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That was also the case for the 2009 influenza A(H1N1) pandemic: While the first detected cases were mild infections in children in the south-west of the United States, it was severe disease in Mexico City that led to the appreciation of the potential seriousness of the threat [8,10]. In this issue of Eurosurveillance a series of articles describes the initial surveillance in the European Union (EU) [11], how new comprehensive surveillance was developed in Iceland [12], the response in Italy [13], the form that detected mortality took in Germany [14] and clinical surveillance for severe cases in Denmark [15]. The Danish paper notably describes successful efforts to mount surveillance in intensive care units. It is striking that at a time when there was infection and disease in the community, it was the hospitals, and their paediatric services and intensive care units in particular, that were most under pressure [1618]. It is a truism that the severe cases are to be found in hospital. However, that is where some of the most important information on this pandemic was found, i.e. data and analyses that were needed to guide the countermeasures. A number of the analyses that filled in the gaps for ECDC’s Known Unknowns (the important features that vary between pandemics and need to be known for control activities) eventually had to come from hospital sources [19]. It is therefore logical to make an effort to gather the early clinical, virological and epidemiological information during a pandemic from hospitals and clinicians in general and intensive care units in particular.

Responding to new severe diseases – the case for routine hospital surveillance and clinical networks in Europe