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Public health responses in mitigating influenza pandemics include enhanced surveillance, quarantine, patient management, and social distancing. This manuscript summarizes non-pharmaceutical public health responses in Japan and identifies 10 lessons learned from pandemic (H1N1) 2009. Pandemic (H1N1) 2009 can be classified into five phases: I) prepandemic; II) overseas, when swine influenza A (H1N1) was identified in Mexico and the United States; III) early localized, when domestic clusters of patients were identified in Japan; IV) smoldering; and V) widespread. Ten lessons were learned and identified: in the prepandemic phase, 1) the initiatives of high-level decision-making bodies must be enforced effectively and comprehensively, and 2) planning must be flexible and based on a range of scenarios. In the overseas phase, 3) difficulties in decision-making and require the public's trust, 4) human rights must be protected, especially for infected individuals, and 5) efficient response operations are essential because of limited resources. In the early localized phase, 6) acceptance of local governments' initiatives, 7) assumption of the identification of the first domestic patients without overseas travel, 8) strategic public communication for minimizing anxiety, and 9) timely resource allocations with termination of unnecessary responses are necessary. In the widespread phase, 10) criteria for school closures are essential. The implementation of these measures could create greater efficiency in public health responses in the face of another epidemic.

Lessons Learned from Non-Pharmaceutical Public Health Responses to Pandemic (H1N1) 2009 in Japan