Our relatively small sample size limited the power of our analysis. However, on the basis of the sample size calculations with 90% power, our patient numbers were sufficient to detect a difference of >45% above the rate of HMPV infection in the non-PICU group (6.4%). Nonetheless, our results demonstrate that the rate of coinfection is low (0% of 23 patients, 95% confidence interval 0%-14.8%). Other studies also support our findings that the frequency of co-infection with HMPV and RSV is rare (7, 14) The basis of the pathogenesis of severe RSV disease is multifactorial. Since severe RSV disease may develop in apparently healthy children, known host risk factors cannot completely account for instances of severe illness. Preexisting or maternally acquired immunity, innate immunity, viral factors and genotypes and environment all likely contribute to disease pathogenesis. Although we did not detect co-infection, HMPV may worsen RSV disease in a small percentage of infants. Nonetheless, HMPV most likely does not play an important role in the severity of RSV disease in the population. Community responses to communication campaigns for influenza A (H1N1): a focus group study BACKGROUND: This research was a part of a contestable rapid response initiative launched by the Health Research Council of New Zealand and the Ministry of Health in response to the 2009 influenza A pandemic. The aim was to provide health authorities in New Zealand with evidence-based practical information to guide the development and delivery of effective health messages for H1N1 and other health campaigns. This study contributed to the initiative by providing qualitative data about community responses to key health messages in the 2009 and 2010 H1N1 campaigns, the impact of messages on behavioural change and the differential impact on vulnerable groups in New Zealand. METHODS: Qualitative data were collected on community responses to key health messages in the 2009 and 2010 Ministry of Health H1N1 campaigns, the impact of messages on behaviour and the differential impact on vulnerable groups. Eight focus groups were held in the winter of 2010 with 80 participants from groups identified by the Ministry of Health as vulnerable to the H1N1 virus, such as people with chronic health conditions, pregnant women, children, Pacific Peoples and Māori. Because this study was part of a rapid response initiative, focus groups were selected as the most efficient means of data collection in the time available. For Māori, focus group discussion (hui) is a culturally appropriate methodology. RESULTS: Thematic analysis of data identified four major themes: personal and community risk, building community strategies, responsibility and information sources. People wanted messages about specific actions that they could take to protect themselves and their families and to mitigate any consequences. They wanted transparent and factual communication where both good and bad news is conveyed by people who they could trust. CONCLUSIONS: The responses from all groups endorsed the need for community based risk management including information dissemination. Engaging with communities will be essential to facilitate preparedness and build community resilience to future pandemic events. This research provides an illustration of the complexities of how people understand and respond to health messages related to the H1N1 pandemic. The importance of the differences identified in the analysis is not the differences per se but highlight problems with a "one size fits all" pandemic warning strategy. During an influenza pandemic the lack of experience of dealing with such hazards increases public reliance on information from government, public health agencies, employers, the community and the media. A challenge for government and health agencies is sustaining public awareness and alertness over a protracted period [1, 2] . Responding to the challenges posed by managing the risk from relatively unknown health hazards requires recognition of the fact that promoting sustained action involves not only getting the information right but also ensuring that it is communicated in ways that accommodate diversity in community characteristics, needs and expectations. The lack of experience also calls for research to provide the evidence base health authorities need to respond effectively in circumstances (e.g. rapid onset of disease outbreak) that precludes learning in situ.