Source: Joanne Silberner, National Public Radio, Morning Edition, August 20, 2008
A study shows bacterial pneumonia attacking virus-weakened lungs killed most of the 50 million victims of the 1918 flu pandemic. That finding may be good news if another pandemic strikes.
Source: Joint Commission, August 2008
The Joint Commission and the Centers for Disease Control and Prevention (CDC) are engaged in a cooperative agreement to evaluate how rapid tests for influenza are used in outpatient medical settings by surveying community health centers, solo and group practice physician offices and hospital emergency departments. Currently, the extent and quality of rapid testing for influenza in outpatient settings is unknown. This study seeks to understand who tests, how they test and how cases of influenza are reported to public health systems. The information gathered will be used to help the CDC formulate guidelines for the appropriate and safe use of rapid tests for influenza.
As part of this project, an online collaborative forum on the subject of rapid influenza testing has been developed and launched. Members of the project's technical advisory panel (TAP), public health officials, outpatient medical care providers, laboratory professionals and others interested in the topic of rapid influenza testing are encouraged to utilize the Wiki web-page that has been created exclusively for this project. The goal of the Wiki is to serve as a forum where participants can share information and experiences with rapid influenza testing. Information exchanged may include: rationale for test use, problems with the testing process, strategies to overcome problems, staff training, quality assurance activities, and perceived advantages and disadvantages to the tests.
The Wiki webpage is divided into six sections:
• Section 1: contains a brief introduction to the project;
• Section2: "Research & Resource Reports" gives users the opportunity to post articles and other resource material, as well as comments related to specific resources;
• Section 3: "Field Experiences" operates just like the "Research & Resource Reports" section; however, its purpose is to allow individuals practicing in outpatient medical settings to share their experiences with rapid influenza tests;
• Section 4: "Links" allows users to post links to external websites and other wiki webpages related to rapid testing for influenza;
• Section 5: "References" is reserved for citations and links to academic research on rapid influenza testing; and
• Section 6: "Recent Comments on Rapid Testing for Influenza" gives users the opportunity to post comments and engage in online dialogue about the topic.
Source: U.S. Department Of Health And Human Services and U.S. Department Of Homeland Security, 2008
Effective allocation of pandemic influenza vaccine will play a critical role in preventing influenza and reducing its effects on health and society when a pandemic arrives. The specific type of influenza that causes a pandemic will not be known until it occurs. Developing a new vaccine in response will take several months and pandemic vaccine may not be available when cases first occur in the United States. Moreover, once vaccine production begins, it will not be possible to make enough new vaccine to protect everyone in the early stages of a pandemic.
The U.S. Government is taking steps to minimize the need to make vaccine allocation decisions by supporting efforts to increase domestic influenza vaccine production capacity. Significant funding is being provided to develop new vaccine technologies that allow production of enough pandemic influenza vaccine for any person in the United States who wants to be vaccinated within six months of a pandemic declaration. Until this goal is met, Federal, State, local and tribal governments, communities, and the private sector will need guidance on who should be vaccinated earlier during the pandemic to best protect our people, communities, and country.
See also:
Vaccination plan puts health care workers first
Source: Maggie Fox, Reuters, July 23, 2008
Using Quality Improvement Methods To Improve Public Health Emergency Preparedness: PREPARE For Pandemic Influenza
(subscription required)
Source: Debra Lotstein, Michael Seid, Karen Ricci, Kristin Leuschner, Peter Margolis, Nicole Lurie, Health Affairs, Web Exclusives, July 15, 2008
- abstract
Source: Agency for Healthcare Research and Quality (HHS), AHRQ Publication No. 08-0018, July 2008
From the press release:
Home Health Care During an Influenza Pandemic: Issues and Resources, a report identifying home health care as a critical component in providing care during a pandemic influenza event and offering resources to home health care providers and community planners to prepare for such an event, was released today by the U.S. Department of Health and Human Services' (HHS) Agency for Healthcare Research and Quality (AHRQ) in collaboration with the Office of the Assistant Secretary for Preparedness and Response (ASPR).
Home health care agencies already provide routine care for acute and chronically ill, permanently disabled and terminally ill patients. In fact, on any given day, there are three times as many patients in home health care settings as there are in hospitals.
The report emphasizes the home health care sector's potential to help handle a surge in patients during a biologic event and stresses the need for involvement of home health care agencies in advance planning and coordination at the local level. It offers resources and suggestions on addressing key elements of home health care preparedness and includes lists of existing tools and models throughout.
Source: Society for General Microbiology, ScienceDaily, July 9, 2008
Scientists have discovered how bird flu adapts in patients, offering a new way to monitor the disease and prevent a pandemic, according to research published in the August issue of the Journal of General Virology. Highly pathogenic H5N1 avian influenza virus has spread through at least 45 countries in 3 continents. Despite its ability to spread, it cannot be transmitted efficiently from human to human. This indicates it is not fully adapted to its new host species, the human. However, this new research reveals mutations in the virus that may result in a pandemic.
Source: Jennifer Ginn, State News, Vol. 51 no. 5, May 2008
A third of your staff is absent because they or their family members are sick. Essential services like water and garbage pickup are falling by the wayside due to sick workers. Hospitals are filled past capacity and essential medical supplies, such as ventilators, are in short supply. What do you do? Those were just some of the questions facing a group of about 30 legislators in March during the Policy Forum on Pandemic Readiness and Emergency Preparedness, conducted by The Council of State Governments through educational support from Roche Laboratories.
Source: U.S. Government (12+ different agencies)
Effective State, local and community functioning during and following an influenza pandemic requires focused planning and practicing in advance of the pandemic to ensure that States can maintain their critical functions. The Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States - Early, Targeted, Layered Use of Nonpharmaceutical Interventions (February 2007) was developed to provide guidance for pandemic planning and response. For community mitigation strategies to be effective, State governments need to incorporate them into their operating plans and assist local communities, businesses, non-governmental organizations, and the public in doing the same. State governments must have robust operating plans that have been sufficiently tested and improved by staff who understand and perform proficiently their supporting activities. Community partners must also perform proficiently their roles and responsibilities and understand accurately what the State government will and won't do and how it will communicate with both them and the public.
This document provides a strategic framework to help the 50 States, the District of Columbia (DC), and the five U.S. Territories improve and maintain their operating plans for responding to and sustaining functionality during an influenza pandemic. Hereinafter within this document, the terms "States" and "State-level" refer to all 56 governmental entities.
At the heart of the strategic framework are the supporting activities that State-level operating plans should address. Representatives of several United States Government (USG) Departments (see Annex) developed this document with input from State representatives.
Full report (PDF; 1.5 MB)
Source: American Civil Liberties Union
As fears of a flu pandemic have grown, the Bush administration has pursued a misguided approach to pandemic preparation that relies on a law enforcement/national security approach, rather than a public health approach to the problem, and which exposes Americans to unnecessary risk. That is the finding of an expert report being released today by the American Civil Liberties Union at the National Press Club in Washington, DC.
"A law enforcement approach is just the wrong tool for the job when it comes to fighting disease," said Barry Steinhardt, director of the ACLU's Technology and Liberty Program. "History makes clear that a heavy-handed, coercive approach to pandemics that treats the sick as potential enemies is not only an unnecessary violation of civil liberties but is also ineffective from a public health standpoint and will leave more Americans stranded, sick and untreated."
"When people are sick, they want help - help getting treated and help ensuring they don't make others sick," said Parmet. "History shows that treating sick people like potential enemies only spurs them to avoid the authorities and exacerbates the spread of disease."
Full Report (PDF; 711 KB)
Source: RAND Corporation
Health care facilities usually have general disaster plans for dealing with the medical consequences of public health emergencies. However, most of their disaster plans do not address the psychological consequences of such events. These training manuals are designed to fill the gap by providing curricula that can be used to train hospital and clinic staff and department of mental health staff who would be deployed to hospitals and clinics about how to prepare for and respond to the psychological consequences of large-scale disasters. Meredith et al. include three separate training modules to address the needs of three audiences: (1) administrators and disaster planning and response staff in hospitals and clinics; (2) clinical, mental health, and non-clinical staff in hospitals and clinics; (3) disaster mental health staff in Los Angeles County. Terrorist attacks, natural disasters, and other large-scale public health emergencies such as severe acute respiratory syndrome (SARS) or pandemic flu can result in a large number of psychological casualties. Large-scale disasters can stress the capacity of hospitals and clinics to deal with the psychological consequences -- the emotional, behavioral, and cognitive reactions -- that could result from a terrorist or other public health event for victims, families, and staff members. The materials in these manuals are intended to be flexible so that hospital and clinic disaster coordinators can tailor a training session to the needs of local staff.
Source: Institute of Medicine/National Academies Press
From press release:
During an influenza pandemic, healthcare workers will be on the front lines delivering care to patients and preventing further spread of the disease. Protecting the more than 13 million healthcare workers in the United States from illness or from infecting their families or the patients in their care is critical to limiting morbidity and mortality and preventing progression of a pandemic. The National Personal Protective Technology Laboratory asked the Institute of Medicine (IOM) to conduct a study on the personal protective equipment (PPE) (respirators, gloves, gowns, eye protection, and other equipment) needed by healthcare workers in the event of an influenza pandemic.
The IOM committee determined that there is an urgent need to address the lack of preparedness regarding effective PPE for use in an influenza pandemic. Three critical areas were identified that require expeditious research and policy action: (1) Influenza transmission research should become an immediate and short-term research priority so that effective prevention and control strategies can be developed and refined. The current paucity of knowledge significantly hinders prevention efforts. (2) Employer and employee commitment to worker safety and appropriate use of PPE should be strengthened. Healthcare facilities should establish and promote a culture of safety. (3) An integrated effort is needed to understand the PPE requirements of the worker and to develop and utilize innovative materials and technologies to create the next generation of PPE capable of meeting these needs. Increasing the use of field testing in the pre-market phase and conducting thorough postmarketing evaluations are vital to producing effective equipment, as is the creation of rigorous federal regulatory and testing requirements. The committee believes that improvements can be made so that healthcare workers will have PPE that provides protection against influenza transmission based on a rigorous risk assessment with solid scientific evidence. The recommendations provided in this report are intended to serve as a framework and catalyst for a national PPE action plan that is an integral part of the overall national plan for an influenza pandemic.
Source: Critical Infrastructure Protection Program, George Mason University School of Law
Preparing for an influenza pandemic is a monumental challenge and requires participation from federal, state and local governments as well as the private sector. It is with great pleasure that the George Mason University School of Law's Critical Infrastructure Protection (CIP) Program publishes a collection of essays (PDF; 737 KB) on vaccine prioritization during an influenza pandemic. The United States government is spending a significant amount of time and resources examining and preparing for the possible threat of an influenza pandemic. A major challenge in preparing for an influenza pandemic encompasses vaccine prioritization. Specifically, if a pandemic were to occur and vaccines needed to be distributed, who should be first to receive vaccines? Should first responders or critical infrastructure employees have priority to receive the vaccines?
The CIP Program invited leading scholars to address this important issue. The essays focus on different concerns about vaccine prioritization. The first essay, submitted by Dr. Colleen Hardy, of the George Mason University School of Law's Critical Infrastructure Protection Program, provides an overview of current federal response plans to an influenza pandemic. Specifically, it summarizes the Department of Health and Human Services' (HHS) influenza plan concerning vaccine prioritization. In addition, the essay describes the National Infrastructure Advisory Council's (NIAC) Working Group on Pandemics' recommendations to the Department of Homeland Security and HHS.
Source: National Association of State Chief Information Officers
Without the flow of electronic information, government comes to a standstill. When a state's data systems and communication networks are disrupted, the problem can be serious and the impact far-reaching. The consequences can be much more than an inconvenience. Serious disruptions to a state's IT systems can lead to public distrust, chaos, fear and potential loss of life. Traditionally, IT disruptions are planned for based on anticipated disasters both natural and man-made that can physically damage facilities and equipment. However, we live in a time that holds the potential for a pandemic outbreak in your city, state or possibly the nation. What would you do as state chief information officer (CIO) if one day your staff did not come to the office because of a pandemic outbreak?
Full report (PDF: 185 KB)
Source: Trust for America's Health and American Academy of Pediatrics, Issue Brief, October 2007
From the summary:
The American Academy of Pediatrics (AAP) and Trust for America's Health (TFAH) issued a report in October 2007, Pandemic Influenza: Warning, Children At-Risk, which finds that children and teens between the ages of 0-19 account for nearly 46 percent of all H5N1 "bird" flu deaths. The report also identifies gaps in U.S. preparedness for treating and caring for children during a possible pandemic flu outbreak.
An influenza pandemic is a real and significant potential threat facing the United States and the world. Pandemics occur when a novel virus emerges that can easily be transmitted among humans who have little immunity. In 2005, the Homeland Security Council (HSC) issued a National Strategy for Pandemic Influenza and, in 2006, an Implementation Plan. Congress and others are concerned about the federal government's preparedness to lead a response to an influenza pandemic. This report assesses how clearly federal leadership roles and responsibilities are defined and the extent to which the Strategy and Plan address six characteristics of an effective national strategy. To do this, GAO analyzed key emergency and pandemic-specific plans, interviewed agency officials, and compared the Strategy and Plan with the six characteristics GAO identified.
Source: Center for Infectious Disease Research & Policy, and the Pew Center on the States, 2007
From the press release:
Public health planners have a new tool to help them prepare for an influenza pandemic. Pew and the Center for Infectious Disease Research & Policy are announcing the launch of www.PandemicPractices.org, a new online resource that highlights promising ways communities are preparing for a flu pandemic.
PandemicPractices.org brings together more than 130 peer-reviewed practices from four countries, 22 states and 33 counties. Compiled as a tool to save communities and states time and resources, the database enables public health professionals to learn from one another and to build on their own pandemic plans. Using PandemicPractices.org, they can examine and download pandemic flu planning materials and use or adapt them to fit local needs.
Source: David N. Sundwall, Robert T. Rolfs, Utah Department of Health, August 28, 2007
An influenza pandemic as severe as the 1918 pandemic could cause nearly a million Utahns to become ill and result in over 350,000 outpatient doctor visits, 80,000 hospitalizations, and 16,000 deaths over the course of a year. Critical assumptions used in developing this plan included: 1) outbreaks would probably occur widely across the state and nation, limiting the ability to share resources among jurisdictions; 2) vaccine would not be available until several months had elapsed; 3) shortages of critical medicines (including antiviral medications) and other supplies would occur; 4) capacity to provide medical care would be severely stressed or exceeded; and 5) absenteeism rates and fear would stress the abilities to maintain business continuity and to provide for essential community services including police, fire, water, food, transportation and sanitation.
The goals of this plan are, first, to minimize serious illness and death, and second, to limit societal disruption and economic losses. The plan is intended to coordinate with global and national plans developed by the World Health Organization (WHO) and the U.S. Department of Health and Human Services (DHHS). It outlines responsibilities and activities in six areas (Planning and Coordination; Public and Risk Communications; Surveillance, Investigation and Containment; Vaccine Management and Administration, Antiviral Medication Stockpiling and Use; Laboratory Testing, and Health Care and Emergency Response). It uses the three pandemic planning phases outlined by WHO (Inter-Pandemic, Pandemic Alert, and Pandemic Periods), the U.S. Federal Stages, and introduces Utah Pandemic Response Levels.
This plan outlines activities and responsibilities for government public health agencies and builds upon preparedness assets developed at federal, state, and local levels of government and in the private sector. The Plan incorporates work by several advisory bodies, including a Pandemic Influenza Planning Committee (2005-2006), the Pandemic Influenza Workgroup (2006-ongoing), and the Governor's Pandemic Influenza Taskforce, which met in 2006-2007 and developed recommendations that are included in and will set the stage for the next phase of this planning process.
See also:
Utah Department of Health's Pandemic Influenza Web site
Source: Patrick Thibodeau, Computerworld, August 28, 2007
Massive planning exercise will assess impact on staffing, telecommunications
What may be the largest pandemic planning exercise ever conducted in the U.S. is set to begin next month. The dry run will force financial services firms to operate with shrinking numbers of employees -- on paper, at least.
More than 1,800 organizations have signed up to participate in the three-week simulation, which is being sponsored by the U.S. Department of the Treasury and the Securities Industry and Financial Markets Association.
See also:
• U.S. Department of the Treasury press release
• FBIIC / FSSCC Pandemic Flu Exercise of 2007
From press release:
Community Measures Prevent Deaths During Pandemic, New Study Finds –
School closures and other community strategies designed to reduce the possibility of spreading disease between people during an epidemic can save lives, particularly when the measures are used in combination and implemented soon after an outbreak begins in a community, according to a new study based on public records from the 1918-1919 influenza pandemic.
The findings (subscription required), which are published in the Aug. 8 issue of the Journal of the American Medical Association, provide vital clues to help public officials planning for the next influenza pandemic and highlight the importance of community strategies. These strategies are particularly important because the intervention most likely to provide the best protection against pandemic influenza — a vaccine — is unlikely to be available at the outset of a pandemic. Community strategies that delay or reduce the impact of a pandemic (also called non-pharmaceutical interventions) may help reduce the spread of disease until a vaccine that is well-matched to the virus is available.
Scientists from the Centers for Disease Control and Prevention (CDC) and the University of Michigan Medical School′s Center for the History of Medicine completed an exhaustive review of public records such as health department reports, U.S. Census mortality data and newspaper archives.
See also:
Early Warning Infectious Disease Program (EWIDS)
Pandemic Planning Update IV
Department of Health and Human Services’ Pandemic Flu Website
Source: Shawn Rhea, Modern Healthcare, Vol. 37 no. 32, August 13, 2007
(subscription required)
As hospitals plan for emergencies such as a flu pandemic, one challenge is how they’ll keep their supply shelves stocked.
Source: Homeland Security Council, July 2007
From the summary:
Since the release of the National Strategy for Pandemic Influenza Implementation Plan one year ago, much has been accomplished to realize the U.S. Government's pandemic preparedness and response goals of: (1) stopping, slowing, or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic and mitigating disease, suffering, and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society.
Although the visibility of avian influenza and pandemic preparedness has waned in the media, the threat of avian influenza and the potential for an influenza pandemic has not. A pandemic occurs when a novel strain of influenza virus emerges that has the ability to infect humans and to cause severe disease, and where efficient and sustained transmission between humans occurs. Though we cannot be certain that highly pathogenic avian influenza A H5N1 (H5N1) will spark a pandemic, we can be sure that a pandemic will occur at some point in the future. It is everyone's responsibility to remain vigilant. We cannot become complacent and must continue to take the threat of a pandemic very seriously.
See also:
• Fact Sheet: Implementation of the National Strategy for Pandemic Influence - White House, July 17, 2007
• Pandemic Flu: Preparing and Protecting Against Avian Influenza - White House
From the press release:
Today a coalition of 18 health organizations led by the American Medical Association (AMA) and American Public Health Association (APHA) released a consensus report with 53 strategic recommendations for legislators, government officials and organizational leaders to more effectively prepare for and respond to catastrophic emergencies. The recommendations, especially nine identified as “critical,” serve as a national call to action from medicine, dentistry, nursing, hospitals, emergency medical services (EMS), and public health. The recommendations seek to strengthen health system preparedness and response through increased funding, greater integration, continued education and training and ensured legal protections for responders.
…
Nine critical recommendations from the consensus report make up a call to action in four categories:
Public health systems must be appropriately funded to adequately respond to day-to-day emergencies and catastrophic mass casualty events;
Public health and disaster response systems must be fully integrated and interoperable at all government levels;
Health care and public health professionals should maintain an appropriate level of education and training; and
Health care and public health responders must be provided and assured adequate legal protections in a disaster.
+ Action Brief
+ Signed Pledge of Commitment
Source: Secretary Leavitt (host), U.S. Department of Health and Human Services
On June 13, Michael O. Leavitt, Secretary, U.S. Department of Health and Human Services, convened a leadership forum on pandemic preparedness, which brought together highly influential leaders from the business, faith, civic and health care sectors to discuss how best to help Americans become more prepared for a possible influenza pandemic. The Department is hosting this five-week blog to expand the conversation as part of an ongoing effort by the Department to help Americans become more prepared. HHS does not edit blog postings and cannot ensure that all included links are functioning. We apologize for any inconvenience.
Source: Robert Barkin, American City & County, Vol. 122 no. 3, March 1, 2007
Preparing for emergencies is nothing new for Patricia Bean, Hillsborough County, Fla., administrator. After all, hurricanes are a way of life in the Southeast, and readiness for the next storm is at the top of every official's list of essential tasks. But, anticipating an influenza pandemic is different. “We're used to dealing with a situation that we see coming and then passes,” she says about hurricanes. “But this situation is very different. We may have 30 to 40 percent of our staff out of work. How can we cover that?”
Source: Occupational Safety and Health Administration U.S. Department of Labor, OSHA 3328-05, 2007
A comprehensive resource for healthcare planners and practitioners, the new guidance offers information and tools to assist the industry in preparing for and responding to an influenza pandemic. It includes technical information on infection control and industrial hygiene practices to reduce the risk of infection in healthcare settings; workplace preparations and planning issues; and OSHA standards that have special importance to pandemic preparedness planners and responders in the industry.
Source: U.S. Office of Personnel Management
The chart on the following page was developed to assist managers and supervisors in determining the appropriate course of action when confronted in the workplace with an employee who appears ill during a declared pandemic influenza outbreak or an employee who has been exposed to pandemic influenza. Employees who appear to be ill include those workers with pandemic flu-like symptoms (based on symptoms identified by the Centers for Disease Control and Prevention (CDC), which will be posted at www.pandemicflu.gov once the symptoms are known). Employees who have been exposed to pandemic influenza include those employees who have a known, recent, and direct exposure to pandemic influenza (also based on guidance from CDC and from the Occupational Safety and Health Administration (OSHA). The chart is intended to assist Federal supervisors and managers in assessing the capacity of their workforce to carry out the work for which the supervisor or manager will remain accountable during a pandemic influenza.
Source: U.S. Fire Administration, April 2007
The purpose of this document is to provide guidance for developing best practices and model protocols for use by State, local, tribal, and territorial personnel in the development of pandemic influenza plans, preparedness activities, training, and exercises. The content is a synopsis of input received from Federal, State, local, territorial, and tribal emergency medical services (EMS), fire, emergency management, public works, and sector-specific participants during a three-day forum sponsored by the Department of Homeland Security’s Chief Medical Officer and hosted by the U.S. Fire Administration on 23-25 February 2007. The results of this forum are being coordinated with the ongoing efforts of the Department of Transportation, the Department of Health and Human Services, and others.