Control of influenza in healthcare settings: Early lessons from the 2009 pandemic

Purpose of review: The emergence of 2009 pandemic H1N1 influenza A (pH1N1) has provided a unique challenge to influenza control in healthcare settings. We provide an overview of the early lessons from the 2009 pandemic. Recent findings: The modes of influenza transmission and their contributions to the development of infections remain unclear. Recent studies in the guinea pig model have demonstrated airborne transmission, but data from human studies and outbreaks are inconclusive. Data on physical interventions to prevent transmission support the use of hand hygiene, gowns, gloves, face shields and respiratory protection. The effectiveness of surgical masks compared to N95 respirators has been investigated, and there is evidence from one trial that surgical masks are noninferior to N95 respirators in preventing infection. Experiences with mandatory vaccination suggest that this is a highly successful approach to increase healthcare personnel vaccination rates. Lessons from pH1N1 have multiple implications for future pandemic preparedness planning. SUMMARY: Further research is needed on appropriate respiratory protection for influenza. Mandatory vaccination programs should be considered in all healthcare settings. Pandemic preparedness plans should be revised, focusing on flexibility, communication, stockpiling of essential supplies, and staffing support for infection control.