A little girl from the central province of Thanh Hoa died of the H1N1 influenza strain known as swine flu at the Hanoi-based Central Hospital for Tropical Diseases on 23 April 2013, reported the hospital’s deputy director Nguyen Hong Ha. It is suspected that the girl caught the flu from her brother-in-law, who is living in Hanoi. The week of 8 April 2013, he paid a visit to the home of his parents-in-law in Thanh Hoa. He had influenza at that time and communicated flu to three others in the family. Two people were free from the disease while the girl’s flu got worse. On 16 April 2013, she had fever, cough, and shortness of breath. The family took her to the hospital of Vinh Loc district in Thanh Hoa. After one day of treatment, the patient got critical breathing problems and was transferred to the Hospital of Thanh Hoa province.
Only a day later, the respiratory problem became more serious. The X-ray scan showed lesions in her lung. The patient was transferred to the Central Hospital for Tuberculosis and Lung Diseases in Hanoi, where the X-ray scan detected that her lung lesions developed very quickly. She was again transferred to another hospital — the Central Hospital for Tropical Diseases.
Deputy Director Nguyen Hong Ha of the Central Hospital for Tropical Diseases said the patient was brought to the hospital in the state of severe respiratory distress. Testing results showed that she was positive for type A/H1N1 flu virus. Upon admission, the patient was treated with antiretroviral drugs but she died on the morning of 23 April 2013.
On 22 April 2013, the Central Hospital for Tropical Diseases also received an 83-year-old man who was transferred from the Agriculture Hospital with symptoms of flu. Dr. Nguyen Van Kinh, Director of the Central Hospital for Tropical Diseases, said that flu patients died because they were brought to the hospital very late, after having complications such as respiratory failure and heavy pneumonia.
A/H1N1 influenza is the same as the other seasonal flu, with certain mortality. In Viet Nam, the fatality rate from A/H1N1 influenza is very low, only about 0.7%.
Zhang Y, Lopez-Gatell H, Alpuche-Aranda CM, et al. PLoS ONE. 3 April 2013. 8(4):e59893. doi:10.1371/journal.pone.0059893.
Available at http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0059893
Background. The 2009 H1N1 outbreak provides an opportunity to identify strengths and weaknesses of disease surveillance and notification systems that have been implemented in the past decade.
Methods. Drawing on a systematic review of the scientific literature, official documents, websites, and news reports, we constructed a timeline differentiating three kinds of events: (1) the emergence and spread of the pH1N1 virus, (2) local health officials’ awareness and understanding of the outbreak, and (3) notifications about the events and their implications. We then conducted a “critical event” analysis of the surveillance process to ascertain when health officials became aware of the epidemiologic facts of the unfolding pandemic and whether advances in surveillance notification systems hastened detection.
Results. This analysis revealed three critical events. First, medical personnel identified pH1N1 in California children because of an experimental surveillance program, leading to a novel viral strain being identified by CDC. Second, Mexican officials recognized that unconnected outbreaks represented a single phenomenon. Finally, the identification of a pH1N1 outbreak in a New York City high school was hastened by awareness of the emerging pandemic. Analysis of the timeline suggests that at best the global response could have been about one week earlier (which would not have stopped spread to other countries), and could have been much later.
Conclusions. This analysis shows that investments in global surveillance and notification systems made an important difference in the 2009 H1N1 pandemic. In particular, enhanced laboratory capacity in the U.S. and Canada led to earlier detection and characterization of the 2009 H1N1. This includes enhanced capacity at the federal, state, and local levels in the U.S., as well as a trilateral agreement enabling collaboration among U.S., Canada, and Mexico. In addition, improved global notification systems contributed by helping health officials understand the relevance and importance of their own information.
Tooher R, Collins JE, Street JM, et al. Influenza and Other Respiratory Viruses. 7 April 2013. doi:10.1111/irv.12103.
Available at http://onlinelibrary.wiley.com/doi/10.1111/irv.12103/abstract
Background. Effectiveness of pandemic plans and community compliance was extensively researched following the H1N1 pandemic. This systematic review examined community response studies to determine whether behavioural responses to the pandemic were related to level of knowledge about the pandemic, perceived severity of the pandemic and level of concern about the pandemic.
Methods. Literature databases were searched from March 2009 to August 2011 and included cross-sectional or repeated population surveys undertaken during or following the H1N1 pandemic which reported on community response to the pandemic. Studies using population subgroups and other respiratory diseases were excluded, as were mathematical modelling and qualitative studies.
Results. Nineteen unique studies were included. Fourteen reported pandemic knowledge, 14 reported levels of concern and risk perception and 18 reported pandemic behaviours. Awareness of the pandemic was high, and knowledge was moderate. Levels of concern and risk were low moderate and precautionary behavioural actions lower than intentions. The most commonly reported factors influencing adopting recommended behaviours were increased risk perception and older age, increased pandemic knowledge and being female.
Conclusions. Important implications for future pandemic planning were identified. A remarkable lack of intercountry variability in responses existed; however, differences between populations within a single country suggest one-size-fits-all plans may be ineffective. Secondly, differences between reported precautionary intentions and preventive behaviours undertaken may be related to people’s perceived risk of infection.