Abstract
BackgroundThe 2009 A/H1N1 influenza pandemic has received a great deal of attention from public health authorities. Our study examines whether this pandemic and the resulting public health measures could have impacted acute diarrhea, a prevalent, highly transmissible and historically monitored disease.MethodsUsing augmentation procedures of national data for the previous five years (2004–2009), we estimated the expected timing and incidence of acute diarrhea in France in 2009–2010 and evaluated differences with the observed. We also reviewed national hand gels for the same period.FindingsNumber of episodes of acute diarrhea in France in 2009–2010 was significantly lower than expected until the third week of December (−24%, 95% CI [−36%; −9%]), then significantly higher (+40%, 95% CI [22%; 62%]), leading to a surplus of 574,440 episodes. The epidemic was delayed by 5 weeks with a peak 1.3 times higher than expected. Hand-gels sales inversely correlated with incidence of both influenza-like illness and acute diarrheal disease. Among individuals >65 yo, no excess cases of influenza and no excess rebound in acute diarrhea were observed, despite similar delay in the onset of the seasonal diarrheal epidemic.InterpretationOur results suggest that at least one endemic disease had an unexpected behavior in 2009–2010. Acute diarrhea seems to have been controlled during the beginning of the pandemic in all age groups, but later peaked higher than expected in the younger population. The all-age delay in seasonal onset seems partly attributable to hand-gels use, while the differential magnitude of the seasonal epidemic between young and old, concurrent for both influenza and acute diarrhea, is compatible with disease interaction.
Highlights
The first cases related to a novel strain of Influenza A/H1N1 appeared in Mexico within the first months of 2009, resulting in the first influenza pandemic of the 21st century [1]
In 2009–2010, the number of acute diarrhea episodes in France was significantly lower than expected until the third week of December (224%; 95% CI: 236%, 29%), and significantly higher (+40%; 95% CI: 22%, 62%), leading to an excess of 574,440 episodes (+14%; 95% CI: 22%,+34%) (Table 1)
We report unusual incidence patterns of acute diarrhea associated with the 2009–2010 influenza A/H1N1 pandemic and accompanying public health measures in France
Summary
The first cases related to a novel strain of Influenza A/H1N1 appeared in Mexico within the first months of 2009, resulting in the first influenza pandemic of the 21st century [1]. During the international crisis that followed, a number of containment measures were taken at the national [2,3] and international levels [4]. While some measures were specific to influenza (e.g. mass vaccinations campaigns, recommended by WHO and initiated in October 2009 in many countries including France [5]), a number of non-pharmaceutical measures able to impact communicable disease transmission generally were variably recommended across communities: restrictions on mass transport services and nonessential travels [4], social distancing interventions (closing schools and workplaces and limiting public gatherings) [4,6], and avoiding contact with the sick. The aim of this study was to take advantage of the unique natural experiment of large-scale multi-focal public health interventions and to assess their impact on a historically monitored commonly transmitted infectious disease. Our study examines whether this pandemic and the resulting public health measures could have impacted acute diarrhea, a prevalent, highly transmissible and historically monitored disease
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