AUGUSTA – A year ago, we faced a newly identified influenza virus with unique genetic characteristics. The 2009 pandemic strain of H1N1 influenza was first detected in Texas, California and Mexico. Preliminary reports from Mexico indicated dozens of young people had died or were hospitalized with symptoms of the virus.

Mainers quickly dusted off pandemic flu plans, which were geared for a severe pandemic, and readied for this uncertain threat. Within days, several cases were identified in Maine and one school was closed.

Over the year, thousands of Mainers became ill with symptoms of H1N1; 40 summer residential camps experienced outbreaks; about 200 schools experienced outbreaks with high absentee rates; almost 250 Mainers were hospitalized with the infection, the majority of them being children and young adults; and tragically, 21 adults died from the infection.

Although the impact of this primarily pediatric and young adult pandemic was severe for a number of people, Maine was extremely fortunate to have experienced one of the mildest disease surges and to lead the nation in its vaccine efforts in all age categories.

These successes are largely due to the heroic efforts of thousands of Maine people, many of them volunteers, who worked very hard to make sure people knew how to protect themselves from getting infected and once the vaccine arrived, how to get vaccinated.

As with any major incident, even if the response is successful, there are lessons to be learned. Here are a few important findings that emerged through statewide debriefings and surveys:

1. The most predictable thing about influenza is its unpredictability. The genetic material of influenza viruses undergoes changes at one of the highest rates known. Therefore, predicting the severity and duration of an influenza outbreak is like predicting earthquakes; the capacity for doing either does not currently exist. Moving forward, we need to make sure that all our pandemic plans are more adjustable for a severe or mild pandemic.

2. The most predictable thing about the influenza vaccine supply is also its unpredictability. Last summer and fall, national predictions were that the vaccine supply would be sufficient by the end of October to cover priority populations.

However, unexpected manufacturing delays resulted in severe vaccine shortages, and demand could not be met until the end of the year. It took nine months from the time the pandemic was detected to have sufficient vaccine. Imagine how much more devastating the outbreaks would have been if the H1N1 virus was much more lethal than it was.

Influenza vaccine shortages are nothing new. We have experienced them three of the past six flu seasons. Moving forward, our nation must increase investments in new technologies to produce critical vaccines more quickly.

In the meantime, Maine CDC will work with our partners to develop an annual plan to address an influenza vaccine shortage should one occur that year. Although we furnish only a small portion of the overall flu vaccine supply in Maine, with most of it flowing through private channels, during a shortage our supply can help assure that those who need the vaccine the most can obtain it, regardless of ability to pay.

3. It takes a village to vaccinate. I was privileged to witness Maine communities coming together to make sure their children were vaccinated.

School nurses and staff, local health care providers and first responders, emergency management, as well as parents and others worked under stressful and uncertain conditions to offer vaccine in schools and other settings.

My deepest gratitude goes to them. Their efforts likely saved the lives of many. Moving forward, we hope to build upon these successes by supporting the creation of a medical reserve corps in every district in Maine. If volunteer health care providers prepare and drill together, they will be even more prepared for the next public health emergency.

4. Be prepared. Those who became ill and unexpectedly needed to stay home in isolation were grateful they had supplies on hand. Organizations that worked together on the vaccine initiative benefited from the relationships they had developed from their prior preparedness efforts.

We hope all Mainers and organizations look back on lessons learned from H1N1 and continue to move forward to plan and prepare.

Although we never know when the next public health emergency may occur, we do know that the response of Maine communities to H1N1 is one we can all be very proud of, and the lessons learned can help us improve our response to the next emergency.


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