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How H1N1 Sparked a Lasting Partnership for Pediatric Public Health Emergencies


Georgina Peacock, MD, MPH, FAAP
August 5, 2019


Editor’s note: This is one of a series of “AAP Voices” posts timed with National Immunization Awareness Month to highlight the importance of vaccination to protect against life-threatening diseases.

It was April 2009. We didn’t know what we were facing. Everyone was on high alert. It was a scary time for individuals, communities, parents, and healthcare providers.

What was causing this concern? A new strain of the flu virus, first detected in two grade-school age children living 130 miles apart in California, had now been identified in a few different locations in the United States. It was a type of “swine flu” called H1N1. The Centers for Disease Control and Prevention (CDC) quickly activated the Emergency Operations Center to tackle the spread of the virus nationwide.

Activating an emergency operations children’s health team
Because of the disproportionate impact that such a virus could have on children, Dr. Richard Bessera pediatrician and CDC’s Acting Director at that timemade the decision to activate a Children’s Health Team. This was the first time the Emergency Operations Center had activated a dedicated team to address pediatric issues during a health emergency. The Children’s Health Team was mobilized in May 2009 and remained active for nine months.

10 years ago, @DrPeacockCDC recalls in #AAPvoices, the nation’s pediatricians & public health officials teamed up in emergency response to the unique needs of children during the #2009H1N1 “swine flu” pandemic. #Ivax2Protect #VaccinesWork

As a practicing pediatrician in the Atlanta area and a medical officer with CDC, I was asked to co-lead the team. It was made up of epidemiologists, pediatricians, health communication experts, and other public health professionals who worked tirelessly to deliver messages about the importance of vaccination (once available) and early treatment with anti-viral medications for young children and children with disabilities who had flu symptoms. The team was responsible for developing educational materials for a wide variety of audiences on how to prevent and treat flu infection in children, compiling resources for parents and providers, and building national partnerships.

One such partnership was with the American Academy of Pediatrics (AAP). This valuable collaboration provided CDC with an avenue for reaching state and local health departments, community groups, and other organizations that could use our prevention and care messages to educate families they served. In addition, it gave CDC a connection to pediatricians on the front lines who were seeing children in overflowing outpatient clinics and emergency rooms. Together, we developed an algorithm that helped clinicians determine the best course of treatment for a child with flu-like symptoms. This was the beginning of a partnership between CDC and the AAP, focused on preparedness and response for children, that has continued into the present.

New virus, new challenges
We knew that children were already at higher risk for adverse outcomes from flu infection because of their age. But a strong focus for CDC was on whether there were specific groups of children who had a higher likelihood of suffering complications after getting the flu. We identified children under age 5, and particularly under age 2, and children with “at-risk” conditions such as neurologic disorders, asthma and others as the most vulnerable group. 

Together, we developed an algorithm that helped clinicians determine the best course of treatment for a child with flu-like symptoms. This was the beginning of a partnership between CDC and the AAP, focused on preparedness and response for children, that has continued into the present.


AAP’s collaboration was also critical to helping us reach providers serving families with at-risk children throughout the United States. Together, we were able to help ensure that our flu prevention and treatment messages were timely, relevant, and reaching as broad an audience as possible. 


Our efforts during the flu pandemic highlighted the need to ensure that children are top-of-mind during a response—and to consider that those less than 2 years old and children with special healthcare needs are at heightened risk. The pandemic also underscored the need for a team dedicated to pediatric issues during an emergency response. As a result, the Children’s Preparedness Unit (CPU) was formed in 2012 to conduct research and promote efforts to ensure that children’s issues are accounted for in future responses.

The CPU has remained an important part of all Emergency Operations Center activations. Further, because the unit is housed within the CDC’s Division of Human Development and Disability, of which I have been Division Director since 2014, I have been able to ensure that at-risk populations, such as children with disabilities, are included in research and program activities.

Beyond H1N1: child-informed public health emergency response
As we mark the 10th anniversary of the H1N1 pandemic, AAP continues its valuable collaboration with CPU through the academy’s Disaster Preparedness Advisory Council. We have continued to collaborate on preparing for and responding to potential anthrax, bioterror incidents, Ebola and Zika virus outbreaks, lead contamination in water, hurricanes, and many other public health emergencies.

My experience with the flu response provided me with the opportunity to broaden my pediatric knowledge and apply skills to new areas of public health, which I have continued to implement during my oversight of the CPU. With the collaboration of expert partners, such as AAP, I am confident that CDC will continue to ensure that the unique needs of children are accounted for during future emergency responses. 


* The views expressed in this article are those of the author, and not necessarily those of the American Academy of Pediatrics.

About the Author


Georgina Peacock, MD, MPH, FAAP, is Director of the Division of Human Development and Disability at the Center for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities.