© 2010 American Thoracic Society doi: 10.1164/rccm.200912-1878CP
Influenza A/H1N1_09: Australia and New Zealand's Winter of Discontent1 Department of Allergy, Immunology and Respiratory Medicine, The Alfred Hospital, Melbourne and Department Medicine, Monash University, Melbourne; 2 School of Medicine and Pharmacology, University of Western Australia; 3 Department of Respiratory Medicine, Concord Hospital, Concord and Department Medicine, University of Sydney, and Woolcock Institute of Medical Research, New South Wales; 4 National Centre for Epidemiology & Population Health, College of Medicine, Biology & Environment, Australian National University, Canberra; 5 Infectious Disease Unit, The Alfred Hospital, and Department of Epidemiology and Preventative Medicine, Monash University, Melbourne; 6 Department of Preventive & Social Medicine Dunedin School of Medicine, University of Otago, Dunedin, New Zealand; 7 The University of Adelaide, Department of Thoracic Medicine, Royal Adelaide Hospital Chest Clinic, Adelaide, South Australia; 8 Department of Respiratory Medicine, Royal Hobart Hospital & Respiratory Research Group, Menzies Research Institute, Hobart, Tasmania; 9 Department Respiratory Medicine, Mater Adult Hospital, Sth Brisbane, Queensland; 10 Department Respiratory Medicine, Royal Melbourne Hospital, and Department Medicine University of Melbourne, Parkville, Melbourne; 11 Lung Institute of Western Australia and the Centre for Asthma, Allergy and Respiratory Research, University of Western Australia, Perth, Australia Correspondence and requests for reprints should be addressed to Tom Kotsimbos, M.D., Department of Allergy, Immunology & Respiratory Medicine, The Alfred Hospital, Commercial Rd, Melbourne, Victoria, Australia, 3004. E-mail: tom.kotsimbos{at}med.monash.edu.au ABSTRACT Influenza A/H1N1_09 emerged in Mexico at the end of the Northern Hemisphere winter. Within weeks, the focus shifted to the Southern Hemisphere as the introduction of the novel virus coincided with the beginning of the influenza season. Intensive public health and health services planning had occurred in Australia and New Zealand as preparation for an influenza pandemic before 2009. However, this first pandemic wave was quite different to what had been expected. Key elements of the pandemic and response are outlined from the perspective of clinicians working at the frontline of patient care. In particular, they examine why past influenza pandemics and recent history are poor predictors of the current pandemic, the discordance between potential for transmission and disease severity, the broad clinical spectrum of H1N1_09 infection, clinical and health service management issues, and the relationship between health care and government policy. Finally, they address the need for the respiratory community to show leadership in times of crisis. Lessons learned in Australia and New Zealand during 2009 have important messages for similarly resourced countries in the Northern Hemisphere in the coming months as they face their own influenza season.
Key Words: Influenza A/H1N1_09 • southern hemisphere • pandemic response plan • clinical perspective • health care policy Related articles in AJRCCM:
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