The largest international event devoted exclusively to all facets of influenza, the Options VII conference was held in the Hong Kong Special Administrative Region (SAR), China in 2010, the first to be convened following an influenza pandemic. This two-part paper presents conference highlights, with emphasis on the 2009 pandemic response and future pandemic preparedness.
All licensed formulations of the pH1N1 vaccine were uniformly immunogenic, having exceeded all regulatory criteria after a single dose in adults and two doses in children in most cases.
Vaccine effectiveness data are being reported at present. Available reports suggest that the pH1N1 vaccine was highly effective at preventing laboratory-confirmed infection, with vaccine effectiveness approaching > 90% for most age groups.
The current influenza vaccine production timelines were the major obstacle to the timely provision of the pH1N1 vaccine during the pandemic. In many countries, the pH1N1 vaccination campaign only began after the second pandemic wave was well underway or had peaked.
WHO had worked vigorously to ensure the access of low-income countries to the pH1N1 vaccines; however, deployment efforts were slower than hoped and were fraught with logistical, legal and ethical barriers.
Neuraminidase inhibitors, namely oseltamivir and zanamivir, were the primary treatment options for pH1N1. Optimal effectiveness was achieved when the drug was given within 48 hours of symptom onset; however, late therapy was still beneficial in severely ill pH1N1 patients.
Oseltamivir-resistant cases remained a rare occurrence, with only 304 cases confirmed globally as of August 18, 2010.
Many investigational anti-influenza agents are in various stages of clinical development, with peramivir and laninamivir being licensed or close to licensure in some countries.
Moving forward in improving preparedness efforts, public health authorities need better tools for describing and understanding the severity of a pandemic. Public health authorities must also contend with the anti-science movement that is counter-productive to public health mitigation measures.
Mathematical modelling can be an important adjunct to the public health armamentarium, but could only be of value when it is explicitly linked to action.