The California Adult Immunization Coalition has the mission and goal of increasing immunization rates for adults in California for a number of potential diseases, including influenza among others. Because there is so much concern in the press and on radio and television about “avian” ("bird") or “pandemic” influenza, the Coalition has decided to post the information found on this page in order to provide a brief update about this subject.
Introduction
Avian flu, commonly called Bird flu, and Pandemic flu refer to aspects of the same thing. There is, at present, a real “epidemic” of avian flu among birds in Asia extending as far west as Turkey, but not, so far, among humans. Although several dozen persons in Asia and Turkey have contracted avian flu directly from birds, it is not yet spreading widely among humans.
Virus Mutation
In order for the disease to spread from person to person (as contrasted with bird-to-bird, or bird-to-human transmission), the virus will have to change (“mutate”) to a new form. So far, this event has not occurred, but there is great concern among experts all over the world that this is highly likely to happen eventually. It is not possible to absolutely or definitely know if this will happen, or when. It has happened several times in the past century, leading to the famous historical influenza pandemics which spread across the world in 1918-9, 1957-8, and again in 1968-9.
What's Being Done
There is great concern about pandemic influenza at all levels of public health and government-- from local health officials to the World Health Organization; the problem is certainly not being minimized, overlooked or ignored. California recently issued a draft Pandemic Influenza Preparedness and Response Plan (see link below).
Since the virus capable of infecting humans hasn’t yet emerged, it has not yet been possible to create a vaccine against it. However, a vaccine supply is being created which may protect against certain components of the emergent virus and might prove useful in an emergency to rapidly limit the spread of the disease within a local area.
What To Do
There are things individuals and health care professionals can do about this now. For travelers to certain parts of Asia, there are precautions that should be followed scrupulously. Both lay persons and especially health care professionals should stay informed, foster and support local efforts to develop plans for vaccine or anti-viral medication dissemination and for quarantine if necessary, and follow any directions that will be widely disseminated by public health authorities in the event of an outbreak. The importance of the “regular” annual flu shot should not be overlooked; although the avian and human strains of influenza virus are quite different, there might be some general protection afforded by the regular annual ‘flu vaccination.
Preparedness and Response Plan
California DHS has released a draft preparedness and response plan for pandemic influenza. In addition to outlines of pandemic planning and response, this plan includes appendices which describe disease surveillance, case investigation, preventing spread of the disease, treatment and other actions to be taken before, during and after a pandemic. The draft plan can be accessed at the link below.
Details Emerge on Government Pandemic Flu Response Plan - 4/17/06
President Bush this week is expected to approve the government's national pandemic influenza response plan, a draft of which details how federal officials would detect and respond to an outbreak and continue functioning through a potential 18-month crisis, the Washington Post reports. The 240-page draft document identifies more than 300 specific tasks for federal agencies, and federal officials working on the plan say it "continues to evolve," according to the Post (Connolly, Washington Post, 4/16).
The plan is based on a worst-case scenario that assumes as many as 90 million people in the U.S. would become sick and two million people would die in a pandemic. The report is based in part on the strategy Bush outlined in October 2005 (Pickler, AP/South Florida Sun-Sentinel, 4/17). Some of the plans outlined in the report include the following:
- The Department of Treasury could produce currency in other countries if its U.S. mints could not operate.
- The Pentagon is considering stockpiling millions of latex gloves due to concerns about acquiring supplies from Asia.
- The Department of Veterans Affairs could employ drive-through medical exams to quickly assess patients who think they have been infected by the flu.
- To protect the 1.8 million-strong federal workforce, the Bush administration could use its stockpile of medications, cancel large gatherings, encourage schools to shut down and move air traffic controllers to busier hubs.
- Retired federal employees could be called back to work, and the National Guard could be sent to cities facing possible "insurrection," according to Jeffrey Runge, chief medical officer of the Department of Homeland Security.
- The U.S could send medical teams and supplies abroad to help contain the first cases and introduce "travel restrictions to help stamp out that spark," Runge said.
- The U.S. Department of Agriculture would stagger shifts, close cafeterias, cancel face-to-face meetings and establish a 24-hour employee hotline to provide medical advice and work updates.
HHS would be in charge of medical aspects of the pandemic, while DHS would have overall authority.
President Bush is expected to create an interagency task force to coordinate the federal response and a high-level Disaster Response Group, which would resolve disputes among agencies or states.
When the plan is accepted, federal officials intend to announce several vaccine manufacturing contracts to help bolster the pharmaceutical industry's role in a pandemic.
According to the Post, some agencies are "far along in preparing for a deadly outbreak," but "[o]thers have yet to resolve basic questions, such as who is designated an essential employee and how the agency would cope if that person were out of commission." In addition, "critical decisions" have yet to be made, such as "how much vaccine would be needed to immunize against a new strain of avian influenza" and "who should have priority for antiviral drugs," the Post reports.
Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, said, "Most of the federal government right now is ill-prepared as any part of society." He said progress has been made, but the government is nowhere near prepared ( Washington Post, 4/16).
California Department of Health Services officials said counties across the state, including Los Angeles, "have nowhere near the capacity" needed to treat the hundreds of thousands of residents who might require medical care in the event of a large-scale flu pandemic, the Los Angeles Times reports.
In March, Los Angeles County released results of a 2005 survey that found that 67% of hospitals in the county did not have plans for handling a flu pandemic. Only three out of five hospitals reported having extra supplies of gloves, masks, gowns and Tamiflu, an anti-flu medication.
To contend with a potential pandemic, Los Angeles County is creating a reserve volunteer medical registry of doctors, nurses and respiratory therapists who could be called for duty, Kay Fruhwirth, assistant director of the Los Angeles County emergency medical services agency, said. Nearly 600 retired doctors and nurses already are part of a reserve corps.
In addition, Los Angeles County is identifying "surge capacity" facilities such as schools, gymnasiums and community centers that could house and feed affected patients (Lin, Los Angeles Times, 4/17).
More Information
, January 18, 2006 (DHS)
