Pandemic (H1N1) 2009 influenza has generated many controversies in Australia around case definitions, laboratory diagnosis, case management, medical logistics and travel restrictions.
Our experience as clinical advisers in the Victorian Department of Human Services Emergency Operations Centre suggests the following:
Case definitions may change frequently, and will tend to become more clinically specific over time.
Early in a pandemic, laboratory diagnosis plays a critical role in case finding and pathogen identification.
Later in the pandemic, standardised case management applied to well crafted case definitions should reduce reliance on the diagnostic laboratory in clinical management. The diagnostic laboratory will remain critical to monitoring disease surveillance, pathogen virulence, and drug susceptibility.
Medical logistics will continue to challenge pandemic managers as the health sector struggles to do the most good for the greatest number of people.
Travel restrictions remain scientifically controversial public health recommendations.
Issues of scalability (escalation and de-escalation of the response) relating to virus lethality need to be resolved in current pandemic planning.
- 1. Australian Government Department of Health and Ageing. Protect phase. Annex to the Australian Health Management Plan for Pandemic Influenza. Canberra: Commonwealth of Australia, 2009. http://www.healthemergency.gov.au/internet/healthemergency/publishing.nsf/Content/resources/$File/AHMPPI-PROTECTannex.pdf (accessed Jun 2009).
- 2. Australian Government Department of Health and Ageing. Australian Health Management Plan for Pandemic Influenza. Canberra: Commonwealth of Australia, 2008. http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/ahmppi (accessed Jun 2009).
- 3. Grayson ML, Johnson PDR. Australia’s influenza containment plan and the swine flu epidemic in Victoria. Med J Aust 2009; 191: 150. <MJA full text>
- 4. Eizenberg P. The general practice experience of the swine flu epidemic in Victoria — lessons from the front line. Med J Aust 2009; 191: 151-153. <MJA full text>
- 5. World Health Organization Department of Communicable Disease Surveillance and Response. WHO recommended surveillance standards. 2nd ed. WHO/CDS/CSR/ISR/99.2. http://www.who.int/csr/resources/publications/surveillance/whocdscsrisr992.pdf (accessed Nov 2009).
- 6. Victorian Department of Human Services. Health professionals alert — SUSTAIN H1N1 influenza 09 (human swine flu). 5 June 2009. http://www.dcgpa.com.au/_cms/CMS_images/resources/3pm%205% 20June%202009%20%20Health%20Professionals%20Alert.1148.pdf (accessed Jun 2009).
- 7. Victorian Department of Human Services. First detailed analysis of influenza sentinel surveillance [media release]. 19 June 2009. http://hnb.dhs.vic.gov.au/web/pubaff/medrel.nsf/LinkView/3FEED59BC 738571FCA2575DA0018F37E?OpenDocument (accessed Jun 2009).
- 8. Bell DM; World Health Organization Writing Group. Non-pharmaceutical interventions for pandemic influenza, international measures. Emerg Infect Dis 2006; 12: 81-87.
- 9. Bell DM; World Health Organization Writing Group. Non-pharmaceutical interventions for pandemic influenza, national and community measures. Emerg Infect Dis 2006; 12: 88-94.
- 10. Victorian Department of Human Services. H1N1 influenza 09 (human swine flu) — medication to treat or prevent influenza. 4 June 2009. http://humanswineflu.health.vic.gov.au/downloads/tamiflu.pdf (accessed Nov 2009).
- 11. Centers for Disease Control and Prevention. Pregnant women and novel influenza A (H1N1) virus: considerations for clinicians. 7 May 2009. http://www.cdc.gov/H1N1flu/clinician_pregnant.htm (accessed May 2009).
- 12. Victorian Human Influenza Pandemic Plan. Melbourne: State Government of Victoria, 2007. http://www.health.vic.gov.au/pandemicinfluenza/government/hipm.htm (accessed Nov 2009).
- 13. Australian Government Department of Health and Ageing. FLUBORDERPLAN: National Pandemic Influenza Airport Border Operations Plan. Canberra: Commonwealth of Australia, 2009. http://www.flupandemic.gov.au/internet/panflu/publishing.nsf/Content/fluborderplan (accessed Nov 2009).
- 14. Nuzzo JB, Henderson DA, O’Toole T, Inglesby TV. Comments from the Center for Biosecurity of UPMC on proposed revisions to 42 CFR 70 and 71 (Quarantine Rules). 27 Jan 2006. http://www.umaryland.edu/health security/docs/Comments%20Center%20for%20Biosecurity%20CDC% 20Revisions.pdf (accessed Jun 2009).
- 15. St John RK, King A, de Jong D, et al. Border screening for SARS. Emerg Infect Dis 2005; 11: 6-10.
- 16. Chan M. World now at the start of 2009 influenza pandemic. Statement to the press by WHO Director-General Dr Margaret Chan. 11 June 2009. http://www.who.int/mediacentre/news/statements/2009/h1n1_pandemic_phase6_20090611/en/index.html (accessed Nov 2009).
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.