H1N1 outbreak US 2009-2010

H1N1 outbreak US 2009-2010

Abstract

A flu strain caused the H1N1 outbreak of 2009 – 2010, multiple organizations were involved to the response towards the H1N1 epidemic, at the beginning of the epidemic FDA designed management systems to help in response, that includes a seven-team structure that was supposed to address some health-related issues of the epidemic, many people were not pleased with the way FDA was responding to the explosion which leads to uproar from the citizens and even some boycotting the vaccine. FDA, in collaboration with CDC, clarified the use of MCMs to both the public and health providers.

Introduction

The outbreak of H1N1 in 2009-2010 was as a result of a novel flu strain, the response to the outbreak involved multiple governmental organizations (Sagy, Feder-Bubis, Novack, Peleg-Sagy & Greenberg, 2018), it was first detected in the United States and it spread at a speedy rate to the rest of the world, the virus contained a unique combination of influenza gene that had never been identified either on people or animals. The infection mostly attacked the young people, but the people who were 60 years and above had antibodies that fought against the virus. At the beginning of the outbreak FDA created seven teams to address specific public health needs related to H1N1 (Hajj Hussein et al. 2015), their response was not meeting the requirements that were happening during the period, the had poor communication while responding to the flu, they didn’t address the issue about concerns that the vaccine was risky and they were not collaborating with other health entities.

A vaccine was produced, but it was not enough since it was available in small quantities, the vaccine was available in large amounts after the peak of illness during the second wave had come and gone in the US, it was estimated by CDC that between 12th April 2009 to 10^th April 2010 there were 60.8 million cases and 12, 469 deaths in the United States (Pirages, 2017). CDC also estimated that the number of people who died worldwide because of the flu was between 151,700 – 575,400 people, 80 percent of people of the population that disappeared from the virus were below the age of 65 years, the statistics differed to other influenza epidemics in which most of the people who die 70percent to 90 percent occur to people who are 65 years and above. A multifacetedmultifaceted and long-term response to the pandemic was mounted by the United States, on 10the August 2010 (Palkonyay & Fatima, 2016), the World Health Organization declared an end to an H1N1 influenza pandemic.

Planning and preparing for a pandemic are essential because it ensures an adequate response, because when an epidemic strikes it affects everyone in the community, CDC decided to come up with nine preparedness goals to strategically direct resources towards achieving this overarching goal, this paper will illustrate how the nine preparedness goals helped in controlling H1N1 virus outbreak.

Prevention

Under prevention is where the first goal for preparedness occurs, this includes increasing the use and Development of interventions known to prevent human illness from chemical, biological, radiological agents and naturally occurring health threat, the CDC during and after the outbreak of H1N1 (Ungchusak, K., Heymann, D., & Pollack, M. (2019), it provides guidance to all healthcare facilities about the explosion, they emphasized that successfully preventing the transmission required a comprehensive approach which included pandemic planning that included developing written plans that are flexible and adaptable should any changes occur in the severity of the illness, they also made sure they have a criteria for identification of suspected influenza patients, changes to isolation precautions based on tasks and anticipated exposures and they had recommendations for time away from work for health personnel, they had prevention interventions in the following order of preference, elimination of vulnerabilities, engineering controls, administrative controls and personal protective equipment’s.

The Food and Drug Administration (FDA)  at the start of the outbreak instituted and H1N1 incident management system to coordinated the responses, it created seven teams to address public health needs related to the virus, it included the vaccine team, the antiviral team, the in vitro diagnostics team, the personal protective equipment team, the blood team, the drug shortage team and the consumer protection team.

Detection and reporting

The second goal is decreasing the time needed to classify health events as terrorism or naturally occurring partnership with other agencies (Rose, Murthy, Brooks & Bryant, 2017), the United States government contracted with five pharmaceutical companies to help in the production of the vaccine that was approved by FDA, four of the companies selected were contracted to produce different formulations of inactivated vaccine that would be administered via injection, while the other remaining company was contracted to develop a LAIV formulation that would be delivered via nasal inhalation. That partnership among the pharmaceutical companies gave the projection of 45 million doses of vaccine to be manufactured.

While the process of making the vaccines was going on, CDC developed plans to distribute the vaccines across the country, and it contracted with a logistics company to establish a central distribution network that would spread the vaccine to state and local health departments based on the population estimates they had. The state health also took part in making sure that the vaccine is administered by working with local health departments to develop the plans for distribution; all this effort was being covered by state and local media.

The third goal is aimed at decreasing the time needed to detect and report chemical, biological, radiological agents in tissue, food, or environmental samples that cause a threat to public health. During the outbreak of the virus it is noted that FDA had approved different formulations of the vaccines, the names of the manufacturers of the vaccines, warnings of potential side effects, dosage recommendation and contraindications without doing proper research, but their aim was for the manufacturing of the vaccine to start so that it should be supplied over a short period of time, FDA did not make any effort to explain the oversight that went into the manufacturing processes to ensure vaccine safety.

The fourth goal aim was to improve the timeliness and accuracy of communications regarding threat to the public’s health, H1N1outbreak main challenge was communication between the organizations that were fighting the outbreak and the public, concerns about vaccine additives such as thimerosal and adjuvants were present during the pandemic (Schoch-Spana, et al. 2016), having the fact that thimerosal, an organomercury preservative was only used in one formulation of the vaccine, blogs and news sources  raised concerns about the possible link between these vaccine components and autism, Gulf war syndrome and other neurological and developmental disorders, the news sources always advise the public to refrain from receiving the vaccine.

Anti-vaccination blogs and news sources raised issues concerning the vaccine; their complaint was based on the reason that the production of the vaccine was rushed and this may lead to the vaccination being unsafe, this topic was also raised by mainstream media. The information that the FDA was no putting across the public is that the H1N1 vaccine was produced by the same manufacturers, and using the same methods as the seasonal flu vaccine; the vaccine had also been tested for safety in clinical trials conducted over the summer. The safety concerns were also raised by Pregnant women; even though they were more at risk for complications from the infection, the main reason why the pregnant women complained is because of the health of their fetuses, including having the fears of miscarriage. Healthcare personnel’s in some areas were also reluctant to receiving the live attenuated vaccine (LAIV) formulation of the virus vaccine; this led to many healthcare providers and pregnant women not being vaccinated. FDA released communication about the raised issues through news releases and also information to the consumers was posted on FDA’s website, they also created a Q&A page that targeted the pregnant women and an update for the health providers.

Investigation

The fifth goal aim was to decrease the time to identify causes, risk factors and appropriate interventions for those affected by threats to the public’s health, the response that was done during this step is that they minimized outpatient visits for patients, they also postponed visits of patients suspected or confirmed that they the virus and also they denied entry to visitors who were sick. They also used strategies like vaccinating as much of the healthcare personnel as possible, identifying and isolating patients with known or suspect of the infections, implementing respiratory hygiene, setting up triage stations, screening personnel and visitors for signs and symptoms of infection at hospital entrances, adhering to appropriate isolation precautions, advising families to allow six feet between the sitting arrangement in case of suspicion of the virus, ensuring compliance with hand, respiratory and cough hygiene and etiquette and locating signage inappropriate language and at the appropriate reading level in areas to alert staff and visitors of need for specific precautions.

Control

The sixth goal is decreasing the time needed to provide countermeasures and health guidance to those affected by threats to the public’s health, efforts to contain the virus were very swift from all the organizations and the government, the first defense mechanism that was used during the outbreak was providing antivirals to affected individuals and personal protective equipment’s to healthcare workers another front line responders, Development and dissemination of the H1N1 vaccine was also in order. After the first case was recognized in the United States was confirmed through laboratory testing, after that the secretary of Health and Human Services issued a public health emergency, that led to FDA issuing a series of emergency authorization, four days after the outbreak FDA issued an emergency use authorization for specific disposal respirators that were known as N95 respirators, during the outbreak FDA issued another emergency use authorizations including one for an unapproved IV antiviral and eighteen for different diagnostic tests.

There have been reviews of emergency user authorization protocols since the H1N1 pandemic occurred, and apart from that, there was the passage of the All-Hazards Preparedness Reauthorization Act; this has made FDA have authority to authorize the emergency use of certain approved MCMs without issuing the emergency user authorization. When the H1N1 vaccine was short in supply CDC recommended that in the US the initial doses should go to priority groups such as pregnant women, babies under six months and people who live with care, there were also modifications that led to people getting one dose of the vaccine from the initial proposed of two, this will enhance the availability of the vaccine and it will reach to larger audience, some of the people who were assumed to be infected with virus were quarantined, airplanes also used safety measures to ensure the control of the spread of the virus, the people who were affected were also advised to wear masks to avoid the spread of the disease.

Recover

The seventh goal is to decrease the time needed to restore health services and environmental safety to prevent levels, from a study of the effectiveness of the vaccine in the United States showed that the efficacy of the vaccine was 56%, it can be concluded that if the vaccine could have been administered earlier enough it could help in taking things back to normal after the pandemic, it was also noted in the study that if the vaccine was administered earlier enough it would have prevented a lot of people from dying (Wilson et al. 2016).

The eight-goal is to improve the long – term follow-up provides to those affected by threats to public health, WHO has defined three meanings of a flu pandemic with regards to periods of pandemic alarm. These definitions were contained in more extensive rules for pandemic readiness gave in 1999, 2005, and 2009. Research on flu pandemics and pandemic infections expanded significantly following the primary human instances of contamination with the H5N1 avian flu infection in 1997 (Thi, 2017). Definitions changed after some time following this developing information and the need to build the exactness and reasonable appropriateness of stage definitions. The 2009 rules, including meanings of a pandemic and the stages prompting its assertion, were settled in February 2009. The new H1N1 infection was neither not too far off around then nor referenced in the report. The media make visit reference to a 2003 archive, accessible on the WHO site, expressing that a flu pandemic outcome in “tremendous quantities of passing and ailment.” At the time, this was viewed as a probable situation that ought to the exceptionally deadly infection build up a capacity to spread promptly among people, yet it was never a conventional definition. The WHO is a vital worldwide asset for and planning the reaction to a pandemic. In the 2009 H1N1 epidemic.

WHO had numerous outstanding accomplishments, the association given direction to educate national influenza preparedness plans, which were set up in 74% of nations at the hour of the main episode in North America, and helped nations screen their advancement of IHR center limits (Cohen & Zenko, 2019). The WHO Global Influenza Surveillance Network distinguished, recognized, and conveniently described the infection and observed the course of the pandemic. Inside 48 hours after the enactment of arrangements in the 2005 IHR, the WHO met the first gathering of the crisis board of specialists who might prompt the WHO on the status what’s more, portion. The WHO gave brief and significant fields help to influenced nations and proficiently dispersed more than 3 million courses of antiviral medications to 72 countries (Nelson, 2018). Against this setting of achievement, the WHO stood up to foundational challenges and made various stumbles throughout adapting with the unfurling pandemic.

Even though the WHO is the primary worldwide organization with an excellent position to lead the reaction to a pandemic, it is troubled by various auxiliary obstructions. Initially, the WHO is at the same time the ethical voice for wellbeing on the planet and the hireling of its part states, which approve the general program what’s more, spending plan. National interests may cause strife with a command to impartially ensure the wellbeing of each individual on the planet. Second, the financial limit of the WHO is disproportionate with the extent of its obligations. Just roughly one-fourth of the spending originates from part state appraisals, and the rest depends on explicit task support from nations and establishments. These spending substances and the staff the board necessities inalienable in being a United Nations office compel adaptability.

Improve

The ninth goal is to decrease the time needed to implement recommendations from after-action reports following threats to the public’s health, CDC is discharging refreshed interval direction on contamination control measures to counteract transmission of 2009 H1N1 flu in social insurance offices (Damani, 2019). The restored between time direction applies particularly to the extraordinary conditions of the ebb and flow 2009 H1N1 pandemic and will be updated as vital as new data gets accessible throughout this flu season. It gives general direction to all medicinal services offices. The updated course develops before course by underscoring that effectively counteracting transmission requires a far-reaching approach, starting with pandemic arranging that incorporates creating composed plans that are adaptable and versatile should changes happen in the seriousness of sickness or different parts of 2009 H1N1 and occasional flu. Modifications from prior direction include: criteria for distinguishing proof of suspected flu patients; suggested time away from work for social insurance faculty; changes to confinement precautionary measures dependent on undertakings and foreseen exposures; development of data on the progressive system of controls which positions preventive intercessions in the accompanying request of inclination: disposal of vulnerabilities, designing controls, regulatory controls, and individual defensive gear; and changes to direction on utilization of respiratory security.

There is more information about the flu that includes, the hatching time frame for flu is evaluated to extend from 1 to 4 days with a normal of 2 days. Flu infection shedding starts the day preceding ailment beginning and can endure for 5 to 7 days, albeit a few people may shed infection for more extended periods, especially little youngsters and seriously immune-compromised people. The measure of infection shed is most noteworthy in the initial 2-3 days of ailment and seems to associate with fever, with higher standards of infection shed when temperatures are most notable.

The indications of flu, including 2009 H1N1 flu, can incorporate fever, hack, sore throat, runny or stuffy nose, body hurts, cerebral pain, chills, weakness, sickness, loose bowels, and spewing. Contingent upon the case arrangement, the extent of people who have research facility affirmed 2009 H1N1 disease and didn’t have a fever can go from around 10 to half. Since flu manifestations are vague, it tends to be hard to decide whether an individual has flu dependent on indications alone. In any case, choices for clinical administration, especially for outpatients, as a rule, can be made based on clinical and epidemiological data.

Conclusion

The H1N1 episode of 2009-2010 exemplified tremendous general public health achievements.

Simultaneously, the overall public health result was not exactly ideal. Not exactly 50% of the US population was inoculated, and immunization rates were altogether lower in specific subpopulations, including some racial/ethnic minorities and pregnant ladies. The reason for this unfortunate general wellbeing result was multifacetedmultifaceted and due to some extent to the activities of various legislative organizations. Concerning FDA, a few correspondence related issues were of specific significance: worries about the security of the H1N1 antibody, perplexity about countermeasure accessibility, unevenness in take-up, and an absence of comprehension about new MCMs/new employments of endorsed MCMs. To address these issues we suggest: fitting messages for specific gatherings and dispersing these messages in such manners that they will be seen/perused by individuals from these gatherings; giving progressively straightforward clarifications of how MCMs are tried to guarantee open security; and utilizing FDA’s job as ‘gatekeepers of people in general enthusiasm’ for request to console the general population about MCM use.

These means should be possible during a general wellbeing crisis, however we additionally recommend that FDA preemptively make the accompanying strides: give pre-calamity safeguard informing identifying with normal MCMs, for example, routinely conveying the means FDA takes to guarantee item security concerning antibody and medication creation; explore how usually spoke with gatherings, similar to medicinal services suppliers and drug specialists, get messages and, in light of the data got, change FDA specialized strategies as fundamental; lastly improve the intelligibility of existing correspondences, from which future interchanges can be demonstrated, by either testing messages for understandability with end clients, including the overall population, or potentially working all the more intimately with social researchers and other correspondence specialists to refine old messages and grow new ones that will help in improving the health sector.

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