Sunday, August 30, 2009

Responding to H1N1

The report “U.S Preparations for 2009-H1N1 Influenza” recently prepared by the President’s Council of Advisors on Science and Technology (PCAST) examined basic strategic issues and how to best minimize the impact of the likely resurgence of the 2009-H1N1 flu.

To further study the impact of the situation, PCAST assembled a Working Group to do an in-depth external review of the possible epidemic and then detail how the nation needs to respond to the problem. The Working Group was chaired by Dr. Harold Varmus, President, Memorial Sloan-Kettering Cancer Center and Dr. Eric Lander, President and Director, Broad Institute of Harvard and MIT. As a result of the group’s review, the “2009 H1N1 Working Group report” was completed.

The report’s chapter “Ensuring Adequate Data for Decision Making: Surveillance Systems” emphasizes the need to respond quickly to a flu epidemic. To do this, data is needed to detail how many people are becoming infected, experiencing illness, seeking medical care, being hospitalized, requiring intensive care, and how many are dying from H1N1. Also, the data needs to show how these numbers are changing over time, who is becoming infected and at the greatest risk for severe outcomes, how is the virus changing, and are medical and public health systems able to respond adequately.

According to the report, CDC works with local and state public health departments to support a large number of systems for surveillance of influenza activity. The output of this accumulated data is summarized publicly and published on

The systems have provided valuable data through the spring and summer and the Working Group is fully aware that CDC is developing plans to expand its surveillance efforts for fall 2009. However, the Working Group sees some shortcomings and thinks that while it is not possible to remedy all of these problems before the fall, there are several short-term steps that could be taken to significantly improve the available data such as:

• CDC needs to combine syndromic surveillance and emergency department data available from existing local and state surveillance systems. The data needs to be incorporated into a geographically representative national network

• Although nationally representative data would be valuable, it may be beneficial for these surveys to oversample in jurisdictions that have relatively robust surveillance plans in place for tracking influenza related primary care visits, hospitalizations, and deaths

• Hospital facilities may also become scarce, so an integrated system needs to be implemented to monitor the healthcare system with an emphasis on reporting the incidence and prevalence of cases occupying hospital beds, ICU beds, and mechanical ventilators

• Timely data on patients hospitalized for respiratory illnesses available to clinicians, public health officials, and the public needs to be make available. This data could be located in a network of participating sites specializing in influenza surveillance, healthcare systems with appropriate electronic record keeping systems, and interested states and localities.

• Adequate surveillance systems are needed for vaccine-associated adverse events with particular attention to adverse events that are likely to occur at high rates in high risk populations. Also, adverse event surveillance and analysis depends to a large degree on the ability to link vaccinations to possible adverse events via medical records

Go to, to download information on the PCAST report “U.S Preparations for 2009 H1N1 Influenza”, and PCAST’s Working Group’s “2009-H1N1 Working Group Report”.