Abstract
The response to the emergence of the 2009 influenza A(H1N1) pandemic was the result of a decade of pandemic planning, largely centred on the threat of an avian influenza A(H5N1) pandemic. Based on a literature review, this study aims to define a set of new pandemic scenarios that could be used in case of a future influenza pandemic. A total of 338 documents were identified using a searching strategy based on seven combinations of keywords. Eighty-three of these documents provided useful information on the 13 virus-related and health-system-related parameters initially considered for describing scenarios. Among these, four parameters were finally selected (clinical attack rate, case fatality rate, hospital admission rate, and intensive care admission rate) and four different levels of severity for each of them were set. The definition of six most likely scenarios results from the combination of four different levels of severity of the four final parameters (256 possible scenarios). Although it has some limitations, this approach allows for more flexible scenarios and hence it is far from the classic scenarios structure used for pandemic plans until 2009.
Highlights
Before the 2009 influenza A(H1N1) pandemic, most European Union (EU) Member States had developed preparedness plans in order to timely respond to an eventual pandemic
The panel of experts was of the opinion that some of the parameters collected through the literature review were more relevant for mathematical modelling than for public health purposes, and others were considered less relevant for defining scenarios; all these were excluded: R0; age-specific clinical attack rate (CAR); communicability/generation interval; modes of transmission; incubation period; timing and duration of pandemic
Age-specific CAR in most of the considered influenza pandemics were derived from studies conducted in small and selected communities not representative of the entire population, while the timing and duration of pandemic is expected to be from several weeks to a few months but will likely vary from country to country or within a single country
Summary
Before the 2009 influenza A(H1N1) pandemic, most European Union (EU) Member States had developed preparedness plans in order to timely respond to an eventual pandemic. The 2009 pandemic influenza A(H1N1) virus caused illness that did not require hospitalisation in the vast majority of cases, and was a highly transmissible virus among humans spreading to several countries within days [3,4]. In this situation, the severity assessment applied during the 2009 influenza A(H1N1) pandemic using a variety of indicators leading to a qualitative assessment in three levels (i.e. mild, moderate and severe) was not specific enough to guide interventions [5,6]
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