The 2009 influenza A (H1N1) pandemic

Management and vaccination strategies in The Netherlands
  • M.A.B. van der Sande
  • A. Jacobi
  • A. Meijer
  • J. Wallinga
  • W. van der Hoek
  • M. van der Lubben
Leitthema

Abstract

Prior to 2009, The Netherlands had prepared itself extensively for a potential pandemic. Multidisciplinary guidelines had been drafted to control transmission and limit adverse outcomes for both a phase of early incidental introduction and for a phase with widespread transmission. The Ministry of Health had ensured a supply and distribution schedule for antivirals and negotiated a contract for vaccine purchases. During the pandemic, existing surveillance was expanded, the established infectious disease response structure was activated, and the previously prepared protocols for communication, diagnostics, use of antivirals, and vaccination implementation were operationalized and implemented.

When the pandemic turned out to be less severe than many had anticipated, risk communication and rapid modification of guidelines and communication became a major challenge. Antivirals and pandemic vaccines were reserved for those at high risk for severe outcomes only. Overall, the impact of the pandemic was comparable to the impact of an average seasonal influenza epidemic, but with a shift in (severe) outcomes from the very young and elderly toward young adults. Established prepared protocols enabled timely coordinated responses. In preparing for the worst, sufficient attention must be given to preparing for a mild scenario as well.

Keywords

2009 influenza pandemic Vaccination The Netherlands Preparation Control 

AbbreviationsGroup

CIb

Centre for Infectious Disease Control

ECDC

European Centre for Disease Control

GP

General practitioner

ILI

Influenza-like illness

NIC

National Influenza Centre

NIVEL

National Institute for Health Services Research

OMT

Outbreak management team

PHS

Public health service

RIVM

National Institute for Public Health and the Environment

WHO

World Health Organization

Die Influenza-A-(H1N1-)Pandemie 2009

Bewältigung und Impfstrategien in den Niederlanden

Zusammenfassung

Vor 2009 hatten sich die Niederlande ausführlich auf eine potenzielle Pandemie vorbereitet. Zur Kontrolle der Übertragung und Begrenzung ungünstiger Verläufe waren sowohl für eine Frühphase der anfänglichen Einschleppung als auch für eine Phase weitverbreiteter Übertragung multidisziplinäre Leitlinien erstellt worden. Das Ministerium hatte einen Versorgungs- und Verteilungsplan für antivirale Substanzen erstellt und über einen Vertrag zum Kauf von Impfstoffen verhandelt. Während der Pandemie wurde die bestehende Überwachung ausgeweitet, das etablierte Reaktionsverfahren für Infektionskrankheiten aktiviert und die zuvor erstellten Protokolle für Kommunikation, Diagnostik, Einsatz antiviraler Substanzen und Impfdurchführung wurden ein- und umgesetzt.

Als sich herausstellte, dass die Pandemie nicht so schwer wie befürchtet war, wurden die Risikokommunikation sowie die schnelle Modifizierung der Leitlinien und ihre Kommunikation zur wesentlichen Herausforderung. Antivirale Substanzen und Pandemieimpfstoffe waren nur für Personen reserviert, bei denen ein hohes Risiko für eine schwere Erkrankung bestand. Insgesamt waren die Auswirkungen der Pandemie vergleichbar mit denen einer durchschnittlichen saisonalen Influenzaepidemie, allerdings mit einer Verlagerung von (schweren) Erkrankungen von den ganz Jungen und Älteren zu jungen Erwachsenen. Etablierte vorbereitete Protokolle ermöglichten zeitlich koordinierte Reaktionen. Bei der Vorbereitung auf das Schlimmste muss auch der Einstellung auf ein weniger dramatisches Szenario ausreichende Aufmerksamkeit geschenkt werden.

Schlüsselwörter

Influenzapandemie 2009 Impfung Niederlande Vorbereitung Kontrolle 

Notes

Acknowledgments

The authors would like to acknowledge all the clinicians, public health officials, laboratory staff, other professionals, patients, and contacts involved; many other RIVM workers involved in pandemic control; and the Dutch Government, ECDC, and WHO.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • M.A.B. van der Sande
    • 1
    • 2
  • A. Jacobi
    • 1
  • A. Meijer
    • 1
  • J. Wallinga
    • 1
  • W. van der Hoek
    • 1
  • M. van der Lubben
    • 1
  1. 1.RIVM – Centre Infectious Disease ControlNational Institute for Public Health and the Environment, BilthovenBilthovenThe Netherlands
  2. 2.Julius Center for Health Sciences and Primary CareUniversity Medical Center UtrechtUtrechtThe Netherlands

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