Open Access Research article

The influenza A (H1N1) pandemic in Reunion Island: knowledge, perceived risk and precautionary behaviour

François Taglioni12*, Michel Cartoux1, Koussay Dellagi23, Cécile Dalban4, Adrian Fianu4, Fabrice Carrat567 and François Favier4

Author Affiliations

1 University of Reunion Island, BP 7151, Saint-Denis cedex 9, Reunion Island, 97715, France

2 Centre de recherche et de Veille sur les Maladies Emergentes dans l’Océan Indien (CRVOI). Plateforme de Recherche CYROI, 2 Rue maxime Rivière, Sainte-Clotilde Cedex, Reunion Island, 97491, France

3 IRD, Représentation de la Réunion, CS 41095, Sainte Clotilde Cedex, Reunion Island, 97495, France

4 CIC-EC, INSERM, BP 350, Saint Pierre Cedex, Reunion Island, 97448, France

5 INSERM UMR-S 707, Faculté de médecine Saint-Antoine, 27, rue Chaligny, PARIS cedex 12, France

6 UMR-S 707, UPMC Université Paris 06, Paris, France

7 U 707, INSERM, Paris, France

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BMC Infectious Diseases 2013, 13:34  doi:10.1186/1471-2334-13-34

Published: 24 January 2013



The effectiveness of preventive measures depends on prevailing attitudes and mindsets within a population. Perceived risk is central to a shift in mindset and behaviour. The present study aims to investigate the perceived severity, vulnerability and precautionary behaviour adopted in response to the influenza A (H1N1) epidemic that broke out in 2009 on Reunion Island (Indian Ocean). As no H1N1 vaccination was available at the time, non-medical interventions appeared of crucial importance to the control of the epidemic.


A cross sectional survey was conducted in Reunion Island between November 2009 and April 2010 within 2 months of the passage of the influenza A (H1N1) epidemic wave. Individual contacts representing 725 households (one contact per household) were interviewed by telephone using validated questionnaires on perceived risks. Mean scores were calculated for perceived severity, vulnerability, efficacy of preventive measures and precautionary behaviour. Univariate analysis was applied to identify preventive measures and attitudes and multivariate analysis was used to study the determinants of precautionary behaviour.


More than 95% of contacted persons accepted to participate to the survey. Eighty seven percent of respondents believed that prevention was possible. On average, three out of six preventive measures were deemed effective. Spontaneously, 57% of the respondents reported that they took one or more preventive measures. This percentage increased to 87% after the interviewer detailed possible precautions one by one. The main precautions taken were frequent hand washing (59%) and avoidance of crowded places (34%). In multivariate logistic regression analysis the following factors were significantly associated with taking one or more preventive measures: young age, previous vaccination against seasonal influenza, having had seasonal influenza in the last five years, effectiveness of the preventive measures taken and low standards of education.


Inhabitants of Reunion Island have expressed a preventive approach adapted to the realities of the H1N1 pandemic, a feature that likely reflects some preparedness gained after the large and severe chikungunya epidemic that hit the island in 2006. The degree of severity was well assessed despite the initial alarmist messages disseminated by national and international media. Precautions that were undertaken matched the degree of severity of the epidemic and the recommendations issued by health authorities. Further qualitative studies are needed to help adapting public messages to the social and cultural realities of diverse communities and to prevent misconceptions.

Influenza A (H1N1) pandemic; Knowledge; Perceived risk; Perceived vulnerability; Precautionary behaviour