Public Health Measures Implemented in Response to the 2009 H1N1 Pandemic Público
Miles, Melody Gretchen (2011)
Abstract
Background: The 2009 influenza A(H1N1) pandemic tested
the capacity and flexibility of global
response mechanisms to mitigate the transmission of an emergent
virus. In the absence of
available vaccine at the height of the pandemic, non-pharmaceutical
public health measures
including school closures, travel screenings, and isolation served
as important tools to assuage
morbidity and mortality.
Objective: To systematically review published literature
documenting experiences and outcomes
of public health measures implemented from April 25, 2009 - April
30, 2010 in response to the
H1N1 2009 pandemic.
Methods: Peer and gray literature databases were
systematically searched. Papers meeting
inclusion criteria were abstracted for relevant information using a
standardized assessment tool
and rated based on methodological rigor.
Results: The search identified 1597 papers, of which 85
met inclusion criteria and thirty-one
provided good quality evidence of impact. Among rigorously designed
studies, hand washing and
post-outbreak school closures showed evidence of reducing disease
transmission. Isolation
showed some positive impact in closed settings such as hospitals
and universities. Travel
screenings and restrictions were of none or very limited effect.
Control measures taken at mass
gatherings stymied any large-scale outbreaks. Qualitative analysis
of author experiences
identified consistent uncertainty on when to initiate measures.
Overall, the scope and timing of
each intervention was highly correlated with its impact.
Discussion: Robust empirical evidence on the impact of
non-pharmaceutical public health
measures implemented during the pandemic is limited. However, much
was learned about the
process of implementation and gaps in preparedness plans.
Implementation and termination
triggers described were largely qualitative, incomplete, and
randomly applied. Response plans
designed for a more virulent virus were of limited use and required
rapid adaption by policy
makers and program managers. A decision-making framework utilizing
pre-established triggers
to initiate a tiered structure of implementation is needed.
Indicators should be standardized to
allow for comparative analysis. Moving forward, efforts should be
made to improve integration
of decision making and coordinate communication across sectors. A
strategy and supporting fund
at the global level for impact studies (and monitoring) on public
health measures should be put in
place before the next pandemic.
Table of Contents
Contents
Informal Abstract
What is Already Known
What This Study Adds
Acronyms
Chapter 1.
Introduction______________________________________
Past Pandemics
Global Response
Timeline of Events
WHO Activity
Non-pharmaceutical Public Health Interventions
Problem Statement
Purpose Statement
Significance Statement
Definition of Terms
Chapter 2.
Background______________________________________
Existing Evidence and Previous Reviews
Conceptual Framework
Global Matrix of PHM Implemented During the 2009 H1N1
Pandemic
Chapter 3. Research Methodology
Search Strategy
Selection/Exclusion Criteria
Data Abstraction and Analysis
Data Quality Assessment
Characteristics of Excluded Abstracts
Chapter 4.
Results__________________________________________
Timeliness of PHM Implementation and H1N1 Epidemiology
School Closures
Mass Gatherings
Travel and Trade
Individual and Societal Measures
Hand Washing/Hygiene Communication
Integrated Measures (Targeted Layered Containment)
Emerging Ideas
Chapter 5.
Discussion________________________________________
Summary of Published Experiences
Lessons Learned
Public Health Implications
Recommendations for Future Research
Limitations
References__________________________________________________110
Appendix____________________________________________________124
Appendix 1: Observational Study Data Quality Assessment Form
Appendix 2: Expert Opinion Data Quality Assessment Form
Appendix 3: Gray Literature Data Quality Assessment Form
Appendix 4: Qualitative Rating Categories for Strength of
Evidence
Appendix 5: Qualitative Rating Categories for
Generalizability
Appendix 6: Data Abstraction Fields
Appendix 7: Annotated Appendix of Literature
About this Master's Thesis
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