by Donya C. Arias
In the event of a flu pandemic, federal health officials are planning to use a unique approach to keep the public updated about disease conditions: a tiered response system similar to that used for hurricanes.
In February, the Centers for Disease Control and Prevention released its "Community Strategy for Pandemic Influenza Mitigation" that sets up a Pandemic Severity Index. The index ranks the severity of pandemics based on categories, ranging from Category 1, which is the most moderate, to Category 5, which is the most severe. The index is designed to enable estimation of the severity of a pandemic on a population level, allow better forecasting of the impact of a pandemic and enable recommendations for interventions. With each stage, the guidelines outline what government and public health officials should do to protect the public and contain infections.
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| Signs in Suffolk, United Kingdom, in February warn about anoutbreak of avian flu among poultry. If a flu pandemic occursamong people, U.S. officials have a new warning system ready.Photo by Leon Neal, courtesy AFP/Getty Images |
The guidelines rely on what officials describe as "early, targeted, layered measures" to both prepare for and respond to a pandemic. The plan is designed to change as new science becomes available.
"We use the word category because there is an analogy here to the hurricane analogy," said CDC Director Julie Gerberding, MD, MPH, during a Feb. 1 news conference.
"Everyone knows what a Category 1 hurricane is. Everyone understands what a Category 4 or 5 hurricane is. And we have embedded in our minds some understanding of the difference in severity, of a different level of planning that might be required and the different harm that could come from these kinds of different scenarios."
The guidelines aim to give community planning strategies to state and local decision-makers, as well as the public, to consider during an influenza pandemic. They focus on community-level interventions that could be used to stem the spread of infection, many of them non-drug interventions such as voluntary home quarantine of households with confirmed or probable influenza cases or school cancellations in the event of a widespread outbreak.
Public input was key to drafting the guidelines, said Paul Jarris, MD, MBA, executive director of the Association of State and Territorial Health Officials. ASTHO worked with CDC to gather comments at five community forums last year. Harvard University also conducted a survey to find out who people might be willing to listen to in the event of a pandemic and how best to get health-related messages to the public. State and local public health agencies also provided input.
"In the end, this will only be successful if the public prepares themselves and decides to follow the guidance," Jarris said.
When drafting the guidelines, officials recognized that schools are not only places of learning. If schools were closed to control infection, many children who rely on school meals would go hungry. At certain categories, the guidelines recommend suspending classes but allowing schools to remain open for other functions.
"The devil is always in the details," Jeff Levi, PhD, executive director of the Trust for America’s Health, told The Nation’s Health. "These guidelines raise a series of issues including the feasibility of schools closing and when and how we’re going to pull the trigger."
He said the Pandemic Severity Index makes sense, but wonders if officials will know in time to institute the appropriate "mitigation strategies" outlined in the guidelines.
"It’s appropriate to put this out there, and it’s appropriate to start the conversation about interventions," Levi said. "I think this is a critical time for public health leaders to be explaining to the public and to policy-makers what these interventions are about and how to prepare to use them."
Health officials are united in their belief that a pandemic is likely to emerge and have been working on preparedness efforts for the past few years. A pandemic is a global disease outbreak of a virus for which people have little or no immunity. Lessons learned from past pandemics, such as the "Spanish flu" pandemic of 1918 that killed millions, include the need for measures to help countries contain infection to lessen risk worldwide.
"We would like to not reproduce some of the lessons of 1918, which is waiting until the bodies and the mortality (are) so high that it’s insufferable to really begin to implement our measures then," said Marty Cetron, MD, director of CDC’s Division of Global Migration and Quarantine, during the Feb. 1 news conference releasing the pandemic preparedness guidelines.
"This is going to be really hard work, and there’s no doubt about it, and what we’re talking about here is not easy to conceive or implement."
What’s also key, health experts say, is a continuation of the kind of collaboration that has emerged as the global public health community eyes the threat of a pandemic.
"Now the challenge for all of us in the public health world is to actually start using (the guide), to make it a living document, to exercise it and improve it," Jarris said.
OSHA releases guides on protecting workers
Less than a week after CDC officials unveiled their pandemic preparedness guidelines, the U.S. Department of Labor and Occupational Safety and Health Administration released new workplace safety and health guidance designed to help employers prepare for a pandemic. Developed with the U.S. Department of Health and Human Services, "Guidance on Preparing Workplaces for an Influenza Pandemic" defines the differences between seasonal, pandemic and avian influenza as well as how a pandemic could affect workplaces and what employers can do to protect their workers. The document advises businesses to use preparedness tools to develop a disaster plan and has steps employers can take to reduce flu exposure on the job.
In mid-February, international health experts met at World Health Organization headquarters in Geneva to discuss advances in pandemic flu vaccine development and reported "encouraging progress." Sixteen manufacturers from 10 countries are developing prototype pandemic influenza vaccines against the H5N1 avian influenza virus, and five are also working on vaccines against other avian viruses. The H5N1 virus first emerged among birds on Asian poultry farms in 2003 and has killed at least 167 people since 2003, according to WHO.
In February, a U.S. Food and Drug Administration advisory committee recommended that the agency approve the nation’s first bird flu vaccine, according to news reports. However, data showed that the vaccine might not be very effective.
APHA is working to help Americans prepare themselves and their families for pandemic flu and other emerging infectious diseases through its Get Ready campaign. In March, CDC’s Gerberding was a guest author of a commentary on pandemic preparedness on the campaign’s Get Ready for Flu blog. The Association has also been working to increase funding for pandemic flu preparedness, recently releasing the "APHA Prescription for Pandemic Flu," which outlines strategies for preparing and responding to a flu pandemic.
The new CDC guidelines as well as the OSHA guidance on workplace infection control are available online from www.pandemicflu.gov.
To read APHA’s flu blog or for pandemic flu resources from APHA’s Get Ready campaign, visit www.getreadyforflu.org.
(Editor's note: This article was corrected following publication.)
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