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Challenges of the 2009 H1N1 Pandemic Influenza:
Charles Penn
Global Influenza Programme
World Health Organization
Geneva
Challenges of 2009 H1N1 Pandemic | March 16th 20102 |
Influenza Pandemics 20th CenturyInfluenza Pandemics 20th Century
A(H1N1) A(H2N2) A(H3N2)
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
20-40 million deaths 1-4 million deaths 1-4 million deaths
Credit: US National Museum of Health and Medicine
Challenges of 2009 H1N1 Pandemic | March 16th 20104 |
Definition of "pandemic"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
Challenges of 2009 H1N1 Pandemic | March 16th 20105 |
OutlineOutline
History of the pandemic
Current status (epidemiology)
Clinical presentation and impact
Vaccines & antivirals
Challenges of 2009 H1N1 Pandemic | March 16th 20106 |
4 April: outbreak of ILI in Veracruz
15-17 April: clusters of severe pneumonia in Mexico
April May June July August OctoberSeptemberMarch
Pandemic H1N1 2009 TimelinePandemic H1N1 2009 Timeline
Challenges of 2009 H1N1 Pandemic | March 16th 20107 |
Age-related distribution of deaths from severe pneumonia compared to influenza seasons 2006-08
(Mexico, 24 March- 29 April 2009)
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
Challenges of 2009 H1N1 Pandemic | March 16th 20108 |
4 April: outbreak of ILI in Veracruz
15-17 April: clusters of severe pneumonia in Mexico
27 April: WHO phase 4
May June July August OctoberSeptemberMarch
21 April: 2 cases of H1N1 confirmed in California, USA
23 April: H1N1 confirmed in several patients in MX
27 April: Canada and Spain report H1N1 cases
April
Pandemic H1N1 2009 TimelinePandemic H1N1 2009 Timeline
29 April: WHO phase 5
Challenges of 2009 H1N1 Pandemic | March 16th 20109 |
4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5
April
27 April: WHO phase 4
11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries
May June July August OctoberSeptemberMarch
21 April: 2 cases of H1N1 confirmed in California, USA
Pandemic H1N1 2009 TimelinePandemic H1N1 2009 Timeline
Challenges of 2009 H1N1 Pandemic | March 16th 201010 |
29 April: WHO phase 5
April
27 April: WHO phase 4
11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries
May June July AugustMarch
WK 24: SA H3N2 peak
Increasing activity throughout Northern Hemisphere
September October
Pandemic H1N1 2009 TimelinePandemic H1N1 2009 Timeline
Challenges of 2009 H1N1 Pandemic | March 16th 201011 |
Challenges of 2009 H1N1 Pandemic | March 16th 201012 |
Challenges of 2009 H1N1 Pandemic | March 16th 201013 |
Exacerbation of Underlying conditions
Disease presentation and progressionDisease presentation and progression
Uncomplicated self limiting illness
Severe lower respiratoryTract infection:
Viral pneumonitisARDS
Bacterial pneumonia
Challenges of 2009 H1N1 Pandemic | March 16th 201014 |
Age-Specific (population based) hospitalization rates (Australia, Chile, Argentina, New Zealand)
Age-Specific (population based) hospitalization rates (Australia, Chile, Argentina, New Zealand)
Challenges of 2009 H1N1 Pandemic | March 16th 201015 |
Within Vaccine Area, Four Particular Priorities
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
Challenges of 2009 H1N1 Pandemic | March 16th 201016 |
Update on DonationsUpdate on Donations
13 donor governments*
5 donor manufacturers**
190 M vaccine doses pledged
74.5 M syringes pledged
US$ 46M pledged for operations
**Becton-Dickinson, CSL, GSK, MedIummune, Sanofi Pasteur, Temptime
*Australia, Belgium, Brazil, Canada, France, Germany, Italy, Japan, New Zealand, Singapore, Switzerland, Thailand, UK, USA (and the Bill and Melinda Gates Foundation)
Challenges of 2009 H1N1 Pandemic | March 16th 201017 |
Guidelinesfor use
Equitable Access
Monitoringeffectiveness
Role of AntiviralsRole of Antivirals
Challenges of 2009 H1N1 Pandemic | March 16th 201018 |
Final commentsFinal 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
Challenges of 2009 H1N1 Pandemic | March 16th 201019 |
Some successesSome 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
Challenges of 2009 H1N1 Pandemic | March 16th 201021 |
THANK YOU