Disaster Medicine and Public Health Preparedness

Research Article

Spring 2009 H1N1 Influenza Outbreak in King County, Washington

Tao Sheng Kwan-Gett c1, Atar Baer and Jeffrey S. Duchin


Background: In April 2009, King County, Washington, experienced a sustained outbreak of 2009 H1N1 influenza A. This report describes the epidemiology of that outbreak in King County, home to a diverse population of 1.9 million people.

Methods: The 2 primary sources of data are case investigations of reported laboratory-confirmed 2009 H1N1 influenza A and a population-based syndromic surveillance system that captures data from emergency departments (EDs). A syndromic category for influenza-like illness was defined based on chief complaint and diagnosis.

Results: ED visits for influenza-like illness peaked quickly in the first week of the outbreak and remained high for approximately 6 weeks, with school-age children accounting for the greater number of ED visits, followed by young adults. Children ages 0 to 4 years had the highest rate of hospitalization. Among reported cases, blacks, Asians, and Hispanics were more likely to be hospitalized. Predisposing factors associated with admission were immune compromise, chronic lung disease, chronic heart disease, pregnancy, diabetes, and asthma. Of people receiving antiviral treatment, 34% started their medication more than 2 calendar days after the onset of illness. Mean days between illness onset and antiviral treatment were greater for blacks, Hispanics, and foreign language speakers.

Conclusions: The spring 2009 influenza A H1N1 outbreak disproportionately affected children, young adults, and racial and ethnic minorities. Opportunities exist to improve the timeliness of antiviral treatment. Potential barriers to care for racial and ethnic minorities should be proactively addressed to ensure prompt evaluation and treatment. (Disaster Med Public Health Preparedness. 2009;3(Suppl 2):S109–S116)

(Received October 10 2009)

(Accepted October 19 2009)

Key Words

  • 2009 H1N1;
  • public health;
  • King County;
  • epidemiology


c1 Address correspondence and reprint requests to Tao Sheng Kwan-Gett, MD, MPH, Public Health–Seattle & King County, 401 Fifth Ave, CNK-0900, Seattle, WA 98104(e-mail: tao.kwan-gett@kingcounty.gov).

All of the authors are with Public Health–Seattle & King County and hold faculty appointments with the University of Washington.

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