2009 flu pandemic in Australia

As at 18 December 2009, Australia had 37,537 confirmed cases of H1N1 Influenza 2009 (Human Swine Influenza) and 191 deaths reported by Department of Health^[1] but only 77 deaths reported by the Australian Bureau of Statistics.^[9] The actual numbers are much larger, as only serious cases are being tested and treated. Suspected cases have not been reported by the Department of Health and Ageing since 18 May 2009 because they are changing too quickly to report.^[10] As many as 1600 Australians may have died as a result of this virus.^[11][12] On 23 May The federal government classified the outbreak as CONTAIN phase^[13] except in Victoria where it was escalated to the SUSTAIN phase on 3 June.^[14] This gives government authorities permission to close schools to slow the spread of the disease.^[13] On 17 June 2009 the Department of Health and Ageing introduced a new phase called PROTECT. This modified the response to focus on people with high risk of complications from the disease. Testing at airports is to be discontinued. The national stockpile of antiviral drugs will no longer be made available to people with the flu unless there are more than mild symptoms or a high risk of dying.^[15]

Australia has a stockpile of 8.7 million doses of Tamiflu and Relenza.^[16] Under the earlier DELAY and CONTAIN phases Airlines were required to report passengers with influenza symptoms, and thermal imaging and nurses were deployed at international airports.^[16] Passengers arriving were required to fill in a health declaration card.^[17]

A large scale immunization effort against swine flu started on Monday 28 September 2009.

Context

There are on average 2,500-3,000 deaths every year as a result of seasonal influenza in Australia. An estimated 1 billion are infected seasonally, throughout the world. In Australia, 37,537 swine flu tests have given positive results and there have been 191 confirmed deaths of people infected with swine flu as of 18 December 2009.^[1]

Reported cases

Queensland

On 9 May 2009, Australia confirmed its first case of swine flu in a 33-year-old woman, when she touched down from a flight from Los Angeles to Brisbane. Although it was confirmed to be not infectious (coming out as a "weak but positive result"), family members and people who were sitting close to her during the flight have been contacted and urged to seek immediate medical attention if they began to show flu-like symptoms.^[18] On 24 May Queensland confirmed its second case.^[19] 41 deaths have been recorded in Queensland. The first person to die in Queensland was a 38-year-old woman who died on 15 July at the Mater Hospital Pimlico.^[20]

Victoria

In Victoria there have been 2,440 cases,^[7] including 24 deaths. An 11-year-old boy, and later his 2 brothers, were confirmed on 20 May to carry the virus.^[21] Victorian health authorities closed Clifton Hill Primary School for two days on 21 May, initially, after the three brothers returned to the school from a trip to Disneyland.^[22] A further case delayed the reopening of the school until Thursday 28 May 2009.^[23][24] On 23 May about 22 year-nine students of Mill Park Secondary College were given anti-viral Tamiflu after one of their classmates was diagnosed with swine flu, the same happened for students in year 9 at the University High School in Parkville and also for the Melton campus of Mowbray College after a year 10 student contracted the virus .^[23] A 35-year-old man from Colac died on 20 June 2009 at Maroondah Hospital after going to Colac Hospital the previous day.^[25] On 23 June 2009, the second swine flu related death in Victoria was reported, in that of a 50-year-old woman at the Peter MacCallum Cancer Centre.^[26] A third death was reported on 25 June.^[27] Two more death were reported on the weekend of 27 and 28 June.^[28] Two more deaths were reported on 1 July, including a 3 year old.^[29] Four more deaths were recorded on 8 July.^[30]

The SUSTAIN phase in Victoria means that less effort will be given to tracing and testing, as there would be insufficient resources available to do this. Antiviral drugs in this phase are only available to confirmed cases or their immediate contacts.^[14]

New South Wales

In New South Wales there have been 51 deaths. The first confirmed death in New South Wales occurred on 29 June^[31] and a second man died on 3 July.^[32]

South Australia

South Australia has recorded 28 deaths, plus a 'clinical positive' where the test was inconclusive and, after swine-flu-like symptoms were reported, Tamiflu was administered, thus making a future positive confirmation unlikely.^[33] Adelaide high schools Eynesbury Senior College and Blackfriars Priory School closed for a week.^[34] The first confirmed death from swine flu in Australia was a 26-year-old Aboriginal man from Kiwirrkurra Community in the Western Desert of Western Australia who died in Royal Adelaide Hospital on 19 June.^[35]

Australian Capital Territory

The Australian Capital Territory has recorded two deaths and 920 confirmed cases by 28 August 2009.^[2] Two of the earliest casualties contracted the disease while on the Pacific Dawn cruise ship.^[36] The first death in the ACT occurred on 28 July 2009.^[37]
During the last week of July 2009, Radford College's year 12 cohort was asked to stay home, after a spike of influenza through the year.

Western Australia

There have been 27 confirmed deaths in Western Australia. The first person to die in the state was a 26-year-old woman who died on 26 June 2009. A 26-year-old Western Australian man died in Adelaide on 19 June.^[35]

Tasmania

Tasmania has recorded seven deaths. Public health authorities expected up to 200,000 Tasmanians could catch swine flu in the three months incoming from June.^[38] The first person to die in Tasmania was an 85-year-old woman who died in Royal Hobart Hospital on 5 July.^[39]

Northern Territory

The Northern Territory confirmed the first infection of a person on 30 May 2009.^[40] Six people have died in the territory so far. The first person in the Territory to die from the current epidemic was a man in his early 50s who died at the Royal Darwin Hospital on 6 July.^[35]

Overseas cases

The swine flu has also affected some Australians internationally:

Three Australians in London had confirmed cases of swine flu.^[41][42]

Australians in quarantine:^[43]

• 7 in South Korea
• 7 in China including 1 confirmed case
• 1 confirmed case in Taiwan; recovered and released
• 2, a mother and child, in the Philippines
• 1 confirmed case of a 12-year-old boy in Singapore who began showing symptoms while on a flight from Sydney

Pacific Dawn cruise ship swine flu scare

On 25 May, about 3 hours after going off the boat, a swine flu scare was reported on board. This shock has caused a spark in the number of cases, going up much more rapidly than before, and somehow causing "Case 1" (see above). The number of cases was around 20 before the scare, and due to this, the amount of cases have risen well over 15,000. This cruise ship caused almost half of the cases in SA, caused the WA case, and the TAS case. Also it caused a scare in New Caledonia.

Government travel advice

Borders have not been closed, and no restrictions have been placed on travel.^[44] Travel to countries with confirmed cases of swine flu have not been reclassed to reconsider, as at 1 May 2009.

Measures to control an outbreak

Starting from 30 April thermal imaging was applied to passenger arrivals at international airports and arriving passengers were required to fill in a card. Customs officers checked aeroplane cabins prior to disembarkation of passengers looking for people with flu symptoms.^[45]

On 23 May the government upgraded the flu alert level from "delay" to "contain", giving authorities in all states the option to close schools if students were at risk.^[13] All states and territories have ordered students returning from countries where flu was widespread (Canada, Japan, Mexico, Panama and United States) not to return to school for a week after entering Australia.^[46] States outside Victoria decided to prevent students returning to school for a week if they have visited Victoria.^[47]

CSL Limited started to produce a vaccine to immunize against swine flu, and received an order from the Australian Government for ten million doses. The inoculations are expected to be ready around the end of July 2009.^[48][49]

In Melbourne, seven special clinics for influenza opened on 29 May.^[50]

There are now additional measures to control the flu outbreak encouraging students returning from Victoria to stay away from school and quarantine themselves for a period of up to seven days.

Preparations

The Australian Government had a stockpile of 40 million surgical grade face masks. However stocks of face masks in pharmacies were depleted due to personal purchases.^[45] The World Health Organisation Influenza Centre in North Melbourne was attempting to develop a vaccine for swine flu, by growing the live virus as found in California, in chicken embryos.^[51] The first one-litre batch of vaccine was announced to be ready on 29 June 2009 by the University of Queensland, but would not be available for use until it was registered as safe with the regulatory authority.^[52]

A Commonwealth Health hotline for Swine Influenza was set up on Australian phone number 1802007 by the Department of Health and Ageing.^[53] The Australian Government set up a health emergency web site.^[17] Daily tallies of suspected cases were given.^[54]

The Tasmanian Government set up a Tasmanian Action Plan for Human Influenza Pandemic.^[55]

The Queensland Government had an action plan prepared in 2008^[56] and a business continuity plan in 2006.^[57] The Australian Capital Territory Chief Medical Officer, Dr Charles Guest, claimed that procedures and systems were very good to detect and respond to the disease outbreak.^[58] South Australia has nominated eight hospitals to handle flu: Royal Adelaide, Flinders Medical Centre or Women's and Children's Hospital, Berri, Mount Gambier, Port Lincoln, Whyalla or Port Augusta.^[59] The Victorian Government Department of Human Services had a nurse on call to answer questions on the topic.^[60]

Hygiene recommendations

The Tasmanian government published a warning poster^[61] and a series of recommendations to health professionals on protective equipment, hand washing and sterilisation.^[62]

Evaluation

In a 2011 article in the Emerging Health Threats Journal, Peter Collignon commented that the media frequently compared the outbreaks to the 1918 flu pandemic that infected 500 million people and killed tens of millions. Widespread public fear of a similar number of deaths lead to "Emergency Departments and doctor surgeries being overwhelmed" with requests for antiviral drugs, jeopardising the supply for the highest risk patients.^[63]

Statistics

• As at 18 December 2009, there have been 37,537 confirmed cases of pandemic (H1N1) 2009 and 191 deaths reported in Australia according to Department of Health.^[1]
• In 2009, H1N1 Influenza 2009 (Human Swine Influenza) was the underlying cause of 77 deaths in Australia. The ABS implemented World Health Organization (WHO) guidelines to code all swine flu deaths to the ICD-10 code of Influenza due to certain identified influenza virus (J09).^[9]

References

External links

• Australian Department of Health and Ageing "Health Emergency" website
• Swine Flu News and Updates From Around the World