Abstract
BackgroundControlling the pandemic spread of newly emerging diseases requires rapid, targeted allocation of limited resources among nations. Critical, early control steps would be greatly enhanced if the key risk factors can be identified that accurately predict early disease spread immediately after emergence.Methodology/Principal FindingsHere, we examine the role of travel, trade, and national healthcare resources in predicting the emergence and initial spread of 2009 A/H1N1 influenza. We find that incorporating national healthcare resource data into our analyses allowed a much greater capacity to predict the international spread of this virus. In countries with lower healthcare resources, the reporting of 2009 A/H1N1 cases was significantly delayed, likely reflecting a lower capacity for testing and reporting, as well as other socio-political issues. We also report substantial international trade in live swine and poultry in the decade preceding the pandemic which may have contributed to the emergence and mixed genotype of this pandemic strain. However, the lack of knowledge of recent evolution of each H1N1 viral gene segment precludes the use of this approach to determine viral origins.Conclusions/SignificanceWe conclude that strategies to prevent pandemic influenza virus emergence and spread in the future should include: 1) enhanced surveillance for strains resulting from reassortment in traded livestock; 2) rapid deployment of control measures in the initial spreading phase to countries where travel data predict the pathogen will reach and to countries where lower healthcare resources will likely cause delays in reporting. Our results highlight the benefits, for all parties, when higher income countries provide additional healthcare resources for lower income countries, particularly those that have high air traffic volumes. In particular, international authorities should prioritize aid to those poorest countries where both the risk of emerging infectious diseases and air traffic volume is highest. This strategy will result in earlier detection of pathogens and a reduction in the impact of future pandemics.
Highlights
Predicting the origin and emergence of new diseases is critical to preventing and controlling them [1,2]
As of May 8th 2009, only two weeks after it was first reported, the 2009 A/H1N1 influenza strain had spread to 24 countries, 40 U.S states in the US, and 9 provinces in Canada (Figure 1)
Of all the models evaluated, a multivariate model with three predictors, (1) total country-level healthcare spending per capita, (2) estimated passenger volume arriving from Mexico via direct flights, and (3) passenger volume from Mexico via indirect, or two-leg, flights, provided the best fit to the data using Akaike Information Criterion (AIC), as detailed under Methods (Table 1, DAIC = 0, overall x2 = 54.33 on 5 degrees of freedom, p-value,0.0001)
Summary
Predicting the origin and emergence of new diseases is critical to preventing and controlling them [1,2]. If the early spread of a newly emerging pathogen can be predicted and curtailed before it becomes pandemic, its impact on public health and global economies may be much reduced [3,4,5,6]. The virus’ lineage and rapid spread suggest that global trade and travel may have played an important role in its early emergence [7,8]. Controlling the pandemic spread of newly emerging diseases requires rapid, targeted allocation of limited resources among nations. Early control steps would be greatly enhanced if the key risk factors can be identified that accurately predict early disease spread immediately after emergence
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