| Abstract|| |
Objective: To assess pandemic Flu A H1N1 in Iran and lessons learnt the study was performed in order to find out it's health impacts in the community. Materials and Methods: The overview is based on literature identified through a search in PubMed and on official reports from WHO and the disease control center of I.R.Iran. Findings: As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths. Conclusion: Good management performed by Iranian Ministry of Health and W.H.O collaboration to reduce the mortality and morbidity related to the disease. For the next pandemic situation different guidelines for different health policy in both national and international level may be required.
Keywords: Community, health, Influeanza A H1N1, lessons learnt, pandemic flu
|How to cite this article:|
Tavana AM. Pandemic influenza A H1N1 in Iran and lessons learnt. Ann Trop Med Public Health 2012;5:295-7
| Introduction|| |
At the beginning of 21 the millennium the pandemic influenza A (H1N1) has been occurred. Between mid March and mid April 2009 a pandemic influenza A virus emerged in Mexico.  In June 2009, the World Health Organization declared the new strain of swine-origin H1N1 as a pandemic. The Pandemic influenza A H1N1 occurred in April 2009 in a Mexican city and quickly spread across the globe resulting in million been infected and thousands killed. The disease very quickly spread in different part of the world. It has to be said the disease has been infected million of population in different continents and killed at least 18449 persons [Table 1].  The disease was appeared more severe than in many countries perhaps as result of genetic susceptibility, low immunity of individual and epidemiological and heath care availability for preventing the disease. , the diseases were papered in Iran too as the same as other countries. As of December 30, 2009, a total of 3672 confirmed cases of human infection with a novel Influenza A (2009 H1N1) virus had been reported in Iran with 140 deaths. The WHO in 2010 (On August 10,) announced that the pandemic was over".  Saying worldwide influenza activity had returned to typical seasonal patterns.  According to World Health Organization (WHO) more than 214 countries and overseas territories or communities have reported laboratory confirmed cases of pandemic influenza H1N1 2009, including over 18,449 deaths. The Aim of this study was to determine the situation of the disease during pandemic period in 2009 in Iran and lessons learnt.
|Table 1: World health organization Regions and number of death related to pandemic influenza in 2009|
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| Material and Methods|| |
The overview is based on literature identified through a search in PubMed (using PubMed's own search strategy) and on official reports from WHO and the disease control center of I.R. Iran.
| Results|| |
The new influenza A (H1N1) has infected thousand and thousands of Iranian population. Only 140 patients with different risk factors were died as result of infection.
| Discussion|| |
Since the declaration of a swine influenza pandemic by the World Health Organization (WHO), the Islamic Republic of Iran has launched a surveillance system to test all suspected cases, both in community and hospital settings. And many researches have been done by Iranian researcher which is showed the situation of the disease during pandemic. Tabarsi et al. 2011 in a retrospective cross-sectional study in Iranian patients was conducted that among patients with mortality and admissions to ICU with confirmed HINI. Demographic, clinical, laboratory, radiological findings, and epidemiologic data were abstracted from medical records, using a standardized data sheet found that delayed antiviral treatment was more common among patients who died and the elderly.  In a study by Gholami et al. 2011, they concluded that mass media as one of the main sources of information providing the required information at the time of H1N1 pandemic for physicians.  Dashti-Khavidaki et al. has reported the first case of Pandemic Influenza AH1N1 referred to Imam Khomeini Hospital in Iran in intensive care unit they mentioned Oseltamivir was administered within three hours of the patient's admission. They noted that the median length of stay for hospitalized patients was 3 days.  The diseases have seen in different age group with different medical status.  Moattari et al. has been analyzed antigenic variation of human infection of the viruses by using multiplex RT-PCR and phylogenetic analysis during pandemic and they were found that The H1N1 subtypes showed a notable resemblance to A/New Caledonia/20/99 vaccine strain and therefore were predicted to be capable of conferring sufficient immunity against H1N1 subtypes.  Moghadami et al. mentioned two wave of pandemic Influenza in Iran. They are investigated that high seroprevalence of antibody against 2009 H1N1 in the sera (2553) of people in the south of Iran, describes either a high level of pre-existing immunity against H1N1 in Iranian population or a high rate of asymptomatic infection.  Jandaghi et al. 2010 reported that no genetic indication of resistance to neuraminidase inhibitors was found in their studies. Although genomic analysis of hemagglutinin and neuraminidase genes of Iranian strains in comparison to the corresponding vaccine strain revealed some mutations, none of these were identified in functionally important receptor-binding sites.  Haghdoost and co-worker 2010 has reported that of the cases, 75% were 5-40 years-old and the prevalence of death had no significance correlation with sex and age (P = 0.720 and 0.194, respectively).  In a research during pandemic a research for pandemic modeling suggested to government it is the best to provide a golden opportunity to vaccinate a considerable proportion of the population.  The first report of Pandemic influenza may be had different sources all most all cases had aboard sources (i.e. in Isfahan in central of Iran the first case was reported from patient who had history to travel as pilgrim came from Saudi Arabia (Mecca) based on Anahita et al. research.  Mogadami et al. has mentioned that high seroprevalence of antibody against 2009 H1N1 in the sera of either a high level of pre-existing immunity against H1N1 or a high rate of asymptomatic infection in Iranian population.  The study of knowledge, attitude and practices of health care workers to influenza infection were good in Iran during pandemic Influenza A H1N1 except in nurses that showed 'the mean knowledge score of nurses was significantly lower than that of the other groups of health workers.  It should be noted the most dying cases were happened in Acute respiratory death syndrome (ARDS) 81 cases (77%) and viral pneumonia with 29 cases (27%) respectively based on Gouya et al. study. 
| Conclusion|| |
The pandemic influenza A H1N1 spread in 214 countries in the world based on W.H.O report, but the rate of mortality and morbidity was related to many factors including, preparation against the diseases, action plans policy, practice, public awareness, health care system and preparation of enough medicine and vaccine for patients. Very fortunately Iranian Government has performed the best including mobilize the heath care system and preparation of medicine particularity Ostamivar and good prescriptions of medicine in order to prevent viral resistance, regular health education to the public by encouraging the governmental and non governmental organization including Iranian Radio and TV board costing try to reduce the risk of infection. Publish much scientific and usual paper in mass media to alert physicians as well as public. , Therefore the pandemic situation was over with at least 3672 confirmed patients and 140 deaths. We were prepared before pandemic situation and good inter-sector collaborations in National level and W.H.O. coordination reduced the mortality and morbidity of infection. I believe that for the next pandemic consideration of personnel hygiene in particular regular hand washing, take a fluid in daily diet, reduce the overcrowding as much as possible in the schools, camps, etc, good laboratory diagnosis and quick case finding and early treatment with appropriate medicine could be focused in national level. In addition, different guidelines for different health policy in international level may be required.
It should be added that, good blood supply before pandemic situation, discipline on health and hygiene in schools, day care center, may be required. Preparations in hospitals in particular in infectious diseases ward and clinics are required before pandemic start too. Non necessary travel must be omitted by W.H.O regulation in order to prevent the risk of infection in international level. In addition the travelers must be taken good attention to take care during travel and with having good knowledge the disease and consulting with General Practitioner before and after their travel.
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Ali Mehrabi Tavana
Health Management Research Center, Baqiyatallah (a.s) University of Medical Sciences, Tehran
Source of Support: None, Conflict of Interest: None