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PubMed2000

[Morbidity and mortality in pandemic influenza in Norway].

This article is partly based on a newly published influenza pandemic preparedness plan and risk analysis for future pandemics in Norway, and presents estimates on morbidity and mortality in influenza pandemics in Norway in the 20th century. In addition, estimates on morbidity and mortality for a future pandemic are given. One of the main conclusions is that excess mortality in connection with Spanish influenza and Asian influenza is highly underestimated. The proportion of the infected that died in the pandemics was low, and was highest for Spanish influenza. The morbidity will be highest if a pandemic similar to Asian influenza reappears, while mortality will be highest if a Spanish flu is repeated. In the worst case scenario for a pandemic today, based on the figures from the Spanish flu, the number of excess deaths could reach 29,000, an increase of 60% compared to the average annual number of deaths seen in the 1990s.

Disease Outbreaks↗
PubMed2006

Interactions between influenza and bacterial respiratory pathogens: implications for pandemic preparedness.

It is commonly believed that the clinical and epidemiological characteristics of the next influenza pandemic will mimic those of the 1918 pandemic. Determinative beliefs regarding the 1918 pandemic include that infections were expressed as primary viral pneumonias and/or acute respiratory distress syndrome, that pandemic-related deaths were the end states of the natural progression of disease caused by the pandemic strain, and that bacterial superinfections caused relatively fewer deaths in 1918 than in subsequent pandemics. In turn, response plans are focused on developing and/or increasing inventories of a strain-specific vaccine, antivirals, intensive care beds, mechanical ventilators, and so on. Yet, there is strong and consistent evidence of epidemiologically and clinically important interactions between influenza and secondary bacterial respiratory pathogens, including during the 1918 pandemic. Countermeasures (eg, vaccination against pneumococcal and meningococcal disease before a pandemic; mass uses of antibiotic(s) with broad spectrums of activity against common bacterial respiratory pathogens during local epidemics) designed to prevent or mitigate the effects of influenza-bacterial interactions should be major focuses of pandemic-related research, prevention, and response planning.

Bacterial Infections↗
PubMed2004

Preparedness for SARS in the UK in 2003.

Severe acute respiratory syndrome (SARS) has been described as the first major emerging infectious disease of the twenty-first century. Having initially emerged, almost unnoticed, in southern China, it rapidly spread across the globe. It severely tested national public health and health systems. However, it also resulted in rapid, intensive international collaboration, led by the World Health Organization, to elucidate its characteristics and cause and to contain its spread. The UK mounted a vigorous public health response. Some particular issues concerned: the practicalities of implementing exit screening had this been required; the likely efficacy of this and other control measures; the legal base for public health action; and the surge capacity in all systems should the disease have taken hold in the UK. We have used this experience of 2003 to inform our preparation of a framework for an integrated, escalating response to a future re-emergence of SARS according to the levels of disease activity worldwide. Recent cases confirm that SARS has not "gone away". We cannot be complacent about our contingency planning.

Disease Outbreaks↗
PubMedDate not supplied

Public health preparedness and response capacity inventory validity study.

The Centers for Disease Control and Prevention's Public Health Practice Program Office has issued a Public Health Preparedness and Response Capacity Inventory to help state and local public health systems assess their progress towards achievement of the critical capacities and benchmarks specified in the federal Supplemental Funds for Public Health Preparedness and Response for Bioterrorism. The criterion validity of the capacity inventory was assessed by comparing selected state and local agency responses with documentation provided by the agencies to corroborate their answers. Content validity assessment took the form of a mailed survey that also identified the most important questions from the perspective of a separate set of state and local officials. Responses generally upheld the validity of the capacity inventory, although circumstantial threats to validity were identified in the testing process. The instrument's use has been reported to the Centers for Disease Control and Prevention by approximately half the states and over 800 local public health entities. An interactive electronic version includes a scoring mechanism that allows agencies to judge progress towards the critical capacities and benchmarks over time.

Bioterrorism↗
PubMed2006

The Law Reform (Epidemic Preparedness) Bill--a proper response to the pandemic threat?

The ethical frameworks for public health practice are not as clearly articulated as those used in clinical medicine. This poses problems when Medical Officers of Health are required to exercise coercive powers over individuals in the context of communicable disease control. Proposed legislation exacerbates this problem. The Law Reform (Epidemic Preparedness) Bill, recently introduced into Parliament, extends coercive powers but does not provide legal protection for individuals subject to such powers. A framework exists to critique the legitimacy of coercive public health powers and includes the principles of necessity, effectiveness, proportionality, and fairness. The fairness principle is under threat in the draft Bill, which fails to provide "due process" procedures to protect the rights of individuals. Experience in managing the SARS epidemic suggests that coercive powers alone will not enhance the response to public health crises. Respect for individual rights, a positive relationship between government and the community, and the scope for review of decisions are more consistent with modern public health practice and are likely to lead to improved outcomes. In our view, the Bill should be amended to include legal protection for individuals before it is passed into law.

Coercion↗
PubMed2002

The future of public health preparedness.

This redacted version of a speech by former United States Senator Sam Nunn, Chairman of the Nuclear Threat Initiative, points out that although there are concerns about global issues involving security and weapons of mass destruction and bioterrorism, it was not until September 11, 2001, that these issues (and new, unforeseen ones) were getting the funding and attention they deserved. In the event of a biological attack, millions of lives may depend on how quickly we diagnose the effects, report the findings, disseminate information to the healthcare communities and to state and local governments, and bring forth a fast and an effective response at the local, state, and federal levels. Public health must become an indispensable pillar of our national security framework. As we develop a national strategy to respond to these challenges, we must think in the broader context of causes as well as symptoms. To provide context for the next 25 years, Senator Nunn provided an overview of the "Seven Revolutions" for change identified by the Center for Strategic and International Studies (CSIS) with which he is also associated. Finally, he discusses major security challenges facing the United States.

Bioterrorism↗
PubMed1999

Managing animal health emergencies through prevention and preparedness in Oceania.

Most countries in Oceania have adequate quarantine legislation, systems and staff to prevent the introduction of new animal diseases. Surveillance and preparedness for dealing with incursions of such diseases are less developed, except in those countries with larger livestock populations. The degree of preparedness for animal health emergencies in the different countries of the region reflects the relative economic importance of exotic diseases to each particular country. For those countries with significant populations of farm animals, appreciable efforts and money are expended. However, in the smaller island countries, it can be assumed that the likelihood of an exotic disease incursion is low and the impact on the economy would be comparatively small. For these reasons, it would be unreasonable to expect these countries to commit significant resources to develop programmes equivalent to those in New Zealand and Australia, for example. Nevertheless, there is a need for increased co-operation between countries in the region. An assessment of each country to determine what resources are available and how they may be used in various aspects of an animal disease emergency, including co-ordinated information sharing, would enable smaller island countries to be fully prepared in the case of an emergency.

Animal Diseases↗
PubMed2006

Estimating the usual prevalence and incidence of acute illness in the community: implications for pandemic influenza and bioterrorism preparedness.

BACKGROUND: Early clinical signs of influenza caused by a pandemic strain will presumably not differ significantly from those caused by other respiratory viruses. Similarly, early signs of diseases that may result from bioterrorism are frequently non-specific and resemble those of influenza-like illness. Since the time window for effective intervention is narrow, treatment may need to be initiated prior to a definitive diagnosis. Consequently, planning of medications, manpower and facilities should also account for those who would be treated for an unrelated acute illness. OBJECTIVES: To estimate usual patterns of acute illness in the community as a baseline for integration into pandemic influenza and bioterrorism preparedness plans. METHODS: Between 2000 and 2003 we conducted 13 telephone surveys to estimate the usual incidence and prevalence of symptoms of acute illness in the community. RESULTS: On average, 910 households were included in each of the surveys, representing about 3000 people. The compliance rates for full interviews ranged from 72.3% to 86.0%. In winter, on average, about 2% of the Israeli population (individuals) suffered each day from fever of > or = 38 degrees C, and about 0.8% during the other months. The prevalence of cough was higher, 9.2% in winter and 3% during summer. Daily incidence of fever ranged from about 0.4% per day in winter to about 0.2% in the fall. The prevalence and incidence of both fever and cough were highest for infants followed by children aged 1-5 years. CONCLUSIONS: These background morbidity estimates can be used for planning the overall treatment requirements, in addition to actual cases resulting from pandemic influenza or a bioterrorist incident.

Acute Disease↗
PubMedDate not supplied

Ensuring a broad and inclusive approach: a provincial perspective on pandemic preparedness.

The SARS crisis revealed critical gaps in Ontario's health emergency response capacity, and identified, in the starkest terms possible, the need for improved emergency response planning. This article reviews the development of the Ontario Health Plan for an Influenza Pandemic (OHPIP), released in June 2005. Some key points arising from the provincial planning process include the necessity to: ensure a broad and inclusive development process; ensure the pandemic plan identifies: 1) clear roles and responsibilities of federal, provincial/territorial and municipal levels of government, 2) the approach to occupational health and safety issues and ethical decision-making, 3) a communications strategy linking all affected sectors and levels of government and health sector; 4) any commitments to antiviral stockpiling, vaccine and antiviral allocation and use, and an approach for drug delivery from provincial stockpiles to local public health units; 5) health human resource management and supplementation; and 6) key programs/services to be scaled back to maximize surge capacity; address best practices (e.g., involve all sectors of the health care system at the outset, acquire strategic expertise, coordinate/advocate with broader emergency response system, etc); and, outline future stages that include strengthening the delivery of clinical care to influenza cases; clarifying the role of primary care practitioners during a pandemic; leveraging Ontario's significant e-Health investments.

Disaster Planning↗
PubMed2006

Pandemic influenza preparedness: the critical role of the syringe.

In the face of an almost unprecedented threat of a global pandemic of influenza it is imperative that stockpiling of appropriate drugs and devices begin now. One vital device is an appropriate syringe for delivering vaccine. With the potential for millions to be infected and the vaccine supply severely stretched it is imperative that the syringe used to vaccinate waste as little vaccine as possible and thus allow for a maximum number of persons to be vaccinated. Our study tested seven leading candidate vaccine syringes for dosing accuracy, dose-capacity per vial, medication wastage and a battery of ergonomic features. One device, the Flu+trade mark syringe, proved superior to the others in all important categories, possibly due to its low dead-space volume and its dosing accuracy. The data suggest that switching to this device from any of the others tested would provide between 2 and 19% additional vaccine doses per vial if the current 10-dose vials are used. Extrapolations from this data suggest that many thousands to millions of additional persons could be vaccinated in mass campaigns. Use of a syringe of this type, and the vaccine savings that would accrue, would likely be important in reducing morbidity and mortality in the event of a pandemic of influenza.

Disease Outbreaks↗
PubMed1997

[Care of a patient with a rare and highly contagious virus disease. An emergency situation resulted in good preparedness].

Ever since the eradication of smallpox, Sweden has been poorly furnished with emergency facilities for the care of patients with serious, very infectious diseases. National interest in creating such facilities was aroused by epidemics of haemorrhagic disease (first and foremost due to Ebola virus during the present decade), at the same time as the first Scandinavian case of haemorrhagic fever associated with a risk of person-to-person infection occurred in Linköping. A special laboratory which has been set up at the Centre for Disease Control, in Stockholm, and University Hospital, Linköping, in collaboration with the Board of Health and Welfare, has introduced a high-security infectious disease unit for the care of such patients, with separate ventilation and waste-water treatment systems. The unit is also equipped to provide intensive care, and a laboratory can be rapidly set up and fully operative within 12-24 hours. Most important of all, personnel are available who are trained both for laboratory work and the care of such patients, and used to working as a team and familiar with the special protective equipment. If a patient can not be transported to the special unit, a team is available to travel to the hospital where the patient has been admitted, to give instruction and help to set up infection control routines and even supply protective equipment.

Clinical Competence↗
PubMed2006

Seasonal and pandemic influenza: recommendations for preparedness in the United States.

There is a continued need to improve the state of preparedness for a potential influenza pandemic in the United States despite the publication of a pandemic influenza plan by the Department of Health and Human Services. Of particular importance are the sense of urgency for a coordinated response plan, an allocation of adequate funds to deal with this issue, and the need for a national leader to coordinate the development and execution of a national plan, including its relationship to the control of seasonal influenza. In addition, an infrastructure needs to be established in the United States to enable the rapid development and large-scale production of a safe and effective vaccine for new influenza strains; methods to treat influenza pneumonia need to be evaluated; a coordinated public health response needs to be defined; a nationally developed blueprint to deal with logistics of pandemic prevention is required; and there is a need to establish reliable communication systems on a national and local basis, to provide accurate information to the lay public, health care workers, and the agricultural sector.

Antiviral Agents↗
PubMedDate not supplied

Risk factors of diarrhoea among flood victims: a controlled epidemiological study.

The concept and practice of 'disaster preparedness and response', instead of traditional casualty relief, is relatively new. Vulnerability analysis and health risks assessment of disaster prone communities are important prerequisites of meaningful preparedness and effective response against any calamity. In this community based study, the risk of diarrhoeal disease and its related epidemiological factors were analysed by collecting data from two selected flood prone block of Midnapur district of West Bengal. The information was compared with that of another population living in two non-flood prone blocks of the same district. The study showed that diarrhoeal disease was the commonest morbidity in flood prone population. Some behaviours, like use of pond water for utensil wash and kitchen purpose, hand washing after defecation without soap, improper hand washing before eating, open field defecation, storage of drinking water in wide mouth vessels etc. were found to be associated with high attack rate of diarrhoea, in both study and control population during flood season compared to pre-flood season. Attack rates were also significantly higher in flood prone population than that of population in non-flood prone area during the same season. Necessity of both community education for proper water use behaviour and personal hygiene along with ensuring safe water and sanitation facilities of flood affected communities were emphasized.

Case-Control Studies↗
PubMed2005

The ABC's of disaster response.

The readiness of our healthcare facilities to respond to terrorist acts or naturally occurring epidemics and disasters has been at the center of public attention since September 11, 2001. The many other tragic events that have occurred throughout the world since then further reinforce the need for all healthcare facilities and medical personnel to increase their level of preparedness if they wish to optimize outcomes. Maximizing survival rates and minimizing disability during any MCI hinges on rapid, seamless, and coordinated response between first responders and first receivers. The Incident Command System and the HEICS are organizational tools that form the foundation for such a rapid and coordinated response. The ICS provides a simple and adaptable management structure that is capable of being expanded or contracted to meet the needs of a specific situation. The HEICS adapts the ICS into the hospital setting and, in addition to the benefits stated above; its use of the ICS nomenclature and terminology facilitates the communication and the sharing of resources between all agencies and health care institutions involved. A basic knowledge and understanding of the ICS principles and structure is essential for all individuals participating in a disaster response. Previous efforts at disaster preparedness have focused predominantly on the pre-hospital and rescue phase of the disaster response, but a complete and coordinated community response requires creation of integrated disaster plans. True readiness can only be achieved by testing and modifying these plans through integrated simulation drills and table top exercises. Hospital-wide drills are essential to educate all staff members as to their institutional plan and serve as the only substitute at present to first hand experience. At present, there is no evidence-based literature to define what constitutes the best medical response by medical personnel within a disaster setting. This information will likely evolve over the next several decades as we now recognize Disaster Medicine as a separate scientific and medical entity. In the interim, we can develop and modify our response plans based on the "lessons learned" from past experience. Prior events have demonstrated that general surgeons and surgical subspecialists are critical components to a successful hospital response for the vast majority of all mass casualty incidents. Thus, surgeons must take responsibility for increasing their knowledge and understanding of basic disaster management principles and must play an active role in developing their institutional disaster plans.

Disaster Planning↗
PubMed2005

Implementation of the community network of reference laboratories for human influenza in Europe.

BACKGROUND: The increased need for accurate influenza laboratory surveillance data in the European Union required formalisation of the existing network of collaborating national influenza reference laboratories participating in the European Influenza Surveillance Scheme (EISS). OBJECTIVE: To establish a Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). METHODS: Virologists in EISS defined the objective and tasks of the CNRL. Performance of the laboratories in the tasks was monitored by questionnaire-based inventories and quality control assessments (QCA). Subsequently, actions were defined to improve the performance of the CNRL. RESULTS: The CNRL started in April 2003 and included as of May 2004 32 laboratories in 24 European countries. The objective is to provide high quality reference services for human influenza surveillance, early warning and pandemic preparedness in Europe. The defined basic tasks are direct detection, culture, typing, subtyping and strain characterisation of influenza virus, diagnostic influenza serology and storage of clinical specimens and virus isolates. The questionnaire-based inventories and QCAs revealed that the majority of CNRL laboratories perform well in most of the basic tasks, although improvements are needed in certain areas of virus testing. Therefore, task groups have been established to further improve the methods used in the network. The CNRL has proven its usefulness during the 2003-2004 season by the reporting of accurate data concerning the flu epidemic caused by A/Fujian/411/2002 (H3N2)-like viruses and by the rapid sharing of information, protocols and reagents during the A(H5N1) and A(H7N3) epizootics in Asia and Canada. CONCLUSION: EISS has established a functioning Community Network of Reference Laboratories for Human Influenza in Europe and laid the foundation for further enhancement and collaborations. Important next steps include improving the laboratories to carry out all basic tasks and collaboration with the European Centre for Disease Prevention and Control.

Community Networks↗
PubMed2003

Educational preparedness of veterinarians for foreign animal diseases.

Veterinary medical education in FADs has been and will continue to be critically important if veterinarians are expected to fulfill the profession's primary obligations to society--those of protecting our animals' health, conserving our animal resources, and promoting public health. It is imperative that curricula and instruction in veterinary schools and colleges provide the depth and breadth of knowledge and understanding necessary to prepare all veterinarians, including those in private practice, for their key role in defending against FADs. Development and implementation of governmental and military programs to diagnose, prevent, control, and eradicate FADs will require a dedicated cadre of public sector veterinarians who have a solid educational foundation in FADs and understand the contemporary issues and global challenges we face. Animal-related industries, associations, and organizations will increasingly rely on well-educated veterinarians to help guide them in ways that will protect animals, clientele, consumers, and trading partners from effects of FADs. Agencies and organizations concerned with conservation of animal resources will require veterinary expertise necessary to prevent FADs in a multitude of animal species, including marine animals, wildlife, endangered species, zoologic specimens, and important genetic lines as well as our domestic companion and livestock species. Species affected by FADs also include human beings for those disease agents with zoonotic potential; thus, veterinary education also plays a key role in public health.

Accreditation↗
PubMed2001

Are US populations appropriate for trials of human immunodeficiency virus vaccine? The HIVNET Vaccine Preparedness Study.

Questions exist about whether testing of preventive human immunodeficiency virus (HIV)-1 vaccines, which will require rapid recruitment and retention of cohorts with high HIV-1 seroincidence, is feasible in the United States. A prospective cohort study was conducted in 1995-1997 among 4,892 persons at high risk for HIV infection in nine US cities. At 18 months, with an 88% retention rate, 90 incident HIV-1 infections were observed (1.31/100 person-years (PY), 95% confidence interval (CI): 1.06, 1.61). HIV-1 seroincidence rates varied significantly by baseline eligibility criteria--1.55/100 PY among men who had sex with men, 0.38/100 PY among male intravenous drug users, 1.24/100 PY among female intravenous drug users, and 1.13/100 PY among women at heterosexual risk-and by enrollment site, from 0.48/100 PY to 2.18/100 PY. HIV-1 incidence was highest among those men who had sex with men who reported unprotected anal intercourse (2.01/100 PY, 95% CI: 1.54, 2.63), participants who were definitely willing to enroll in an HIV vaccine trial (1.96/100 PY, 95% CI: 1.41, 2.73), and women who used crack cocaine (1.62/100 PY, 95% CI: 0.92, 2.85). Therefore, cohorts with HIV-1 seroincidence rates appropriate for HIV-1 vaccine trials can be recruited, enrolled, and retained.

AIDS Vaccines↗
PubMed2006

Local public health workers' perceptions toward responding to an influenza pandemic.

BACKGROUND: Current national preparedness plans require local health departments to play an integral role in responding to an influenza pandemic, a major public health threat that the World Health Organization has described as "inevitable and possibly imminent". To understand local public health workers' perceptions toward pandemic influenza response, we surveyed 308 employees at three health departments in Maryland from March-July 2005, on factors that may influence their ability and willingness to report to duty in such an event. RESULTS: The data suggest that nearly half of the local health department workers are likely not to report to duty during a pandemic. The stated likelihood of reporting to duty was significantly greater for clinical (Multivariate OR: 2.5; CI 1.3-4.7) than technical and support staff, and perception of the importance of one's role in the agency's overall response was the single most influential factor associated with willingness to report (Multivariate OR: 9.5; CI 4.6-19.9). CONCLUSION: The perceived risk among public health workers was shown to be associated with several factors peripheral to the actual hazard of this event. These risk perception modifiers and the knowledge gaps identified serve as barriers to pandemic influenza response and must be specifically addressed to enable effective local public health response to this significant threat.

Adult↗