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Research Article

Did Advances in Global Surveillance and Notification Systems Make a Difference in the 2009 H1N1 Pandemic?–A Retrospective Analysis

  • Ying Zhang,

    Affiliation: Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, United States of America

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  • Hugo Lopez-Gatell,

    Affiliation: National Institute of Public Health, Cuernavaca, Mexico

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  • Celia M. Alpuche-Aranda,

    Affiliation: National Institute of Public Health, Cuernavaca, Mexico

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  • Michael A. Stoto mail

    stotom@georgetown.edu

    Affiliation: Department of Health Systems Administration, Georgetown University, Washington, District of Columbia, United States of America

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  • Published: April 03, 2013
  • DOI: 10.1371/journal.pone.0059893

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Warning Sequence Regarding the 2009 H1N1 Influenza Pandemic

Posted by jmwilsonv on 25 Nov 2013 at 22:36 GMT

Here we offer a perspective from the viewpoint of those who recognized the unusual signature pattern in Mexico in April, later recognized as the 2009 H1N1 influenza pandemic:
http://biosurveillance.ty...

Hindsight recollection of data collected by a computer is insufficient for global surveillance operations. One must have an astute analyst who understands event signature processing, is able to triage those signatures for priority notification human-to-human, and promote the issuance of warning. It is the difference between declaration that the "information was there in the Internet... and it was collected with hundreds of other non-prioritized media articles" versus a human being having a direct phone conversation to explain why a particular signature is worthy of all attention by a government agency.

Report of H1N1 cases in California were documented through laboratory surveillance, however *recognition* of the threat it represented was indeed missing. It is only in hindsight these initial positives were claimed to be the first indicators. They were expressly not the initial *recognized* indicators.

Regarding verification of the situation in Mexico, it was clear that miscommunication between Mexican authorities and PAHO hindered the all-critical verification step needed to issue a worldwide advisory. Here the Canadians, based on their experience with SARS, provided us with the best example of warning to their national press. They stated a recognition of a most unusual situation but did not have verification- therefore, check travel histories in returning travelers.

As someone who designed, operationalized, and executed the mission for several of the capabilities mentioned in this paper, I would suggest that while technological improvements have been made in the detection and warning of serious public health threats, it is the sociology that will continue to impair full mission realization of biosurveillance.

James M. Wilson V, M.D.
Director
National Infectious Disease Forecast Center

No competing interests declared.

Identifying the 2009 H1N1 Influenza Pandemic: Response to Wilson

mstoto replied to jmwilsonv on 16 Dec 2013 at 17:06 GMT

It is hard to know what Dr. Wilson means by his comment that "Hindsight recollection of data collected by a computer is insufficient for global surveillance operations." If he is saying that automated analysis of electronic surveillance data, without human review and interpretation, is insufficient for surveillance operations, I agree. Indeed our analysis of the 2001 H1N1 pandemic provides evidence supporting this conclusion.

If, however, Dr. Wilson is referring to our analysis as a “hindsight recollection of data collected by a computer,” he has misread the paper. What we did was to recreate, from a number of practitioner perspectives and based on contemporaneous records as much as possible, how the outbreak developed and how knowledge about it developed and was shared globally. And what we found was sharply inconsistent with Dr. Wilson’s conclusions, based mainly on his involvement with Veratect.

Dr. Wilson states that "Report (sic) of H1N1 cases in California were documented through laboratory surveillance, however *recognition* of the threat it represented was indeed missing. It is only in hindsight these initial positives were claimed to be the first indicators. They were expressly not the initial *recognized* indicators." As we document in our analysis, however, the Mexican authorities were well aware of a number of outbreak signals for weeks before the Centers for Disease Control (CDC) published its results on the two California H1N1 on April 21, 2009, but the identification of a novel influenza virus was critical, allowing them to "connect the dots" and understand that these were all manifestations of the same epidemiological phenomenon. Indeed, this supports Wilson's call for "an astute analyst who understands event signature processing, is able to triage those signatures for priority notification human-to-human, and promote the issuance of warning."

Dr. Wilson’s claim that "miscommunication between Mexican authorities and PAHO hindered the all-critical verification step needed to issue a worldwide advisory" is not “clear” (as he says) but actually untrue. Mexico was open with PAHO, but before CDC published its results, no one knew the importance of the information that the Mexican authorities had. Our analysis shows that CDC's information about the novel H1N1 virus began to emerge about a week before the public report on April 21. Perhaps if Mexico and PAHO had been aware of this, their discussions during this week would have been different.

Dr. Wilson’s statement that the Canadians, based on their experience with SARS, urged preventive measures even though they did not have verification of the virus is misleading.
Canada's statement came one day after CDC's, and was based not only on CDC’s results, but on their communication with the Mexican authorities. Indeed, CDC’s confirmation of the novel viral strain, and global communication, was critical for everything, including Canada’s response.

Dr. Wilson ends with the suggestion that “while technological improvements have been made in the detection and warning of serious public health threats, it is the sociology that will continue to impair full mission realization of biosurveillance." If "sociology" means the social capital represented by the global surveillance systems and communication within it, I agree about the importance of this factor, and indeed our analysis shows how improvements in global communications made a positive difference in 2009.

No competing interests declared.