Pandemic (H1N1) 2009, Australia | CDC EID

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Volume 16, Number 8–August 2010
Research
Responses to Pandemic (H1N1) 2009, Australia
Keith Eastwood, David N. Durrheim, Michelle Butler, and Alison Jon
Author affiliations: Hunter New England Health, Newcastle, New South Wales, Australia (K. Eastwood, D.N. Durrheim, M. Butler); University of Newcastle, Newcastle (D.N. Durrheim); and University of Western Sydney, Sydney, New South Wales, Australia (A. Jones)

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Abstract
In 2007, adults in Australia were interviewed about their willingness to comply with potential health interventions during a hypothetical influenza outbreak. After the first wave of pandemic (H1N1) 2009 in Australia, many of the same respondents were interviewed about behavior and protection measures they actually adopted. Of the original 1,155 respondents, follow-up interviews were conducted for 830 (71.9%). Overall, 20.4% of respondents in 2009 had recently experienced influenza-like illness, 77.7% perceived pandemic (H1N1) 2009 to be mild, and 77.8% reported low anxiety. Only 14.5% could correctly answer 4 questions about influenza virus transmission, symptoms, and infection control. Some reported increasing handwashing (46.6%) and covering coughs and sneezes (27.8%) to reduce transmission. Compared with intentions reported in 2007, stated compliance with quarantine or isolation measures in 2009 remained high. However, only respondents who perceived pandemic (H1N1) 2009 as serious or who had attained higher educational levels expressed intention to comply with social distancing measures.
The World Health Organization (WHO) declared a public health event of international importance on April 24, 2009, after recognition of a novel pandemic influenza virus strain, pH1N1, now called pandemic (H1N1) 2009 virus, which caused serious disease and deaths in Mexico and other parts of North America. This declaration triggered an immediate response in Australia; national pandemic plans were implemented, and the public was alerted to the risk and the activities that could keep them from contracting and spreading the infection.

Imported cases of pandemic (H1N1) 2009 were first identified in Australia on May 7, 2009, and within a month, local transmission had been identified in all 8 states and territories (1,2). By September 1, 2009, of Australia';s population of 22 million, 154 had died and 4,440 had been hospitalized for pandemic (H1N1) 2009 (3 ). Within the first 2 months of the outbreak, the Australian Commonwealth instituted 3 management phases: delay, contain, and protect. Each phase required different messages to the public and healthcare workers (1,2,4 ). Ensuring consistent implementation through Australia';s 3 government levels—national, state, and local—was challenging. The delay phase was aimed at preventing pandemic (H1N1) 2009 from arriving in Australia and focused attention on border control and communication with international travelers. However, after local transmission was recognized and the disease became established in Australia, the contain phase was implemented with an emphasis on identifying cases and tracing contacts. Those with confirmed pandemic (H1N1) 2009 infection and their contacts were actively managed by using isolation, home quarantine, antiviral medication, and enhanced infection control practices to reduce the spread of disease. Finally, when it became clear that pandemic (H1N1) 2009 infection in Australia was less severe than initially considered and that the workload was adversely affecting the provision of health services, the protect phase was implemented and the public health response was changed to early detection and management of infection in persons from recognized risk groups. The change in focus (from aggressively tracking new infections to treating all persons in Australia with influenza-like illness [ILI] to concentrating on those in high-risk groups) presented a major risk-communication challenge for health authorities.

The success of the pandemic management plan in Australia depends critically on public compliance with health measures (5,6 ). A study completed in 2007 found that a high proportion of respondents reported willingness to accept a range of public health measures (although the scenario provided in that study was a more severe pandemic) (7). In that study, 1,166 (58.0%) of 2,012 adults contacted participated in the survey. Nearly all (1,155) agreed to be available for future related research.

The 2009 pandemic provided a unique opportunity to conduct a follow-up study to compare respondents'; previously reported willingness to adopt public health measures with their experiences during and after pandemic (H1N1) 2009 in Australia. We thus conducted a study during the protect phase, from August 20 through September 11, 2009, almost 4 months after the WHO declaration and 1 month after the peak of reported hospitalizations from the first wave of pandemic (H1N1) 2009 in Australia (1,2,4 ). We sought to identify the level of public knowledge concerning measures required to contain pandemic influenza spread, social impact of the pandemic wave, effectiveness of communication, compliance with control measures instituted by public health authorities, and relationships among these parameters.

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Suggested Citation for this Article
Suggested citation for this article: Eastwood K, Durrheim DN, Butler M, Jones A. Responses to pandemic (H1N1) 2009, Australia. Emerg Infect Dis [serial on the Internet]. 2010 Aug [date cited]. http://www.cdc.gov/EID/content/16/8/1211.htm

DOI: 10.3201/eid1608.100132