State of Alaska: Division of Public Health: Pandemic Influenza Response Plan  [open pdf - 451KB]
"Unlike influenza epidemics, which occur seasonally and result in an average of 36,000 deaths in the U.S. each year, influenza pandemics (global epidemics) occur sporadically, and have the potential to result in hundreds of thousands of deaths nationally over the course of one year. During the 20th century there were three influenza pandemics, the most severe of which occurred in 1918-19 and caused over 500,000 deaths in the U.S. and more than 50 million deaths worldwide. Influenza pandemics occur when there is a major change in the structure of a strain of influenza virus such that most (or all) of the world's population is vulnerable to infection. These major changes emerge by at least two mechanisms: genetic recombination and adaptive mutation. Of the three influenza pandemics in the 20th century, two (1957 and 1968) occurred as a result of major changes in the genetic composition of the virus through the recombination of genetic elements from avian and human influenza strains, and one (1918) occurred as a result of adaptive mutations that allowed the virus to be efficiently transmitted first from birds to humans and then from person-to-person. At some point in the future, the world will be faced with another pandemic caused by a novel strain of influenza virus that spreads rapidly and causes extraordinarily high rates of illness and death-higher, in fact, than virtually any other natural health threat. Because novel influenza viruses have the potential to spread rapidly, high levels of absenteeism in the workforce can quickly jeopardize essential community services, including health care services throughout affected regions."
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