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PubMed2006

The Australian response: pandemic influenza preparedness.

Australia's preparedness for a potential influenza pandemic involves many players, from individual health carers to interdepartmental government committees. It embraces a wide number of strategies from the management of the disease to facilitating business continuity. The key strategy underlying Australia's planned response is an intensive effort to reduce transmission of the virus. This includes actions to reduce the likelihood of entry of the virus into the country and to contain outbreaks when they occur. Containment will provide time to allow production of a matched vaccine. The health strategies are outlined in the Australian health management plan for pandemic influenza. The plan is accompanied by technical annexes setting out key considerations and guidelines in the areas of clinical management and infection control. National plans present overall strategies and guidance, but the operational details can only be determined by individual states and territories, regions, and the services themselves. Primary health care practices will be on the frontline of an influenza pandemic. Every practice needs a plan that defines the roles of staff, incorporates infection control and staff protection measures, and considers business continuity. Most importantly, a practice needs to know how to implement that plan.

Australia↗
PubMed2003

[The possibility and preparedness for pandemic of new influenza].

Influenza is endemic in the world. Influenza A/H1N1(USSR), A/H3N2(Hong Kong), and B are the major strain for human influenza. Both influenza A/H1N1 and H3N2 has been overrun for 20-20 years, and it has been warned new influenza A virus should appeared in near future. As foretaste, avian influenza A/H5N1 was transmitted to human in Hong Kong in 1997 and 2003, and avian influenza A/H7N7 was transmitted to human in Netherlands in 2003. WHO requests member states to prepare influenza pandemic and to strengthen and encourage influenza surveillance. In Japan, Ministry of Health and Welfare organized Expert Committee for Preparedness for Influenza Pandemic in 1997 and New Committee will be organized in 2003. New influenza surveillance system has been started since 1999. The data on influenza surveillance in Japan are shown on website of IDSC/NIID(http://idsc.nih.go.jp/index-j.html).

Animals↗
PubMed2004

Australian contingency plans for emergency animal disease control: the role of antigen/vaccine banks.

Vaccination is an important element of contingency plans for many animal diseases. The decision whether or not to use vaccine is complex, and must consider epidemiological, economic and social issues. Vaccines are rarely available in a country for emergency animal diseases unless a low pathogenicity strain of the agent is present or it is localised in carrier hosts. High quality commercial vaccine from overseas is often the preferred source of vaccine in an emergency, although less reliable sources may be used with additional safeguards. Alternatively, master seeds may be imported or developed for production within the country For contingency planning, diseases may be ranked according to the expected role of vaccine in the disease eradication strategy, with diseases for which vaccine is part of the initial response strategy receiving highest priority for action. A range of preparedness options is available, ranging from identifying producers of vaccine, obtaining permits for import and use from regulatory authorities, to establishing vaccine or antigen banks. Countries need to consider their individual situations and develop strategies to address the diseases of significance to them.

Animals↗
PubMed1994

Application of subjective methods to the determination of the likelihood and consequences of the entry of foot-and-mouth disease into New Zealand.

New Zealand has a history of continuous freedom from foot-and-mouth disease and relies on a two-tier system of surveillance to maintain this status. The first involves border control procedures and stringent importation standards, and the second is an exotic disease and pest response programme. As part of an economic evaluation comparing the exotic disease and pest response programme against a hypothetical lower grade ;measured response programme subjective judgements of the risks involved were required. Twenty-eight selected animal health professionals, predominantly veterinarians, were posted a questionnaire that used three techniques (single point estimates, three point estimates and elicitation methods) to determine the risk components in a foot-and-mouth disease outbreak. The two key variables were the probability of an outbreak in New Zealand, and the number of secondary properties to which the disease spread during the epidemic. A Delphi conference of ten selected participants then focused mainly on the two key variables, with a second round postal extension to this group for the first variable. The individual data sets were then analysed and combined using a stochastic simulation technique. The final mean probability of an outbreak was about once in 50 years (0.0199). The mean numbers of farms to which disease would spread during an epidemic under the existing exotic disease and pest response programme, a measured response programme which allowed vaccination and a measured response programme which excluded vaccination were estimated to be 61, 478 and 2230 respectively. The policy implications arising from the quantification of these two key variables are that more expenditure on preparedness is justifiable and current resource planning is barely adequate.

Journal Article↗
PubMed2001

Bioterrorism preparedness and response in European public health institutes.

The terrorist attacks on 11 September 2001 and the deliberate release of anthrax in the United States had consequences for public health not only there, but also in Europe. Europe's public health systems had to manage numerous postal materials possibly contaminated with anthrax. Our survey aimed to document the response of European public health institutes to recent bioterrorist events to identify the gaps that need to be addressed; 18 institutes from 16 countries participated in this Euroroundup. Bioterrorist threats in Europe were hoaxes only, and should be considered as a "preparedness exercise" from which three lessons can be drawn. Firstly, because of inadequate preparedness planning and funding arrangements, Europe was not ready in October 2001 to respond to bioterrorism. Secondly, although European institutes reacted quickly and adapted their priorities to a new type of threat, they need adequate and sustained support from national governments to maintain their overall capacity. Thirdly, the recent crisis demonstrated the need for increased investment in epidemiology training programmes and the establishment of a technical coordination unit for international surveillance and outbreak response in the European Union.

Bioterrorism↗
PubMed2004

Perspective of an emergency physician group as a data provider for syndromic surveillance.

The need for enhanced biologic surveillance has led to the search for new sources of data. Beginning in September 2001, Emergency Medical Associates (EMA) of New Jersey, an emergency physician group practice, undertook a series of surveillance projects in collaboration with state and federal agencies. This paper examines EMA's motivations and concerns and discusses the collaborative opportunities available to data suppliers for syndromic surveillance. Motivations for supplying data included altruism and public service, previous involvement in terrorism and disaster preparedness, academic research interests, and the opportunity to find added value in the group's existing information systems. Concerns and barriers included cost, maintaining patient confidentiality, and challenges in interacting with the public health community. The extensive and carefully maintained electronic medical record enabled EMA to conduct multiple studies in collaboration with state and federal agencies. The electronic medical record provides useful data that might be more sensitive and specific in detecting outbreaks than the patient-chief-complaint data more commonly used for surveillance. EMA's experience also indicates that opportunities exist for the public health community to work with emergency physicians and emergency physician groups as suppliers of data. Such collaborations not only are useful for syndromic surveillance systems but also can help build relations that might facilitate a response to an actual biologic attack.

Bioterrorism↗
PubMed2005

Public health strategies for distribution of influenza vaccine during an influenza pandemic.

In order to consider the ethical issues around vaccine distribution during an influenza pandemic, it is critical to have an understanding of the role of influenza vaccine in a pandemic, the rate at which vaccine is likely to be come available, who will likely produce and "own" the vaccine, how vaccine distribution and administration might be accomplished, and which are the groups that might be deemed highest priority to be vaccinated against influenza. The United States and Connecticut have been considering the more challenging of these issues and have learned from Canada, which previously discussed and made decisions on the challenges related to vaccine distribution. Although there is still some critical advance thinking that needs to be done, planning for the response to an influenza pandemic is now at an advanced stage. The keys to preparedness at this stage are to be aware of the vaccine distribution options, to know the benefits and limitations of each option, and to be flexible but nimble in dealing with a real pandemic.

Canada↗
PubMed2003

Control and prevention of emerging zoonoses.

Emerging and re-emerging zoonoses are zoonotic diseases caused by either totally new or partially new agents or by microorganisms previously known but now occurring in places or in species where the disease was previously unknown. Zoonotic diseases account for the majority of all emerging infectious diseases. Several factors have led to the emergence of these infections, including human demographics, the industrialization of food production, globalization, international travel and commerce, land use, microbial adaptation, and changes and breakdown in public health measures. Several zoonotic agents are also potential agents that could be used as biological weapons. The recent use of anthrax spores in tainted mall in the US underlines our need for preparedness against bioterrorism. Prevention and control of these emerging zoonotic diseases is based on recognition, investigation, and collaboration, the development of advanced diagnosis and surveillance tools, the use of applied epidemiology and molecular biology methods, as well as education, information, communication, and technology transfer.

Animals↗
PubMed2006

Reducing the impact of the next influenza pandemic using household-based public health interventions.

BACKGROUND: The outbreak of highly pathogenic H5N1 influenza in domestic poultry and wild birds has caused global concern over the possible evolution of a novel human strain [1]. If such a strain emerges, and is not controlled at source [2,3], a pandemic is likely to result. Health policy in most countries will then be focused on reducing morbidity and mortality. METHODS AND FINDINGS: We estimate the expected reduction in primary attack rates for different household-based interventions using a mathematical model of influenza transmission within and between households. We show that, for lower transmissibility strains [2,4], the combination of household-based quarantine, isolation of cases outside the household, and targeted prophylactic use of anti-virals will be highly effective and likely feasible across a range of plausible transmission scenarios. For example, for a basic reproductive number (the average number of people infected by a typically infectious individual in an otherwise susceptible population) of 1.8, assuming only 50% compliance, this combination could reduce the infection (symptomatic) attack rate from 74% (49%) to 40% (27%), requiring peak quarantine and isolation levels of 6.2% and 0.8% of the population, respectively, and an overall anti-viral stockpile of 3.9 doses per member of the population. Although contact tracing may be additionally effective, the resources required make it impractical in most scenarios. CONCLUSIONS: National influenza pandemic preparedness plans currently focus on reducing the impact associated with a constant attack rate, rather than on reducing transmission. Our findings suggest that the additional benefits and resource requirements of household-based interventions in reducing average levels of transmission should also be considered, even when expected levels of compliance are only moderate.

Antiviral Agents↗
PubMed2004

Establishment and maintenance of records under the Public Health Security and Bioterrorism Preparedness and Response Act of 2002. Final rule.

The Food and Drug Administration (FDA) is issuing a final regulation that requires the establishment and maintenance of records by persons who manufacture, process, pack, transport, distribute, receive, hold, or import food in the United States. Such records are to allow for the identification of the immediate previous sources and immediate subsequent recipients of food. The final rule implements the Public Health Security and Bioterrorism Preparedness and Response Act of 2002 (the Bioterrorism Act), and is necessary to help address credible threats of serious adverse health consequences or death to humans or animals. The requirement to establish and maintain records is one of several tools that will help improve FDA's ability to respond to, and further contain, threats of serious adverse health consequences or death to humans or animals from accidental or deliberate contamination of food. In the event of an outbreak of foodborne illness, such information will help FDA and other authorities determine the source and cause of the event. In addition, the information will improve FDA's ability to quickly notify the consumers and/or facilities that might be affected by the outbreak.

Animals↗
PubMed2003

Pandemic influenza and healthcare demand in the Netherlands: scenario analysis.

In accordance with World Health Organization guidelines, the Dutch Ministry of Health, Welfare and Sports designed a national plan to minimize effects of pandemic influenza. Within the scope of the Dutch pandemic preparedness plan, we were asked to estimate the magnitude of the problem in terms of the number of hospitalizations and deaths during an influenza pandemic. Using scenario analysis, we also examined the potential effects of intervention options. We describe and compare the scenarios developed to understand the potential impact of a pandemic (i.e., illness, hospitalizations, deaths), various interventions, and critical model parameters. Scenario analysis is a helpful tool for making policy decisions about the design and planning of outbreak control management on a national, regional, or local level.

Age Factors↗
PubMed2003

An innovative approach to training hospital-based clinicians for bioterrorist attacks.

The recent attacks of September 11, 2001, and the subsequent dissemination event of anthrax in the United States demonstrated the necessity for hospitals to initiate bioterrorism education for clinicians. Events such as the release of sarin gas into the Tokyo subway by the Aum Shinrikyo cult provided some insight into how quickly emergency medical personnel may be overwhelmed by causalities of unconventional weapons. Educational interventions to prepare hospital-based practitioners for such disasters must fit among the demands of patient care, administrative duties, and continuing education within specialties. In addition, the priority placed on the topic, confusion about reputable resources to consult, and concerns of funding for preparedness training mandate the need for an authoritative, comprehensive, and easily accessible approach. A pilot project supported in part by the Agency for Healthcare Research and Quality was developed to facilitate streamlining of preparedness efforts through the implementation of interactive screen savers as an alternative to traditional educational modalities. This report presents the successful application of this model, which was quantified with pretests and posttests given to users of the system.

Bioterrorism↗
PubMed2001

[Update on biological weapons and bioterrorism. Important that health services pay attention to unusual events].

Biological weapons and biological terrorism have recently been in focus due to the deliberate release of Bacillus anthracis via mail delivered in the USA. Since the 1930s biological weapons have been developed in a number of countries. In 1975 a biological and toxin weapons convention prohibiting the use of these weapons were signed by a large majority of world countries. Unfortunately, a number of countries have failed to respect this treaty. The Soviet union continued and expanded its biological weapons program and after the Gulf war it was revealed that Iraq also had an extensive bio-weapons program. Large scale deliberate release of for example B. anthracis or an epidemic following a release of smallpox virus would have a devastating effect. This has urged the world community to strengthen the biological and toxin weapons convention with a control function which as of yet has not been successful. Furthermore, many countries including Sweden, increase stocks of antibiotics and smallpox vaccines. Sweden is also increasing preparedness regarding diagnostics of these and similar agents and is setting up an epidemiological task force that can be used in infectious disease emergencies such as the deliberate release of a biological weapon.

Anthrax↗
PubMed2002

The Model State Emergency Health Powers Act: planning for and response to bioterrorism and naturally occurring infectious diseases.

The Center for Law and the Public's Health at Georgetown and Johns Hopkins Universities drafted the Model State Emergency Health Powers Act (MSEHPA or Model Act) at the request of the Centers for Disease Control and Prevention. The Model Act provides state actors with the powers they need to detect and contain bioterrorism or a naturally occurring disease outbreak. Legislative bills based on the MSEHPA have been introduced in 34 states. Problems of obsolescence, inconsistency, and inadequacy may render current state laws ineffective or even counterproductive. State laws often date back to the early 20th century and have been built up in layers over the years. They frequently predate the vast changes in the public health sciences and constitutional law. The Model Act is structured to reflect 5 basic public health functions to be facilitated by law: (1) preparedness, comprehensive planning for a public health emergency; (2) surveillance, measures to detect and track public health emergencies; (3) management of property, ensuring adequate availability of vaccines, pharmaceuticals, and hospitals, as well as providing power to abate hazards to the public's health; (4) protection of persons, powers to compel vaccination, testing, treatment, isolation, and quarantine when clearly necessary; and (5) communication, providing clear and authoritative information to the public. The Model Act also contains a modernized, extensive set of principles and requirements to safeguard personal rights. Law can be a tool to improve public health preparedness. A constitutional democracy must balance the common good with respect for personal dignity, toleration of groups, and adherence to principles of justice.

Bioterrorism↗
PubMed2006

[Surveillance of acute respiratory illnesses (ARI) in Lower Saxony: first experience from the years 2005-2006].

In the context of influenza pandemic preparedness planning, a surveillance system for influenza and other acute respiratory illnesses was implemented in Lower Saxony at the beginning of the influenza season 2004/2005 and coordinated by the Governmental Institute of Public Health of Lower Saxony. This surveillance system represents an addition to already existing national monitoring systems. The goal of this surveillance system is to have available prompt information on the beginning, course and end of the influenza season and to recognise the spectrum of pathogens and identify outbreaks of other viral acute respiratory illnesses (ARI). For this purpose an all-season surveillance was established consisting of two supplementary modules. The first module is a symptom-oriented surveillance of acute respiratory illnesses in children of pre-school day care facilities. In the second module a virological surveillance in co-operation with selected medical practices was established. While the temporal course and burden of ARI in all Lower Saxony can be assessed by the surveillance of children in the day-care facilities in a sensitive, but less specific way, the virological surveillance provides highly specific information on the prevailing pathogens in ARI patients at a certain time. This information, in return, gives an indication about the responsible pathogens causing ARI in children of the day-care facilities. The first experience with these two complementary surveillance modules shows that in Lower Saxony a well accepted, prompt and meaningful monitoring system is available for the recognition and description of the occurrence of ARI and concomitantly of influenza. An extension of this surveillance to other pathogens or disease scenarios is possible.

Disease Outbreaks↗
PubMed2005

The next pandemic: anticipating an overwhelmed health care system.

INTRODUCTION: In September 2005, an overview of current health care system planning efforts was presented to the audience at the Yale University Ethics Symposium on Avian and Pandemic Influenza. The speaker, also the author of this article, provided the audience with a summary of what was being undertaken with the use of federal preparedness funds to improve the overall infrastructure of the health care system. All of Connecticut's 31 acute care hospitals, the Veteran's Administration Hospital in West Haven, Hospital for Special Care, Gaylord Rehabilitation Hospital, Natchaug Psychiatric Hospital, and the state's 13 Community Health Centers are currently recipients of federal preparedness funds. Federal funding for this planning comes from Health Resources and Services Administration, Department of Health and Human Service's National Bioterrorism Hospital Preparedness Program. OBJECTIVES: This article outlines the planning activities around pandemic influenza that the state's health care system partners started in 2004-2005 and also those they are currently participating in or will be participating in the next 12 to 15 months. The article highlights the key objectives and strategies that health care facilities will be using in this planning. There are four major objectives that each health care facility's Emergency Operations Plan must address. They are: increasing bed availability, developing strategies to deal with the potential staffing shortages, developing strategies for dealing with potential critical equipment and pharmaceutical shortages, and, lastly, the implementation of education, training and communication strategies for their health care workers and the public they serve. These plans, and all the activities needed to operationalize the plans, such as education, training, drills, and exercises, will include their key partners, i.e., local health departments, local emergency management, police, fire, and Emergency Medical Services. This article will describe this work plan in detail. METHODS: Descriptive information was obtained through the author's observations and personal experiences, in addition to governmental guidance, reports, and plans. CONCLUSION: The "all-hazards" planning currently being undertaken by the key health care system partners in Connecticut as a result of federal funding for preparedness post 9/11 has fostered great working relationships between these entities and their local, regional, and statewide planning counterparts. Many of the specific grant dollars being provided to these facilities can assist in the planning that must be done for pandemic flu.

Connecticut↗
PubMed2006

Update on preparing for the next influenza pandemic.

While previous pandemics have taken the world by surprise, the present situation has given the world advanced warning and a rare opportunity to prepare for the next pandemic. WHO urges all countries to take action now to assess their level of preparedness, identify priority needs, and develop a national influenza preparedness plan. If containing or delaying the spread of a new human influenza strain is possible, it will take rapid, massive coordinated global and national actions. The success of these actions will depend on the preparations made in advance by each member of the international community.

Communicable Disease Control↗
PubMed2005

Evaluation of public health interventions for Anthrax: a report to the secretary's council on Public Health Preparedness.

To aid in understanding how best to respond to a bioterror anthrax attack, we analyze a system of differential equations that includes a disease progression model, a set of spatially distributed queues for distributing antibiotics, and vaccination (pre-event and/or post-event). We derive approximate expressions for the number of casualties as a function of key parameters and management levers, including the time at which the attack is detected, the number of days to distribute antibiotics, the adherence to prophylactic antibiotics, and the fraction of the population that is preimmunized. We compare a variety of public health intervention policies in the event of a hypothetical anthrax attack in a large metropolitan area. Modeling assumptions were decided by the Anthrax Modeling Working Group of the Secretary's Council on Public Health Preparedness. Our results highlight the primary importance of rapid antibiotic distribution and lead us to argue for ensuring post-attack surge capacity to rapidly produce enough anthrax vaccine for an additional 100 million people.

Anthrax↗