2009 H1N1 Pandemic Response: Looking backward and forward

Recently in PLoS Medicine, Gabriel M. Leung from the Food and Health Bureau, Hong Kong and Angus Nicoll from the European Centre for Disease Prevention and Control reflected on the public health response to pandemic H1N1. They discuss what went right and what should be done now to augment our future responses.

I really liked that their primary points highlighted that "public health messages...should not confuse what could happen (and should be prepared for) with what is most likely to happen" and that "decisions regarding pandemic response during the exigencies of a public health emergency must be judged according to the best evidence available at the time."  I've pasted below the list of pandemic "Firsts" which included a special shout out to the challenging "blogosphere," of which this here ye olde blogge was a member.

Box 1. A Series of “Firsts” about Pandemic (H1N1) 2009

• The first pandemic to emerge in the twenty-first century. It has been more widespread and remains ongoing, compared to SARS.
  
• The first pandemic to occur after major global investments in pandemic preparedness had been initiated.
  
• The first pandemic for which effective vaccines and antivirals were widely available in many countries, thus requiring public health authorities to earn and retain the confidence of health care providers through whom such are usually distributed.
  
• The first influenza pandemic to coincide with the ongoing HIV/AIDS pandemic and for which preliminary data do not suggest a substantial, disproportionate impact on HIV-infected patients.
  
• The first pandemic that took place within the context of a set of International Health Regulations and global governance, which had not been widely tested until the present.
  
• The first pandemic with early diagnostic tests that led to rapid diagnosis but also an early obsession in the media and of policymakers with having reports of the numbers of those infected.
  
• The first pandemic with antivirals available in many countries that led to a hopeful expectation that the pandemic might be containable, leading to the preparation for and implementation of a “containment phase” in some places.
  
• The first pandemic in which intensive care was available in many countries to treat critically ill patients, fostering an expectation that everyone could be treated and cured.
  
• The first pandemic with instant communication so that early impressions (such as the experience and response in Mexico and the Ukraine) could be shared ahead of proper scientific analysis.
  
• The first pandemic in which web-based platforms of traditional journals expedited dissemination, complemented by other innovative online resources (e.g. PLoS Currents: Influenza, http://knol.google.com/k/plos-currents-i​nfluenza#, based on Google's knol technology).
• The first pandemic with a “blogosphere” and other rapid social media messaging tools that challenged conventional public health communication.

Source: G. Leung and A. Nicoll. Reflections on Pandemic (H1N1) 2009 and the International Response. PLoS Med 2010

Putting the "or" back in your org chart

Having trouble figuring out how to reward and promote people within your department, hospital, or infection prevention program? Maybe you should try this. Playing off the age-old Peter principle (that every new member of an organization eventually is promoted to his/her level of incompetence), these investigators use game theory to demonstrate that the best way to improve organizational efficiency is to promote people at random.

The History of Vaccines (new website)

The College of Physicians of Philadelphia, the oldest professional society in the United States, has just launched a new educational website on the History of Vaccines. There is so much information available, that it literally will blow your mind. I should post a picture, it's not pretty. Topics include "The Development of the Immunization Schedule," a timeline of vaccination history from the year 1000, "History of the anti-Vaccination Movements," and "Top 20 Questions about Vaccines." There are already 424 images and videos for your use and education. Wow.

The site has been planned for several years and has been in development for a year. It will officially launch on November 3, 2010, when Stanley A. Plotkin, MD, developer of the current rubella vaccine, and emeritus professor of The Wistar Institute and The University of Pennsylvania, will give the Samuel X Radbill lecture entitled "Four Centuries of Vaccinology" in Philadelphia.

Check out the preview version of the website "The History of Vaccines" and related blog. Just fantastic.

h/t Tara Smith at Aetiology

Happy World MRSA Day (10.2.10)

The World as seen on World MRSA Day

I hope you guys are all out celebrating/observing World MRSA Day.  It's pretty quiet around here, well, except for the Penn State-Iowa game tailgating.  Go Hawkeyes! and, ah, go wash your hands...

Swine flu & conflict of interest

There is an interesting editorial in this month's Journal of Public Health that looks at conflicts of interest with regards to the swine flu pandemic. The author briefly describes some examples of organizations that manage financial and intellectual conflicts quite well. It's worth reading and the full text can be viewed here.

In it to win it

Good news going into the weekend: the CDC just declared Healthcare Associated Infections (HAIs) to be one of their first six “Winnable Battles”. They have coined this term to describe “public health priorities with large-scale impact on health and with known, effective strategies to intervene.”

I hope this leads to more resources—not just for implementation but for novel prevention research. As we’ve pointed out before, there is more than one view of what it means to “win” the war on HAIs. By one assessment, we already know how to prevent HAIs. All we need to do is implement this knowledge and such infections will drop to zero (and if they don’t, we can finesse the definitions until they do!). A more nuanced view is that our current prevention strategies are effective, but only against the subset of infections those strategies target. That is, there are still infections that cause harm and for which we do not currently have effective prevention strategies. These differences in perspective are also well illustrated by Mike’s earlier post on hospital epidemiology and quality improvement.

Where you fall on this continuum makes a big difference in terms of where you’d like to see more resources. Should they be devoted primarily to implementation of existing strategies (and to “implementation science”), or to research addressing novel approaches to infection prevention? (I realize that the correct answer is "both". But resources, sadly, are not infinite)

*motivational poster image courtesy of Despair, Inc.

Happy Weekend: VALORI or Volaré?

Remember those 1979 Plymouth Volaré ads?  Remember how the Volaré was the car that brought bankruptcy Chrysler's way?  Me neither.  Well, when I see the the acronym VALORI (Ventilator Associated Lower Respiratory Infection) like in Dan's recent VALORI post, I start singing Volare in my head.  Now, perhaps, the same thing will happen to you. For that, I'm truly sorry. To apologize, I bring you Dean Martin, the pride of Steubenville, Ohio.