title: Major incidents in rural areas: managing a pandemic A/H1N1/2009 cluster.
abstract: BACKGROUND
  Pandemic Influenza (A/H1N1/2009) caused worldwide concern because of its potential to spread rapidly in human populations. In Scotland, Government policy had been to seek to contain the spread of the virus for as long as possible in order to allow time for service preparations, and for vaccine development and supply.
  
  
  OBJECTIVE
  The first major Scottish outbreak of pandemic A/H1N1/2009 was in the rural area of Cowal and Bute. After two initial cases were identified, contact tracing found a cluster of cases associated with a football supporters' bus. Within 3 weeks, 130 cases had been identified in the area. Rapid provision of treatment doses of anti-viral medication to cases and prophylactic treatment of asymptomatic close contacts, advice on self-isolation and, where required, interruption of transmission by temporary school closure, were successful in containing the outbreak.
  
  
  CONCLUSIONS
  Pre-existing Major Incident and Pandemic Flu plans were used and adapted to the particular circumstances of the outbreak and the area. Supporting operational decision-making as close to the cases as possible allowed for speed and flexibility of response. Contact tracing and tracking of cases and results was performed by specialist public health staff who were geographically removed from the cases. This was possible because of effective use of existing telephone conferencing facilities, clarity of roles, and frequent communication among staff working on all areas of the response. Basing the work on established plans, staff experience of rural areas and rural service provision was successful.
authors.affiliation: NHS Highland, Inverness, Scotland, United Kingdom. cameron.stark@nhs.net
authors.forename: Cameron
authors.initials: C
authors.lastname: Stark
authors.forename: Elaine
authors.initials: E
authors.lastname: Garman
authors.forename: Jim
authors.initials: J
authors.lastname: McMenamin
authors.forename: Duncan
authors.initials: D
authors.lastname: McCormick
authors.forename: Ken
authors.initials: K
authors.lastname: Oates
mesh_terms: D000293:Adolescent; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D003659:Decision Making, Organizational; D004189:Disaster Planning / Q000458:organization & administration*; D004196:Disease Outbreaks / Q000517:prevention & control* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control; D008297:Male; D015397:Program Evaluation; D036301:Qualitative Research; D019035:Rural Health Services / Q000458:organization & administration*; D012424:Rural Population / Q000706:statistics & numerical data*; D012606:Scotland / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000998:Antiviral Agents