title: From containment to community: Trigger points from the London pandemic (H1N1) 2009 influenza incident response.
abstract: OBJECTIVE
  In the UK, during the first wave of pandemic (H1N1) 2009 influenza, a national 'containment' strategy was employed from 25 April to 2 July 2009, with case finding, treatment of cases, contact tracing and prophylaxis of close contacts. The aim of the strategy was to delay the introduction and spread of pandemic flu in the UK, provide a better understanding of the course of the novel disease, and thereby allow more time for the development of treatment and vaccination options.
  
  
  METHODS
  Descriptive study of the management of the containment phase of pandemic (H1N1) 2009 influenza.
  
  
  METHODS
  Analysis of data reported to the London Flu Response Centre (LFRC).
  
  
  RESULTS
  The average number of telephone calls and faxes per day from health professionals before 15 June 2009 was 188, but this started to rise from 363 on 12 June, to 674 on 15 June, and peaked on 22 June at 2206 calls. The number of cases confirmed [by pandemic (H1N1) 2009 influenza specific H1 and N1 polymerase chain reaction] in London rose to a peak of 200 cases per day. There were widespread school outbreaks reporting large numbers of absences with influenza-like illnesses. Activity in the LFRC intensified to a point where London was declared a 'hot spot' for pandemic (H1N1) 2009 influenza on 19 June 2009 because of sustained community transmission. The local incident response was modified to the 'outbreak management phase' of the containment phase.
  
  
  CONCLUSIONS
  The sharp rise in the number of telephone calls and the rise in school outbreaks appeared to be trigger points for community transmission. These indicators should inform decisions on modifying public health strategy in pandemic situations.
authors.affiliation: Health Protection Agency, 2nd Floor, Buckingham Palace Road, London, SW1W 9SZ, UK.
authors.forename: S
authors.initials: S
authors.lastname: Balasegaram
authors.forename: A
authors.initials: A
authors.lastname: Glasswell
authors.forename: V
authors.initials: V
authors.lastname: Cleary
authors.forename: D
authors.initials: D
authors.lastname: Turbitt
authors.forename: B
authors.initials: B
authors.lastname: McCloskey
mesh_terms: D003140:Communicable Disease Control / Q000379:methods; D016208:Databases, Factual; D004196:Disease Outbreaks / Q000517:prevention & control*; D006801:Humans; D015994:Incidence; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology* / Q000517:prevention & control*; D008131:London / Q000453:epidemiology; D058873:Pandemics; D016133:Polymerase Chain Reaction; D015980:Public Health Practice; D012574:Schools; D013689:Telephone