaccination rates across the country and the accuracy of immunization estimates being used by some cities and provinces.
On Tuesday, Toronto Public Health released a report that showed 28 per cent of Toronto residents received the H1N1 vaccine. That’s far below national estimates from the Public Health Agency of Canada that indicate nearly half of the country’s population received the shot. And it’s lower than the 40 per cent that Ontario typically immunizes against seasonal flu.
“I’m surprised that it appears to be significantly lower than that,” said Allison McGeer, director of infection control at Toronto's Mount Sinai Hospital.
As policy-makers and health experts evaluate the response to the H1N1 pandemic, Toronto’s relatively low vaccination rate signals serious problems that need to be addressed across the system, said Earl Brown, professor in the biochemistry, microbiology and immunology department at the University of Ottawa.
Vaccine programs in Toronto and elsewhere were dogged by inconsistent communication from the government over the availability of the vaccine and who should receive it first, as well as problems with vaccine supply and the prominence of anti-vaccine advocates who spread myths about immunization risks, Prof. Brown said.
“When the experts start equivocating, then the public really had to throw up their hands sometimes,” he said.
Alberta’s chief medical officer of health said the province immunized about 33 per cent of its population and agreed that missteps were made and that pandemic planning needs major improvements.
http://www.theglobeandmail.com/news/national/low-h1n1-vaccination-rate-alarms-health-experts/article1583841/
Wednesday, 19 May 2010
BIOTERRORISM: Difficulty of Containing an Epidemic
Though some consider the precautionary measures taken during the H1N1 swine flu epidemic to have been excessive, ‘better safe than sorry’ was an understandable position for health officials to take.
That stance is justified to some degree by the results of a study published today in PLoS Medicine. The analysis of the first few months of the epidemic in Vietnam suggests that actions taken in Ho Chi Minh City probably bought healthcare services valuable time to build up their response.
The researchers, from the Wellcome Trust Major Overseas Programme and Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Vietnam, analysed records from the 2009 strain of influenza virus A (H1N1) cases from the Ministry of Health, the Hospital of Tropical Diseases and the healthcare services of Ho Chi Minh City.
This produced a dataset of 321 people who tested positive for H1N1 and 298 people who tested negative between May and July 2009. The researchers say this represents 76 per cent of the known cases in southern Vietnam at the time.
Their analysis confirmed that the effects of H1N1 at the time were largely mild. Encouragingly, most cases responded well to treatment with the flu drug oseltamivir – the average time from starting treatment to completely clearing the virus was between 2.6 and 2.8 days (for those who began treatment 1-4 days after they became ill).
However, the study indicated that containing the epidemic in Ho Chi Minh City was never an achievable goal. Vietnam reported its first case of infection on 31 May 2009 and despite containment measures it had spread throughout Ho Chi Minh City by the second half of July. As of February 2010 there had been over 11,000 confirmed cases in Vietnam, including 58 confirmed deaths.
Yet the measures taken weren’t totally in vain. When the World Health Organisation declared a Phase 4 risk of a pandemic on 27 April 2009, the Vietnamese Ministry of Health mandated body temperature scans and questionnaires about symptoms for international travellers arriving at Ho Chi Minh City airport. Any suspected cases were quickly isolated in hospital.
Between 27 April and 24 July 2009 around 760,000 passengers who entered the airport on international flights were screened (0.15 per cent of incoming passengers). In the two months between 26 May and 24 July, this identified 200 positive cases among passengers.
According to the study, the intervention strategies shortened the amount of time infected individuals spent in the community, helping reduce the chances of transmission. The researchers also estimate that one in six passengers on incoming flights would have heard announcements suggesting self-quarantine, mask wearing, and guidelines for monitoring personal health. This increased the likelihood of people taking up hygienic behaviour and reporting if they had influenza-like symptoms.
“The containment measures seemed to delay the onset of large-scale transmission by at least three weeks,” said Dr Maciej Boni, one of the researchers from the University of Oxford.
“This may not sound like a lot, but in a country like Vietnam this bought valuable time for the local health services, laboratories and travel authorities to understand what was happening and start logistical preparations for the pandemic response.”
The researchers warn against reading too much into the results in terms of predicting the success of similar measures against future pandemics.
“The problem is that you don’t know what kind of virus you’re dealing with at the moment that measures need to be installed,” said Dr Rogier van Doorn of the Oxford Unit, who led the study.
“For a different type of virus, it will depend what we turn out to be dealing with. Human H5N1 bird flu cases are usually very severe, but not very transmissible, so they are easy to find and contain, and our strategies of drug treatment, contact tracing, isolation, poultry vaccination seem to have made such outbreaks manageable so far.”
The researchers are hesitant to put too much weight behind their findings. They point out that the study is largely based on observational data that is also incomplete. In addition, the patients studied were not randomised and some of the data from different sources are not directly comparable as they use different definitions. It’s also hard to assess the impact of intervention measures quantitatively without knowing how much of the virus was circulating among asymptomatic patients or how much the containment measures cost.
http://wellcometrust.wordpress.com/2010/05/19/h1n1-measures-%e2%80%98bought-valuable-time%e2%80%99-in-vietnam/#more-2021
That stance is justified to some degree by the results of a study published today in PLoS Medicine. The analysis of the first few months of the epidemic in Vietnam suggests that actions taken in Ho Chi Minh City probably bought healthcare services valuable time to build up their response.
The researchers, from the Wellcome Trust Major Overseas Programme and Oxford University Clinical Research Unit at the Hospital for Tropical Diseases in Vietnam, analysed records from the 2009 strain of influenza virus A (H1N1) cases from the Ministry of Health, the Hospital of Tropical Diseases and the healthcare services of Ho Chi Minh City.
This produced a dataset of 321 people who tested positive for H1N1 and 298 people who tested negative between May and July 2009. The researchers say this represents 76 per cent of the known cases in southern Vietnam at the time.
Their analysis confirmed that the effects of H1N1 at the time were largely mild. Encouragingly, most cases responded well to treatment with the flu drug oseltamivir – the average time from starting treatment to completely clearing the virus was between 2.6 and 2.8 days (for those who began treatment 1-4 days after they became ill).
However, the study indicated that containing the epidemic in Ho Chi Minh City was never an achievable goal. Vietnam reported its first case of infection on 31 May 2009 and despite containment measures it had spread throughout Ho Chi Minh City by the second half of July. As of February 2010 there had been over 11,000 confirmed cases in Vietnam, including 58 confirmed deaths.
Yet the measures taken weren’t totally in vain. When the World Health Organisation declared a Phase 4 risk of a pandemic on 27 April 2009, the Vietnamese Ministry of Health mandated body temperature scans and questionnaires about symptoms for international travellers arriving at Ho Chi Minh City airport. Any suspected cases were quickly isolated in hospital.
Between 27 April and 24 July 2009 around 760,000 passengers who entered the airport on international flights were screened (0.15 per cent of incoming passengers). In the two months between 26 May and 24 July, this identified 200 positive cases among passengers.
According to the study, the intervention strategies shortened the amount of time infected individuals spent in the community, helping reduce the chances of transmission. The researchers also estimate that one in six passengers on incoming flights would have heard announcements suggesting self-quarantine, mask wearing, and guidelines for monitoring personal health. This increased the likelihood of people taking up hygienic behaviour and reporting if they had influenza-like symptoms.
“The containment measures seemed to delay the onset of large-scale transmission by at least three weeks,” said Dr Maciej Boni, one of the researchers from the University of Oxford.
“This may not sound like a lot, but in a country like Vietnam this bought valuable time for the local health services, laboratories and travel authorities to understand what was happening and start logistical preparations for the pandemic response.”
The researchers warn against reading too much into the results in terms of predicting the success of similar measures against future pandemics.
“The problem is that you don’t know what kind of virus you’re dealing with at the moment that measures need to be installed,” said Dr Rogier van Doorn of the Oxford Unit, who led the study.
“For a different type of virus, it will depend what we turn out to be dealing with. Human H5N1 bird flu cases are usually very severe, but not very transmissible, so they are easy to find and contain, and our strategies of drug treatment, contact tracing, isolation, poultry vaccination seem to have made such outbreaks manageable so far.”
The researchers are hesitant to put too much weight behind their findings. They point out that the study is largely based on observational data that is also incomplete. In addition, the patients studied were not randomised and some of the data from different sources are not directly comparable as they use different definitions. It’s also hard to assess the impact of intervention measures quantitatively without knowing how much of the virus was circulating among asymptomatic patients or how much the containment measures cost.
http://wellcometrust.wordpress.com/2010/05/19/h1n1-measures-%e2%80%98bought-valuable-time%e2%80%99-in-vietnam/#more-2021
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