Giuseppe
Emeritus
Calibrated response to emerging infections -- Doshi 339: b3471 -- BMJ (Extracts, edited)
Published 3 September 2009, doi:10.1136/bmj.b3471
Cite this as: BMJ 2009;339:b3471
[Full Free Document: http://www.bmj.com/cgi/content/full/339/sep03_2/b3471 ]
Analysis
Calibrated response to emerging infections
Peter Doshi, doctoral student
1 Program in History, Anthropology, and Science, Technology and Society, E51-070, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA pnd@mit.edu
WHO has revised its definition of pandemic flu in response to current experience with A/H1N1. Peter Doshi argues that our plans for pandemics need to take into account more than the worst case scenarios
The current flu pandemic raises a public health policy question that could have been asked after the emergence of severe acute respiratory syndrome (SARS): what is the proper response to clinically mild or epidemiologically limited (small number) outbreaks caused by new viruses? Over the past four years, pandemic preparations have focused on responding to worst case scenarios. As a result, officials responded to the H1N1 outbreak as an unfolding disaster. Measures were taken that in hindsight may be seen as alarmist, overly restrictive, or even unjustified. Assumptions about the nature of emerging infections along with advanced laboratory surveillance have changed the way we understand epidemics and we need a new framework for thinking about epidemic disease.
Predictions that missed the mark
Before the arrival of novel A/H1N1 virus, pandemics were said to occur when a new subtype of influenza virus to which humans have no immunity enters the population, begins spreading widely, and causes severe illness.1 2 Reference was often made to the catastrophic pandemic of 1918 and the ongoing threat of highly pathogenic avian influenza H5N1 that has killed over half of the 456 people with recorded infection since 1997. Without proper preparation, "The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined," one highly cited article concluded in 2005.3 The large sums of public money spent on pandemic preparedness (over $7bn (?4bn; {euro}5bn) in the US) underlined the seriousness of the threat, and often repeated phrases such as "not a question of IF a pandemic will happen, but WHEN"4 characterised the next flu pandemic as a high probability, high consequence event.
But the 2009 pandemic, taken as a whole, bears little resemblance to the forecasted pandemic. Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal A/H1N1 that has been circulating since 1977. Furthermore, a substantial portion of the population may have immunity. The US Centers for Disease Control and Prevention (CDC) found that 33% of those aged over 60 had cross reactive antibody to novel A/H1N1,5 which may explain why cases have been rare in elderly people.
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<cite cite="http://www.bmj.com/cgi/content/full/339/sep03_2/b3471">Calibrated response to emerging infections -- Doshi 339: b3471 -- BMJ</cite>Cite this as: BMJ 2009;339:b3471
[Full Free Document: http://www.bmj.com/cgi/content/full/339/sep03_2/b3471 ]
Analysis
Calibrated response to emerging infections
Peter Doshi, doctoral student
1 Program in History, Anthropology, and Science, Technology and Society, E51-070, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, MA 02139, USA pnd@mit.edu
WHO has revised its definition of pandemic flu in response to current experience with A/H1N1. Peter Doshi argues that our plans for pandemics need to take into account more than the worst case scenarios
The current flu pandemic raises a public health policy question that could have been asked after the emergence of severe acute respiratory syndrome (SARS): what is the proper response to clinically mild or epidemiologically limited (small number) outbreaks caused by new viruses? Over the past four years, pandemic preparations have focused on responding to worst case scenarios. As a result, officials responded to the H1N1 outbreak as an unfolding disaster. Measures were taken that in hindsight may be seen as alarmist, overly restrictive, or even unjustified. Assumptions about the nature of emerging infections along with advanced laboratory surveillance have changed the way we understand epidemics and we need a new framework for thinking about epidemic disease.
Predictions that missed the mark
Before the arrival of novel A/H1N1 virus, pandemics were said to occur when a new subtype of influenza virus to which humans have no immunity enters the population, begins spreading widely, and causes severe illness.1 2 Reference was often made to the catastrophic pandemic of 1918 and the ongoing threat of highly pathogenic avian influenza H5N1 that has killed over half of the 456 people with recorded infection since 1997. Without proper preparation, "The loss of human life even in a mild pandemic will be devastating, and the cost of a world economy in shambles for several years can only be imagined," one highly cited article concluded in 2005.3 The large sums of public money spent on pandemic preparedness (over $7bn (?4bn; {euro}5bn) in the US) underlined the seriousness of the threat, and often repeated phrases such as "not a question of IF a pandemic will happen, but WHEN"4 characterised the next flu pandemic as a high probability, high consequence event.
But the 2009 pandemic, taken as a whole, bears little resemblance to the forecasted pandemic. Pandemic A/H1N1 virus is not a new subtype but the same subtype as seasonal A/H1N1 that has been circulating since 1977. Furthermore, a substantial portion of the population may have immunity. The US Centers for Disease Control and Prevention (CDC) found that 33% of those aged over 60 had cross reactive antibody to novel A/H1N1,5 which may explain why cases have been rare in elderly people.
(...)
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