Pandemic influenza virus surveillance, Izu-Oshima Island, Japan

Pandemic Influenza

This chapter will describe pandemic threats and the steps necessary to reduce morbidity and mortality. An explanation is provided on genetic mutations leading to the emergence of novel influenza strains. Medical countermeasures include vaccination and antiviral medications. Public messaging is also important to promote flu shots, reinforce basic hygiene measures, and instruct those who may be ill to limit contacts. The World Health Organization (WHO) tracks seasonal influenza for anomalies indicating an emerging pandemic influenza strain. WHO updated the international pandemic alert system after the 2009–2010 H1N1 pandemic. With each declaration, temporary recommendations are provided, and added regulatory actions are taken by WHO member states. In addition, the Centers for Disease Control and Prevention (CDC) updated the U.S. framework for pandemic influenza preparedness and response. Each pandemic interval is accompanied by specific recommendations for state and local public health authorities. Effective influenza control includes both pharmaceutical and nonpharmaceutical recommendations. Other severe viral pandemic respiratory threats, including the “Middle East Respiratory Syndrome Coronavirus” (MERS-CoV), require similar resources and infrastructure to manage.

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Differentiate between seasonal and pandemic influenza.

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Identify proteins that change during genetic mutation of influenza viruses.

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Describe pharmaceutical options available to prevent influenza or reduce severity of disease.

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List the World Health Organization (WHO) phases of pandemic response.

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Explain the difference between the WHO pandemic phases and the US pandemic intervals.

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Describe how an outbreak peak curve can be compressed and what benefits are derived from compressing it.

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List what individuals can do to reduce the risk of influenza.

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Define nonpharmaceutical interventions and give examples.

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Summarize the types of activities local public health agencies should consider for each of the US pandemic intervals.

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Describe the limitations of a government response to a pandemic.

Influenza A(H1N1)pdm09 and cystic fibrosis lung disease: a systematic meta-analysis

Background

To systematically assess the literature published on the clinical impact of Influenza A(H1N1)pdm09 on cystic fibrosis (CF) patients.

Methods

An online search in PUBMED database was conducted. Original articles on CF patients with Influenza A(H1N1)pdm09 infection were included. We analyzed incidence, symptoms, clinical course and treatment.

Results

Four surveys with a total of 202 CF patients infected by Influenza A(H1N1)pdm09 were included. The meta-analysis showed that hospitalisation rates were higher in CF patients compared to the general population. While general disease symptoms were comparable, the clinical course was more severe and case fatality rate (CFR) was higher in CF patients compared to asthmatics and the general population.

Conclusions

Evidence so far suggests that CF patients infected with Influenza A(H1N1)pdm09 show increased morbidity and a higher CFR compared to patients with other chronic respiratory diseases and healthy controls. Particularly, CF patients with advanced stage disease seem to be more susceptible to severe lung disease. Accordingly, early antiviral and antibiotic treatment strategies are essential in CF patients. Preventive measures, including vaccination as well as hygiene measures during the influenza season, should be reinforced and improved in CF patients.