Influenza A: Lessons Four Years After the Public Alarm

Photo: Boy with mask

The study analyzed the management of the 2009 influenza A crisis and shows possible courses of action for the coming years; © panthermedia.
net/Josef Müllek

Paediatrician Eider Oñate analyzed how the H1N1 virus affected the paediatric population in Gipuzkoa in 2009.

She looks at what was done well, what was done badly, and whether the health services allowed themselves to be led by the public alarm rather than by exclusively clinical criteria when deciding hospital admissions. With autumn just around the corner and a new flu strain lying in wait for us, the presentation of a study analyzing the management of the 2009 influenza A crisis could not, if anything, be better timed. Oñate has analyzed the information gathered during the pandemic to address these questions, and responses to them could be of use when tackling a similar situation in the future.

“On the basis of the theoretical assumptions the alarm of the health authorities was justified, but fortunately the pandemic did not turn out to be as serious as expected,” recalls Oñate from the Paediatric Intensive Care Unit at the Hospital Universitario Donostia-San Sebastian. “What would have been inexcusable would have been the failure to adopt the measures that were taken, and that such caution should have turned out to be responsible for many avoidable victims.” Oñate sought to quantify the impact of the pandemic on the paediatric population of Gipuzkoa, during as well as in the periods prior to and following the appearance and spread of the H1N1 virus. The research has confirmed that in this sector of the population (one of the a priori risk groups), the impact of this influenza subtype was similar compared with that of seasonal flu, even though older children and young adults were the ones mostly affected.

The World Health Organisation (WHO) announced the “ongoing pandemic” in June 2009 and a set of protocols were activated in hospitals; as a result, all the cases of children suspected of being infected by influenza A were required to be studied in depth. The gathering of information that under normal circumstances is not obtained offered the chance to study, for the first time, in an organized health system and with the resources for viral diagnosis, the impact of the new virus on the population and on health care and its clinical and epidemiological behavior. It was also a scenario that had not been repeated since 1968, the year of the previous flu pandemic caused by the appearance of a new strain of the influenza A virus.

The conclusion drawn from the analysis of the data indicates that influenza A caused mostly mild symptoms, even in patients belonging to risk groups, and mortality, as in non-pandemic flu, was low and lower than expected. Despite that, the study has also confirmed that, compared with the data prior to and following the pandemic, there was a substantial increase in the number of consultations handled by the emergency departments and an increase in the number of hospital admissions. “The public alarm had a lot to do with that,” admits Oñate. “It not only changed the attitude of the population, but also the routine clinical practice of the paediatricians.” So, when an asthmatic child with influenza A for example was involved, they acted differently without basing themselves so much on clinical training. Usually a child with asthma and common flu without any breathing problems is sent home, but during the pandemic the most usual thing was to have him/her admitted to hospital as a precaution.

Oñate stresses that the experience acquired after the first pandemic in the 21st century by the A (H1N1) pandemic influenza virus will make it possible to set up new diagnostic and therapeutic strategies over the coming years. Firstly, one should not allow oneself to be ruled by the alarm. At the same time, it would be necessary in the light of the new experiences to review and assess the strategies affecting the use of antiviral drugs, including the famous Oseltamivir, of proven effectiveness in specific situations. On a practical level it would be necessary to have available methods for early diagnosis that are sufficiently sensitive and reliable for detecting the flu and which would obviate the need for aggressive tests.; Source: Elhuyar Fundazioa