1. Challenges of the 2009 H1N1 Pandemic Influenza: Charles Penn Global Influenza Programme World Health Organization Geneva

2. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 2 |2 | Influenza Pandemics 20th Century A(H1N1)A(H2N2)A(H3N2) 1918: “Spanish Flu”1957: “Asian Flu”1968: “Hong Kong Flu” 20-40 million deaths1-4 million deaths Credit: US National Museum of Health and Medicine

3. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 3 |3 | Historical & Contemporary Concerns Broadly Shaped Influenza Pandemic Preparedness Severity and disruption of 1918 pandemic Consequences of 1976 Swine flu vaccination Renewed focus on (re)-emerging infectious diseases Impact of 2003 SARS Global spread, lethality and persistence of H5N1 viruses

4. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 4 |4 | Definition of "pandemic" Many definitions: –"Epidemic over a wide geographic area and affecting a large proportion of the population" –"Worldwide epidemic" Context of influenza virus: –New strain –Antigenic "shift" (new subtype) –Transmissible human to human –Cause illness

5. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 5 |5 | Outline History of the pandemic Current status (epidemiology) Clinical presentation and impact Vaccines & antivirals

6. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 6 |6 | 4 April: outbreak of ILI in Veracruz 15-17 April: clusters of severe pneumonia in Mexico April May June July August October September March Pandemic H1N1 2009 Timeline

7. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 7 |7 | Age-related distribution of deaths from severe pneumonia compared to influenza seasons 2006-08 (Mexico, 24 March- 29 April 2009) During 5-weeks period, 2155 cases of severe pneumonia with 821 hospitalizations + 100 deaths: 87% of deaths and 71% of severe pneumonia cases aged 5- 59 yrs

8. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 8 |8 | 4 April: outbreak of ILI in Veracruz 15-17 April: clusters of severe pneumonia in Mexico 27 April: WHO phase 4 May June July August October September March 21 April: 2 cases of H1N1 confirmed in California, USA 23 April: H1N1 confirmed in several patients in MX 27 April: Canada and Spain report H1N1 cases April Pandemic H1N1 2009 Timeline 29 April: WHO phase 5

9. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 9 |9 | 4 April: outbreak of ILI in Veracruz 29 April: WHO phase 5 April 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August October September March 21 April: 2 cases of H1N1 confirmed in California, USA Pandemic H1N1 2009 Timeline

10. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 10 | 29 April: WHO phase 5 April 27 April: WHO phase 4 11 June: WHO phase 6 pandemic declared; H1N1 in 74 countries May June July August March WK 24: SA H3N2 peak Increasing activity throughout Northern Hemisphere September October Pandemic H1N1 2009 Timeline

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13. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 13 | Exacerbation of Underlying conditions Disease presentation and progression Uncomplicated self limiting illness Severe lower respiratory Tract infection: Viral pneumonitis ARDS Bacterial pneumonia

14. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 14 | Age-Specific (population based) hospitalization rates (Australia, Chile, Argentina, New Zealand)

15. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 15 | Within Vaccine Area, Four Particular Priorities Facilitate rapid development and manufacture of pandemic vaccine Provide guidance on use of pandemic vaccine Monitor vaccine safety Open or increase vaccine access for developing & middle income countries

16. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 16 | Update on Donations 13 donor governments* 5 donor manufacturers** 190 M vaccine doses pledged 74.5 M syringes pledged US$ 46M pledged for operations **Becton-Dickinson, CSL, GSK, MedIummune, Sanofi Pasteur, Temptime *Australia, Belgium, Brazil, Canada, France, Germany, Italy, Japan, New Zealand, Singapore, Switzerland, Thailand, UK, USA (and the Bill and Melinda Gates Foundation)

17. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 17 | Guidelines for use Equitable Access Monitoring effectiveness Role of Antivirals

18. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 18 | Final comments Never enough information World looks to WHO for leadership –Evidence-based responses –Be prepared to go where others don't –Unintended consequences Tide of media interest, public opinion Better prepared than ever before BUT... –Virus still spread faster than we could act –News and opinion travels faster and further than ever before

19. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 19 | Some successes Rapid isolation and characterisation of new virus Vaccine developed and available in 6 months New antivirals since last pandemic which are effective –Reducing severity of illness, hospitalisation, death Advances in healthcare (especially CC/ICU) Clinical networks effective in real time –From science to public health to critical care

21. Challenges of 2009 H1N1 Pandemic | March 16 th 2010 21 | THANK YOU