[Enhancement of surveillance is the basic for pandemic preparedness].
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In February 1999, the Maryland Department of Health and Mental Hygiene initiated pandemic influenza planning for the state of Maryland. This process involved several major steps, including the development of the Maryland Pandemic Influenza Preparedness Plan, and culminated in a high-level tabletop exercise to test the plan in April 2004. During the tabletop exercise, participants were presented with nine different fictitious scripts encompassing a single scenario. They were asked to respond to the information presented in each script, discuss organization-specific questions posed by the exercise facilitator, and make decisions regarding action steps that their organization would take in response to the various issues raised. The exercise identified a number of important gaps that need to be addressed, including (1) additional surge capacity specific to a pandemic, (2) greater understanding of the realities and implications of pandemic influenza among elected officials and decision-makers, (3) coordination of pandemic influenza planning with the existing emergency response infrastructure coupled with additional training in incident command, (4) further steps to operationalize several aspects of the Maryland Pandemic Influenza Preparedness Plan, and (5) additional federal guidance.
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.
Influenza has not been treated with the degree of medical attention that the disease warrants. As such, there is not an adequate baseline of preparedness in the United States to deal with the potential of pandemic influenza. The National Institute of Allergy and Infectious Diseases (NIAID) has been working to enact measures to deal more effectively with a potential influenza pandemic and also to assist in the management of seasonal influenza. The majority of the NIAID's efforts have been dedicated to basic research aimed ultimately at developing and testing, in clinical trials, countermeasures in the form of antiviral drugs and vaccines. Some of the NIAID's current and planned antiviral projects include the (1) assessment of oseltamivir therapy in infants, (2) conduct of clinical trials of higher doses of osteltamivir for avian influenza, (3) appraisal of combination therapies, and (4) evaluation of the next generation of neuraminidase inhibitors. In addition, the NIAID is screening potential new antiviral drugs and evaluating novel drug targets. Similarly, significant funding has been committed to vaccine preparedness, and numerous novel candidate influenza vaccines are in various stages of development. Importantly, there is an integral relationship between preparation for seasonal influenza and preparation for pandemic influenza. Until these approaches are firmly linked, the community will not have optimized its preparedness for a pandemic.
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).
The increase in the incidence of avian influenza worldwide in both poultry and humans introduces the potential for another influenza A pandemic that could pose a significant threat to both human health and the global economy. The impact of the next influenza pandemic will be influenced, in part, by how well the medical, government, business, and lay communities are prepared. Despite the additional tools and resources that have become available since prior epidemics, there are limits to the quantity of antiviral drugs that can be manufactured and concerns over the current vaccine production systems. Despite these challenges, there is an opportunity to take action before the emergence of a pandemic influenza strain and, possibly, to prevent its spread or at least mitigate its impact on the world. In February 2006, a group of representatives from federal, state, and local governments; professional bodies; academia; and the pharmaceutical industry met to review the current state of preparedness in the United States for a potential influenza pandemic and its relationship to seasonal influenza. The goal of the meeting was to examine the recently revised US Department of Health and Human Services plan for preparedness and response to an influenza pandemic and to make recommendations to actualize this plan at the state and local levels.
BACKGROUND: Planning for the next pandemic influenza outbreak is underway in hospitals across the world. The global SARS experience has taught us that ethical frameworks to guide decision-making may help to reduce collateral damage and increase trust and solidarity within and between health care organisations. Good pandemic planning requires reflection on values because science alone cannot tell us how to prepare for a public health crisis. DISCUSSION: In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework. SUMMARY: The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.
Concerns are mounting that the threat of another influenza pandemic will become a reality and that the epicentre of the outbreak could be the Asia-Pacific region. We assessed the documents that some Asia-Pacific countries have published as part of preparedness planning for an outbreak of influenza in people. Regional approaches were polarised. Thailand, China, and Vietnam had set out a strategic vision to strengthen future capacity in preparedness planning. By contrast, Hong Kong, Australia, and New Zealand took a strategic approach aimed mainly at harnessing available resources or preparing for the deployment of resources such as stockpiled antiviral agents and vaccines. The plans of Hong Kong, Australia, and New Zealand compared favourably with the best European plans. The plans of resource-poor countries addressed some issues that were largely neglected by most European plans. Other countries (including those that do not yet have plans) could benefit from analysis of the strengths and weaknesses of the plans drawn up by countries in the region and in Europe.
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.
The major focus of the WHO Influenza Programme has been on the annual recommendations of the influenza vaccine formulation and related activities committees. The Programme's main structural components are National Influenza Centres (NIC) which sample patients with influenza-like-illness and WHO Collaborating Centres (WHO CC) which receive representative isolates from NICs for antigenic and genetic analyses. In addition, WHO CCs, jointly with key national reference laboratories, conduct annual studies on whether the current vaccines induce satisfactory antibody levels to new epidemic strains. They also make available high yielding reassortant viruses for vaccine production as well as vaccine potency testing reagents. The WHO Global Influenza Programme jointly with its partners published Pandemic Preparedness Guidelines and Recommendations on the Use of Inactivated Influenza Vaccine. It has recently initiated the development of a Global Agenda on Influenza (www.who.int/influenza) and expanded its mission from surveillance to pandemic preparedness, assessment of impact of influenza and increasing influenza vaccine usage.
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