An outbreak of influenza A (H1N1) virus in a remote Aboriginal community post‐pandemic: implications for pandemic planning and health service policy

Abstract

The pandemic had a less severe impact on the general population than originally anticipated; 2 however, Aboriginal people were more likely to require admission to hospital and more likely to die from influenza than non-Aboriginal Australians. 1,3,4 In addition, the 2009 pandemic confirmed that Aboriginal people experience the complications of the influenza virus, whether pandemic or seasonal strains, more often than the non-Aboriginal Australian population. 1,4,5 Reasons for these disparities are multifactorial, including high prevalence of chronic diseases, high pregnancy rates and socioeconomic factors such as reduced access to health care and barriers to health-seeking behaviour. 1,5,6 Since causing the pandemic in 2009, the influenza A(H1N1) virus (abbreviated as A(H1N1)pdm09) 2,7 has been circulating in the Australian population and is now considered a seasonal strain. The strain has been incorporated into the trivalent seasonal influenza vaccine since 2010. 8 The general population is no longer considered to be A(H1N1)pdm09 naïve due to previous exposure or vaccination. 9 Thus, the strain is not expected to cause greater morbidity or mortality than other seasonal strains.As currently available seasonal influenza vaccines confer protection for about a year, annual vaccination is required for ongoing protection. 10Globally, Aboriginal populations are at higher risk of increased exposure, clinical infection, complications and consequences of influenza. Socioeconomic and cultural circumstances often determine that large families live together. 11,12 Overcrowding leads to increased transmission of the influenza virus, 13,14 resulting in high influenza attack rates in Indigenous populations internationally. 11,15,16 Aboriginal people in Australia also are known to be an at-risk group for influenza; 2,17 however, less is known about the natural history of the influenza virus within remote Aboriginal communities.In March 2013, a paediatrician reported a suspected outbreak of influenza-like illness (ILI) in a remote Aboriginal community in north-west Western Australia to the regional population health unit. An investigation was conducted by the regional population health unit with the following objectives: to describe and control the outbreak; to determine why the community had remained vulnerable to A(H1N1)pdm09 more than three years after Aust NZ J Public Health. 2015; 39:15-20; doi: 10.1111/1753 Abstract Objective: To describe a 2013 outbreak of pandemic influenza A (H1N1) virus in a remote Western Australian Aboriginal community; inform outbreak prevention and control measures and discuss the community susceptibility to H1N1, three years after the A(H1N1)pdm09 pandemic. An outbreak of influenza A (H1N1) virus in a remote Methods:Records at the local clinic were used to classify cases as 'confirmed' (laboratory test positive for H1N1 or temperature >38°C with cough and/or sore throat) or 'probable' (selfreported fever with cough and/or sore throat). Additional data were collected from medical records and public ...

Investigation of an outbreak of acute respiratory disease in an indigenous village in Brazil: Contribution of Influenza A(H1N1)pdm09 and human respiratory syncytial viruses

“…The high attack rate (ARI: 42.9%; ILI+SARI: 35.9%) seen in the Guarani village resulted from the rapid and efficient spread of the disease, as reported in other small indigenous communities in French Polynesia [6] and Canada [7]. The ILI+SARI attack rate in the Guarani village was greater than the majority of that reported for other indigenous groups (13% to 20% in French Polynesia; 28% in Wallis and 38% in Futuna; 18% in New Caledonia [6]; 23% in an Aboriginal village in Australia [2]; 28.7% in a First Nations Community in Manitoba, Canada [7]) in the pandemic and post pandemic influenza 2009. It was also higher than the attack rate reported in Aboriginal and Torres Strait Islander in Australia (22.9%), estimated by immunity seroconversion after pandemic period [21].…”

“…As far as we know, there is only one publication describing the investigation of an acute respiratory outbreak among indigenous peoples [11]. This study was carried out in 2010, in the North Region, and showed high attack rates of influenza-like syndrome when compared to other native people worldwide [2, 6, 7]. Attack rates were greater in children under five years of age, who also presented a higher degree of severity, and higher rates of hospitalization and mortality.…”

Covid-19 pandemic and the motivations for demanding health service in indigenous villages

“…The sanitation conditions of villages that maintain contact with the surrounding society are a challenge for the prevention of the coronavirus infection (covid-19). The control of respiratory outbreaks among native people requires good sanitation and access to treated water (9)(10) . The reality presented in the ethnographic study conducted with the Terena ethnicity of the TI Buriti showed the lack of piped water and bathrooms in the houses (use of rustic septic tanks), and reflects the reality of many indigenous lands in Brazil (4,8) .…”

“…Health education actions need to be translated considering the culture of each indigenous people and, in some cases, the local language. Researches on outbreaks in indigenous villages during the H1N1 pandemic in different locations around the world in 2009 reinforce the importance of health education provided massively by health professionals in the villages for disease control (9)(10) . Studies on outbreaks and prevalence of respiratory syndromes in Brazil reiterate this aspect (4)(5)(6) .…”

“…The treatment of respiratory outbreaks in indigenous people must consider factors that strengthen the rate of attack of the disease, such as nutrition (9)(10) . Many indigenous people suffer nutritional deficiencies because they live in remote areas, a fact that also makes them susceptible to developing acute respiratory syndromes (5,(9)(10) . With the isolation necessary to combat covid-19, many indigenous population groups may be left without access to the food needed for a minimal nutritional diet.…”