Perceptions of and willingness to engage in public health precautions to prevent 2009 H1N1 influenza transmission

Background  

Recommendations about precautionary behaviors are a key part of public health responses to infectious disease threats such as the 2009 H1N1 pandemic. Individuals' interpretation of recommendations, willingness to comply, and factors predicting willingness were examined.     

Self-reported anticipated compliance with physician advice to stay home during pandemic (H1N1) 2009: Results from the 2009 Queensland Social Survey

Background  

One strategy available to public health officials during a pandemic is physician recommendations for isolation of infected individuals. This study was undertaken during the height of the Australian pandemic (H1N1) 2009 outbreak to measure self-reported willingness to comply with physician recommendations to stay home for seven days, and to compare responses for the current strain of pandemic influenza, avian influenza, seasonal influenza, and the common cold.     

The exposure of the nursing profession in online and print media

Objective

to describe the coverage of news concerning the nursing profession in the Portuguese media: informative sites on the Internet and in print media.

Method

a total of 1,271 health news items were collected in September and October of 2011 (956 online news items and 325 news items originating from the press review of the Portuguese Order of Nurses). Statistical analysis was used to characterize the variables.

Results

nurses were the sources of information in 6.6% of cases, suggesting limited media exposure. The health news collected is characterized by a production based on limited information sources, that is, male and official sources, on information disseminated by news agencies focused on economic and political issues in the health field.

Conclusion

the presence of nurses in the news concerning nursing health is reduced. We suggest that nurses develop public communication skills to disseminate the importance of their profession in society and their relationship with the media.     

Perceived risk,anxiety, and behavioural responses of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands: results of three consecutive online surveys

Background  

Research into risk perception and behavioural responses in case of emerging infectious diseases is still relatively new. The aim of this study was to examine perceptions and behaviours of the general public during the early phase of the Influenza A (H1N1) pandemic in the Netherlands.     

The impact of mass gatherings and holiday traveling on the course of an influenza pandemic: a computational model

Background  

During the 2009 H1N1 influenza pandemic, concerns arose about the potential negative effects of mass public gatherings and travel on the course of the pandemic. Better understanding the potential effects of temporal changes in social mixing patterns could help public officials determine if and when to cancel large public gatherings or enforce regional travel restrictions, advisories, or surveillance during an epidemic.     

The Black Canyon Forecast Station: Experiences And Lessons Learned

Objective

To evaluate the sociological effect on indigenous biological event signature recognition and community resilience due to the operational activities of an infectious disease forecast station.

Introduction

The nation’s first operational infectious disease forecast station, modeled after warning protocols developed in the meteorology community, was activated in 2011. The approach was originally pioneered in Haiti following the 2010 earthquake.

Methods

We assembled global event signature and forecast libraries that reflected locally diagnosed infectious disease activity and infrastructure impact in a rural community from a public health, veterinary, and human clinical medicine perspective. The deployment site is home to a variety of infectious disease including hantavirus, plague, tularemia, and West Nile in the context of high wildlife-livestock-human interfacing. Information derived from the issuance of forecasts coupled to situational awareness was shared with the public, local officials, public health officers, veterinarians, healthcare providers, and patients through various social media methods.

Results

Provision of 30-60-90 day forecasts for routine and non-routine endemic infectious disease activity and impact facilitated better coordination of public health messaging and daily conversation with patients in the inpatient and outpatient settings. The signature of an unusual, infrastructure-disruptive outbreak of metapneumovirus and respiratory syncytial virus was recognized and communicated with enough time to activate effective clinical mitigation protocols. Cost estimates demonstrated financial benefit at a local level to anticipating surges of infectious disease activity with enough time to mitigate patient demand. Community-wide engagement with infectious disease forecasts and live event advisories included the promotion of proactive infection control and public health surveillance and response, healthcare provider recognition of non-routine infectious disease, clinical sampling and diagnostic testing protocols, clinician and patient education, and synchronization of proactive disease reporting both in the routine daily clinical setting and in times of crisis. Collateral benefit of consistent messaging delivered to the public by the participating entities was noted. Community awareness of the repertoire of indigenous infectious disease activity was expanded beyond the official public health notification list. Neither issuance of infectious disease forecasts nor advisories issued during crises triggered an influx of anxious well phone calls or visits to the medical system that was deemed operationally relevant.

Conclusions

Activation of a local infectious disease forecast station modeled after a local weather station promotes routine communication of a broader array of infectious disease activity than that monitored by public health; facilitates proactive, cost effective healthcare; and enabled recognition of unusual, disruptive infectious activity with enough time to enable mitigation of clinical, infrastructure, and financial impact to the community. Routine communication of comprehensive infectious disease forecast and situational awareness information promotes community adaptive fitness to a wide variety of infectious hazards. The results suggest it is possible to transform the traditional public health model of data collection and analysis to one of transparent and open data availability to support innovative reduction in morbidity and mortality.     

Political ill-health coverage: professional-ethical questions regarding news reporting of leaders' ailments

While reporting on Presidential health has increased of late, there has been very little discussion of the professional-ethical issues involved from the perspective of the journalist, especially when such medical information is not disclosed voluntarily and/or the public official is someone other than the President. Within the general issue of press freedom vs. the right to privacy, and in light of relevant laws, judicial rulings, legal scholarship, and especially journalistic professional ethics, this essay raises and discusses several questions that reporters should take into account when considering whether to publish unauthorized medical information about public officials: 1) do officials have any right to medical privacy? 2) if so, before, during, and/or after tenure? 3) what is the significance of false vs. non-disclosure by the official? 4) are there limits to informed speculation? 5) what types and degree of ill health justify reporting? 6) regarding what level of elected and/or appointed officials? Other ancillary questions are noted as well: means of newsgathering; obsolescence of news item; extenuating circumstances justifying not publishing such news; low IQ as a health problem; who is to be considered a journalist; appropriate sanctions for going over the line. The article's conclusion explains why the issue of ill health reporting of public officials will become even more problematic in the coming years.     

High effectiveness of pandemic influenza A (H1N1) vaccination in healthcare workers from a Portuguese hospital

Objectives

Vaccination of healthcare workers (HCWs) was made a high priority during the phase six pandemic of the novel influenza A H1N1 (pH1N1) virus. We surveyed adherence to pH1N1 vaccination and the incidence of pH1N1 infection between vaccinated and unvaccinated HCWs.

Methods

Employees at the S. Jo?o Hospital in Porto, Portugal, were offered pH1N1 vaccinations free of charge. Pandemrix^? was the vaccine administered. As part of the pandemic plan, employees with influenza-like symptoms (ILS) were called upon to take an RT-PCR H1N1 test. If the test results were positive, they had to stay off work for at least 7?days. Sociodemographic data, vaccination status, contact with infectious patients, ILS and pH1N1 test results were documented in a standardised manner.

Results

The survey population comprised 5,592 employees. The vaccination rate was 30.8% (n?=?1,720) for pH1N1 and 50.4% (n?=?2,819) for the 2009/2010 seasonal trivalent inactivated influenza vaccine (TIV). One mild anaphylactic reaction occurred after pH1N1 vaccination. Minor local side effects occurred more often after pH1N1 vaccination than after 2009/2010 seasonal TIV (38.0% vs. 12.3%). Pandemic H1N1 infection was diagnosed in 97 HCWs (1.7%). Compared to employees with no regular patient contact, nurses (2.8%) had the highest risk of pH1N1 infection (adjusted OR 3.8; 95% CI 1.2–6.8). Vaccination reduced the pH1N1 infection risk (OR 0.12; 95% CI 0.05–0.29). Vaccine effectiveness was 90.4% (95% CI 73.5–97.3%).

Conclusion

Vaccination reduced the pH1N1 infection risk considerably. The pandemic plan to contain the pH1N1 infection was successful. Nurses had the highest risk of pH1N1 infection and are therefore a target group for vaccination measures.     

Analysis of the effectiveness of interventions used during the 2009 A/H1N1 influenza pandemic

Background  

Following the emergence of the A/H1N1 2009 influenza pandemic, public health interventions were activated to lessen its potential impact. Computer modelling and simulation can be used to determine the potential effectiveness of the social distancing and antiviral drug therapy interventions that were used at the early stages of the pandemic, providing guidance to public health policy makers as to intervention strategies in future pandemics involving a highly pathogenic influenza strain.     

Epidemic and intervention modelling?– a scientific rationale for policy decisions? Lessons from the 2009 influenza pandemic

Problem

Outbreak analysis and mathematical modelling are crucial for planning public health responses to infectious disease outbreaks, epidemics and pandemics. This paper describes the data analysis and mathematical modelling undertaken during and following the 2009 influenza pandemic, especially to inform public health planning and decision-making.

Approach

Soon after A(H1N1)pdm09 emerged in North America in 2009, the World Health Organization convened an informal mathematical modelling network of public health and academic experts and modelling groups. This network and other modelling groups worked with policy-makers to characterize the dynamics and impact of the pandemic and assess the effectiveness of interventions in different settings.

Setting

The 2009 A(H1N1) influenza pandemic.

Relevant changes

Modellers provided a quantitative framework for analysing surveillance data and for understanding the dynamics of the epidemic and the impact of interventions. However, what most often informed policy decisions on a day-to-day basis was arguably not sophisticated simulation modelling, but rather, real-time statistical analyses based on mechanistic transmission models relying on available epidemiologic and virologic data.

Lessons learnt

A key lesson was that modelling cannot substitute for data; it can only make use of available data and highlight what additional data might best inform policy. Data gaps in 2009, especially from low-resource countries, made it difficult to evaluate severity, the effects of seasonal variation on transmission and the effectiveness of non-pharmaceutical interventions. Better communication between modellers and public health practitioners is needed to manage expectations, facilitate data sharing and interpretation and reduce inconsistency in results.     

Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia

Background  

Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources.     

Partners in Immunization: 2010 Survey Examining Differences Among H1N1 Vaccine Providers in Washington State

Objectives

Emergency response involving mass vaccination requires the involvement of traditional vaccine providers as well as other health-care providers, including pharmacists, obstetricians, and health-care providers at correctional facilities. We explored differences in provider experiences administering pandemic vaccine during a public health emergency.

Methods

We conducted a cross-sectional survey of H1N1 vaccine providers in Washington State, examining topics regarding pandemic vaccine administration, participation in preparedness activities, and communication with public health agencies. We also examined differences among provider types in responses received (n=619, 80.9% response rate).

Results

Compared with other types of vaccine providers (e.g., family practitioners, obstetricians, and specialists), pharmacists reported higher patient volumes as well as higher patient-to-practitioner ratios, indicating a broad capacity for community reach. Pharmacists and correctional health-care providers reported lower staff coverage with seasonal and H1N1 vaccines. Compared with other vaccine providers, pharmacists were also more likely to report relying on public health information from federal sources. They were less likely to report relying on local health departments (LHDs) for pandemic-related information, but indicated a desire to be included in LHD communications and plans. While all provider types indicated a high willingness to respond to a public health emergency, pharmacists were less likely to have participated in training, actual emergency response, or surge capacity initiatives. No obstetricians reported participating in surge capacity initiatives.

Conclusions

Results from this survey suggest that efforts to increase communication and interaction between public health agencies and pharmacy, obstetric, and correctional health-care vaccine providers may improve future preparedness and emergency response capability and reach.Responding to a public health emergency involving vaccines requires preparation, training, collaboration, and clear communication between public health and frontline health-care providers. As experienced during the 2009–2010 H1N1 influenza vaccination campaign, large-scale public health emergencies involving vaccines or other countermeasures often require the involvement of a diverse set of health-care providers. In addition to providers who routinely administer vaccines (e.g., pediatricians and family practitioners), nontraditional vaccine providers (e.g., obstetricians and correctional health-care providers) can play a vital role in emergency response. Pharmacists are now permitted to administer vaccines in all states. As such, they serve an increasingly important role as community vaccinators during events requiring mass vaccination and were identified during the H1N1 influenza response as a target group for receiving pandemic vaccine.^1–3Studies conducted to date on practices of health-care providers during public health emergencies have been limited and mainly conducted in homogeneous groups of traditional providers. However, other providers are often called upon during an emergency response.⁴ Pharmacists in particular have been identified as potential first responders, as they often report a willingness to respond in emergency situations.^5,6 Because of their ubiquitous presence in communities (93% of Americans live within five miles of a community retail pharmacy), pharmacists are uniquely situated to provide swift, broad-reaching care.⁷ Pharmacists also have increased capacity through extended hours of operation as well as established and streamlined access to prophylactics, and they have established themselves as vaccine providers.^6,8,9In addition to pharmacy providers, other unique providers can play important roles during vaccine-related emergencies. Obstetricians can influence maternal immunization, which is particularly important in the context of influenza immunization for both seasonal and pandemic influenza seasons.^10–12 Correctional facility providers often must contend with dangers posed by crowding, inmates'' high mixing ratio with the public, and patients with higher susceptibility to infectious diseases.¹³ We explored differences in provider experiences administering vaccine during a public health emergency.     

Regional distribution of fatiguing illnesses in the United States: a pilot study

Background  

Chronic fatigue syndrome (CFS) is a debilitating illness with no known cause or effective therapy. Population-based epidemiologic data on CFS prevalence are critical to put CFS in a realistic context for public health officials and others responsible for allocating resources.     

The Cognitive Mediation Model: Factors Influencing Public Knowledge of the H1N1 Pandemic and Intention to Take Precautionary Behaviors

This study uses the cognitive mediation model as the theoretical framework to examine the influence of motivations, communication, and news elaboration on public knowledge of the H1N1 pandemic and the intention to take precautionary behaviors in Singapore. Using a nationally representative random digit dialing telephone survey of 1,055 adult Singaporeans, the authors' results show that the cognitive mediation model can be applied to health contexts, in which motivations (surveillance gratification, guidance, and need for cognition) were positively associated with news attention, elaboration, and interpersonal communication. News attention, elaboration, and interpersonal communication in turn positively influence public knowledge about the H1N1 influenza. In addition, results show that the motivations have significant indirect effects on behavioral intentions, as partially mediated by communication (media attention and interpersonal communication), elaboration, and knowledge. The authors conclude that the cognitive mediation model can be extended to behavioral outcomes, above and beyond knowledge. Implications for theory and practice for health communication were discussed.     

Effective media communication of disasters: Pressing problems and recommendations

Background  

Public health officials and journalists play a crucial role in disseminating information regarding natural disasters, terrorism and other human-initiated disasters. However, research suggests that journalists are unprepared to cover terrorism and many types of natural disasters, in part because of lack sufficient expertise in science and medicine and training. The objective of this research was to identify solutions to problems facing journalists and public health public information officer (PIOs) of communicating with the public during natural and human-initiated disasters.     

Staying physically active after spinal cord injury: a qualitative exploration of barriers and facilitators to exercise participation

Background  

While enhancing physical activity has been an essential goal of public health officials, people with physical impairments such as spinal cord injury (SCI) are more likely to live a sedentary lifestyle. Exercise has been shown to decrease the risk for many of the secondary conditions associated with SCI, including osteoporosis, cardiovascular disease, pressure ulcers, urinary tract infections, diabetes and arthritis, yet this population is rarely a target for health promotion efforts. This paper examines the self-reported exercise experiences of people with SCI using a qualitative-exploratory design.     

Response to the challenges of pandemic H1N1 in a small island state: the Barbadian experience

Background

Having been overwhelmed by the complexity of the response needed for the severe acute respiratory syndrome (SARS) epidemic, public health professionals in the small island state of Barbados put various measures in place to improve its response in the event of a pandemic

Methods

Data for this study was collected using Barbados’ National Influenza Surveillance System, which was revitalized in 2007. It is comprised of ten sentinel sites which send weekly notifications of acute respiratory illness (ARI) and severe acute respiratory illness (SARI) to the Office of the National Epidemiologist. During the 2009 H1N1 pandemic, meetings of the National Pandemic Planning Committee and the Technical Command Committee were convened. The pharmaceutical and non-pharmaceutical interventions (NPIs) implemented as a result of these meetings form the basis of the results presented in this paper.

Results

On June 3, 2009, Barbados reported its first case of 2009 H1N1. From June until October 2009, there were 155 laboratory confirmed cases of 2009 H1N1, with one additional case occurring in January 2010. For the outbreak period (June-October 2009), the surveillance team received reports of 2,483 ARI cases, compared to 412 cases for the same period in 2008. The total hospitalization rate due to SARIs for the year 2009 was 90.1 per 100,000 people, as compared to 7.3 per 100,000 people for 2008. Barbados’ pandemic response was characterized by a strong surveillance system combining active and passive surveillance, good risk communication strategy, a strengthened public and private sector partnership, and effective regional and international collaborations. Community restriction strategies such as school and workplace closures and cancellation of group events were not utilized as public health measures to delay the spread of the virus. Some health care facilities struggled with providing adequate isolation facilities.

Conclusions

The number of confirmed cases was small but the significant surge in ARI and SARI cases indicate that the impact of the virus on the island was moderate. As a result of 2009 H1N1, virological surveillance has improved significantly and local, regional and international partnerships have been strengthened.

     

Communication about environmental health risks: A systematic review

Background  

Using the most effective methods and techniques for communicating risk to the public is critical. Understanding the impact that different types of risk communication have played in real and perceived public health risks can provide information about how messages, policies and programs can and should be communicated in order to be most effective. The purpose of this systematic review is to identify the effectiveness of communication strategies and factors that impact communication uptake related to environmental health risks.