Elsevier

Journal of Infection

Volume 59, Issue 2, August 2009, Pages 122-127
Journal of Infection

Widespread public misconception in the early phase of the H1N1 influenza epidemic

https://doi.org/10.1016/j.jinf.2009.06.004Get rights and content

Summary

Objectives

To investigate the community responses and preparedness for a possible epidemic of H1N1 influenza in Hong Kong shortly after an imported case was confirmed.

Methods

A random sample of 550 Chinese adults in the Hong Kong general population was interviewed during May 7–9, 2009.

Results

The public did not perceive a high likelihood of having a local H1N1 outbreak, nor did they regard H1N1 as a threatening disease. Frequent hand-washing (73.6%) and use of face-masks in case of flu symptoms (47.9%) were prevalent. The public approved of governmental policies including the quarantining of hotel guests, was not panicking and perceived a high self-efficacy of self-protection. However, misconceptions were prevalent and the public avoided visiting crowded places (9.3%), which many people wrongly believed was a government recommendation.

Conclusion

Although the public response demonstrated vigilance and preparedness there were signs of complacency. Clear communication, updated scientific information and transparency on government decision making are warranted. Data of the study provide a baseline for an ongoing surveillance program to help shape policy and provide information to the international community.

Introduction

The new H1N1 virus raises world-wide concern about the possibility of an influenza pandemic. As of May 23, 2009, 12,022 confirmed H1N1 cases were detected in 43 countries and 86 deaths had been reported.1 The WHO raised the influenza pandemic alert level to ‘Phase 5’ on April 29, 2009. A preliminary study showed that the fatality and infectivity of the new H1N1 virus is more infectious and fatal, as compared to seasonal influenza.2 In Hong Kong, the first confirmed case, a traveler from Mexico, was reported on May 1, 2009, leading to the closure and isolation of the Metropark Hotel and to the quarantining of 350 guests and staff from May l–May 8, 2009.3 The Hong Kong alert level was raised to the highest ‘Emergency Response Level’. Six more confirmed imported cases were reported in Hong Kong from May 13 to May 24, 2009.

Surveillance of community responses at the beginning of an emerging epidemic is particularly useful to inform the government and the public of the level of preparedness. The SARS epidemic affected 26 countries and claimed 774 lives.4 Hong Kong was one of the worst affected countries; 299 lives were lost5, 6; panic was wide-spread and the economic loss created severe hardship in the community. The lessons learned from the SARS experience in Hong Kong7 and other countries demonstrated the importance of understanding community responses.8, 9

In Hong Kong, SARS-related perceptions and behaviors changed dramatically during the early phase of the outbreak.8, 10, 11, 12 The prevalence of preventive behaviors increased sharply and remained high throughout the epidemic,8, 13 and such measures contributed its control.14 Panic and worry were wide-spread during the epidemic and remained high in the post-SARS period.15, 16 The general public avoided going out, avoided traveling to other countries and avoided social activities to a large extent.8 There were misperceptions about the nature of the epidemic (e.g., mode of transmission).8 However, a substantial proportion of the general public doubted the government's ability to control the SARS epidemic.15 Travelers were less likely to adopt preventive measures when they were out of Hong Kong17 and those visiting mainland China delay seeking medical consultation for flu symptoms and waited until their return to Hong Kong.18 Similar studies were conducted to investigate community preparedness toward human-to-human H5N1 transmissions.19, 20, 21, 22

The objectives of this study was to investigate the community responses and preparedness for a possible epidemic of H1N1 influenza in Hong Kong, amongst the general population between Day 7 and Day 9 following identification of the first confirmed H1N1 case in Hong Kong. The results serve as baseline data of a series of ongoing surveillance studies on the H1N1 epidemic. No similar studies have been reported.

Section snippets

Sampling and data collection

The study population comprised of all Chinese Hong Kong adults who were 18–60 years old. Anonymous telephone interviews were conducted by well-trained interviewers, using a structured questionnaire. Random telephone numbers were selected from an up-to-date telephone directory and over 95% of the households in Hong Kong have a fix-line telephone at home.23 The interviews were conducted from 6:30 to 10 p.m. to avoid over-representing the non-work population. One member was selected by the

Socio-demographic characteristics

The distributions are presented in Table 1. The age and gender compositions are more or less comparable to those of the recent census data (see footnote of Table 1).

Knowledge, misconceptions and unconfirmed beliefs

Of all respondents, 43.1% wrongly believed that the new H1N1 influenza is one type of avian flu. The prevalence of unconfirmed beliefs related to modes of transmission were high: ‘via eating well-cooked pork’ (6.9%), ‘via long-distance airborne aerosols (from one building to another)’ (39.0%), ‘via insect bites’ (25.3%) or ‘via

Discussion

As the H1N1 is a new virus, this study, therefore, filled up some important information gaps. The public in Hong Kong misconceived that H1N1 is airborne, waterborne and could be transmitted via various vectors such as insects. Misconceptions about modes of transmission about avian flu were associated with emotional distress in the general population.19 The public mixed up different types of emerging infectious diseases (such as avian flu and the new H1N1 flu). The confusion might have misled

Conflict of interest

The authors declare no conflict of interest.

Acknowledgements

The authors would like to thank all participants of this study. Thanks are extended to Mr. Nelson Yeung for his help in the early drafts of the manuscript, Mr. Tony Yung and Mr. Johnson Lau for their assistance in the preparation of the questionnaire, Ms. M. W. Chan, Mr. Mason Lau, and Ms. Cheri Tong for coordination of the telephone survey and all colleagues who served as telephone interviewers of this study. The study was supported by the Li Ka Shing Institute of Health Sciences.

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