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Lessons from a Virus - Public Health Laboratories Respond to the H1N1 Pandemic (US CDC, September 9 2011, extract, edited)

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  • Lessons from a Virus - Public Health Laboratories Respond to the H1N1 Pandemic (US CDC, September 9 2011, extract, edited)

    [Source: US Centers for Disease Control and Prevention, full PDF document: (LINK). Extract, edited.]

    Lessons from a Virus - Public Health Laboratories Respond to the H1N1 Pandemic



    By Thomas R. Frieden, MD, MPH, Director, Centers for Disease Control and Prevention

    The 2009 H1N1 influenza pandemic required rapid mobilization of public health laboratories around the world. The speed with which labs at the CDC and worldwide responded is a testament to how far we had come in just a few years. The H1N1 pandemic also highlighted areas where we need to improve so we can more effectively address the next global disease threat.

    On April 15, while I was still serving as New York City?s Health Commissioner, CDC labs detected the first case of H1N1 in California.

    About a week later and shortly after a larger number of cases of H1N1 were confirmed in Mexico, there was an outbreak of respiratory disease at a city high school. Given the large number of cases?more than 100 in just two days?and the knowledge of a possible global pandemic, we needed to know as quickly as possible whether H1N1 had arrived.

    Within a day, the CDC confirmed that our cases were the same H1N1 pandemic strain circulating elsewhere.

    By the end of the month, the CDC developed diagnostic tests, which were quickly approved by the FDA and sent to labs throughout the country. Over the next week or so, testing kits were also sent to labs across the world. By the time I joined the CDC in June, this rapid laboratory response had established the foundation for dealing with the pandemic.

    That same month, there were troubling reports from Europe that the H1N1 virus had mutated?always a major concern with any influenza strain. Our lab generated models of the impact of the mutation on the structure of the virus, facilitating analysis that accurately projected that the impact of this mutation, even if it spread, would be minimal.

    There were limitations as to what labs were able to accomplish. For example, because commercially available rapid tests in use had a high rate of false negatives, many people with H1N1 may have been falsely reassured and gone untreated. CDC labs continue their research, including work to develop better tests.

    Effective international pandemic response requires that all sectors of government and civil society be as prepared as possible; that all of these groups work in close partnerships that complement each other?s strengths; and that communications among policymakers, health professionals, and the public be timely, accurate, clear, and consistent.

    Labs will continue to be at the core of pandemic detection and response. H1N1 revealed a general need to strengthen global public health lab systems so that they have the capacity and workforce able to act swiftly and decisively.


    Public health professionals in the past 30 years have worked through acts of bioterrorism with the potential to kill hundreds in days. They have tackled emerging infectious diseases and antibiotic-resistant strains that could turn an airplane cabin into a deadly hazard. They have raced to apply detective skills to trace pathogens that threaten the food supply of entire regions.

    So why do so many name the 2009 H1N1 influenza pandemic as their greatest challenge and finest moment in laboratory science? In matters of morbidity and mortality, H1N1 took less of a toll on the United States than some seasonal outbreaks overall. Although the virus had a disproportionate impact on certain groups, such as those under 18 years of age?who experienced four to five times more flu deaths than in regular flu seasons?older Americans were largely spared the illness and deaths seen in past pandemics. Its duration could be considered most narrowly as one of a few weeks in April and May. New York magazine dubbed it ?The 0.5 epidemic,? adding, in a headline: ?Relax. H1N1 is not going to be nearly as bad as you may have been led to believe ? unless.? It is the ?? unless??what could have been?that gives the H1N1 response its unique impact. What the H1N1 pandemic meant to public health laboratorians could be summed up in two words: two weeks. This is the time it took between the identification of the novel virus and the creation, emergency FDA authorization, manufacture, and distribution of a test capable of being used at public health labs in the United States and internationally.

    This diagnostic was the sine qua non of every action in public health regarding the virus, from closing a neighborhood school to shutting down international flights. Effects near and far rippled from what the test could tell about the virus, and the test was a product of CDC scientists and a longstanding partnership among APHL, public health laboratories, commercial partners, and the CDC.

    Years, even decades, of preparation, training, and capabilities were compressed into those two weeks. Patterns and procedures that might have emerged over months in other crises were adopted, attempted, and adapted in a matter of days. Every chit was called in; nascent partnerships advanced overnight; missing pieces were revealed in stark relief under the time pressure. Heroes, individual and collective, surprised even themselves by rising to the challenge.

    By the time the second wave of the virus appeared, laboratorians knew what they had done right. They had seen how damage had been averted. And they knew what they needed to improve for the future. This publication collects that knowledge?so that others can use it and so that the once-in-a-lifetime accomplishments of these public health science leaders won?t be forgotten.