The response to the pandemic influenza A(H1N1) virus by the governments and public health officials of Mexico City and New York City in the spring of 2009 reveals successful strategies, but also points to issues that need to be addressed, according to a report from the Centers for Disease Control and Prevention.
“In each case, advance planning laid the foundation for enhanced surveillance and a generally effective response, made possible by an extensive public communications campaign and effective political leadership,” wrote Dr. David M. Bell of the CDC, and his associates.
The researchers summarized the responses of Mexico City and New York City to the H1N1 virus in spring 2009 (Emerg. Infect. Dis. 2009 [doi: 10.3201/eid1512.091232]).
“These megacities may not be representative of cities in low-income countries, which face more daunting problems,” the researchers noted.
After the novel H1N1 virus was identified on April 23, 2009, Mexico City followed a pandemic influenza preparedness plan that had been developed for any virus that originated outside Mexico. Efforts to decrease the spread of the virus included an intense media campaign encouraging people to stay home if they were sick and to avoid close contact such as hugging or kissing in greeting.
“Early in the epidemic, the federal government released antiviral drugs from the national strategic reserve and controlled their distribution,” Dr. Bell and his colleagues wrote.
The government successfully introduced a mass media campaign that addressed Mexico City's diverse population and range of literacy rates. In addition, it mobilized private businesses, such as grocery stories and pharmacies, to deliver health messages. The Ministry of Health also used text messages and e-mails to convey public health messages.
The closure of thousands of businesses in Mexico City and throughout Mexico is estimated to have cost the country more than $2.3 billion, and large gatherings such as sporting events were canceled or postponed, the researchers said.
Despite these costs, the researchers concluded that Mexico City's preparations paid off. “The preexisting pandemic plan and planning process facilitated collaboration, decision making, and rapid development of a communications campaign,” they said. But the emergency of the pandemic illustrated several areas in need of improvement, including a limited capacity of laboratories to handle tests and a lack of criteria for reopening schools that closed because of the outbreak.
In New York City, 77% of emergency departments collect electronic information from more than 90% of patient visits. “During spring 2009, these systems were essential for real-time monitoring of the pandemic in NYC,” allowing public health officials to track the spread of the virus through the city, the investigators emphasized.
The New York City government kept the public informed during the spring 2009 H1N1 outbreak with press conferences in both English and Spanish, and a government information hotline staffed with live operators answered 98% of calls within 30 seconds, the researchers said. About 50 schools in New York City closed for approximately 1 week.
Unlike Mexico City, New York City did not distribute antiviral drugs from the emergency stockpile because “normal distribution channels sufficed,” Dr. Bell and his associates said, but emergency plans called for the distribution of antivirals from the stockpile via hospitals, public clinics, and community health centers if necessary.
Decision making based on flu severity in New York City proved challenging, given that the case-fatality ratio was unknown. Other challenges included deciding when and whether to close and reopen schools and how to keep children from gathering in groups elsewhere when schools were closed.
In response to the surge in emergency department visits from individuals with flulike symptoms, New York City hospitals were able to plan for additional care sites to handle the expected surge in cases of influenza-like illness in the fall and winter of 2009, the researchers said.
Overall, they concluded that the early responses of Mexico City and New York City to the H1N1 virus outbreak were promising.
The problems that did occur would likely have been worse if the disease had been more severe or if schools and businesses had remained closed for longer periods, they wrote. More research is needed to continue to identify best practices for pandemic situations in cities.
Advance planning led to a generally effective response to H1N1 outbreaks.
Source ©CDC