School closures during the 2009 influenza pandemic: national and local experiences.

Background: School closure is a non-pharmaceutical intervention that was considered in many national pandemic plans developed prior to the start of the influenza A(H1N1)pdm09 pandemic, and received considerable attention during the event. Here, we retrospectively review and compare national and local experiences with school closures in several countries during the A(H1N1)pdm09 pandemic. Our intention is not to make a systematic review of country experiences; rather, it is to present the diversity of school closure experiences and provide examples from national and local perspectives.

Modelling the risk-benefit impact of H1N1 influenza vaccines.

Background: Shortly after the H1N1 influenza virus reached pandemic status in June 2009, the benefit-risk project team at the European Medicines Agency recognized this presented a research opportunity for testing the usefulness of a decision analysis model in deliberations about approving vaccines soon based on limited data or waiting for more data. Undertaken purely as a research exercise, the model was not connected to the ongoing assessment by the European Medicines Agency, which approved the H1N1 vaccines on 25 September 2009.

Methods: A decision tree model constructed initially on 1 September 2009, and slightly revised subsequently as new data were obtained, represented an end-of-September or end-of-October approval of vaccines.

The consortium for the standardization of influenza seroepidemiology (CONSISE): a global partnership to standardize influenza seroepidemiology and develop influenza investigation protocols to inform public health policy.

CONSISE - The consortium for the Standardization of Influenza Seroepidemiology - is a global partnership to develop influenza investigation protocols and standardize seroepidemiology to inform health policy. This international partnership was formed in 2011 and was created out of a need, identified during the 2009 H1N1 pandemic, for timely seroepidemiological data to better estimate pandemic virus infection severity and attack rates to inform policy decisions. CONSISE has developed into a consortium of two interactive working groups: epidemiology and laboratory, with a steering committee composed of individuals from several organizations.

Comment on "Seroevidence for H5N1 influenza infections in humans: meta-analysis".

A better understanding of the severity of H5N1 in humans is needed. Wang et al. (Brevia, 23 March 2012, p.

Influenza serological studies to inform public health action: best practices to optimise timing, quality and reporting.

Background: Serological studies can detect infection with a novel influenza virus in the absence of symptoms or positive virology, providing useful information on infection that goes beyond the estimates from epidemiological, clinical and virological data. During the 2009 A(H1N1) pandemic, an impressive number of detailed serological studies were performed, yet the majority of serological data were available only after the first wave of infection. This limited the ability to estimate the transmissibility and severity of this novel infection, and the variability in methodology and reporting limited the ability to compare and combine the serological data.

Developing pandemic preparedness in Europe in the 21st century: experience, evolution and next steps.

Problem: Improving pandemic planning and preparedness is a challenge in Europe, a diverse region whose regional bodies (the Regional Office for Europe of the World Health Organization [WHO], the European Commission and the European Centre for Disease Prevention and Control) have overlapping roles and responsibilities.

Approach: European pandemic preparedness indicators were used to develop an assessment tool and procedure based on the 2005 global WHO checklist for pandemic preparedness. These were then applied to Member States of WHO's European Region, initially as part of structured national assessments conducted during short visits by external teams.

The importance of influenza prevention for public health.

Annual epidemics of seasonal (inter-pandemic) influenza represent a significant burden on society in terms of morbidity, mortality, hospitalizations and lost working time. The impact of influenza depends on a mix of direct and indirect effects and is not easy to assess. Nevertheless there is a consensus in considering influenza prevention and mitigation high priorities for public health.

Factors associated with uptake of vaccination against pandemic influenza: a systematic review.

Background: In June 2009 a global influenza pandemic was declared by the World Health Organisation. A vaccination programme against H1N1 influenza was introduced in many countries from September 2009, but there was low uptake in both the general population and health professionals in many, though not all, countries.

Purpose: To examine the psychological and demographic factors associated with uptake of vaccination during the 2009 pandemic.

Seroprevalence to influenza A(H1N1) 2009 virus--where are we?

Age-specific seroprevalences for influenza virus make important contributions to estimating the burden of infection and determining the vulnerable populations. It is especially difficult to know the true clinical attack rates of the 2009 influenza A(H1N1) pandemic; however, we can estimate infection rates through analyses of seroprevalences based on national studies from different continents and countries with different demographics. After the 2009 influenza A(H1N1) pandemic, seroprevalence studies found 5 to 60% of populations across different continents and age groups having antibodies against the A(H1N1) 2009 virus.

Reflections on pandemic (H1N1) 2009 and the international response.

Gabriel Leung and Angus Nicoll provide their reflections on the international response to the 2009 H1N1 influenza pandemic, including what went well and what changes need to be made in anticipation of future flu pandemics.

The epidemiology of progressive intellectual and neurological deterioration in childhood.

Objective: To study the epidemiology of diseases that cause progressive intellectual and neurological deterioration (PIND) in UK children.

Design: Since May 1997, the authors have performed active surveillance to search for variant Creutzfeldt-Jakob Disease (vCJD) among the many diseases that cause neurological deterioration in children, using the monthly surveillance card sent to all UK consultant paediatricians by the British Paediatric Surveillance Unit. The authors obtain clinical details from reporting paediatricians by questionnaire or site visit, and an Expert Group then independently classifies the cases.

Seasonal and pandemic influenza vaccines for the elderly and other risk groups: a review of available data.

Human seasonal influenza is a large burden of morbidity and mortality for societies, affecting mainly elderly people and those with underlying chronic medical conditions. Annual vaccination of older adults and other risk groups is the most effective measure for reducing morbidity and mortality associated with infection. A 2008 survey showed 40-fold differences between the vaccination coverage in various European Union countries in individuals aged >or=65 years, ranging from less that 2% to more than 80% in the 2006-2007 season, with Poland belonging to the countries with low influenza vaccination coverage.

Closure of schools during an influenza pandemic.

In response to WHO raising the influenza pandemic alert level from phase five to phase six, health officials around the world are carefully reviewing pandemic mitigation protocols. School closure (also called class dismissal in North America) is a non-pharmaceutical intervention that is commonly suggested for mitigating influenza pandemics. Health officials taking the decision to close schools must weigh the potential health benefits of reducing transmission and thus case numbers against high economic and social costs, difficult ethical issues, and the possible disruption of key services such as health care.

Europe makes progress in preparing for influenza pandemic, but further work needed.

Progress has been made in influenza pandemic preparedness in Europe in the past six month.