Because the H1N1 vaccine was initially in short supply in the United States, the CDC recommended that initial doses should go to priority groups such as pregnant women, people who live with or care for babies under six months old, children six months to four years old and health-care workers. In the United Kingdom, the NHS recommended vaccine priority go to people over six months old who were clinically at risk for seasonal flu, pregnant women and households of people with compromised immunity. Although it was initially thought that two injections would be required, clinical trials showed that the new vaccine protected adults "with only one dose instead of two;" thus the limited vaccine supplies would go twice as far as had been predicted. Health officials worldwide were also concerned because the virus was new and could easily mutate and become more virulent, even though most flu symptoms were mild and lasted only a few days without treatment. Officials also urged communities, businesses, and individuals to make contingency plans for possible school closures, multiple employee absences for illness, surges of patients in hospitals, and other effects of potentially widespread outbreaks. Disaster response organizations such as Direct Relief helped by providing protective items to clinical workers to help them stay healthy throughout flu season. In February 2010, the CDC's Advisory Committee on Immunization Practices voted for "universal" flu vaccination in the United States to include all people over six months of age. The 2010–2011 vaccine will protect against the 2009 H1N1 pandemic virus and two other flu viruses.
Public health response On 27 April 2009, the
European Union health commissioner advised Europeans to postpone nonessential travel to the United States or Mexico. This followed the discovery of the first confirmed case in Spain. On 6May 2009, the
Public Health Agency of Canada announced that their
National Microbiology Laboratory (NML) had mapped the genetic code of the swine flu virus, the first time that had been done. In the United Kingdom, the
National Health Service launched a website, the National Pandemic Flu Service, allowing patients to self-assess and get an authorisation number for antiviral medication. The system was expected to reduce the burden on
general practitioners. The CDC and other U.S. governmental agencies used the summer lull to take stock of the United States response to H1N1 flu and attempt to patch any gaps in the
public health safety net before flu season started in early autumn. Preparations included planning a second influenza vaccination program in addition to the one for seasonal flu, and improving coordination between federal, state, and local governments and private health providers.
Vaccines being vaccinated against H1N1 flu on 20 December 2009 By 19 November 2009, doses of vaccine had been administered in over 16 countries. A 2009 review by the U.S. National Institutes of Health (NIH) concluded that the 2009 H1N1 vaccine has a safety profile similar to that of the seasonal vaccine. In 2011, a study from the US Flu Vaccine Effectiveness Network estimated the overall effectiveness of all pandemic H1N1 vaccines at 56%. A CDC study released 28 January 2013, estimated that the Pandemic H1N1 vaccine saved roughly 300 lives and prevented about a million illnesses in the US. The study concluded that had the vaccination program started two weeks earlier, close to 60% more cases could have been prevented. The study was based on an effectiveness in preventing cases, hospitalizations, and deaths of 62% for all subgroups except people over 65, for whom the effectiveness was estimated at 43%. The effectiveness was based on European and Asian studies and expert opinion. The delay in vaccine administration demonstrated the shortcomings of the world's capacity for vaccine-production, as well as problems with international distribution. Some manufacturers and wealthy countries had concerns regarding liability and regulations, as well as the logistics of transporting, storing, and administering vaccines to be donated to poorer countries.
Accusations of conflict of interest In January 2010,
Wolfgang Wodarg, a German deputy who trained as a physician and chaired the health committee at the
Council of Europe, claimed that major firms had organized a "campaign of panic" to put pressure on the
World Health Organization (WHO) to declare a "false pandemic" to sell vaccines. Wodarg said the WHO's "false pandemic" flu campaign is "one of the greatest medicine scandals of the century". He said that the "false pandemic" campaign began in May 2009 in
Mexico City, when a hundred or so "normal" reported influenza cases were declared to be the beginning of a threatening new pandemic, although he said there was little scientific evidence for it. Nevertheless, he argued that the WHO, "in cooperation with some big pharmaceutical companies and their scientists, re-defined pandemics," removing the statement that "an enormous amount of people have contracted the illness or died" from its existing definition and replacing it by stating simply that there has to be a virus, spreading beyond borders and to which people have no immunity. The WHO responded by stating that they take their duty to provide independent advice seriously and guarded against interference from outside interests. Announcing a review of the WHO's actions, spokeswoman Fadela Chaib stated: "Criticism is part of an outbreak cycle. We expect and indeed welcome criticism and the chance to discuss it". The WHO also stated on their website that "The world is going through a real pandemic. The description of it as a fake is wrong and irresponsible". In March 2010, the Council of Europe launched an enquiry into "the influence of the pharmaceutical companies on the global swine flu campaign", and a preliminary report was in preparation. On 12 April 2010, Keiji Fukuda, the WHO's top influenza expert, stated that the system leading to the declaration of a pandemic led to confusion about H1N1 circulating around the world and he expressed concern that there was a failure to communicate in regard to uncertainties about the new virus, which turned out to be not as deadly as feared. WHO Director-General Margaret Chan appointed 29 flu experts from outside the organization to conduct a review of WHO's handling of the H1N1 flu pandemic. She told them, "We want a frank, critical, transparent, credible and independent review of our performance." In June 2010,
Fiona Godlee, editor-in-chief of the
BMJ, published an editorial which criticised the WHO, saying that an investigation had disclosed that some of the experts advising WHO on the pandemic had financial ties with drug companies which were producing antivirals and vaccines. Margaret Chan, Director-General of the WHO, replied stating, "Without question, the
BMJ feature and editorial will leave many readers with the impression that WHO's decision to declare a pandemic was at least partially influenced by a desire to boost the profits of the pharmaceutical industry. The bottom line, however, is that decisions to raise the level of pandemic alert were based on clearly defined virological and epidemiological criteria. It is hard to bend these criteria, no matter what the motive". On 26 April 2009, the
Chinese government announced that visitors returning from flu-affected areas who experienced flu-like symptoms within two weeks would be quarantined. U.S. airlines had made no major changes as of the beginning of June 2009, but continued standing practices which include looking for passengers with symptoms of flu,
measles or other infections, and relying on in-flight
air filters to ensure that aircraft were sanitised. According to studies conducted in Australia and Japan, screening individuals for influenza symptoms at airports during the 2009 H1N1 outbreak was not an effective method of infection control.
Schools U.S. government officials were especially concerned about schools because the H1N1 flu virus appeared to disproportionately affect young and school-age people, between six months and 24 years of age. The H1N1 outbreak led to numerous precautionary school closures in some areas. Rather than closing schools, the CDC recommended that students and school workers with flu symptoms should stay home for either seven days total, or until 24 hours after symptoms subsided, whichever was longer. The CDC also recommended that colleges should consider suspending fall 2009 classes if the virus began to cause severe illness in a significantly larger share of students than the previous spring. They also urged schools to suspend rules, such as penalties for late papers or missed classes or requirements for a doctor's note, to enforce "self-isolation" and prevent students from venturing out while ill; schools were advised to set aside a room for people developing flu-like symptoms while they waited to go home and to have ill students or staff and those caring for them use face masks. In California, school districts and universities were on alert and worked with health officials to launch education campaigns. Many planned to stockpile medical supplies and discuss worst-case scenarios, including plans to provide lessons and meals for low-income children in case elementary and secondary schools closed. To help prepare for contingencies,
University of Maryland School of Medicine professor of
pediatrics James C. King Jr. suggested that every county should create an "influenza action team" to be run by the local
health department, parents, and school administrators. By 28 October 2009, about 600 schools in the United States had been temporarily closed, affecting over 126,000 students in 19 states.
Workplace Fearing a worst-case scenario, the U.S.
Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention and the
Department of Homeland Security (DHS) developed updated guidance The CDC estimated that as much as 40% of the workforce might be unable to work at the peak of the pandemic due to the need for many healthy adults to stay home and care for an ill family member, and advised that individuals should have steps in place should a workplace close down or a situation arise that requires
remote work. The CDC further advised that persons in the workplace should stay home sick for seven days after getting the flu, or 24 hours after symptoms end, whichever is longer.
Face masks , Japan The U.S. CDC did not recommend the use of face masks or
respirators in non-health care settings, such as schools, workplaces, or public places, with a few exceptions: people who were ill with the virus when around other people, and people who were at risk for severe illness while caring for someone with the flu. There was some disagreement about the value of wearing face masks, as some experts feared that masks may have given people a false sense of security and should not have replaced other standard precautions. Yukihiro Nishiyama, professor of virology at
Nagoya University's School of Medicine, commented that the masks are "better than nothing, but it's hard to completely block out an airborne virus since it can easily slip through the gaps". They are particularly popular in Japan, where cleanliness and hygiene are highly valued and where etiquette obligates those who are sick to wear masks to avoid spreading disease. As a result, the
US State Department issued a travel alert about China's anti-flu measures and warned travellers against travelling to China if ill. In Hong Kong, an entire hotel was quarantined with 240 guests; Australia ordered a cruise ship with 2,000 passengers to stay at sea because of a swine flu threat. Egyptian Muslims who went on the annual
pilgrimage to
Mecca risked being quarantined upon their return. Russia and
Taiwan said they would quarantine visitors with fevers who come from areas where the flu was present. Japan quarantined 47 airline passengers in a hotel for a week in mid-May, then in mid-June India suggested pre-screening "outbound" passengers from countries thought to have a high rate of infection.
Pigs and food safety The pandemic virus is a type of swine influenza, derived originally from a strain which lived in pigs, and this origin gave rise to the common name of "swine flu". This term is widely used by mass media, though the Paris-based
World Organisation for Animal Health as well as industry groups such as the U.S.
National Pork Board, the
American Meat Institute, and the Canadian Pork Council objected to widespread media use of the name "swine flu" and suggested it should be called "North American flu" instead, while the World Health Organization switched its designation from "swine influenza" to "influenza A (H1N1)" in late April 2009. The virus has been found in U.S. hogs, and Canadian as well as in hogs in Northern Ireland, Argentina, and Norway. Leading health agencies and the
United States Secretary of Agriculture have stressed that eating properly cooked pork or other food products derived from pigs will not cause flu. Nevertheless, on 27 April,
Azerbaijan imposed a ban on the importation of
animal husbandry products from the entire
Americas. The
Indonesian government also halted the importation of pigs and initiated the examination of pigs in Indonesia. The Egyptian government ordered the slaughter of all pigs in Egypt on 29 April. ==Treatment==