title: An outbreak of influenza A (H1N1) virus in a remote Aboriginal community post-pandemic: implications for pandemic planning and health service policy.
abstract: OBJECTIVE
  To describe a 2013 outbreak of pandemic influenza A (H1N1) virus in a remote Western Australian Aboriginal community; inform outbreak prevention and control measures and discuss the community susceptibility to H1N1, three years after the A(H1N1)pdm09 pandemic.
  
  
  METHODS
  Records at the local clinic were used to classify cases as 'confirmed' (laboratory test positive for H1N1 or temperature >38°C with cough and/or sore throat) or 'probable' (self-reported fever with cough and/or sore throat). Additional data were collected from medical records and public health databases.
  
  
  RESULTS
  A total of 108 individuals met case definitions. Clinical attack rate was 23%. Children under five years of age had the highest age-specific attack rate (545 per 1,000 population). Thirty cases (28%) experienced complications with six (5.6%) requiring aero-evacuation. Only 7% of the community had received H1N1-containing vaccine during the previous year. No H1N1 cases from the community were previously reported.
  
  
  CONCLUSIONS
  This is the first description of the effects of a novel influenza strain on a remote Australian Aboriginal community. Isolation and low vaccination are likely explanations for the apparent naivety to H1N1.
  
  
  CONCLUSIONS
  There may be other remote communities at risk of H1N1. High attack and complication rates confirm that Aboriginal Australians should be prioritised in pandemic planning.
authors.affiliation: Kimberley Population Health Unit, Western Australia Country Health Service, WA; National Centre for Epidemiology and Population Health, ANU College of Medicine and Health Sciences, Australian National University, ACT.
authors.forename: Philippa J
authors.initials: PJ
authors.lastname: Chidgzey
authors.forename: Stephanie
authors.initials: S
authors.lastname: Davis
authors.forename: Peta
authors.initials: P
authors.lastname: Williams
authors.forename: Carole
authors.initials: C
authors.lastname: Reeve
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006291:Health Policy; D006303:Health Services, Indigenous; D006801:Humans; D007223:Infant; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification*; D007251:Influenza, Human / Q000453:epidemiology*; D008297:Male; D058873:Pandemics
keywords: Aboriginal; influenza; outbreak; remote; susceptibility