Giuseppe
Emeritus
Preparing for pandemic (H1N1) 2009 (CMAJ, excerpts, edited)
[Original Full Document: LINK. EDITED.]
Paul C. H?bert MD MHSc - Editor-in-Chief -- Noni MacDonald MD MSc - Section Editor, Public Health CMAJ
With the Editorial-Writing Team (Matthew B. Stanbrook MD PhD, Ken Flegel MDCM MSc, Amir Attaran LLB DPhil, Laura Eggertson BA)
Competing interests: See www.cmaj.ca/misc/edboard.shtml
Cite as: CMAJ 2009. DOI:10.1503/cmaj.091426
Preparing for pandemic (H1N1) 2009
We must not underestimate an enemy like pandemic (H1N1) 2009, especially now. This influenza pandemic has already created havoc in communities worldwide, including some in Canada. The virus?s place of origin, the speed of its spread and the severity of the illness in otherwise healthy people could not be foreseen before the initial outbreaks, even by experts. In addition, containment, a first step in the control of an outbreak, has failed.
The pandemic (H1N1) 2009 virus is life-threatening for some patients and mild for most who are infected. If the disease continues to evolve in the northern hemisphere as it is has in the southern hemisphere, especially in Chile and Australia, we will probably experience a more severe resurgence this coming influenza season. Most industrialized countries have already put their pandemic plans into action, to good effect. However, based on round one, we should plan for important increases in pandemic (H1N1) 2009 cases that manifest at the two ends of the spectrum of disease severity.
Obviously, prevention through immunization should remain our top priority. However, we must identify vulnerable or at-risk groups as a first step. Then, we must decide how best to vaccinate these groups.
Canada and much of the Western world have limited experience in conducting time-sensitive mass vaccination campaigns.
We already have problems delivering routine influenza vaccination to vulnerable groups. For instance, in some years only 15% of individuals in Nunavut communities received the vaccine.1 During the most recent outbreak of mumps among young adults among Nova Scotia, only 15% of targeted individuals were vaccinated.2 This is the same age group likely to be severely affected in the upcoming second wave of pandemic (H1N1) 2009. We need to act now to overcome these access and delivery problems.
No immunization program is 100% effective. If a sufficient number of cases are not prevented, we can expect a large number of young critically ill patients filling all tertiary level intensive care beds. Unlike most seasonal influenza strains, this pandemic (H1N1) 2009 strain seems to invade the lower airway and alveoli, not just the upper airways, resulting in more severe illness.3,4 The world?s experience so far tells us that serious illness associated with this virus often manifests as acute lung injury resulting in overwhelming hypoxemia.
Advanced life-support technologies, including high-frequency oscillation, extracorporeal membrane oxygenation and nitric oxide for prolonged periods are often required to save these young lives. All of these technologies (...)
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[Original Full Document: LINK. EDITED.]
Paul C. H?bert MD MHSc - Editor-in-Chief -- Noni MacDonald MD MSc - Section Editor, Public Health CMAJ
With the Editorial-Writing Team (Matthew B. Stanbrook MD PhD, Ken Flegel MDCM MSc, Amir Attaran LLB DPhil, Laura Eggertson BA)
Competing interests: See www.cmaj.ca/misc/edboard.shtml
Cite as: CMAJ 2009. DOI:10.1503/cmaj.091426
Preparing for pandemic (H1N1) 2009
We must not underestimate an enemy like pandemic (H1N1) 2009, especially now. This influenza pandemic has already created havoc in communities worldwide, including some in Canada. The virus?s place of origin, the speed of its spread and the severity of the illness in otherwise healthy people could not be foreseen before the initial outbreaks, even by experts. In addition, containment, a first step in the control of an outbreak, has failed.
The pandemic (H1N1) 2009 virus is life-threatening for some patients and mild for most who are infected. If the disease continues to evolve in the northern hemisphere as it is has in the southern hemisphere, especially in Chile and Australia, we will probably experience a more severe resurgence this coming influenza season. Most industrialized countries have already put their pandemic plans into action, to good effect. However, based on round one, we should plan for important increases in pandemic (H1N1) 2009 cases that manifest at the two ends of the spectrum of disease severity.
Obviously, prevention through immunization should remain our top priority. However, we must identify vulnerable or at-risk groups as a first step. Then, we must decide how best to vaccinate these groups.
Canada and much of the Western world have limited experience in conducting time-sensitive mass vaccination campaigns.
We already have problems delivering routine influenza vaccination to vulnerable groups. For instance, in some years only 15% of individuals in Nunavut communities received the vaccine.1 During the most recent outbreak of mumps among young adults among Nova Scotia, only 15% of targeted individuals were vaccinated.2 This is the same age group likely to be severely affected in the upcoming second wave of pandemic (H1N1) 2009. We need to act now to overcome these access and delivery problems.
No immunization program is 100% effective. If a sufficient number of cases are not prevented, we can expect a large number of young critically ill patients filling all tertiary level intensive care beds. Unlike most seasonal influenza strains, this pandemic (H1N1) 2009 strain seems to invade the lower airway and alveoli, not just the upper airways, resulting in more severe illness.3,4 The world?s experience so far tells us that serious illness associated with this virus often manifests as acute lung injury resulting in overwhelming hypoxemia.
Advanced life-support technologies, including high-frequency oscillation, extracorporeal membrane oxygenation and nitric oxide for prolonged periods are often required to save these young lives. All of these technologies (...)
-
-----