Surveillance & Response to Pandemic Influenza A (H1N1) 2009 in the
Pacific Island countries and territories
centres in New Caledonia
Influenza A (H1N1) surveillance
overview – Palau, May–September 2009
H1N1 on Guam
Mathew and Robert L. Haddock
– Influenza A (H1N1): ZERO cases
A (H1N1) pdm in French Polynesia – Assessment of epidemiological
situation as at 21 October 2009
Henri-Pierre Mallet, Elise Daudens, Antonio Chee-Ayee, Hervé
Vergeaud, Eddy Frogier, Jean-Paul Pescheux, Bernard Le, Stéphane
Influenza A (H1N1) outbreak on the island of Moorea from August to
on the measures taken at Nuutania Penitentiary (Tahiti) during the
outbreak of pandemic influenza A (H1N1) 2009(September
Vergeaud, Elise Daudens, Martine Boisson,
Situation report on influenza H1N1 2009 in Samoa
25 August 2009
and Pandemic influenza A (H1N1) surveillance in Solomon Islands -
Situation as at 11 October 2009
Holland Teika and Chris Bishop
disease surveillance in Solomon Islands
Allison Sio and Chris Bishop
laboratory-confirmed pandemic influenza H1N1 (2009) in Pacific
Islands countries and territories, 2009
Jennie Musto Jacob Kool, Boris Pavlin, Christelle Lepers
Pandemic Influenza A (H1N1) 2009:
lessons and vigilance!
Well, the pandemic finally arrived. It
had been both expected and feared. People trembled at the thought of
a mutation in avian flu H5N1 somewhere in Asia, where the most
recent pandemics probably began. Instead, the pandemic began in
Mexico and quickly spread to the United States of America - an
ironic turn of events for this rich and well-prepared country, which
is a recognised reference in disease surveillance and control.
Given its genetic mix, it was first
called ‘swine flu’, in spite of the fact that it had never been
detected in pigs before. Since then, a few animals here and there
have been infected by humans. This did not stop certain countries
and people from taking this inappropriate name literally and blaming
this poor animal and its trade.
In the beginning, it was suspected to be
a severe form of flu; as with all emerging diseases, serious cases
were the first ones noticed. But it seems to be moderate in
severity, mitigated by the response activities various countries
have prepared over the past few years.
However, it does behave like a pandemic
flu in that it eliminates the seasonal flu in its wake, affects
younger age groups, hits indigenous people (who are often
disadvantaged populations) more severely and sends people who have
no risk factors to the hospital or the morgue.
Many countries and territories in our
region tried to delay its entry through border controls. They may
have succeeded for a few weeks. It’s difficult to say, particularly
as the initial case definition used to detect people who were ill
often did not cover cases resulting from local transmission. In any
event, the region experienced a good-sized outbreak and,
unfortunately, several deaths.
Currently, the reported mortality rate
in the Pacific region is low (0.002 ‰). The question is whether or
not all the cases of death due to the flu have really been reported.
Even if only half the deaths from pandemic flu were reported, the
mortality rate would still be very low for this first wave. It would
be, however, interesting to see the magnitude of deaths not
attributed to the flu and to analyse those deaths.
This pandemic has provided us with an
opportunity to conduct a real-time test of our preparations over the
past few years. Among other things, it has revealed certain weak
points, particularly with regard to lab tests — qualitative problems
for rapid tests, limits on the number of samples that can be tested
by polymerase chain reaction (PCR), and a little bit of both
(qualitative and quantitative problems) for immunofluorescence (IFA)
— along with the difficulties and costs for certain countries to
send samples to reference labs; the state of preparedness of sectors
other than health; the communication of appropriate messages to many
different population groups in order to motivate them to change
certain behaviours; and the state of exhaustion of certain health
worker groups due to the workload brought about by the pandemic.
Rapid tests have, in fact, never been
great and, in the region, they have always been recommended more for
population surveillance activities or for detecting outbreaks, i.e.
many people corresponding to the case definition are tested and the
chances of getting one or two positive results are greater in the
event of infection. But they have never been recommended for trying
to confirm rare individual cases — whatever the rapid test might be.
This is, however, what was done at the beginning of the pandemic,
when countries were free of the disease and wanted to find out if
imported symptomatic cases were infected or not.
The quality of samples remains a vital
concern. They must be properly taken from the nasopharynx area and
then stored correctly if they are not tested immediately. It would
seem that the Wallis lab was able to get excellent results with
rapid tests by carefully following quality procedures.
There are similar problems with IFA.
Although, in general, it is more sensitive than rapid tests, its
accuracy also depends on the quality of samples, and it requires
solid experience in reading IFA slides and more work time.
Like IFA, PCR – the most sensitive
method and the one used as reference – requires a great deal of
expertise and time, and the number of samples that can be analysed
in one day is limited.
The preparedness and response of sectors
other than health varied, especially when we realised that this flu
was not that different from the ‘regular’ flu. Response has remained
the privilege and burden of the health sector.
Communication efforts used several
existing channels, but many populations, particularly those either
isolated or having their own specific cultural traits, would
undoubtedly have benefited from more precise and better-adapted
messages. Unfortunately, it is difficult to say what worked in terms
of the various communication exercises and what didn’t.
Whatever the case may be, many people
are tired of hearing about this pandemic flu. However, we do not
know what the future will bring. It would be a nice surprise to find
that this flu completely eliminates other types of seasonal flu or
that it becomes milder, or even that it does not develop resistance
to neuramidase inhibitors. Unfortunately, several bad-case scenarios
are also possible, e.g. an increase in its virulence due to mutation
or genetic mixing with, for example, the H5N1 virus, a cause of
serious concern for certain flu specialists as it could give rise to
a deadly virus; increased resistance to all the antivirals or even a
rapid shift in the virus that would make existing vaccines
Most of the region’s countries and
territories have experienced the first wave of the pandemic, but
there are still many people who have not gotten the flu yet and are
therefore vulnerable to a second wave in our region.
There are good reasons, then, to analyse
the workloads of the various groups of health workers, identify real
or potential overload points that require more human resources or a
management-level solution and try to ensure better distribution of
the tasks involved – both for this pandemic and other epidemics.
Vaccination, which has begun almost
everywhere and targets priority groups, is our most effective
prevention tool. Even if it may not cover the entire population, it
makes it possible to avoid certain problems and, if it reaches its
objectives, to limit the pandemic’s impact. If the virus evolves
rapidly, this may prove to be less effective and the virus may
manage to get around the population’s growing immunity.
In closing: we are not done yet, the
pandemic continues and the virus may evolve without it being
possible for us to predict when. These are all reasons to be
properly prepared and remain alert and ensure that the preparedness
plan phases for a serious pandemic are operational in the event they
Congratulations on a
remarkable level of sharing of information and experience
We would like to warmly congratulate and thank our many
colleagues from Guam, Palau, French Polynesia,
New Caledonia, Solomon
Islands, Samoa and Tokelau who contributed to this very
interesting issue, which provides a wealth of field
experience. We are planning to have another special issue on
the pandemic and would like to invite those in the other
Pacific Island countries and territories to share their
experiences with their colleagues in the Pacific Public
Health and Surveillance Network (PPHSN).
In order to respect
the form of the original articles and show the reality, we
have not standardised the name of the Pandemic Influenza A
(H1N1) 2009. Therefore, you will find a variety of names in
these articles, e.g. influenza A (H1N1) 2009, influenza
H1N1, influenza A (H1N1) pdm, swine
influenza H1N1 2009, etc. In a
certain way, these differences reflect the pandemic’s
novelty and evolution.