Category Archives: Pandemics & Infectious Diseases

U.S. Policy Regarding Pandemic-Influenza Vaccines

Source: Julie Somers and Philip Webre, Congressional Budget Office, September 2008

The possibility of an influenza pandemic is cause for concern among policymakers, public health experts, and the world’s populations. Against that prospect, in 2005, the Department of Health and Human Services (HHS) published a plan that includes a series of measures, first to monitor the spread of disease in the event of a worldwide outbreak and then to facilitate a rapid response. That second step includes developing influenza vaccines and expanding the nation’s capacity for producing influenza vaccine; creating stockpiles of antiviral drugs and other medical supplies (to avert an influenza pandemic or minimize its effects); coordinating federal, state, and local preparations; and planning for public outreach and communications.

HHS’s plan has two specific goals that relate to vaccines. The first goal is to have in place by 2011 domestic production capacity sufficient to supply vaccine to the entire U.S. population within six months of the onset of a pandemic. The second goal is to stockpile enough doses of vaccine to inoculate 20 million people as soon as possible after the onset of a pandemic.

This Congressional Budget Office (CBO) paper, which was prepared at the request of the
Senate Majority Leader, focuses on the government’s role in the vaccine market that stems from HHS’s plan. It provides information on the current state of readiness, the additional expenditures likely to be necessary to achieve HHS’s vaccine-related goals, the expenditures that are likely to be needed to maintain preparedness, and the approaches of other countries as they too face the prospect of an influenza pandemic.

Evaluating the Use of Rapid Influenza Testing in Outpatient Medical Settings

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.

Guidance on Allocating and Targeting Pandemic Influenza Vaccine

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

Report Offers Resources for Home Health Care Response During a Flu Pandemic

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.

Pandemic Mutations In Bird Flu Revealed

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.

Is Your State Ready for the Bird Flu?

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.

Federal Guidance to Assist States in Improving State-Level Pandemic Influenza Operating Plans

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)

ACLU Report: Government Must Abandon Misguided Approach to Pandemic Preparedness

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)

Preparing Hospitals and Clinics for the Psychological Consequences of a Terrorist Incident or Other Public Health Emergency

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.