Early Detection of Pandemic (H1N1) 2009, Bangladesh

Eduardo Azziz-Baumgartner

, Mustafizur Rahman, Abdullah Al Mamun, Mohammad Sabbir Haider, Rashid Uz Zaman, Polash Chandra Karmakar, Sharifa Nasreen, Syeda Mah-E Muneer, Nusrat Homaira, Doli Rani Goswami, Be-Nazir Ahmed, Mohammad Mushtuq Husain, Khondokar Mahbuba Jamil, Selina Khatun, Mujaddeed Ahmed, Apurba Chakraborty, Alicia Fry, Marc-Alain Widdowson, Joseph Bresee, Tasnim Azim, A.S.M. Alamgir, Abdullah Brooks, Mohamed Jahangir Hossain, Alexander Klimov, Mahmudur Rahman, and Stephen P. Luby

Author affiliations: International Centre for Diarrhoeal Diseases Research, Bangladesh, Dhaka, Bangladesh (E. Azziz-Baumgartner, M. Rahman, A.A. Mamun, R.U. Zaman, P.C. Karmakar, S. Nasreen, S. Mah-E-Muneer, N. Homaira, D.R. Goswami, A. Chakraborty, T. Azim, A. Brooks, M.J. Hossain, S.P. Luby); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (E. Azziz-Baumgartner, A. Fry, M.-A. Widdowson, J. Bresee, A. Klimov, S.P. Luby); Institute of Epidemiology, Disease Control and Research, Dhaka (M.S. Haider, B.-N. Ahmed, M.M. Husain, K.M. Jamil, A. Chakraborty, A.S.M. Alamgir, M. Rahman); World Health Organization, Dhaka (S. Khatun, M. Ahmed)

Abstract

To explore Bangladesh’s ability to detect novel influenza, we examined a series of laboratory-confirmed pandemic (H1N1) 2009 cases. During June–July 2009, event-based surveillance identified 30 case-patients (57% travelers); starting July 29, sentinel sites identified 252 case-patients (1% travelers). Surveillance facilitated response weeks before the spread of pandemic (H1N1) 2009 infection to the general population.

After 2 children in North America were confirmed to have pandemic (H1N1) 2009 infections on April 17, 2009 (1), the virus rapidly spread throughout the world. By July 2, 2009, Southeast Asia had reported 1,866 cases (2). Officials worried about the effects of pandemic (H1N1) 2009 on the 147,030,000 million population (1,021 persons/km²) of Bangladesh (3), where 41% of children <5 years of age are underweight (4). These concerns prompted Bangladesh to leverage 3 existing surveillance systems (5), preparedness plans, and personal protective equipment and oseltamivir stockpiles to guide the response to the pandemic.
During April 2009, Bangladesh enhanced surveillance by implementing border screenings. Upon identification of pandemic (H1N1) 2009 in the general population, Bangladesh encouraged physicians to empirically treat patients who had acute respiratory infection with free oseltamivir if they had risk factors for complications from influenza (i.e., age <5 years or >65 years; diabetes; chronic heart, lung, or liver disease; asthma; neurologic, neuromuscular, hematologic, or metabolic disorders; immune suppression; cancer; obesity; pregnancy; danger signs [rapid, labored or noisy breathing, lethargy, cyanosis, inability to drink, or convulsion], or hospitalization) (6). We report the effects of this strategy on a case-series of laboratory-confirmed pandemic (H1N1) 2009 infection identified through enhanced surveillance.