title: Pandemic (H1N1) 2009 influenza community transmission was established in one Australian state when the virus was first identified in North America.
abstract: BACKGROUND
  In mid-June 2009 the State of Victoria in Australia appeared to have the highest notification rate of pandemic (H1N1) 2009 influenza in the world. We hypothesise that this was because community transmission of pandemic influenza was already well established in Victoria at the time testing for the novel virus commenced. In contrast, this was not true for the pandemic in other parts of Australia, including Western Australia (WA).
  
  
  METHODS
  We used data from detailed case follow-up of patients with confirmed infection in Victoria and WA to demonstrate the difference in the pandemic curve in two Australian states on opposite sides of the continent. We modelled the pandemic in both states, using a susceptible-infected-removed model with Bayesian inference accounting for imported cases.
  
  
  RESULTS
  Epidemic transmission occurred earlier in Victoria and later in WA. Only 5% of the first 100 Victorian cases were not locally acquired and three of these were brothers in one family. By contrast, 53% of the first 102 cases in WA were associated with importation from Victoria. Using plausible model input data, estimation of the effective reproductive number for the Victorian epidemic required us to invoke an earlier date for commencement of transmission to explain the observed data. This was not required in modelling the epidemic in WA.
  
  
  CONCLUSIONS
  Strong circumstantial evidence, supported by modelling, suggests community transmission of pandemic influenza was well established in Victoria, but not in WA, at the time testing for the novel virus commenced in Australia. The virus is likely to have entered Victoria and already become established around the time it was first identified in the US and Mexico.
authors.affiliation: Victorian Infectious Diseases Reference Laboratory, Melbourne, Australia. heath.kelly@mh.org.au
authors.forename: Heath A
authors.initials: HA
authors.lastname: Kelly
authors.forename: Geoff N
authors.initials: GN
authors.lastname: Mercer
authors.forename: James E
authors.initials: JE
authors.lastname: Fielding
authors.forename: Gary K
authors.initials: GK
authors.lastname: Dowse
authors.forename: Kathryn
authors.initials: K
authors.lastname: Glass
authors.forename: Dale
authors.initials: D
authors.lastname: Carcione
authors.forename: Kristina A
authors.initials: KA
authors.lastname: Grant
authors.forename: Paul V
authors.initials: PV
authors.lastname: Effler
authors.forename: Rosemary A
authors.initials: RA
authors.lastname: Lester
mesh_terms: D004196:Disease Outbreaks; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification* / Q000502:physiology; D007251:Influenza, Human / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D009656:North America; D011159:Population Surveillance; D014739:Victoria / Q000453:epidemiology; D014779:Virus Replication; D014904:Western Australia / Q000453:epidemiology