As Novel H1N1 Influenza Reaches Pandemic Level, Public Health Preparedness Efforts Build

Laura Newman, MA


June 26, 2009

In This Article

First Pandemic Systematically Monitored in Real Time

"The world is now at the start of the 2009 influenza pandemic," said Margaret Chan, MD, Director-General of the World Health Organization (WHO), on June 11. Dr. Chan added: "No previous pandemic has been detected so early or watched so closely in real time, right at the very beginning. The world can now reap the benefits of investments over the last 5 years, in pandemic preparedness."

A multidisciplinary expert panel on the Human Swine Flu (H1N1) and Novel Influenza Pandemics -- held at the New York Academy of Sciences, New York, NY, on May 28, 2009 -- drew attention to worldwide, national, and local surveillance and preparedness efforts under way for a possible pandemic. The scope of the public health program could change in the fall and winter if the virus appears in the southern hemisphere. So far, the virus has been stable, but the virus could mutate and become more transmissible or virulent, perhaps becoming more of a threat to the northern hemisphere. Clinicians need to keep abreast of the situation by following the US Centers for Disease Control and Prevention (CDC), WHO, and area health department Websites for real-time recommendations and guidance, according to the panelists.

Raising the pandemic level to 6, its highest level, on the basis of geographic spread alone was not a surprise. The novel H1N1 virus has shown no sign of abatement. Dr. Chan reported 30,000 confirmed cases in 74 countries on June 11. In the United States, cases have been identified in all 50 states.

The New York Academy of Sciences meeting focused on the need to ramp up continuing surveillance worldwide, while preparing for possible mass immunization and treatment with antiviral medications. Panelists made it abundantly clear that international health authorities have been preparing for a possible pandemic since the avian flu outbreak. The CDC and New York City Department of Health and Mental Hygiene (NYC DOHMH) representatives provided a snapshot of the continuing international, national, and community response and broad collaborations across the globe. The challenges behind developing safe and effective vaccines and antiviral medications for novel influenza viruses were also addressed.

Throughout the afternoon, panelists contrasted the deadly 1918 Spanish influenza pandemic, which killed 50 million people -- more than those killed in World War I -- with the "great nonpandemic of 1976." That year's swine flu attack hit Army recruits at Fort Dix, New Jersey, and inspired a National Immunization Program of 43 million people. "A death of a 24-year-old soldier sounded the alarm, but the epidemic fizzled in terms of virulence," John G. Bartlett, MD, told Medscape Medical News. Dr. Bartlett, Professor and Founding Director of the Center for Civilian Biodefense Strategies, Johns Hopkins University School of Medicine, Baltimore, Maryland, was not part of the panel, and he did not attend the symposium.

Panel member Edwin D. Kilbourne, MD, Emeritus Professor of Microbiology and Immunology at New York Medical College, Valhalla, New York, was at the center of the 1976 story and had a long career in influenza research. He sheepishly shared photos of President Gerald Ford and himself getting the vaccine, along with news clips mocking what soon proved to be a nonpandemic. The program was the butt of jokes in public health because it never extended beyond Fort Dix. Many referred to it as a "fiasco" and a "debacle"; others called it a "noble effort in public health" and valuable in teaching people about the value of vaccination. The immunization program was halted in December 1976.

Some people who were vaccinated developed Guillain-Barré syndrome. "What we learned is that mass vaccination in such a short span of time is not without risks," said Dr. Kilbourne. However, there have been questions of the precise relationship between vaccination and Guillain-Barré syndrome. Dr. Kilbourne said that the vaccine manufacturers should be indemnified by the government. Dr. Bartlett acknowledged that Guillain-Barré syndrome was a "serious complication," but added that "its connection to the vaccine was never terribly convincing."


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