THE DOMESTIC AND INTERNATIONAL IMPACTS OF THE 2009-H1N1 INFLUENZA A PANDEMIC
Global Challenges, Global Solutions
Workshop Summary
David A. Relman, Eileen R. Choffnes, and Alison Mack, Rapporteurs
INSTITUTE OF MEDICINE
OF THE NATIONAL ACADEMIES
THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu
THE NATIONAL ACADEMIES PRESS
500 Fifth Street, N.W.
Washington, DC 20001
NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine.
This project was supported by contracts between the National Academy of Sciences and the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense, Department of the Army: Global Emerging Infections Surveillance and Response System, Medical Research and Materiel Command, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
International Standard Book Number-13: 978-0-309-14677-7
International Standard Book Number-10: 0-309-14677-1
Additional copies of this report are available from the
National Academies Press,
500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu.
For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu.
Copyright 2010 by the National Academy of Sciences. All rights reserved.
Printed in the United States of America
The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.
Cover image: A stained glass window 21″ × 56″ depicting the natural history of influenza viruses and zoonotic exchange in the emergence of new strains is shown in reduced size. Based on the work done at St. Jude Children’s Research Hospital supported by American Lebanese Syrian Associated Charities and the National Institute of Allergy and Infectious Diseases. Artist: Jenny Hammond, Highgreenleycleugh, Northumberland, England. Commissioned by Rob and Marjorie Webster.
Suggested citation: IOM (Institute of Medicine). 2010. The domestic and international impacts of the 2009-H1N1 influenza A pandemic: Global challenges, global solutions. Washington, DC: The National Academies Press.
THE NATIONAL ACADEMIES
Advisers to the Nation on Science, Engineering, and Medicine
The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences.
The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering.
The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine.
The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council.
FORUM ON MICROBIAL THREATS
DAVID A. RELMAN (Chair),
Stanford University and VA Palo Alto Health Care System, Palo Alto, California
JAMES M. HUGHES (Vice Chair),
Global Infectious Diseases Program, Emory University, Atlanta, Georgia
RUTH L. BERKELMAN,
Emory University, Center for Public Health Preparedness and Research, Rollins School of Public Health, Atlanta, Georgia
ENRIQUETA C. BOND, Consultant,
Marshall, Virginia
ROGER G. BREEZE,
Centaur Science Group, Washington, DC
STEVEN J. BRICKNER,
SJ Consulting, LLC, Ledyard, Connecticut
JOHN E. BURRIS,
Burroughs Wellcome Fund, Research Triangle Park, North Carolina
GAIL H. CASSELL,
Eli Lilly & Company, Indianapolis, Indiana
MARK B. FEINBERG,
Merck Vaccine Division, Merck & Co., West Point, Pennsylvania
DARRELL R. GALLOWAY,
Medical S&T Division, Defense Threat Reduction Agency, Fort Belvoir, Virginia
S. ELIZABETH GEORGE,
Biological and Chemical Countermeasures Program, Department of Homeland Security, Washington, DC
JESSE L. GOODMAN,
Center for Biologics Evaluation and Research, Food and Drug Administration, Rockville, Maryland
EDUARDO GOTUZZO,
Instituto de Medicina Tropical–Alexander von Humbolt, Universidad Peruana Cayetano Heredia, Lima, Peru
JO HANDELSMAN,
College of Agricultural and Life Sciences, University of Wisconsin, Madison
CAROLE A. HEILMAN,
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
DAVID L. HEYMANN,
Health Protection Agency, London, UK
PHIL HOSBACH,
Sanofi Pasteur, Swiftwater, Pennsylvania
STEPHEN A. JOHNSTON,
Arizona BioDesign Institute, Arizona State University, Tempe
KENT KESTER,
Walter Reed Army Institute of Research, Silver Spring, Maryland
GERALD T. KEUSCH,
Boston University School of Medicine and Boston University School of Public Health, Massachusetts
RIMA F. KHABBAZ,
Centers for Disease Control and Prevention, Atlanta, Georgia
LONNIE J. KING,
Ohio State University, Columbus, Ohio
STANLEY M. LEMON,
School of Medicine, University of Texas Medical Branch, Galveston
EDWARD McSWEEGAN,
National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland
PAUL F. MILLER,
Pfizer, Groton, Connecticut
STEPHEN S. MORSE,
Center for Public Health Preparedness, Columbia University, New York
MICHAEL T. OSTERHOLM,
Center for Infectious Disease Research and Policy, School of Public Health, University of Minnesota, Minneapolis
GEORGE POSTE,
Complex Adaptive Systems Initiative, Arizona State University, Tempe
JOHN C. POTTAGE, JR.,
GlaxoSmithKline, Collegeville, Pennsylvania
GARY A. ROSELLE,
Veterans Health Administration, Department of Veterans Affairs, Washington, DC
KEVIN RUSSELL,
Global Emerging Infections Surveillance and Response System, Department of Defense, Silver Spring, Maryland
JANET SHOEMAKER,
American Society for Microbiology, Washington, DC
P. FREDERICK SPARLING,
University of North Carolina, Chapel Hill
TERENCE TAYLOR,
International Council for the Life Sciences, Washington, DC
MURRAY TROSTLE,
U.S. Agency for International Development, Washington, DC
Staff
EILEEN CHOFFNES, Director
KATE SKOCZDOPOLE, Senior Program Associate
KATHLEEN C. OSTAPKOVICH, Research Associate (until October 2009)
KENISHA PETERS, Senior Program Assistant (until August 2009)
ROBERT GASIOR, Senior Program Assistant (from September 2009)
ALISON MACK, Science Writer
BOARD ON GLOBAL HEALTH
Richard Guerrant (Chair), Thomas H. Hunter Professor of International Medicine and Director,
Center for Global Health, University of Virginia School of Medicine, Charlottesville
Jo Ivey Boufford (IOM Foreign Secretary), President,
New York Academy of Medicine, New York
Claire V. Broome, Adjunct Professor,
Division of Global Health, Rollins School of Public Health, Emory University
Jacquelyn C. Campbell, Anna D. Wolf Chair, and Professor,
Johns Hopkins University School of Nursing, Baltimore, Maryland
Thomas J. Coates, Professor,
David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
Valentin Fuster, Director,
Wiener Cardiovascular Institute Kravis Cardiovascular Health Center,
Professor,
Cardiology, Mount Sinai School of Medicine, Mount Sinai Medical Center, New York, New York
Sue Goldie, Associate Professor of Health Decision Science, Department of Health Policy and Management,
Center for Risk Analysis, Harvard University School of Public Health, Boston, Massachusetts
Peter J. Hotez, Professor and Chair,
Department of Microbiology, Immunology, and Tropical Medicine, The George Washington University, Washington, DC
Gerald T. Keusch, Assistant Provost for Global Health,
Boston University School of Medicine, and
Associate Dean for Global Health,
Boston University School of Public Health, Massachusetts
Michael Merson, Director,
Duke Global Health Institute, Duke University, Durham, North Carolina
Fitzhugh Mullan, Professor,
Department of Health Policy, George Washington University, Washington, DC
Philip Russell, Professor Emeritus,
Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
Staff
Patrick Kelley, Director
Allison Brantley, Senior Program Assistant (until November 2009)
Angela Mensah, Program Associate
Reviewers
This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of this report:
Roger Breeze, Centaur Science Group
John Pottage, Infectious Disease Medicine Development Center, GlaxoSmithKline
P. Frederick Sparling, School of Medicine, University of North Carolina
Mary Wilson, Department of Population and International Health, Harvard University
Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the final draft of the report before its release. The review of this report was overseen by Dr. Melvin Worth. Appointed by the Institute of Medicine, he was responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.
Acknowledgments
The Forum on Emerging Infections was created by the Institute of Medicine (IOM) in 1996 in response to a request from the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH). The purpose of the Forum is to provide structured opportunities for leaders from government, academia, and industry to meet and examine issues of shared concern regarding research, prevention, detection, and management of emerging or reemerging infectious diseases. In pursuing this task, the Forum provides a venue to foster the exchange of information and ideas, identify areas in need of greater attention, clarify policy issues by enhancing knowledge and identifying points of agreement, and inform decision makers about science and policy issues. The Forum seeks to illuminate issues rather than resolve them; for this reason, it does not provide advice or recommendations on any specific policy initiative pending before any agency or organization. Its value derives instead from the diversity of its membership and from the contributions that individual members make throughout the activities of the Forum. In September 2003, the Forum changed its name to the Forum on Microbial Threats.
The Forum on Microbial Threats, and the IOM, wish to express their warmest appreciation to the individuals and organizations who gave their valuable time to provide information and advice to the Forum through their participation in this workshop. A full list of presenters may be found in Appendix A.
The Forum is indebted to the IOM staff who contributed during the course of the workshop and the production of this workshop summary. On behalf of the Forum, we gratefully acknowledge the efforts led by Dr. Eileen Choffnes, director of the Forum; Kate Skoczdopole, senior program associate; K. C. Ostapkovich, research associate; Kenisha Peters, senior program assistant; and Robert Gasior,
senior program assistant, for dedicating much effort and time to developing this workshop’s agenda and for their thoughtful and insightful approach and skill in planning for the workshop and in translating the workshop’s proceedings and discussion into this workshop summary. We would also like to thank the following IOM staff and consultants for their valuable contributions to this activity: Alison Mack, Jordan Wyndelts, Jill Grady, Jackie Turner, and Heather Phillips.
Finally, the Forum wishes to recognize the sponsors that supported this activity. Financial support for this project was provided by the U.S. Department of Health and Human Services: National Institutes of Health, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, and Food and Drug Administration; U.S. Department of Defense, Department of the Army: Global Emerging Infections Surveillance and Response System, Medical Research and Materiel Command, and Defense Threat Reduction Agency; U.S. Department of Veterans Affairs; U.S. Department of Homeland Security; U.S. Agency for International Development; American Society for Microbiology; Sanofi Pasteur; Burroughs Wellcome Fund; Pfizer; GlaxoSmithKline; Infectious Diseases Society of America; and the Merck Company Foundation. The views presented in this workshop summary report are those of the workshop participants and rapporteurs and are not necessarily those of the Forum on Microbial Threats or its sponsors.
Contents
|
||||
|
Appendixes |
|
||
A1 Technical Report for State and Local Public Health Officials and School Administrators on CDC Guidance for School (K-12) Responses to Influenza during the 2009-2010 School Year, |
||||
A2 Predicting Emerging Diseases in the Twenty-first Century: The Case of Zoonotic Influenza, |
||||
A3 The Spring 2009 Influenza A H1N1 Outbreak: A Local Public Health Perspective, |
A4 I nternational Law and Equitable Access to Vaccines and Antivirals in the Context of 2009-H1N1 Influenza, |
||||
A5 In Vitro and In Vivo Characterization of New Swine-Origin H1N1 Influenza Viruses, |
||||
A6 Estimation of the Reproductive Number and the Serial Interval in Early Phase of the 2009 Influenza A/H1N1 Pandemic in the USA, |
||||
A7 The Severity of Pandemic H1N1 Influenza in the United States, from April to July 2009: A Bayesian Analysis, |
||||
A8 Hard Choices in Difficult Situations: Ethical Issues in Public Health Emergencies, |
||||
A9 Rumors of Pandemic: Monitoring Emerging Disease Outbreaks on the Internet, |
A10 Preliminary Observation of the Epidemiology of Seasonal and Pandemic Influenza A (H1N1) in South Africa, 2009, |
||||
A11 Reflections on the 1976 Swine Flu Vaccination Program, |
||||
A12 Southern Hemisphere, Northern Hemisphere: A Global Influenza World, |
||||
A13 Influenza (H1N1) Pandemic 2009, |
||||
A14 Origins and Evolutionary Genomics of the 2009 Swine-Origin H1N1 Influenza A Epidemic, |
||||
Tables, Figures, and Boxes
TABLES
WO-1 |
Mortality Associated with Influenza Pandemics and Selected Seasonal Epidemic Events, 1918-2009, |
|||
WO-2 |
Age-Specific Severity Estimates, |
|||
A4-1 |
Overview of Resource Mobilization (millions), |
|||
A5-1 |
Virus Titres in Organs of Infected Cynomolgus Macaques, |
|||
A5-2 |
Virus Titres in Organs of Infected Mice, |
|||
A5-3 |
Virus Titres in Respiratory Swabs from Infected Cynomolgus Macaques, |
|||
A5-4 |
Virus Titres in Respiratory Organs of Infected Ferrets, |
|||
A5-5 |
Virus Titres in Nasal Swabs of Inoculated and Contact Ferrets, |
|||
A5-6 |
Virus Titres in Organs of Infected Miniature Pigs, |
|||
A5-7 |
Virus Titres in Nasal Swabs from Infected Miniature Pigs, |
|||
A5-8 |
Virus Susceptibility to Antiviral Compounds in Cell Culture, |
|||
A5-9 |
Virus Sensitivity in Neuraminidase Assays, |
|||
A6-1 |
Estimates Obtained from the Original, Imputed, and Augmented Data, |
|||
A6-2 |
Estimates of the Reproductive Number the Mean of the Serial Interval (SI) Is 3.6 Days with SD of 1.6 Days (Cowling et al., 2009) or Mean of 1.91 Days and SD of 1 Days (Fraser et al., 2009), |
|||
A7-1 |
Detection Probabilities and Their Prior Distributions, |
|||
A7-2 |
Cases at Each Level of Severity, |
A7-3 |
Posterior Median (95% CI) Estimates of the sCFR, sCIR, and sCHR, by Age Group, Based on a Combination of Data from New York City and Milwaukee, and Survey Data on the Frequency of Medical Attendance for Symptomatic Cases, |
|||
A7-4 |
Posterior Median (95% CI) Estimates of the sCFR, sCIR, and sCHR by Age Group, Using Self-Reported ILI as the Denominator of Symptomatic Cases, |
|||
A8-1 |
Ethical Considerations During a Declared Public Health Emergency, |
|||
A10-1 |
First Confirmed Cases of 2009-H1N1 Influenza A, |
|||
A10-2 |
Travel History of 42 Cases Within the First 100 Investigated, |
|||
A10-3 |
Laboratory-Confirmed Pandemic 2009-H1N1 Influenza A Cases by Province, South Africa, as of December 15, 2009, |
|||
A10-4 |
Pandemic 2009-H1N1 Influenza A Cases by Age Group, South Africa, as of December 15, 2009, |
|||
A10-5 |
Breakdown of First 100 Cases by Race, |
|||
A12-1 |
China H1N1—Then and Now, |
|||
A12-2 |
Deaths Due to Influenza in Hong Kong for Each Month from 1918-1928, |
|||
A12-3 |
Respiratory Pathogens Isolated in Hong Kong at Selected Times During the 2009-H1N1 Influenza A Outbreak, |
|||
A12-4 |
Some Areas for Investigation, |
|||
A13-1 |
Underlying Conditions Present by Age Group, |
|||
A14-1 |
Time of Most Recent Common Ancestors for the S-OIV Outbreak, |
|||
A14-2 |
SLAC Results, |
|||
A14-3 |
SNAP Results, |
|||
A14-4 |
Hong Kong Swine Genetic Origins, |
|||
A14-5 |
S-OIV Sequences Available on NCBI Influenza Virus Database at the Time of Analysis, |
FIGURES
WO-1 |
Host cell invasion and replication by the influenza virus, |
|||
WO-2 |
Genetic relationships among human and relevant swine influenza viruses, 1918-2009, |
|||
WO-3 |
The rate of globalization has accelerated to the point where we are connected as never before via globalized travel and trade networks, |
|||
WO-4 |
Reconstruction of the sequence of reassortment events leading up to the emergence of S-OIV, |
|||
WO-5 |
Lung tissues infected with 2009-H1N1 influenza A, |
WO-6 |
Spherical viral particles typical of seasonal H1N1 influenza, and the filamentous 2009-H1N1 influenza A, |
|||
WO-7 |
Virus transmission from infected ferrets to those in adjacent cages, |
|||
WO-8 |
Pathological examination of the lungs of infected cynomolgus macaques, |
|||
WO-9 |
Neutralization activities in human sera against viruses, |
|||
WO-10 |
CA04 sensitivity to antiviral compounds in mice, |
|||
WO-11 |
2009-H1N1 influenza A pandemic laboratory-confirmed cases and cumulative number of deaths as reported to WHO as of March 7, 2010, |
|||
WO-12 |
Number of specimens positive for influenza by subtype, Northern Hemisphere, April 19 to August 29, 2009, |
|||
WO-13 |
Number of specimens positive for influenza by subtypes, Southern Hemisphere, April 19 to August 29, 2009, |
|||
WO-14 |
Number of specimens positive for influenza by subtype, Chile, |
|||
WO-15 |
Number of specimens positive for influenza by subtype, Australia, |
|||
WO-16 |
Number of specimens positive for influenza by subtype, Hong Kong, |
|||
WO-17 |
Number of specimens positive for influenza by subtype, Cambodia, |
|||
WO-18 |
Number of specimens positive for influenza by subtype, Kenya, |
|||
WO-19 |
Influenza viral watch sentinel surveillance, update to end of week 35 (week ending August 30, 2009), |
|||
WO-20 |
Total influenza viruses from sentinel surveillance by type and week reported to August 23, 2009, and the total percentage positive from the swabs received, New Zealand, |
|||
WO-21 |
Percentage of visits for ILI reported by the U.S. Outpatient ILI Surveillance Network (ILINet) weekly national summary, October 1, 2006 to February 27, 2010, |
|||
WO-22 |
Epidemic curve in Mexico, cumulative through early September 2009, |
|||
WO-23 |
Viral shedding prior to and following treatment, |
|||
WO-24 |
Confirmed 2009-H1N1 influenza A cases in Peru, 2009, |
|||
WO-25 |
The long tradition of pigs and poultry sharing human dwellings in China, |
|||
WO-26 |
Spatial pattern in emerging infectious disease events, |
|||
WO-27 |
The pandemic severity scale developed by the U.S. government for planning and response, |
|||
WO-28 |
Severity pyramid, |
A2-1 |
Chicken: a growth category, |
|||
A3-1 |
Laboratory-confirmed 2009-H1N1 influenza A infections by age, April-July 2009, King County, Washington, |
|||
A3-2 |
Emergency department visits for influenza-like illness, January 1, 2009 through June 20, 2009, King County, Washington, |
|||
A5-1 |
Pathological examination of the lungs of infected cynomolgus macaques, |
|||
A5-2 |
CA04 sensitivity to antiviral compounds in mice, |
|||
A5-3 |
Neutralization activities in human sera against viruses, |
|||
A5-4 |
Growth properties of viruses in cells, |
|||
A5-5 |
Morphology of budding CA04 virions, |
|||
A5-6 |
Body weight changes in infected mice, |
|||
A5-7 |
Pathological findings in infected mice, |
|||
A5-8 |
Pro-inflammatory cytokine/chemokine responses in the lungs of infected mice, |
|||
A5-9 |
Body temperatures of infected cynomolgus macaques, |
|||
A5-10 |
Pathological findings in infected cynomolgus macaques, |
|||
A5-11 |
Detection of viral antigens in type II pneumocytes in the lungs of CA04-infected cynomolgus macaques, |
|||
A5-12 |
Pro-inflammatory cytokine/chemokine responses in the lungs of infected cynomolgus macaques, |
|||
A5-13 |
Pathological findings in infected ferrets, |
|||
A5-14 |
Pathological findings in infected miniature pigs, |
|||
A6-1 |
Confirmed and probable cases in the United States plotted by onset time, |
|||
A6-2 |
(A) Reporting delay by the date of report. (B) Imputed data and original data. (C) All data (right frame), (D) only augmented data where at least 5% of the data is observed, |
|||
A6-3 |
Serial interval estimates for k = 4, 5, 6, and 7 days with –log(likelihood) values, |
|||
A6-4 |
Estimates for the reproductive number, mean, and variance of the serial interval, |
|||
A6-5 |
Serial interval estimate using data up to and including 4/25/2009 (top figure), 4/26/2009 (second), 4/27/2009 (third), and 4/28/2009 (bottom figure), |
|||
A7-1 |
Diagram of two approaches to estimating the sCFR, |
|||
A7-2 |
Schematic illustration of the relationship between the observed data (rectangles) and the conditional probabilities (blue circles), |
|||
A7-3 |
Assumed severity hierarchy, |
|||
A7-4 |
Simplified directed acyclic graph displaying the dependencies in part of the model, |
|||
A7-5 |
Prior versus posterior number of symptomatic infections, Approach 1, |
A7-6 |
Prior vs posterior number of symptomatic infections, by age, Approach 1, |
|||
A9-1 |
Hierarchichal nature of traditional public health reporting, |
|||
A9-2 |
Informal-source surveillance, |
|||
A9-3 |
HealthMap screen shot, |
|||
A9-4 |
Google Flu Trends screen shot, |
|||
A9-5 |
Quantitation of subjects in ProMED reports from 1996-2008, |
|||
A9-6 |
Timeline showing time differences between official WHO reports, selected informal reports, and various “outbreak milestones,” |
|||
A10-1 |
Influenza results by type and subtype: South Africa 2005-2008, |
|||
A10-2 |
Onset and duration of influenza season, 1985-2007, |
|||
A10-3 |
Influenza strains detected, South Africa, 1984-2008, |
|||
A10-4 |
Epidemic curve of laboratory-confirmed pandemic 2009-H1N1 influenza A cases and deaths by week, South Africa, as of December 15, 2009 (n[cases]=12,683), |
|||
A10-5 |
Positive samples by influenza types and subtype: Viral Watch South Africa 2009, |
|||
A10-6 |
Severe acute respiratory illness (SARI) surveillance: respiratory virus report, |
|||
A10-7 |
Number of laboratory confirmed pandemic 2009-H1N1 influenza A cases by age group, as of December 15, 2009 (n = 11,729), |
|||
A10-8 |
Age distribution of patients with seasonal A H3N2 and pandemic 2009-H1N1 influenza A, |
|||
A10-9 |
Age distribution of patients with seasonal A H1N1 (2008) and pandemic 2009-H1N1 influenza A, |
|||
A10-10 |
Age distribution of patients with influenza B and pandemic 2009-H1N1 influenza A, |
|||
A10-11 |
Reported symptoms in first 100 confirmed cases, South Africa, |
|||
A12-1 |
General patterns of temporal occurrence of influenza A and B viruses in eastern Asia and Australasia, |
|||
A12-2 |
Long-term steps for the prevention of influenza pandemics, |
|||
A12-3 |
Emphasizing the need for increasing influenza virus surveillance for the prevention of pandemic influenza, |
|||
A12-4 |
Toward a unified, global effort for the prevention of pandemic influenza, |
|||
A12-5 |
Fundamental principles still apply, |
|||
A13-1 |
Cases of 2009-H1N1 influenza A by date of onset of symptoms, April-May 2009, Argentina (n = 250), |
|||
A13-2 |
Distribution of confirmed cases by date of onset of symptoms (n = 99), |
|||
A13-3 |
Temporal presentation of cases and contacts in the school population under study, May 16-31, 2009 (n = 102), |
|||
A13-4 |
Affected schools, May 2009, |
A13-5 |
Distribution of confirmed cases and cases under study by age and date of onset of symptoms, city of Buenos Aires and Province of Buenos Aires, April-July 2009 (n = 5,145), |
|||
A13-6 |
Distribution of confirmed cases and cases under study by age and date of onset of symptoms, rest of country (except Buenos Aires and Province of Buenos Aires), April-July 2009 (n = 5,030), |
|||
A13-7 |
Distribution of confirmed cases in the country by jurisdiction, Argentina, April-July 2009, |
|||
A13-8 |
Confirmed and under study of influenza and pandemic influenza (H1N1) 2009 by date of onset of symptoms (n = 15,455), Argentina, April-September 2009, |
|||
A13-9 |
Distribution of respiratory viruses by epidemiological week, Argentina 2009, |
|||
A13-10 |
Distribution of respiratory viruses by age group, Argentina 2009, |
|||
A13-11 |
Distribution of SARI by age group, rates per hundred thousand inhabitants, Argentina 2009 (n = 8,872), |
|||
A13-12 |
Distribution of SARI by epidemiological week of onset of symptoms, Argentina 2009 (n = 10,397 EW37), |
|||
A13-13 |
Distribution of confirmed fatalities by age group and sex, rates per hundred thousand inhabitants, Argentina 2009 (n = 505), |
|||
A13-14 |
Number of H1N1 cases among pregnant women, 2009 by day according to date of symptom onset, Argentina 2009 (n = 243), |
|||
A13-15 |
Fatal cases by underlying conditions and age, |
|||
A13-16 |
Time between events, |
|||
A13-17 |
Signs and symptoms identified in medical records, |
|||
A13-18 |
Descriptive analysis of epidemiological data 2009-H1N1 influenza A pandemic, Health Region II, Province of Buenos Aires, Argentina, May 21 through August 30, 2009, |
|||
A13-19 |
Descriptive analysis of epidemiological data of 2009-H1N1 influenza A pandemic, Tierra del Fuego, Argentina, May 21 through August 30, 2009, |
|||
A14-1 |
Reconstruction of the sequence of reassortment events leading up to the emergence of S-OIV, |
|||
A14-2 |
Genetic relationships and timing of S-OIV for each genomic segment, |
|||
A14-3 |
Phylogenetic relationships of each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS) of swine influenza A viruses indicating genetic components of the swine-origin influenza A (H1N1) virus, |
|||
A14-4 |
Phylogenetic relationships scaled to time for each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS) of the swine-origin influenza A (H1N1) virus as represented in Figure A14-2 of the main text but with full virus names and GenBank accession numbers, |
A14-5 |
For each gene segment (PB2, PB1, PA, HA, NP, NA, M & NS), we plot the isolation date of each influenza sequence against the genetic distance from that sequence to the root of the phylogeny, |
BOXES
WO-1 |
The Influenza Life Cycle, |
|||
WO-2 |
The 1976 Swine Flu Campaign: Chronology of Major Events, |
|||
WO-3 |
Clinical and Epidemiological Overview of 2009-H1N1 Influenza A, |
|||
WO-4 |
Influenza Trends, September 2009, |
|||
A4-1 |
Possible Components of a Global Access Framework, |
|||
A9-1 |
Pneumonia—China (Guangdong): RFI, |
|||
A9-2 |
Swine Flu Day by Day, |
|||
A11-1 |
Lessons Learned from the 1976 National Influenza Immunization Program (NIIP), |
|||
A12-1 |
Brief Overview of the Origin of the 1918 Pandemic H1N1 Virus and the Classical H1N1 Swine Flu Virus, |