The Writing Committee of the World Health Organization Consultation on Clinical Aspects of Pandemic (H1N1) 2009 Influenza is calling for better international collaboration in clinical research. Although much information on the natural history and clinical management of H1N1 flu has been obtained in a remarkably short time, major gaps in the understanding of the virus remain, the committee stated in the New England Journal of Medicine.

“Both the gaps in knowledge and the experience to date underline the urgent need for better international collaboration in clinical research, particularly in the case of diseases with pandemic potential, for which rapid detection, investigation, and characterization of clinical syndrome are prerequisites for improved mitigation of their public health consequences,” the committee wrote.

The committee said a better understanding of the evolution of the virus among humans—and potentially among other species—is needed and noted that this knowledge gap underscores the need for “continued virological surveillance for antigenic changes, viral reassortment, antiviral resistance, and altered virulence.”

Improvements in the global capacity for detection via molecular analysis also are needed, as is a better understanding of the extent and character of the disease in areas with limited resources, where lack of access to care can increase the risk of more serious outcomes. The committee also called for new, more effective antiviral regimens and combined treatment with targeted adjunctive therapies.

Such treatments, along with improved management of influenza-associated acute respiratory distress syndrome, and better prevention, recognition, and treatment of invasive bacterial coinfections are among the committee’s top priorities going forward.