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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

THE DOMESTIC AND INTERNATIONAL IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC

Global Challenges, Global Solutions

Workshop Summary

David A. Relman, Eileen R. Choffnes, and Alison Mack, Rapporteurs

Forum on Microbial Threats

Board on Global Health

INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.

This project was supported by contracts between the National Academy of Sciences and the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense, Department of the Army: Global Emerging Infections Surveillance and Response System, Medical Research and Materiel Command, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.

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Cover image: A stained glass window 21″ × 56″ depicting the natural history of influenza viruses and zoonotic exchange in the emergence of new strains is shown in reduced size. Based on the work done at St. Jude Children’s Research Hospital supported by American Lebanese Syrian Associated Charities and the National Institute of Allergy and Infectious Diseases. Artist: Jenny Hammond, Highgreenleycleugh, Northumberland, England. Commissioned by Rob and Marjorie Webster.

Suggested citation: IOM (Institute of Medicine). 2010. The domestic and international impacts of the 2009-H1N1 influenza A pandemic: Global challenges, global solutions. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

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INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES


Advising the Nation. Improving Health.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

THE NATIONAL ACADEMIES

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

FORUM ON MICROBIAL THREATS

DAVID A. RELMAN (Chair),

Stanford University and VA Palo Alto Health Care System, Palo Alto, California

JAMES M. HUGHES (Vice Chair),

Global Infectious Diseases Program, Emory University, Atlanta, Georgia

RUTH L. BERKELMAN,

Emory University, Center for Public Health Preparedness and Research, Rollins School of Public Health, Atlanta, Georgia

ENRIQUETA C. BOND, Consultant,

Marshall, Virginia

ROGER G. BREEZE,

Centaur Science Group, Washington, DC

STEVEN J. BRICKNER,

SJ Consulting, LLC, Ledyard, Connecticut

JOHN E. BURRIS,

Burroughs Wellcome Fund, Research Triangle Park, North Carolina

GAIL H. CASSELL,

Eli Lilly & Company, Indianapolis, Indiana

MARK B. FEINBERG,

Merck Vaccine Division, Merck & Co., West Point, Pennsylvania

DARRELL R. GALLOWAY,

Medical S&T Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia

S. ELIZABETH GEORGE,

Biological and Chemical Countermeasures Program, Department of Homeland Security, Washington, DC

JESSE L. GOODMAN,

Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland

EDUARDO GOTUZZO,

Instituto de Medicina Tropical–Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru

JO HANDELSMAN,

College of Agricultural and Life Sciences, University of Wisconsin, Madison

CAROLE A. HEILMAN,

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

DAVID L. HEYMANN,

Health Protection Agency, London, UK

PHIL HOSBACH,

Sanofi Pasteur, Swiftwater, Pennsylvania

STEPHEN A. JOHNSTON,

Arizona BioDesign Institute, Arizona State University, Tempe

KENT KESTER,

Walter Reed Army Institute of Research, Silver Spring, Maryland

GERALD T. KEUSCH,

Boston University School of Medicine and Boston University School of Public Health, Massachusetts

RIMA F. KHABBAZ,

Centers for Disease Control and Prevention, Atlanta, Georgia

IOM Forums and Roundtables do not issue, review, or approve individual documents. The responsibility for the published workshop summary rests with the workshop rapporteur(s) and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

LONNIE J. KING,

Ohio State University, Columbus, Ohio

STANLEY M. LEMON,

School of Medicine, University of Texas Medical Branch, Galveston

EDWARD McSWEEGAN,

National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland

PAUL F. MILLER,

Pfizer, Groton, Connecticut

STEPHEN S. MORSE,

Center for Public Health Preparedness, Columbia University, New York

MICHAEL T. OSTERHOLM,

Center for Infectious Disease Research and Policy, School of Public Health, University of Minnesota, Minneapolis

GEORGE POSTE,

Complex Adaptive Systems Initiative, Arizona State University, Tempe

JOHN C. POTTAGE, JR.,

GlaxoSmithKline, Collegeville, Pennsylvania

GARY A. ROSELLE,

Veterans Health Administration, Department of Veterans Affairs, Washington, DC

KEVIN RUSSELL,

Global Emerging Infections Surveillance and Response System, Department of Defense, Silver Spring, Maryland

JANET SHOEMAKER,

American Society for Microbiology, Washington, DC

P. FREDERICK SPARLING,

University of North Carolina, Chapel Hill

TERENCE TAYLOR,

International Council for the Life Sciences, Washington, DC

MURRAY TROSTLE,

U.S. Agency for International Development, Washington, DC

Staff

EILEEN CHOFFNES, Director

KATE SKOCZDOPOLE, Senior Program Associate

KATHLEEN C. OSTAPKOVICH, Research Associate (until October 2009)

KENISHA PETERS, Senior Program Assistant (until August 2009)

ROBERT GASIOR, Senior Program Assistant (from September 2009)

ALISON MACK, Science Writer

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

BOARD ON GLOBAL HEALTH

Richard Guerrant (Chair), Thomas H. Hunter Professor of International Medicine and Director,

Center for Global Health, University of Virginia School of Medicine, Charlottesville

Jo Ivey Boufford (IOM Foreign Secretary), President,

New York Academy of Medicine, New York

Claire V. Broome, Adjunct Professor,

Division of Global Health, Rollins School of Public Health, Emory University

Jacquelyn C. Campbell, Anna D. Wolf Chair, and Professor,

Johns Hopkins University School of Nursing, Baltimore, Maryland

Thomas J. Coates, Professor,

David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California

Valentin Fuster, Director,

Wiener Cardiovascular Institute Kravis Cardiovascular Health Center,

Professor,

Cardiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York

Sue Goldie, Associate Professor of Health Decision Science, Department of Health Policy and Management,

Center for Risk Analysis, Harvard University School of Public Health, Boston, Massachusetts

Peter J. Hotez, Professor and Chair,

Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC

Gerald T. Keusch, Assistant Provost for Global Health,

Boston University School of Medicine, and

Associate Dean for Global Health,

Boston University School of Public Health, Massachusetts

Michael Merson, Director,

Duke Global Health Institute, Duke University, Durham, North Carolina

Fitzhugh Mullan, Professor,

Department of Health Policy, George Washington University, Washington, DC

Philip Russell, Professor Emeritus,

Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland

Staff

Patrick Kelley, Director

Allison Brantley, Senior Program Assistant (until November 2009)

Angela Mensah, Program Associate

IOM boards do not review or approve individual reports and are not asked to endorse conclusions and recommendations. The responsibility for the content of the report rests with the authors and the institution.

Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:

Roger Breeze, Centaur Science Group

John Pottage, Infectious Disease Medicine Development Center, GlaxoSmithKline

P. Frederick Sparling, School of Medicine, University of North Carolina

Mary Wilson, Department of Population and International Health, Harvard University

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Dr. Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

Acknowledgments

The Forum on Emerging Infections was created by the Institute of Medicine (IOM) in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The purpose of the Forum is to provide structured opportunities for leaders from government, academia, and industry to meet and examine issues of shared concern regarding research, prevention, detection, and management of emerging or reemerging infectious diseases. In pursuing this task, the Forum provides a venue to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them; for this reason, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its value derives instead from the diversity of its membership and from the contributions that individual members make throughout the activities of the Forum. In September 2003, the Forum changed its name to the Forum on Microbial Threats.

The Forum on Microbial Threats, and the IOM, wish to express their warmest appreciation to the individuals and organizations who gave their valuable time to provide information and advice to the Forum through their participation in this workshop. A full list of presenters may be found in Appendix A.

The Forum is indebted to the IOM staff who contributed during the course of the workshop and the production of this workshop summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Dr. Eileen Choffnes, director of the Forum; Kate Skoczdopole, senior program associate; K. C. Ostapkovich, research associate; Kenisha Peters, senior program assistant; and Robert Gasior,

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

senior program assistant, for dedicating much effort and time to developing this workshop’s agenda and for their thoughtful and insightful approach and skill in planning for the workshop and in translating the workshop’s proceedings and discussion into this workshop summary. We would also like to thank the following IOM staff and consultants for their valuable contributions to this activity: Alison Mack, Jordan Wyndelts, Jill Grady, Jackie Turner, and Heather Phillips.

Finally, the Forum wishes to recognize the sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense, Department of the Army: Global Emerging Infections Surveillance and Response System, Medical Research and Materiel Command, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. The views presented in this workshop summary report are those of the workshop participants and rapporteurs and are not necessarily those of the Forum on Microbial Threats or its sponsors.

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
   

 A4  I nternational Law and Equitable Access to Vaccines and Antivirals in the Context of 2009-H1N1 Influenza,
David P. Fidler, J.D.

 

137

   

 A5  In Vitro and In Vivo Characterization of New Swine-Origin H1N1 Influenza Viruses,
Yasushi Itoh, Kyoko Shinya, Maki Kiso, Tokiko Watanabe, Yoshihiro Sakoda, Masato Hatta, Yukiko Murramoto, Daisuke Tamura, Yuko Sakai-Tagawa, Takeshi Noda, Saori Sakabe, Masaki Imai, Yasuko Hatta, Shinji Watanabe, Chengjun Li, Shinya Yamada, Ken Fujii, Shin Murakami, Hirotaka Imai, Satoshi Kakugawa, Mutsumi Ito, Ryo Takano, Kiyoko Iwatsuki-Horimoto, Masayuki Shinmojima, Taisuke Horimoto, Hideo Goto, Kei Takahashi, Akiko Makino, Hirohito Ishigaki, Misako Nakayama, Masatoshi Okamatsu, Kazuo Takahashi, David Warshauer, Peter A. Shult, Reiko Saito, Hiroshi Suzuki, Yousuke Furuta, Makoto Yamashita, Keiko Mitamura, Kunio Nakano, Morio Nakamura, Rebecca Brockman-Schneider, Hiroshi Mitamura, Masahiko Yamazaki, Norio Sugaya, M. Suresh, Makoto Ozawa, Gabriele Neumann, James Gern, Hiroshi Kida, Kazumasa Ogasawara, and Yoshihiro Kawaoka1

 

155

   

 Supplementary Information,

 

173

   

 A6  Estimation of the Reproductive Number and the Serial Interval in Early Phase of the 2009 Influenza A/H1N1 Pandemic in the USA,
Laura Forsberg White, Jacco Wallinga, Lyn Finelli, Carrie Reed, Steven Riley, Marc Lipsitch,2 and Marcello Pagano

 

191

   

 A7  The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis,
Anne M. Presanis, Daniela De Angelis, The New York City Swine Flu Investigation Team, Angela Hagy, Carrie Reed, Steven Riley, Ben S. Cooper, Lyn Finelli, Paul Biedrzycki, and Marc Lipsitch2

 

208

   

 Text S1 Supplementary Methods,

 

234

   

 A8  Hard Choices in Difficult Situations: Ethical Issues in Public Health Emergencies,
Bernard Lo, M.D.

 

248

   

 A9  Rumors of Pandemic: Monitoring Emerging Disease Outbreaks on the Internet,
Lawrence C. Madoff, M.D., and John Brownstein, Ph.D.

 

269

1

Dr. Kawaoka was a speaker at the workshop.

2

Dr. Lipsitch was a speaker at the workshop.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
   

 A10  Preliminary Observation of the Epidemiology of Seasonal and Pandemic Influenza A (H1N1) in South Africa, 2009,
B. D. Schoub, M.D., D.Sc., F.R.C.Path., B. N. Archer, B.Med., M.P.H., C. Cohen, M.Sc., M.B.B.Ch., F.C.Path., D. Naidoo, M.Sc., J. Thomas, M.B.B.Ch., F.C.Path., C. Makunga, B.Sc.Hons., M.B.B.Ch., M. Venter, Ph.D., G. Timothy, M.B.B.Ch., A. Puren, Ph.D., M.B.B.Ch., J. McAnerney, R.N., A. Cengimbo, M.B.B.Ch., and L. Blumberg, M.B.B.Ch., M.Med.

 

283

   

 A11  Reflections on the 1976 Swine Flu Vaccination Program,
David J. Sencer and J. Donald Millar

 

297

   

 A12  Southern Hemisphere, Northern Hemisphere: A Global Influenza World,
Kennedy F. Shortridge, Ph.D.

 

306

   

 A13  Influenza (H1N1) Pandemic 2009,
Osvaldo Uez, Karina Balbuena, Martina Iglesias, María del Carmen Weis, Christian Hertlein, Ana Balanzat, Cora Santandrea, Sebastián Genero, Teresa Varela, Alicia Manana, Claudia Ling, Luis Carlino

 

327

   

 A14  Origins and Evolutionary Genomics of the 2009 Swine-Origin H1N1 Influenza A Epidemic,
Gavin J. D. Smith, Dhanasekaran Vijaykrishna, Justin Bahl, Samantha J. Lycett, Michael Worobey,3 Oliver G. Pybus, Siu Kit Ma, Chung Lam Cheung, Jayna Raghwani, Samir Bhatt, J. S. Malik Peiris, Yi Guan, and Andrew Rambaut

 

342

   

 Supplementary Information,

 

354

B

 

Agenda

 

381

C

 

Acronyms

 

386

D

 

Glossary

 

389

E

 

Forum Member Biographies

 

397

3

Dr. Worobey was a speaker at the workshop.

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

Tables, Figures, and Boxes

TABLES

WO-1

 

Mortality Associated with Influenza Pandemics and Selected Seasonal Epidemic Events, 1918-2009,

 

8

WO-2

 

Age-Specific Severity Estimates,

 

63

A4-1

 

Overview of Resource Mobilization (millions),

 

151

A5-1

 

Virus Titres in Organs of Infected Cynomolgus Macaques,

 

159

A5-2

 

Virus Titres in Organs of Infected Mice,

 

186

A5-3

 

Virus Titres in Respiratory Swabs from Infected Cynomolgus Macaques,

 

186

A5-4

 

Virus Titres in Respiratory Organs of Infected Ferrets,

 

187

A5-5

 

Virus Titres in Nasal Swabs of Inoculated and Contact Ferrets,

 

188

A5-6

 

Virus Titres in Organs of Infected Miniature Pigs,

 

189

A5-7

 

Virus Titres in Nasal Swabs from Infected Miniature Pigs,

 

189

A5-8

 

Virus Susceptibility to Antiviral Compounds in Cell Culture,

 

190

A5-9

 

Virus Sensitivity in Neuraminidase Assays,

 

190

A6-1

 

Estimates Obtained from the Original, Imputed, and Augmented Data,

 

199

A6-2

 

Estimates of the Reproductive Number the Mean of the Serial Interval (SI) Is 3.6 Days with SD of 1.6 Days (Cowling et al., 2009) or Mean of 1.91 Days and SD of 1 Days (Fraser et al., 2009),

 

203

A7-1

 

Detection Probabilities and Their Prior Distributions,

 

217

A7-2

 

Cases at Each Level of Severity,

 

220

Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

A7-3

 

Posterior Median (95% CI) Estimates of the sCFR, sCIR, and sCHR, by Age Group, Based on a Combination of Data from New York City and Milwaukee, and Survey Data on the Frequency of Medical Attendance for Symptomatic Cases,

 

221

A7-4

 

Posterior Median (95% CI) Estimates of the sCFR, sCIR, and sCHR by Age Group, Using Self-Reported ILI as the Denominator of Symptomatic Cases,

 

222

A8-1

 

Ethical Considerations During a Declared Public Health Emergency,

 

252

A10-1

 

First Confirmed Cases of 2009-H1N1 Influenza A,

 

287

A10-2

 

Travel History of 42 Cases Within the First 100 Investigated,

 

288

A10-3

 

Laboratory-Confirmed Pandemic 2009-H1N1 Influenza A Cases by Province, South Africa, as of December 15, 2009,

 

290

A10-4

 

Pandemic 2009-H1N1 Influenza A Cases by Age Group, South Africa, as of December 15, 2009,

 

291

A10-5

 

Breakdown of First 100 Cases by Race,

 

293

A12-1

 

China H1N1—Then and Now,

 

308

A12-2

 

Deaths Due to Influenza in Hong Kong for Each Month from 1918-1928,

 

308

A12-3

 

Respiratory Pathogens Isolated in Hong Kong at Selected Times During the 2009-H1N1 Influenza A Outbreak,

 

313

A12-4

 

Some Areas for Investigation,

 

315

A13-1

 

Underlying Conditions Present by Age Group,

 

340

A14-1

 

Time of Most Recent Common Ancestors for the S-OIV Outbreak,

 

346

A14-2

 

SLAC Results,

 

374

A14-3

 

SNAP Results,

 

374

A14-4

 

Hong Kong Swine Genetic Origins,

 

375

A14-5

 

S-OIV Sequences Available on NCBI Influenza Virus Database at the Time of Analysis,

 

376

FIGURES

WO-1

 

Host cell invasion and replication by the influenza virus,

 

7

WO-2

 

Genetic relationships among human and relevant swine influenza viruses, 1918-2009,

 

9

WO-3

 

The rate of globalization has accelerated to the point where we are connected as never before via globalized travel and trade networks,

 

16

WO-4

 

Reconstruction of the sequence of reassortment events leading up to the emergence of S-OIV,

 

20

WO-5

 

Lung tissues infected with 2009-H1N1 influenza A,

 

23

Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

WO-6

 

Spherical viral particles typical of seasonal H1N1 influenza, and the filamentous 2009-H1N1 influenza A,

 

24

WO-7

 

Virus transmission from infected ferrets to those in adjacent cages,

 

25

WO-8

 

Pathological examination of the lungs of infected cynomolgus macaques,

 

26

WO-9

 

Neutralization activities in human sera against viruses,

 

27

WO-10

 

CA04 sensitivity to antiviral compounds in mice,

 

30

WO-11

 

2009-H1N1 influenza A pandemic laboratory-confirmed cases and cumulative number of deaths as reported to WHO as of March 7, 2010,

 

31

WO-12

 

Number of specimens positive for influenza by subtype, Northern Hemisphere, April 19 to August 29, 2009,

 

35

WO-13

 

Number of specimens positive for influenza by subtypes, Southern Hemisphere, April 19 to August 29, 2009,

 

36

WO-14

 

Number of specimens positive for influenza by subtype, Chile,

 

37

WO-15

 

Number of specimens positive for influenza by subtype, Australia,

 

38

WO-16

 

Number of specimens positive for influenza by subtype, Hong Kong,

 

39

WO-17

 

Number of specimens positive for influenza by subtype, Cambodia,

 

40

WO-18

 

Number of specimens positive for influenza by subtype, Kenya,

 

41

WO-19

 

Influenza viral watch sentinel surveillance, update to end of week 35 (week ending August 30, 2009),

 

42

WO-20

 

Total influenza viruses from sentinel surveillance by type and week reported to August 23, 2009, and the total percentage positive from the swabs received, New Zealand,

 

43

WO-21

 

Percentage of visits for ILI reported by the U.S. Outpatient ILI Surveillance Network (ILINet) weekly national summary, October 1, 2006 to February 27, 2010,

 

44

WO-22

 

Epidemic curve in Mexico, cumulative through early September 2009,

 

45

WO-23

 

Viral shedding prior to and following treatment,

 

46

WO-24

 

Confirmed 2009-H1N1 influenza A cases in Peru, 2009,

 

47

WO-25

 

The long tradition of pigs and poultry sharing human dwellings in China,

 

50

WO-26

 

Spatial pattern in emerging infectious disease events,

 

59

WO-27

 

The pandemic severity scale developed by the U.S. government for planning and response,

 

61

WO-28

 

Severity pyramid,

 

62

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

A2-1

 

Chicken: a growth category,

 

117

A3-1

 

Laboratory-confirmed 2009-H1N1 influenza A infections by age, April-July 2009, King County, Washington,

 

121

A3-2

 

Emergency department visits for influenza-like illness, January 1, 2009 through June 20, 2009, King County, Washington,

 

121

A5-1

 

Pathological examination of the lungs of infected cynomolgus macaques,

 

160

A5-2

 

CA04 sensitivity to antiviral compounds in mice,

 

162

A5-3

 

Neutralization activities in human sera against viruses,

 

164

A5-4

 

Growth properties of viruses in cells,

 

173

A5-5

 

Morphology of budding CA04 virions,

 

174

A5-6

 

Body weight changes in infected mice,

 

176

A5-7

 

Pathological findings in infected mice,

 

177

A5-8

 

Pro-inflammatory cytokine/chemokine responses in the lungs of infected mice,

 

178

A5-9

 

Body temperatures of infected cynomolgus macaques,

 

180

A5-10

 

Pathological findings in infected cynomolgus macaques,

 

181

A5-11

 

Detection of viral antigens in type II pneumocytes in the lungs of CA04-infected cynomolgus macaques,

 

182

A5-12

 

Pro-inflammatory cytokine/chemokine responses in the lungs of infected cynomolgus macaques,

 

183

A5-13

 

Pathological findings in infected ferrets,

 

184

A5-14

 

Pathological findings in infected miniature pigs,

 

185

A6-1

 

Confirmed and probable cases in the United States plotted by onset time,

 

195

A6-2

 

(A) Reporting delay by the date of report. (B) Imputed data and original data. (C) All data (right frame), (D) only augmented data where at least 5% of the data is observed,

 

197

A6-3

 

Serial interval estimates for k = 4, 5, 6, and 7 days with –log(likelihood) values,

 

198

A6-4

 

Estimates for the reproductive number, mean, and variance of the serial interval,

 

200

A6-5

 

Serial interval estimate using data up to and including 4/25/2009 (top figure), 4/26/2009 (second), 4/27/2009 (third), and 4/28/2009 (bottom figure),

 

201

A7-1

 

Diagram of two approaches to estimating the sCFR,

 

213

A7-2

 

Schematic illustration of the relationship between the observed data (rectangles) and the conditional probabilities (blue circles),

 

216

A7-3

 

Assumed severity hierarchy,

 

237

A7-4

 

Simplified directed acyclic graph displaying the dependencies in part of the model,

 

239

A7-5

 

Prior versus posterior number of symptomatic infections, Approach 1,

 

246

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

A7-6

 

Prior vs posterior number of symptomatic infections, by age, Approach 1,

 

247

A9-1

 

Hierarchichal nature of traditional public health reporting,

 

272

A9-2

 

Informal-source surveillance,

 

273

A9-3

 

HealthMap screen shot,

 

275

A9-4

 

Google Flu Trends screen shot,

 

276

A9-5

 

Quantitation of subjects in ProMED reports from 1996-2008,

 

279

A9-6

 

Timeline showing time differences between official WHO reports, selected informal reports, and various “outbreak milestones,”

 

281

A10-1

 

Influenza results by type and subtype: South Africa 2005-2008,

 

285

A10-2

 

Onset and duration of influenza season, 1985-2007,

 

286

A10-3

 

Influenza strains detected, South Africa, 1984-2008,

 

286

A10-4

 

Epidemic curve of laboratory-confirmed pandemic 2009-H1N1 influenza A cases and deaths by week, South Africa, as of December 15, 2009 (n[cases]=12,683),

 

287

A10-5

 

Positive samples by influenza types and subtype: Viral Watch South Africa 2009,

 

289

A10-6

 

Severe acute respiratory illness (SARI) surveillance: respiratory virus report,

 

289

A10-7

 

Number of laboratory confirmed pandemic 2009-H1N1 influenza A cases by age group, as of December 15, 2009 (n = 11,729),

 

291

A10-8

 

Age distribution of patients with seasonal A H3N2 and pandemic 2009-H1N1 influenza A,

 

292

A10-9

 

Age distribution of patients with seasonal A H1N1 (2008) and pandemic 2009-H1N1 influenza A,

 

292

A10-10

 

Age distribution of patients with influenza B and pandemic 2009-H1N1 influenza A,

 

293

A10-11

 

Reported symptoms in first 100 confirmed cases, South Africa,

 

294

A12-1

 

General patterns of temporal occurrence of influenza A and B viruses in eastern Asia and Australasia,

 

310

A12-2

 

Long-term steps for the prevention of influenza pandemics,

 

319

A12-3

 

Emphasizing the need for increasing influenza virus surveillance for the prevention of pandemic influenza,

 

320

A12-4

 

Toward a unified, global effort for the prevention of pandemic influenza,

 

321

A12-5

 

Fundamental principles still apply,

 

322

A13-1

 

Cases of 2009-H1N1 influenza A by date of onset of symptoms, April-May 2009, Argentina (n = 250),

 

328

A13-2

 

Distribution of confirmed cases by date of onset of symptoms (n = 99),

 

328

A13-3

 

Temporal presentation of cases and contacts in the school population under study, May 16-31, 2009 (n = 102),

 

329

A13-4

 

Affected schools, May 2009,

 

330

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

A13-5

 

Distribution of confirmed cases and cases under study by age and date of onset of symptoms, city of Buenos Aires and Province of Buenos Aires, April-July 2009 (n = 5,145),

 

331

A13-6

 

Distribution of confirmed cases and cases under study by age and date of onset of symptoms, rest of country (except Buenos Aires and Province of Buenos Aires), April-July 2009 (n = 5,030),

 

331

A13-7

 

Distribution of confirmed cases in the country by jurisdiction, Argentina, April-July 2009,

 

332

A13-8

 

Confirmed and under study of influenza and pandemic influenza (H1N1) 2009 by date of onset of symptoms (n = 15,455), Argentina, April-September 2009,

 

333

A13-9

 

Distribution of respiratory viruses by epidemiological week, Argentina 2009,

 

334

A13-10

 

Distribution of respiratory viruses by age group, Argentina 2009,

 

335

A13-11

 

Distribution of SARI by age group, rates per hundred thousand inhabitants, Argentina 2009 (n = 8,872),

 

335

A13-12

 

Distribution of SARI by epidemiological week of onset of symptoms, Argentina 2009 (n = 10,397 EW37),

 

336

A13-13

 

Distribution of confirmed fatalities by age group and sex, rates per hundred thousand inhabitants, Argentina 2009 (n = 505),

 

337

A13-14

 

Number of H1N1 cases among pregnant women, 2009 by day according to date of symptom onset, Argentina 2009 (n = 243),

 

337

A13-15

 

Fatal cases by underlying conditions and age,

 

338

A13-16

 

Time between events,

 

339

A13-17

 

Signs and symptoms identified in medical records,

 

339

A13-18

 

Descriptive analysis of epidemiological data 2009-H1N1 influenza A pandemic, Health Region II, Province of Buenos Aires, Argentina, May 21 through August 30, 2009,

 

341

A13-19

 

Descriptive analysis of epidemiological data of 2009-H1N1 influenza A pandemic, Tierra del Fuego, Argentina, May 21 through August 30, 2009,

 

341

A14-1

 

Reconstruction of the sequence of reassortment events leading up to the emergence of S-OIV,

 

344

A14-2

 

Genetic relationships and timing of S-OIV for each genomic segment,

 

345

A14-3

 

Phylogenetic relationships of each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS) of swine influenza A viruses indicating genetic components of the swine-origin influenza A (H1N1) virus,

 

354

A14-4

 

Phylogenetic relationships scaled to time for each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS) of the swine-origin influenza A (H1N1) virus as represented in Figure A14-2 of the main text but with full virus names and GenBank accession numbers,

 

362

Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×

A14-5

 

For each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS), we plot the isolation date of each influenza sequence against the genetic distance from that sequence to the root of the phylogeny,

 

370

BOXES

WO-1

 

The Influenza Life Cycle,

 

6

WO-2

 

The 1976 Swine Flu Campaign: Chronology of Major Events,

 

11

WO-3

 

Clinical and Epidemiological Overview of 2009-H1N1 Influenza A,

 

32

WO-4

 

Influenza Trends, September 2009,

 

34

A4-1

 

Possible Components of a Global Access Framework,

 

152

A9-1

 

Pneumonia—China (Guangdong): RFI,

 

271

A9-2

 

Swine Flu Day by Day,

 

277

A11-1

 

Lessons Learned from the 1976 National Influenza Immunization Program (NIIP),

 

303

A12-1

 

Brief Overview of the Origin of the 1918 Pandemic H1N1 Virus and the Classical H1N1 Swine Flu Virus,

 

309

Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR1
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR2
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR3
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR4
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR7
Page viii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR12
Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR16
Page xvii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR17
Page xviii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
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Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR21
Page xxii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2010. The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/12799.
×
PageR22
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In March and early April 2009, a new, swine-origin 2009-H1N1 influenza A virus emerged in Mexico and the United States. During the first few weeks of surveillance, the virus spread by human-to-human transmission worldwide to over 30 countries. On June 11, 2009, the World Health Organization (WHO) raised the worldwide pandemic alert level to Phase 6 in response to the ongoing global spread of the novel influenza A (H1N1) virus. By October 30, 2009, the H1N1 influenza A had spread to 191 countries and resulted in 5,700 fatalities. A national emergency was declared in the United States and the swine flu joined SARS and the avian flu as pandemics of the 21st century. Vaccination is currently available, but in limited supply, and with a 60 percent effectiveness rate against the virus.

The story of how this new influenza virus spread out of Mexico to other parts of North America and then on to Europe, the Far East, and now Australia and the Pacific Rim countries has its origins in the global interconnectedness of travel, trade, and tourism. Given the rapid spread of the virus, the international scientific, public health, security, and policy communities had to mobilize quickly to characterize this unique virus and address its potential effects. The World Health Organization and Centers for Disease Control have played critical roles in the surveillance, detection and responses to the H1N1 virus.

The Domestic and International Impacts of the 2009-H1N1 Influenza A Pandemic: Global Challenges, Global Solutions aimed to examine the evolutionary origins of the H1N1 virus and evaluate its potential public health and socioeconomic consequences, while monitoring and mitigating the impact of a fast-moving pandemic. The rapporteurs for this workshop reported on the need for increased and geographically robust global influenza vaccine production capacities; enhanced and sustained interpandemic demand for seasonal influenza vaccines; clear "triggers" for pandemic alert levels; and accelerated research collaboration on new vaccine manufacturing techniques. This book will be an essential guide for healthcare professionals, policymakers, drug manufacturers and investigators.

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