Australia Australia, officially the Commonwealth of Australia, is a sovereign country comprising the mainland of the Australian continent, the island of Tasmania, and numerous smaller islands. With an area of , Australia is the largest country by ...

had 37,537 confirmed cases of H1N1 Influenza 2009 (Human Swine Influenza) and 191 deaths reported by Department of Health but only 77 deaths reported by the Australian Bureau of Statistics. The actual numbers are much larger, as only serious cases warranted being tested and treated at the time. Suspected cases have not been reported by the Department of Health and Ageing since 18 May 2009 because they were changing too quickly to report. Sources say that as many as 1600 Australians may have actually died as a result of this virus. On 23 May 2009 the federal government classified the outbreak as CONTAIN phase except in Victoria where it was escalated to the SUSTAIN phase on 3 June 2009. This gave government authorities permission to close schools in order to slow the spread of the disease. 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 was discontinued. The national stockpile of antiviral drugs were no longer made available to people with the flu unless there were more than mild symptoms or a high risk of dying.

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. By 18 December 2009 in Australia, 37,537 swine flu tests yielded positive results and the confirmed death toll of people infected with swine flu was 191.

Epidemiology

The first case of swine flu in Australia was reported on 9 May 2009 in a 33-year-old woman from Queensland when she touched down from a flight from

Los Angeles Los Angeles ( ; es, Los Ángeles, link=no , ), often referred to by its initials L.A., is the largest city in the state of California and the second most populous city in the United States after New York City, as well as one of the world ...

Brisbane Brisbane ( ) is the capital and most populous city of the Australian state of Queensland, and the third-most populous city in Australia and Oceania, with a population of approximately 2.6 million. Brisbane lies at the centre of the South ...

. 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 were contacted and urged to seek immediate medical attention if they began to show flu-like symptoms. On 24 May

Queensland ) , nickname = Sunshine State , image_map = Queensland in Australia.svg , map_caption = Location of Queensland in Australia , subdivision_type = Country , subdivision_name = Australia , established_title = Before federation , establishe ...

confirmed its second case. 41 deaths were recorded in Queensland. The first person to die in Queensland was a 38-year-old woman on 15 July at the

Mater Hospital Pimlico The Mater Private Hospital, Pimlico, formerly known as the Mater Misericordiae Hospital, and commonly known as 'The Mater', is the largest private hospital in Townsville, Queensland, Australia.

Victoria

In Victoria 2,440 cases were reported, including 24 deaths. An 11-year-old boy, and later his 2 brothers, were confirmed on 20 May to carry the virus. 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 Disneyland is a theme park in Anaheim, California. Opened in 1955, it was the first theme park opened by The Walt Disney Company and the only one designed and constructed under the direct supervision of Walt Disney. Disney initially envisio ...

. Another case delayed the reopening of the school until Thursday 28 May 2009. On 23 May about 22 year-nine students of

Mill Park Secondary College Mill Park Secondary College is located in Victoria, Australia with its Junior Campus located on Moorhead Drive Mill Park and its Senior Campus located on Civic Drive, Epping. The high school was built in the early 1990s for the residents of Mill ...

were given anti-viral Tamiflu after one of their classmates was diagnosed with swine flu. The same situation happened for students in year nine at the University High School in Parkville and also for the Melton campus of

Mowbray College Mowbray College was an independent, selective, co-educational day school, located in Kurunjang, Victoria and Caroline Springs, Victoria, Australia. The school had three campuses. The Patterson campus, located at Kurunjang, taught students fr ...

after a year 10 student contracted the virus . A 35-year-old man from Colac died on 20 June 2009 at

Maroondah Hospital Maroondah Hospital established in 1976, is a public hospital located in the Melbourne suburb of Ringwood East, Victoria, Australia. Affiliated with Deakin University the hospital provides clinical rotations for students enrolled in years 3 and 4 ...

after going to Colac Hospital the previous day. On 23 June 2009, the second swine flu related death in Victoria was reported, that of a 50-year-old woman at the

Peter MacCallum Cancer Centre The Peter MacCallum Cancer Centre, also known as the Peter MacCallum Cancer Institute and commonly abbreviated as Peter Mac, is an Australian oncology research institute, cancer treatment and professional oncologist training centre located in M ...

. A third death was reported on 25 June. Two more deaths were reported on the weekend of 27 and 28 June. Two more deaths were reported on 1 July, which included a 3-year-old. Four more deaths were recorded on 8 July.

New South Wales

New South Wales ) , nickname = , image_map = New South Wales in Australia.svg , map_caption = Location of New South Wales in AustraliaCoordinates: , subdivision_type = Country , subdivision_name = Australia , established_title = Before federation , es ...

51 deaths were recorded. The first confirmed death in New South Wales occurred on 29 June and a second man died on 3 July.

South Australia

South Australia South Australia (commonly abbreviated as SA) is a States and territories of Australia, state in the southern central part of Australia. It covers some of the most arid parts of the country. With a total land area of , it is the fourth-largest o ...

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. Adelaide high schools Eynesbury Senior College and Blackfriars Priory School closed for a week. The first confirmed death from swine flu in South Australia was a 26-year-old Aboriginal man from Kiwirrkurra Community in the Western Desert of Western Australia who died in

Royal Adelaide Hospital The Royal Adelaide Hospital (RAH), colloquially known by its initials or pronounced as "the Rah", is South Australia's largest hospital, owned by the state government as part of Australia's public health care system. The RAH provides tertiary hea ...

on 19 June.

Australian Capital Territory

The

Australian Capital Territory The Australian Capital Territory (commonly abbreviated as ACT), known as the Federal Capital Territory (FCT) until 1938, is a landlocked federal territory of Australia containing the national capital Canberra and some surrounding township#Aust ...

recorded 2 deaths and confirmed 920 cases by 28 August 2009. Two of the earliest casualties contracted the disease while on the Pacific Dawn cruise ship. The first death in the ACT occurred on 28 July 2009.
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 were 27 confirmed deaths in

Western Australia Western Australia (commonly abbreviated as WA) is a state of Australia occupying the western percent of the land area of Australia excluding external territories. It is bounded by the Indian Ocean to the north and west, the Southern Ocean to t ...

. On 26 June 2009, a 26-year-old woman was the first person to die in the state. A 26-year-old Western Australian man died in Adelaide on 19 June.

Tasmania

Tasmania recorded seven deaths. The first person to die in Tasmania was an 85-year-old woman who died in Royal Hobart Hospital on 5 July.

Northern Territory

The

Northern Territory The Northern Territory (commonly abbreviated as NT; formally the Northern Territory of Australia) is an Australian territory in the central and central northern regions of Australia. The Northern Territory shares its borders with Western Aust ...

confirmed the first infection of a person on 30 May 2009. By this time, six people in the territory had died. The first person in the Territory to die from the epidemic was a man in his early 50s who died at the

Royal Darwin Hospital Royal Darwin Hospital (RDH) is a 360-bed Australian teaching hospital located in Tiwi, Northern Territory, a northern suburb of the Territory capital Darwin. It is part of the Top End Health Service, which covers an area of . RDH is the only ...

on 6 July.

Overseas cases

The swine flu also affected some Australians internationally: * 3 Australians in London had confirmed cases of swine flu. :Australians in

quarantine A quarantine is a restriction on the movement of people, animals and goods which is intended to prevent the spread of disease or pests. It is often used in connection to disease and illness, preventing the movement of those who may have been ...

: * 7 in

South Korea South Korea, officially the Republic of Korea (ROK), is a country in East Asia, constituting the southern part of the Korea, Korean Peninsula and sharing a Korean Demilitarized Zone, land border with North Korea. Its western border is formed ...

* 7 in

China China, officially the People's Republic of China (PRC), is a country in East Asia. It is the world's List of countries and dependencies by population, most populous country, with a Population of China, population exceeding 1.4 billion, slig ...

including 1 confirmed case * 1 confirmed case in

Taiwan Taiwan, officially the Republic of China (ROC), is a country in East Asia, at the junction of the East and South China Seas in the northwestern Pacific Ocean, with the People's Republic of China (PRC) to the northwest, Japan to the no ...

recovered and released * 2, a mother and child, in the

Philippines The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no), * bik, Republika kan Filipinas * ceb, Republika sa Pilipinas * cbk, República de Filipinas * hil, Republ ...

* 1 confirmed case of a 12-year-old boy in

Singapore Singapore (), officially the Republic of Singapore, is a sovereign island country and city-state in maritime Southeast Asia. It lies about one degree of latitude () north of the equator, off the southern tip of the Malay Peninsula, bor ...

who began showing symptoms while on a flight from

Sydney Sydney ( ) is the capital city of the state of New South Wales, and the most populous city in both Australia and Oceania. Located on Australia's east coast, the metropolis surrounds Sydney Harbour and extends about towards the Blue Mounta ...

Pacific Dawn cruise ship swine flu scare On 25 May, about 3 hours after going off the boat, a case of swine flu was reported on board. This caused a spike 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 but grew to well over 15,000. This cruise ship is believed to have caused almost half of the cases in SA, the WA case, and the TAS case. It also caused a flu scare in

New Caledonia ) , anthem = "" , image_map = New Caledonia on the globe (small islands magnified) (Polynesia centered).svg , map_alt = Location of New Caledonia , map_caption = Location of New Caledonia , mapsize = 290px , subdivision_type = Sovereign st ...

Containment and control

Preparations

In 2008, the Australian government prepared for a possible flu pandemic by creating the Australian Health Management Plan for Pandemic Influenza (AHMPPI). When the outbreak hit its peak in 2009, this plan went into action. The plan followed six steps: # ALERT: Before the pandemic even began, the country was following ALERT protocol. This entailed watching out for a possible pandemic. # DELAY: Activated 28 April 2009 with the goal to prevent the virus from coming into Australia for as long as possible. # CONTAIN: Activated on 22 May 2009 after several cases of H1N1 flu were reported in various states of Australia. This phase of the plan aimed to contain the spread of the flu by encouraging those who were sick to stay home, quarantine, and isolate themselves. This also gave authorities in all states the option to close schools if students were at risk. All states and territories 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. States outside Victoria decided to prevent students returning to school for a week if they had visited Victoria. # SUSTAIN: On 3 June 2009, the state of Victoria escalated from CONTAIN to SUSTAIN. The SUSTAIN phase in Victoria meant that less effort was given to tracing and testing, as there would have been insufficient resources available to do this. Antiviral drugs in this phase were only available to confirmed cases or their immediate contacts. # CONTROL # RECOVER * PROTECT: A new phase of the plan that was activated in June 2009 to identify and protect the populations that were the most at risk of fatality from the flu. 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. The

World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...

Influenza Centre in North

Melbourne Melbourne ( ; Boonwurrung/ Woiwurrung: ''Narrm'' or ''Naarm'') is the capital and most populous city of the Australian state of Victoria, and the second-most populous city in both Australia and Oceania. Its name generally refers to a metro ...

was attempting to develop a vaccine for swine flu by growing the live virus as found in California, in chicken embryos. The first one-litre batch of vaccine was announced to be ready on 29 June 2009 by the

University of Queensland , mottoeng = By means of knowledge and hard work , established = , endowment = A$224.3 million , budget = A$2.1 billion , type = Public research university , chancellor = Peter Varghese , vice_chancellor = Deborah Terry , city = B ...

, but would not be available for use until it was registered as safe with the regulatory authority. A Commonwealth Health

hotline A hotline is a point-to-point communications link in which a call is automatically directed to the preselected destination without any additional action by the user when the end instrument goes off-hook. An example would be a phone that auto ...

for Swine Influenza was set up on Australian phone number 1802007 by the Department of Health and Ageing. The Australian Government set up a health emergency web site. Daily tallies of suspected cases were given. The

Tasmanian Government The Tasmanian Government is the democratic administrative authority of the state of Tasmania, Australia. The leader of the party or coalition with the confidence of the House of Assembly, the lower house of the Parliament of Tasmania, is invit ...

set up a ''Tasmanian Action Plan for Human Influenza Pandemic''. The

Queensland Government The Queensland Government is the democratic administrative authority of the Australian state of Queensland. The Government of Queensland, a parliamentary constitutional monarchy was formed in 1859 as prescribed in its Constitution, as amended f ...

had an action plan prepared in 2008 and a business continuity plan in 2006. The

Chief Medical Officer, Dr Charles Guest, claimed that procedures and systems were very good to detect and respond to the disease outbreak.

nominated eight hospitals to handle the flu: Royal Adelaide, Flinders Medical Centre or Women's and Children's Hospital, Berri, Mount Gambier, Port Lincoln, Whyalla or Port Augusta. The

Victorian Government The Victoria State Government, also referred to as just the Victorian Government, is the state-level authority for Victoria, Australia. Like all state governments, it is formed by three independent branches: the executive, the judicial, and t ...

Department of Human Services had a nurse on call to answer questions on the topic.

CSL Limited CSL Limited is an Australian multinational specialty biotechnology company that researches, develops, manufactures, and markets products to treat and prevent serious human medical conditions. CSL's product areas include blood plasma derivative ...

started to produce a vaccine to immunize against swine flu. The Australian Government ordered ten million doses of the new vaccine. In Melbourne, seven special clinics for influenza opened on 29 May.

Government travel advice

Per recommendations by the World Health Organization, Australia decided against closing their borders during the DELAY phase of the outbreak. There were also no restrictions of travel to and from countries where outbreaks were occurring. However, starting on 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 to look for people with flu symptoms.

Health recommendations

The Australian Government created a nationwide campaign project that encouraged Australians to take up healthy practices such as adequate hand washing, avoiding people who were more susceptible to death from the flu, and getting the vaccine that was available. This was done in media, print, and radio forms so that it could reach the most people as possible. Another main focus of the Australian campaign was to dispel myths about the flu in order to provide citizens with the most factual information available at the time. A large scale immunization effort against swine flu started on Monday 28 September 2009. At the peak of the outbreak, Australia had a stockpile of 8.7 million doses of

Tamiflu Oseltamivir, sold under the brand name Tamiflu, is an antiviral medication used to treat and prevent influenza A and influenza B, viruses that cause the flu. Many medical organizations recommend it in people who have complications or are at hi ...

and Relenza to combat the virus.

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 The 1918–1920 influenza pandemic, commonly known by the misnomer Spanish flu or as the Great Influenza epidemic, was an exceptionally deadly global influenza pandemic caused by the H1N1 influenza A virus. The earliest documented case was ...

that infected 500 million people and killed tens of millions. Widespread public fear of a similar number of deaths led to "Emergency Departments and doctor surgeries being overwhelmed" with requests for antiviral drugs, jeopardising the supply for the highest risk patients.

Statistics

* During the 2009 flu season in Australia, there were 37,537 confirmed cases of pandemic (H1N1) 2009 and 191 deaths reported in Australia according to Department of Health. * 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).

References

External links

Australian Department of Health and Ageing "Health Emergency" website

Swine Flu News and Updates From Around the World
{{Influenza

Flu pandemic An influenza pandemic is an epidemic of an influenza virus that spreads across a large region (either multiple continents or worldwide) and infects a large proportion of the population. There have been six major influenza epidemics in the las ...

Disease outbreaks in Australia