Outcomes reported for Australian First Nation populations for the influenza A(H1N1) 2009 pandemic and lessons for future infectious disease emergencies: a systematic review

Aims: Enhanced data collection during infectious disease emergencies, such as the COVID-19 pandemic, must inform the clinical and public health responses appropriate for Australian First Nations populations. To inform the design of such data collection protocols, we systematically reviewed the reported outcomes for the First Nations population related to A(H1N1) 2009 pandemic influenza infection.

Methods: We searched PubMed and Google using the search terms: pandemic AND Australia AND 2009 AND (Indigenous OR Aboriginal OR “Torres Strait”). Data extracted included: location; study design; data source(s), number of study participants and the number and percentage that were First Nations; completeness of First Nations status; and reported outcomes (stratified by First Nations status). Each study was also reviewed for documentation of engagement or consultation with First Nation individuals, communities or health services regarding the study design, data collection, analysis, interpretation and reporting.

Results: Our search identified 53 citations, with 13 deemed eligible for inclusion. Most studies were case-series (n=6) and used primary data (n=8) and/or secondary data (n=10). The number of First Nations participants ranged from 13 to 3,966. The proportion of First Nations participants per study varied from 1.8% to 100%. Completeness of reporting First Nations status ranged from 62% to 100%. Reported outcomes stratified by First Nations status included notification rate (n=3), comorbidities/risk factors (n=4), severity of disease (hospital admission (n=8), intensive care unit admission (n=8), death (n=5)) and interventions (anti-viral use (n=2) and vaccination (n=4)). There were no studies that described engagement/consultation with First Nations individuals, communities or health services regarding any aspect of the study process.

Conclusion: Studies identified in this review mostly used secondary data and reported on outcomes relating to severity, and comorbidities and other risk factors. Studies specifically designed for First Nations populations are required to fully understand the contributing factors for the frequency and severity of disease in an infectious disease emergency and inform appropriate responses. First Nations communities and health services need to be adequately engaged and participate in the design, implementation, analysis and reporting of such enhanced data collection studies.

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