# 4614
Although an influenza pandemic has been the world’s most widely anticipated public health crisis for a great many years, our ability to monitor, evaluate, and manage a global outbreak remains limited.
Many of our public health decisions leading up to, and during this pandemic, have therefore been based on less-than-complete information.
Maria Van Kerkhove of the MRC Centre for Outbreak Analysis and Modelling, Imperial College London, along with a host of colleagues – have produced a paper for PLoS Medicine outlining 6 informational challenges for this, and future, outbreaks.
The open access study, which was published yesterday (June 1st), is entitled:
Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling
Van Kerkhove MD, Asikainen T, Becker NG, Bjorge S, Desenclos J-C, et al. 2010 Studies Needed to Address Public Health Challenges of the 2009 H1N1 Influenza Pandemic: Insights from Modeling. PLoS Med 7(6): e1000275. doi:10.1371/journal.pmed.1000275
There is no abstract, but the authors do provide a short summary (slightly reformatted for readability).
Summary Points
As the global epidemiology of the pandemic (H1N1) 2009 influenza (H1N1pdm) virus strain unfolds into 2010, substantial policy challenges will continue to present themselves for the next 12 to 18 months.
Here, we anticipate six public health challenges and identify data that are required for public health decision making:
- Measuring age-specific immunity to infection
- Accurately quantifying severity
- Improving treatment outcomes for severe cases
- Quantifying the effectiveness of interventions
- Capturing the full impact of the pandemic on mortality
- Rapidly identifying and responding to antigenic variants
Representative serological surveys stand out as a critical source of data with which to reduce uncertainty around policy choices for both pharmaceutical and nonpharmaceutical interventions after the initial wave has passed.
Continuing to monitor the time course of incidence of severe H1N1pdm cases will give a clear picture of variability in underlying transmissibility of the virus during population-wide changes in behavior such as school vacations and other nonpharmaceutical interventions.
Surveillance and reporting of infectious diseases from around the world, and even in developed countries like the United States, is less than ideal.
For example, we have only a rough estimate of how many people are sickened (or even die) from seasonal influenza each year in the United States (and those estimates are not without their critics).
We deal often in descriptors like `influenza-like illnesses’ (ILI’s), since rapid test results are not always reliable, and most patients presenting at their doctor’s office with an ILI aren’t tested anyway.
Complicating matters, even during the height of flu season, less than half of all respiratory `flu-like’ illnesses are caused by influenza A (see ILI’s Aren’t Always The Flu).
All of which makes quantifying an influenza outbreak, and comparing it to past events, extremely difficult in real time.
The authors of this report argue that increased serological studies, along with rapid dissemination of the data, stands out as perhaps the best (but not the only) tool available for gauging an emerging, or evolving, pandemic.
Follow this link to read their report, and recommendations, in its entirety.
