Open Access Highly Accessed Research article

The community impact of the 2009 influenza pandemic in the WHO European Region: a comparison with historical seasonal data from 28 countries

Liana Martirosyan1*, W John Paget1, Pernille Jorgensen2, Caroline S Brown2, Tamara J Meerhoff3, Dmitriy Pereyaslov2, Joshua A Mott2 and the EuroFlu group

Author Affiliations

1 Netherlands Institute for Health Services Research (NIVEL), Otterstraat 118-124, P.O. Box 1568, 3500 BN Utrecht, the Netherlands

2 Influenza & other Respiratory Pathogens, Division of Health Security, Infectious Diseases and the Environment, WHO Regional Office for Europe, Scherfigsvej 8, 2100, Copenhagen, Denmark

3 Department of primary and community care, the Netherlands Radboud University Medical Center Nijmegen, Geert Grooteplein-Zuid 10 6525 GA, Nijmegen, the Netherlands

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BMC Infectious Diseases 2012, 12:36  doi:10.1186/1471-2334-12-36

Published: 10 February 2012



The world has recently experienced the first influenza pandemic of the 21st century that lasted 14 months from June 2009 to August 2010. This study aimed to compare the timing, geographic spread and community impact during the winter wave of influenza pandemic A (H1N1) 2009 to historical influenza seasons in countries of the WHO European region.


We assessed the timing of pandemic by comparing the median peak of influenza activity in countries of the region during the last seven influenza seasons. The peaks of influenza activity were selected by two independent researchers using predefined rules. The geographic spread was assessed by correlating the peak week of influenza activity in included countries against the longitude and latitude of the central point in each country. To assess the community impact of pandemic influenza, we constructed linear regression models to compare the total and age-specific influenza-like-illness (ILI) or acute respiratory infection (ARI) rates reported by the countries in the pandemic season to those observed in the previous six influenza seasons.


We found that the influenza activity reached its peak during the pandemic, on average, 10.5 weeks (95% CI 6.4-14.2) earlier than during the previous 6 seasons in the Region, and there was a west to east spread of pandemic A(H1N1) influenza virus in the western part of the Region. A regression analysis showed that the total ILI or ARI rates were not higher than historical rates in 19 of the 28 countries. However, in countries with age-specific data, there were significantly higher consultation rates in the 0-4 and/or 5-14 age groups in 11 of the 20 countries.


Using routine influenza surveillance data, we found that pandemic influenza had several differential features compared to historical seasons in the region. It arrived earlier, caused significantly higher number of outpatient consultations in children in most countries and followed west to east spread that was previously observed during some influenza seasons with dominant A (H3N2) ifluenza viruses. The results of this study help to understand the epidemiology of 2009 influenza pandemic and can be used for pandemic preparedness planning.

Influenza; Human; Pandemics; Epidemiology; Community health services; Ambulatory care; Sentinel surveillance