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q&a

People line up to get their H1N1 vaccination on Friday, October 30, 2009 in St. Eustache Que. Waiting times of seven hours are common as vaccination centres are overwhelmed by the demand.Ryan Remiorz

Its worldwide spread could not be stopped. It infected and killed thousands, pushing countries to rush to develop a vaccine that would limit its reach. The World Health Organization raised its pandemic alert level to the maximum 6. But now, months later, is the H1N1 pandemic virus still creating havoc?

That's the main topic of discussion when the WHO's emergency committee of 15 influenza experts meets tomorrow. New clusters of the virus may still emerge, but Gregory Hartl, WHO's spokesman for the H1N1 pandemic, said the experts will look at the possibility of moving into a new phase of the pandemic.

What are the main talking points of the meeting?

The emergency committee ... will be meeting to look, first of all, at the current epidemiological situation to see how the pandemic has been progressing. Secondly, it will consider whether or not temporary recommendations should be continued [such as trade or travel restrictions] ... We are also using this meeting to look at a third point - the emergency committee will be asked to consider whether or not we are now in what is called a post-peak period. Are we past the peak of the pandemic? Are we past the peak of H1N1 transmission? The committee will look at the evidence, will consider the evidence and then will make a decision and recommendation on whether we are past the peak or not.

What markers will be examined to determine if the virus is in the post-peak period?

If you looked at how many cases, for example, per week of H1N1 infection there have been since this started, are they going down or are they going up in those countries? They look at factors like that.

If it's determined that we are in the post-peak period, what signal does it send to the world?

It basically says countries should do two things: First of all, we are still in the pandemic. So we need to still be prepared for there being perhaps localized upsurges of activity in the coming months. In a generalized fashion, it means that we probably will not see an upsurge all over the world of pandemic activity. ... And secondly, it would be a signal for countries, on the one hand, while they are being vigilant and continue to remain vigilant, they need to start making plans and preparing to transition out of pandemic mode.

So when is the pandemic over?

To know that the pandemic is over, we really have to see a bit more evidence of the fact that there isn't a lot of influenza activity out of season. So we wouldn't want to see pandemic influenza in the summer period. We would need to see what happens in the summer, for example, in the Northern Hemisphere before we could say definitively [the pandemic is over] And for the moment at least, pandemic H1N1 has a disproportionate effect on pregnant women or young children or people with underlying respiratory conditions. ... Those are groups who are normally not affected by influenza. As long as these groups are being affected by H1N1, it means that H1N1 is not behaving like a seasonal influenza.

This pandemic hasn't been as devastating as first thought, at least in North America. Will the criteria on determining a pandemic be reviewed?

Certainly we always can learn how to do things better. But there's no doubt in our minds that this was a pandemic, because the definition of a pandemic is the worldwide spread of a virus to which people do not have immunity. ... I think that at some point in the future, certainly the pandemic preparedness guidance of which the levels are part of, they'll be reviewed. It behooves us to update the pandemic preparedness guidance to take account of what we've learned, what we've experienced and how science develops.

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