December 1997
ATLANTA - Despite the 20 years spent designing the influenza pandemic preparedness plan, the recent isolation of a new influenza A (H5N1) virus has raised questions about the plan's completeness.
According to Keiji Fukuda, MD, National Center for Infectious Diseases (NCID) Influenza Vaccine Research and Development Division, the recent isolation of an avian influenza A (H5N1) virus from a child who died in Hong Kong indicates that further work is needed to prepare for the next pandemic.
This isolation "really pointed out to us in the Influenza Branch that as far as we've gotten with the pandemic plan, there are really things which are not covered with how to respond to this kind of situation. I think that this has really `put a fire under everyone' to push the development of this plan," said Fukuda here at a recent Advisory Committee on Immunization Practices meeting.
The epidemiologic and laboratory investigation by the Hong Kong Department of Health and the Centers for Disease Control and Prevention (CDC) has turned out to be a wake-up call for the next influenza pandemic, according to Nancy Cox, PhD, chief of the Influenza Branch.
"Fortunately for us, the H5N1 virus does not appear to have the ability to spread from person-to-person, so it's only a dress rehearsal," said Cox. "However, the circumstances surrounding the isolation of the virus and the characteristics of the virus itself are extremely interesting. The publicity surrounding this incident has generally increased the global awareness of the need for pandemic preparedness."
This observation raised the immediate concern of whether the United States is facing a new pandemic and whether a new pandemic virus had appeared, said Fukuda.
"Based on the previous killer influenza viruses, the $64,000 question is when will the next pandemic occur?" Fukuda said. "This is an unpredictable event." In its current configuration, the influenza A (H5N1) virus appears to have little pandemic potential. However, animal influenza viruses can unpredictably reassort human influenza genes, which increases the pandemic potential, Fukuda explained.
"We're talking about a disease that can spread globally, causing near universal infection with a potentially high mortality rate," said Raymond Strikas, MD, deputy chief of the Adult Vaccine Preventable Disease Branch, National Immunization Program. "Something that would make Ebola virus look like a walk in the park."
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Despite the problems surrounding the new virus isolation, the 20-year effort has already paid off in many ways, and many things are still being worked out, Strikas said.
"We've looked at our present capabilities and found a lot of gaps in what we're trying to do to control influenza. We've identified special pandemic-specific actions and are trying to integrate this plan with ongoing initiatives," he said.
Additional areas of research include further studies of animal subtypes; in-depth field studies; vaccine purchase programs; allocation of antivirals and vaccine; and effectiveness models to help with decision making and disaster planning.
The objectives of the plan include reducing morbidity and mortality, community disruption and economic loss.
The plan focuses not only on pandemic preparedness, but improving influenza control in interpandemic periods, ranging from efforts in surveillance, vaccine production and delivery and communication coordination, as well as emergency preparedness issues, Strikas explained.
In addition to the plan, detailed state and local guidelines have been developed and will be tested in five locations over the next six months to determine if the concepts can actually be put into place in a "table-top disaster exercise," Strikas said.
"There is a plan for the military that is being reviewed and a host of international colleagues are working on plans," he added.
Numerous other government agencies, consultants and organizations outside the public sector are involved in the plan, in addition to pharmaceutical companies which have guaranteed there will be enough vaccine to accommodate the public need in the event of a pandemic.
"We've been pleased to hear from our colleagues in vaccine companies that it's likely that enough vaccine can be produced to protect people in the United States," said Strikas.
The preparedness plan uses the worst-case scenario and assumes that everyone in the United States, and maybe worldwide, will be susceptible to the pandemic influenza virus, according to Strikas.
"We're operating under the assumption that we are going to see a pandemic at some point in the future," Strikas said. "It's a `when,' not an `if.'"
The report was prepared by the working group on influenza pandemic preparedness and emergency response, otherwise known as GRIPPE. The plan is currently at the Department of Health and Human Services for review.
"We trust that it will be approved as a department-wide plan in the not-too-distant future," Strikas said.
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