Abstract

BackgroundHistorically, Pacific island countries and territories (PICTs) have been more severely affected by influenza pandemics than any other part of the world. We herein describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in PICTs from 2009 to 2010.MethodsThe World Health Organization gathered reports of influenza-like-illness and laboratory-confirmed pandemic H1N1 cases from all 23 Pacific island countries and territories, from April 2009 through August 2010. Data were gathered through weekly email reports from Pacific island countries and territories and through email or telephone follow-up.ResultsPacific island countries and territories started detecting pandemic H1N1 cases in June 2009, firstly in French Polynesia, with the last new detection occurring in August 2009 in Tuvalu. Nineteen Pacific island countries and territories reported 1,972 confirmed cases, peaking in August 2009. No confirmed pandemic H1N1 cases were identified in Niue, Pitcairn and Tokelau; the latter instituted strict maritime quarantine. Influenza-like-illness surveillance showed trends similar to surveillance of confirmed cases.Seven Pacific island countries and territories reported 21 deaths of confirmed pandemic H1N1. Case-patients died of acute respiratory distress syndrome or multi-organ failure, or both. The most reported pre-existing conditions were obesity, lung disease, heart disease, and pregnancy.Pacific island countries and territories instituted a variety of mitigation measures, including arrival health screening. Multiple partners facilitated influenza preparedness planning and outbreak response.ConclusionsPandemic influenza spread rapidly throughout the Pacific despite enormous distances and relative isolation. Tokelau and Pitcairn may be the only jurisdictions to have remained pandemic-free. Despite being well-prepared, Pacific island countries and territories experienced significant morbidity and mortality, consistent with other indigenous and low-resource settings.For the first time, regional influenza-like-illness surveillance was conducted in the Pacific, allowing health authorities to monitor the pandemic’s spread and severity in real-time.Future regional outbreak responses will likely benefit from the lessons learned during this outbreak.

Highlights

  • IntroductionWe describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in Pacific island countries and territories (PICTs) from 2009 to 2010

  • Pacific island countries and territories (PICTs) have been more severely affected by influenza pandemics than any other part of the world

  • Epidemiology of influenzalike illness (ILI) and confirmed pH1N1 in PICTs Hawaii and New Zealand were the first jurisdictions in the Pacific region to detect pH1N1 cases in late April, 2009

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Summary

Introduction

We describe the emergence and epidemiologic characteristics of pandemic influenza H1N1 in PICTs from 2009 to 2010. Pacific island countries and territories (PICTs) have been more severely affected by influenza pandemics than any other part of the world. As an extreme example, during the 1918 influenza pandemic, Western Samoa ( Samoa) experienced the loss of 19-22% of its population [1]. During the 1918 pandemic, four Pacific island nations were able to delay or prevent introduction of the influenza virus through strict application of maritime quarantine. The remote Lau and Yasawa islands of Fiji, is the only known Pacific area that appears to have avoided the 1918 pandemic altogether [2]. By 2009, all PICTs except for Tokelau and Pitcairn Islands could be reached by commercial air line, making timely quarantine unrealistic for most

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