Keynote 3: Report from a pandemic, the 2009/10 flu

Introduction:

The basic characteristic of an influenza pandemic compared to seasonal influenza is the presence of a substantial susceptibility in the global population. Pandemics occur when a new virus or a virus which has not circulated in the population for many generations appears. The virus may cause mild or more severe disease in the individual or the virus may be more or less contagious.

WHO had for years prepared the global community for a flu pandemic, an effort which had been accelerated since the appearance of the avian flu (H5N1) some years ago. Accordingly many countries had contingency plans available and in the wealthy part of the world this included stockpiling of antivirals and prepaid contracts for buying pandemic vaccines, once it was produced. A condition for the latter to be put into force would be the WHO declaration of a pandemic.

In the case of flu pandemic many aspects are known on beforehand, however very specific characteristics are not known, e.g. severity of the disease, the ability of a particular virus to growth for large scale vaccine production, the ability of the virus to develop resistance to antivirals etc. The time factor is crucial not least in a globalised world. Furthermore it should not be forgotten that it is more than half a century ago since the last flu pandemic and the personal experience of handling such a pandemic was virtually none in the beginning.

As of 1 December 2009 most countries have experienced or are experiencing a first epidemic wave. For planning purposes in the northern hemisphere, the experiences (from the winter season) in the southern hemisphere have been very helpful. As an interim status it may be concluded that the pandemic cause relatively mild disease in most individuals including the risk groups known from seasonal influenza. However some “new” or perhaps rather forgotten groups at risk have come into attention (pregnancy and obesity). The vaccine available is more immunogenic than expected and development of resistance to antivirals has been relatively rare.

At the congress an updated summary of the most important events since the beginning of the pandemic (H1N1) in March 2009 and the reasons for changes of strategy and recommendations during the pandemic will be presented and discussed.

Teaching goals:

• Summarise the risk and spreading of the H1N1 flu from its start to the present situation.
• What is special about the flu compared to earlier worldwide virus induced diseases?
• The role of the WHO, EMA (formally EMEA) and the European Centre for Disease Control and Prevention (ECDC) in preparing the world for the flu and how do these international organizations manage the fight against the diseases.
• The role of a national health care organisation in preparing and managing the heath care interventions. Differences in attitude across Europe?
• Development and availability of drugs and vaccines for the global population, how is it done in case of the H1N1 flu?
• The role of the hospital pharmacist

Learning objectives:

After the seminar the delegates should:

• Understand the spread of the H1N1 and the risk of the pandemic as reported at the time of the congress
• Know the role of the different global, regional and national organisations and their role in the fight against the infection
• Have a general understanding of the potential of the drugs available and the ability to create potent vaccines in due time to fight the infection
• Be better prepared for the next wave to come.