In April 2009, a new influenza A (H1N1) virus, novel influenza A (H1N1) virus, was determined to be the cause of illness in two children in the United States and the cause of outbreaks of respiratory illness in Mexico. This virus was transmitted in communities across North America and was identified in many areas of the world by May 2009. On June 11, 2009, the World Health Organization (WHO) declared a worldwide pandemic. Current seasonal influenza vaccines are not likely to provide protection against novel influenza A (H1N1) virus. Specific vaccines against the H1N1 virus became available in the US by October 2009. CDC's Advisory Committee on Immunization Practices (ACIP) recommended that certain groups at highest risk for infection or influenza-related complications be the initial targets for vaccination.

These recommendations included:

1. the identification of five initial target groups for vaccination efforts (pregnant women, persons who live with or provide care for infants aged <6 months, health-care and emergency medical services personnel, children and young adults aged 6 months--24 years, and persons aged 25--64 years who have medical conditions that put them at higher risk for influenza-related complications), and
2. establishment of priority for a subset of persons within the initial target groups in the event that initial vaccine availability was unable to meet demand. While data have been collected related to vaccination coverage, H1N1 prevalence and trends nationally, there has been little study of the issues of this pandemic for rural communities, where fewer resources for vaccination and care may exist. Therefore, this study proposes to analyze the rural experience with novel influenza A (H1N1) during the 2009-2010 flu season.

The aims of the study are to:

1. determine the incidence of H1N1 vaccination in rural versus urban people;
2. determine the incidence of documented H1N1 influenza illness in rural (RUCA codes 4 and higher) people;
3. describe point of service patterns for people with active H1N1illness in rural communities;
4. determine the incidence of documented mortality from H1N1 virus in rural people; and
5. analyze the impact of rural concerns in decision making at the state and local health department relative to vaccine distribution.

The study incorporates survey approaches with analysis of existing secondary data sources to characterize the rural H1N1 experience. The existing data sets used to achieve study aims 1 through 4 include a variety of CDC databases. In data sets where ZIP code or RUCA codes are available, appropriate rural and urban comparisons will be made. For aim 5, each state Office of Rural Health will be surveyed using an online survey. The results of this study will guide policy recommendations for best practices and models for prevention and treatment of rural populations in future pandemics.

Publications

• The Rural H1N1 Experience: Lessons Learned for Future Pandemics
  West Virginia Rural Health Research Center
  Date: 06/2013
  This report describes the rural H1N1 experience, including comparisons of rural versus urban H1N1 vaccination rates, and describes rural H1N1 incidence, care patterns, and mortality.