title: The 2009 influenza pandemic: a review of the strengths and weaknesses of the health sector response in New Zealand.
abstract: BACKGROUND
  To inform future pandemic planning and disaster response, we aimed to review the literature on the health sector response to the influenza A (H1N1) 2009 pandemic in New Zealand in 2009.
  
  
  METHODS
  We searched PubMed and Google Scholar along with the websites of government agencies for the period 1 April 2009 to 20 May 2012.
  
  
  RESULTS
  In 2009, 18% of the New Zealand population had evidence of infection from the pandemic strain, 1122 people were hospitalised (with pandemic influenza as the primary diagnosis), 102 of those hospitalised were treated in intensive care units (ICU), and there were an estimated 49 pandemic-attributed deaths. At the severe end of the disease spectrum (ICU admissions and mortality), the health burden was significantly worse for Maori and Pacific peoples. The available evidence (including various estimates of low case-fatality risk relative to other high income countries), is consistent with the overall response in the public health, primary care and hospital sectors being fairly successful. Nevertheless, a number of likely weaknesses were identified, including a relative lack of: (i) a detailed review of the epidemiology and health sector response; (ii) sophisticated analytic studies to identify risk factors (e.g., using case-control studies); (iii) studies on pandemic vaccine uptake and public acceptability; and (iv) evaluation of the health protection messages that were used in campaigns and in media releases from health authorities.
  
  
  CONCLUSIONS
  There appear to have been both strengths and weakness in the New Zealand health sector's response to the 2009 influenza pandemic. Nevertheless, it is probably still worthwhile to address some of the omissions to inform future pandemic and natural disaster planning and preparations.
authors.affiliation: Department of Public Health, University of Otago Wellington, PO Box 7343 Wellington South, New Zealand. nick.wilson@otago.ac.nz
authors.forename: Nick
authors.initials: N
authors.lastname: Wilson
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Summers
authors.forename: Michael G
authors.initials: MG
authors.lastname: Baker
mesh_terms: D003140:Communicable Disease Control; D017281:Cost of Illness; D019981:Health Care Sector; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053118:Influenza A Virus, H1N1 Subtype; D007251:Influenza, Human / Q000453:epidemiology / Q000517:prevention & control* / Q000628:therapy; D009520:New Zealand / Q000453:epidemiology; D058873:Pandemics; D012307:Risk Factors