Pandemic Influenza

"The U.S. poultry industry is experiencing a severe outbreak of highly-pathogenic avian influenza (HPAI). The U.S. Department of Agriculture's (USDA's) Animal and Plant Health Inspection Service (APHIS) has reported 223 cases of HPAI in domestic flocks in 15 states. With the start of summer, the finding of new cases slowed. The last reported new case was in Iowa on June 17, 2015. More than 48 million chickens, turkeys, and other poultry have been euthanized to stem the spread of the disease. Cases have been caused by several highly pathogenic H5 avian influenza (AI) strains that result in substantial mortality in domestic poultry. Turkey and egg-laying hen farms in Minnesota and Iowa have been hardest hit. Commercial broiler farms have not been affected to date. According to the Centers for Disease Control and Prevention (CDC), no infections in humans have been associated with the HPAI outbreak, and the public health risk is low. […] It is believed that an HPAI outbreak is likely to occur again in the fall when wild birds begin their migrations through the four flyways. This may result in more spread of AI, possibly in the poultry-producing eastern and southeastern regions untouched by the current outbreak. APHIS and the poultry industry are taking lessons from the current outbreak to prepare for the fall. USDA is developing a vaccine to be available for manufacture if the agency decides to adopt a vaccination policy to manage any future outbreak. APHIS and the poultry industry are reassessing biosecurity, indemnity payment formulas, and other measures that aim to improve the containment and elimination process."

"In 2007, the Association of State and Territorial Health Officials (ASTHO) received funding from the Centers for Disease Control and Prevention (CDC) to develop guidance for state, territorial, tribal, and local health departments on at-risk populations in an influenza pandemic. ASTHO worked with state, local, tribal, and territorial health agencies; federal entities including CDC; and other key stakeholders to develop this guidance. Certain populations are at increased risk of harm during an influenza pandemic; special provisions, plans, and procedures must be arranged prior to an event to ensure the health and safety of these groups. Prior to this project, there was no specific national guidance in place to direct the development of such plans. […] Both CDC and ASTHO recognize that many entities have work in progress to develop plans and procedures for at-risk populations in emergencies. This guidance differs from those projects because of its singular focus on pandemic influenza. While many of the recommendations provided in this guidance will be applicable to all-hazards planning, specific considerations come into play in an influenza pandemic that cannot be addressed in all-hazards planning. Influenza pandemics will be widespread events that affect all jurisdictions. They occur over extended periods of time, affect the entire country, and may include a series of waves rather than one isolated outbreak. During a severe pandemic, hospitals and other healthcare centers are likely to be overwhelmed with patients, and business may experience a substantial reduction in staff."

From the document: "The U.S. Army estimates that if a severe infectious disease pandemic were to occur today, the number of U.S. fatalities could be almost twice the total number of battlefield fatalities in all of America's wars since the American Revolution in 1776. A pandemic occurs when an infectious agent emerges that can be efficiently transmitted between humans and has crossed international borders. DOD's day-to-day functioning and the military's readiness and operations abroad could be impaired if a large percentage of its personnel are sick or absent, and DOD's assistance to civil authorities might be limited. House Report 114-102 included a provision for GAO (Government Accountability Office) to assess DOD's planning and coordination to support civil authorities during a pandemic. This report assesses the extent to which (1) DOD has guidance and plans for supporting civil authorities in the event of a domestic outbreak of a pandemic disease and (2) HHS (Health and Human Services) and DHS have plans to respond to a pandemic if DOD support capabilities are limited, and they have mechanisms to coordinate their pandemic preparedness and response. GAO reviewed agency pandemic guidance and plans, interagency coordination mechanisms, and pandemic-related exercises and after-action reports"

"Planning for an influenza pandemic is an ongoing process involving many individuals from many public health, healthcare, and emergency response agencies at the federal, state, and community levels. It involves continuous research on and incorporation of lessons learned from actual responses to influenza pandemics and other public health emergencies, simulated exercises and drills, and issues identified in facilitated group discussions. This Public Health Discussion Guide focuses on these group discussions. [...] This discussion guide is designed for a community emergency management agency and those emergency response partners who support the agency during disasters, such as public safety departments (e.g., police and fire) and private partners (e.g., American Red Cross or faith-based organizations), with the focus being on those personnel within the agency for whom pandemic influenza preparedness or response planning is a job responsibility."

"Planning for an influenza pandemic is an ongoing process involving many individuals from many public health, healthcare, and emergency response agencies at the federal, state, and community levels. It involves continuous research on and incorporation of lessons learned from actual responses to influenza pandemics and other public health emergencies, simulated exercises and drills, and issues identified in facilitated group discussions. This Hospital Discussion Guide focuses on these group discussions."

The objectives of this U.S. Department of Health and Human Services, Office of Inspector General report were to determine the extent to which 10 selected localities addressed vaccine and antiviral drug distribution and dispensing in their pandemic influenza guidance, assess how extensively they had conducted exercises related to these activities, and measure how they had collaborated with community partners to develop and exercise vaccine and antiviral drug distribution in the event of an influenza pandemic.

"This Three Year Summary provides a historical record to report the Federal Government's progress in addressing actions due to be completed within 36 months of the initial release of the Implementation Plan and reflects that progress as of April 30, 2009. Although the closely-monitored H5N1 influenza strain did not evolve into a human pandemic strain over those three years, a different influenza virus caused a pandemic in 2009. In late April 2009, human outbreaks associated with a novel influenza virus, 2009 H1N1 Influenza A, were confirmed in Mexico and the United States. On June 11, 2009, the WHO officially declared an influenza pandemic and raised its pandemic alert phase to 6. Fortunately, however, the characteristics of 2009 H1N1 influenza virus have not caused the economic or societal interruptions anticipated in the Implementation Plan and its actions. 2009 H1N1 disease severity has been generally similar to what is seen during regular influenza seasons (although different age groups have been predominantly affected, with most cases, and most severe cases, occurring in older children and adults less than 65 years of age)."

"This thesis addresses planning for vulnerable populations, those segments of each community that are normally independent but that may require special assistance during a health emergency such as an influenza pandemic. Analysis of plans from sixty of Georgia's 159 counties provides insight into the extent to which vulnerable populations are defined and identified; relevant agencies are engaged in planning; and opportunities are identified for improvement. Recommended strategies will enable local jurisdictions to more effectively plan for vulnerable populations. Some strategies have now been implemented and others are in progress."

"The 2009 H1N1 influenza outbreak tested the revised International Health Regulations [IHR (2005)] robustly for the first time. The IHR (2005) contributed to swift international notification, allowing nations to implement their pandemic preparedness plans while Mexico voluntarily adopted stringent social distancing measures to limit further disease spread -- factors that probably delayed sustained human-to-human transmission outside the Americas. While the outbreak revealed unprecedented efficiency in international communications and cooperation, it also revealed weaknesses at every level of government. The response raises questions regarding the extent to which the IHR (2005) can serve as a framework for global pandemic response and the balance between global governance of disease control measures and national sovereignty."

"The WHO and health authorities worldwide have recognized that the world is under threat of a major pandemic of influenza which could potentially have serious effects on the health of the human population. Major pandemics have occurred in 1889, 1918/19, 1957 and 1968 and another major pandemic may well occur in the near future. The 1918/19 pandemic of influenza was one of the most devastating epidemics of an infectious disease to have affected mankind. This pandemic was directly responsible for over 20 million deaths, more than perished in conflict in the preceding Great War, and mainly affected previously healthy young adults. In South Africa the pandemic killed over 300 000 persons, overwhelming the ability of the authorities to dispose of the corpses, in addition to the total paralysis of the healthcare facilities for treating patients. Following on this epidemic there was, also, considerable post-epidemic morbidity in the form of encephalitis lethargica. Unfortunately science has not yet developed the tools to be able to predict when and where a future major pandemic will occur or what the impact of it will be. For this reason countries throughout the world have been invited to prepare contingency plans in the event of a future major pandemic. Were such an event to occur in the future, this would result in a vast demand for vaccine which could result in inequitable distribution as well as major demands for drugs such as antivirals and antibiotics.The WHO has established an influenza pandemic task force to prepare a blueprint plan to guide governments in preparing for the next pandemic. Account will need to be taken of this document when it does appear, probably towards the end of this year, in finalizing a definitive pandemic preparedness plan."

"A new influenza strain, influenza A (H5N1), is spreading through bird populations across Asia, Africa, and Europe, infecting domesticated birds, including ducks and chickens, and long-range migratory birds. In response to this threat, the President issued the National Strategy for Pandemic Influenza on November 1, 2005. The Strategy outlines the coordinated Federal Government effort to prepare for pandemic influenza. This Implementation Plan for the National Strategy for Pandemic Influenza further clarifies the roles and responsibilities of governmental and non-governmental entities, including Federal, State, local, and tribal authorities and regional, national, and international stakeholders, and provides preparedness guidance for all segments of society. It also provides guidance for families and individuals to ensure appropriate personal protection. The Implementation Plan represents a comprehensive effort by the Federal Government to identify the critical steps that must be taken immediately and over the coming months and years to address the threat of an influenza pandemic. It assigns specific responsibilities to Departments and Agencies across the Federal Government, and includes measures of progress and timelines for implementation to ensure that we meet our preparedness objectives. This Plan will be revised over time. The pandemic threat is constantly evolving, as is our level of preparedness."

"Since the release of the National Strategy for Pandemic Influenza Implementation Plan one year ago, much has been accomplished to realize the U.S. Government's pandemic preparedness and response goals of: (1) stopping, slowing, or otherwise limiting the spread of a pandemic to the United States; (2) limiting the domestic spread of a pandemic and mitigating disease, suffering, and death; and (3) sustaining infrastructure and mitigating impact to the economy and the functioning of society. Although the visibility of avian influenza and pandemic preparedness has waned in the media, the threat of avian influenza and the potential for an influenza pandemic has not. A pandemic occurs when a novel strain of influenza virus emerges that has the ability to infect humans and to cause severe disease, and where efficient and sustained transmission between humans occurs. Though we cannot be certain that highly pathogenic avian influenza A H5N1 (H5N1) will spark a pandemic, we can be sure that a pandemic will occur at some point in the future. It is everyone's responsibility to remain vigilant. We cannot become complacent and must continue to take the threat of a pandemic very seriously."

"Pandemic (H1N1) 2009 was the first public health emergency of international concern (PHEIC) declared under the International Health Regulations (2005) [IHR (2005)] and the first influenza pandemic in more than 40 years. Canada, Mexico, and the United States recognize that the risk of another pandemic has not diminished and that the world faces an ongoing threat posed by the emergence and spread of influenza viruses with the potential to cause a human influenza pandemic. The three countries continue to work together to strengthen their preparedness in anticipation of a highly contagious influenza virus or other pandemic either originating in or spread to this continent. […] The 'North American Plan for Animal and Pandemic Influenza' (NAPAPI) retains the key elements of the 2007 version, while incorporating the lessons learned from the North American response to Pandemic (H1N1) 2009, including recognizing that a pandemic influenza virus may emerge in our region and expanding the focus on animal influenza viruses to incorporate both avian and non-avian species. The NAPAPI outlines how the three countries intend to strengthen their emergency response capacities as well as our trilateral and cross-sectoral collaborations and capabilities in order to assist each other and ensure a faster and more coordinated response to future outbreaks of animal influenza or an influenza pandemic. [… ] In brief, the NAPAPI is a comprehensive cross-sectoral regional health security framework developed mainly with the input of the health, agriculture, security, and foreign affairs sectors to protect against, control and provide a public health response to animal and pandemic influenza in North America, while avoiding unnecessary interference with international travel and trade."

"This report examines early lessons learned from the response and ongoing concerns about overall U.S. preparedness for potential pandemic flu outbreak. The first section reviews 10 key lessons based on the initial response to the H1N1 outbreak; and the second section discusses 10 underlying concerns and provides recommendations for addressing serious continued vulnerabilities in the nation's preparedness in the event that H1N1 returns in the fall, either in its current form or as a more virulent strain, or if a different strain of influenza, like the H5N1 (bird) flu, emerges. Overall, the H1N1 outbreak has shown that the investment the country has made in preparing for a potential pandemic flu has significantly improved U.S. capabilities for a large scale infectious disease outbreak, but it has also revealed how quickly the nation's core public health capacity would be overwhelmed if the outbreak were more widespread and more severe."

"In 2005, the U.S. Department of Health and Human Services (HHS) developed the HHS Pandemic Influenza Plan to prevent, control, and mitigate the effects of influenza viruses that pose high risk to humans. Influenza viruses, of which there are many types, can cause rapid, widespread disease and death. Pandemic influenza outbreaks in the 20th Century alone left tens of millions of people dead in their wake and cost hundreds of billions of dollars in lost lives, wages, productivity and economic devastation. Influenza viruses with pandemic potential require the rapid development, production and availability of medical countermeasures (MCMs) such as vaccines, diagnostics and antiviral drugs to mitigate the impact of the pandemic, as well as additional preparedness and response efforts beyond medical countermeasures. HHS has made substantial progress in pandemic influenza preparedness since the 2005 Plan was released. In the current document, HHS reviews that progress, highlighting both the successes and remaining gaps in our preparedness and response activities for pandemic influenza. Most significantly, HHS efforts in pandemic influenza preparedness now are closely aligned with seasonal influenza activities, harnessing expanded surveillance, laboratory, vaccine, and antiviral drug resistance monitoring capacity. These activities are linked to efforts to communicate protective measures to the public and to help the health care system manage the demands of seasonal and potential pandemic influenza. Research across all these areas, and increased global capacity to diagnose and type the influenza viruses encountered outside the United States, contribute to domestic preparedness against pandemic influenza."

"The information and recommendations contained in this guidance is the product of expert opinion, derived from several international consultations which included examination of available information and modeling studies, input from public health experts on lessons learned from SARS [severe acute respiratory syndrome] and both animal and human influenza responses, and consolidation of recommendations in existing WHO [World Health Organization] guidance. This guidance was subject to an extensive public review. All external experts and contributors for all meetings and consultations, including those in the public review, have signed a declaration of interest statement in accordance with WHO policy. A small number of participants indicated a conflict of interest. However it was deemed by the working group that these declarations were not sufficient in conflict with the recommendations, to exclude them from the guidance development process. The declarations of interest are available upon request. For more information on the revision process, see Annex 2. The Global Influenza Programme will revise this guidance in 2014, or sooner in the event of significant developments which impact pandemic preparedness and response planning."

The Morbidity and Mortality Weekly Report (MMWR) Series is prepared by the Centers for Disease Control and Prevention (CDC). [It] is the agency's primary vehicle for scientific publication of timely, reliable, authoritative, accurate, objective, and useful public health information and recommendations. This issue of MMWR contains the "Updated Preparedness and Response Framework for Influenza Pandemics". From the summary: "'This updated framework can be used for influenza pandemic planning and serves as recommendations for risk assessment, decision-making, and action in the United States. The updated framework replaces the U.S. federal government stages from the 2006 implementation plan for the National Strategy for Pandemic Influenza (US Homeland Security Council. National strategy for pandemic influenza: implementation plan. Washington, DC: US Homeland Security Council; 2006. [...] The six intervals of the updated framework are as follows: 1) investigation of cases of novel influenza, 2) recognition of increased potential for ongoing transmission, 3) initiation of a pandemic wave, 4) acceleration of a pandemic wave, 5) deceleration of a pandemic wave, and 6) preparation for future pandemic waves. The following eight domains are used to organize response efforts within each interval: incident management, surveillance and epidemiology, laboratory, community mitigation, medical care and countermeasures, vaccine, risk communications, and state/local coordination.'"

This report "provides access to names and contact information for CRS experts on policy concerns relating to swine influenza A virus (H1N1). Policy areas identified include: 1) identification, diagnosis, and surveillance of the virus; 2) treatment and prevention-antiviral drugs (Tamiflu, Relenza) and vaccines; 3) declarations of emergencies; 4) official plans and organizational responsibilities; and 5) restrictions on travel and trade."

"On June 11, the World Health Organization (WHO) raised the level of influenza pandemic alert to phase 6, which indicates the start of an actual pandemic. This change reflects the spread of the influenza A(H1N1) virus, not its severity. Although currently the pandemic is of moderate severity with the majority of patients experiencing mild symptoms and making a rapid and full recovery, this experience could change. This report provides a brief overview of selected legal issues including emergency measures, civil rights, liability issues, and employment issues."

This webpage published by the Centers for Disease Control and Prevention as a resource for relevant data on the subject of H1N1 Flu. "Novel influenza A (H1N1) is a new flu virus of swine origin that was first detected in April, 2009. The virus is infecting people and is spreading from person-to-person, sparking a growing outbreak of illness in the United States. An increasing number of cases are being reported internationally as well. It's thought that novel influenza A (H1N1) flu spreads in the same way that regular seasonal influenza viruses spread; mainly through the coughs and sneezes of people who are sick with the virus. It's uncertain at this time how severe this novel H1N1 outbreak will be in terms of illness and death compared with other influenza viruses. Because this is a new virus, most people will not have immunity to it, and illness may be more severe and widespread as a result. In addition, currently there is no vaccine to protect against this novel H1N1 virus. CDC anticipates that there will be more cases, more hospitalizations and more deaths associated with this new virus in the coming days and weeks. Novel influenza A (H1N1) activity is now being detected through CDC's routine influenza surveillance systems and reported weekly in FluView. CDC tracks U.S. influenza activity through multiple systems across five categories."

"This report is intended to stimulate discussion within HHS, with other federal departments and across relevant organizations--both governmental and non-governmental--about how to build upon the successful elements of the response and concretely address areas that warrant improvement. […] Discussions, accompanied by careful analysis of scientific evidence, can inform concrete actions to improve pandemic and all-hazards preparedness. This report represents an early step in a multifaceted improvement process that will require continued participation by the public, and health and preparedness officials at all levels, both public and private. […] The 2009 H1N1 influenza pandemic, which was declared by the World Health Organization (WHO) in June 2009 and officially ended in August 2010, provided an important test of our nation's preparedness activities and our ability to respond and adapt to a large-scale, protracted public health emergency with the potential for enormous health consequences. […] It is appropriate for the Department of Health and Human Services (HHS) to step back and examine which aspects of our preparedness and response worked well and which did not, as well as which elements of our preparedness were not stressed in our response to the 2009 H1N1 pandemic, but could be in a very severe pandemic as experienced in 1918."

"The purpose of 'Preparing for the Flu: A Communication Toolkit for Businesses and Employers' is to provide information and communication resources to help businesses and employers implement recommendations from CDC's Guidance for Businesses and Employers to Plan and Respond to the 2009-2010 Influenza Season. […] The new guidance applies to any flu virus circulating during the 2009- 2010 flu season, not only 2009 H1N1 flu. It will be very hard to tell if someone who is sick has 2009 H1N1 flu or seasonal flu. It offers specific steps for business owners and managers to take to protect workers and to maintain continuity of operations. It provides guidance for the current flu conditions as well as for more severe flu conditions. This guidance also recommends that, based on current flu conditions, employees with flu-like illness stay home until at least 24 hours after they no longer have a fever (100 degrees Fahrenheit or 38 degrees Celsius) or signs of a fever (have chills, feel very warm, have a flushed appearance, or are sweating). This should be determined without the use of fever-reducing medications (any medicine that contains ibuprofen or acetaminophen). This is a shorter time period than the previous guidance, which recommended that sick people stay home for 7 days after symptoms began. The 7-day period would still be recommended in business settings under more severe flu conditions."

This Press Briefing on Swine Influenza from the Department of Homeland Security, Centers for Disease Control and Prevention, and White House from April 26, 2009 brought together many of the people that have the primary governmental responsibility in dealing with the situation to discuss the government's capacity and capability and the steps the government is taking to address this. The briefing explains the importance of cooperating with the Government of Mexico, the origination of the recent case of swine flu, and how the United States Government and all related governmental organs can take steps to prepare for and reduce the potential for further transmission. From a security perspective, there is no current evidence whatsoever that anyone has witnessed regarding the possibility of bioterrorism. According to Dr. Richard Besser, Acting Director, Centers for Disease Control and Prevention, "today we can confirm that there are 20 cases of swine flu in the United States. We have five affected states: There are eight cases confirmed in New York City, there's one case confirmed in Ohio, two in Kansas, two in Texas, and seven in California." According to Press Secretary Robert Gibbs, "in terms of anything that is affected economically both here and worldwide… it's probably far too early to determine whether that will be a case or whether that will have some factor." Secretary Napolitano and the Department of Homeland Security have the overall lead for coordinating the federal response to an influence epidemic in the United States. The department is closely coordinating with Health and Human Services and CDC to monitor the situation. The press briefing also explains the role everyone can play during the outbreak.

"Established just one week before Sept. 11, 2001, CIDRAP has, from the beginning, made public health preparedness a major focus. Our efforts have included evaluation of the public health system and its readiness to respond to an infectious disease crisis as well as analysis of the state of infectious disease medical practice and the ability of the nation's health care system to respond in the event of a catastrophe- perhaps one caused by a bioterrorist act. CIDRAP is a member of the Consortium on Law and Values in Health, Environment & the Life Sciences, which aims to support work on the legal, ethical, and policy implications of problems in health, environment, and the life sciences. The Consortium coordinates among and builds on the strength of 17 centers and programs at the University of Minnesota. Its goal is to advance knowledge, public understanding, and sound policy. It undertakes a wide range of activities including sponsoring public lectures and conferences; offering intramural funding to support faculty, students, and colloquia; recommending faculty hiring and programmatic innovation; encouraging and supporting curricular innovation; facilitating collaborative research; and advising on public policy. The Consortium is directed by its member centers and programs and is open to all points of view."

This web-based interactive document published by the National Archives and Records Administration is the homepage to a more extensive page with selected photos and documents related to the Influenza Epidemic of 1918. The following is taken from the website: "World War I claimed an estimated 16 million lives. The influenza epidemic that swept the world in 1918 killed an estimated 50 million people. One fifth of the world's population was attacked by this deadly virus. Within months, it had killed more people than any other illness in recorded history. The plague emerged in two phases. In late spring of 1918, the first phase, known as the 'three-day fever,' appeared without warning. Few deaths were reported. Victims recovered after a few days. When the disease surfaced again that fall, it was far more severe. Scientists, doctors, and health officials could not identify this disease which was striking so fast and so viciously, eluding treatment and defying control. Some victims died within hours of their first symptoms. Others succumbed after a few days; their lungs filled with fluid and they suffocated to death. The plague did not discriminate. It was rampant in urban and rural areas, from the densely populated East coast to the remotest parts of Alaska. Young adults, usually unaffected by these types of infectious diseases, were among the hardest hit groups along with the elderly and young children. The flu afflicted over 25 percent of the U.S. population. In one year, the average life expectancy in the United States dropped by 12 years."

"Global Viral's mission is to promote understanding, exploration and stewardship of the microbial world. Global Viral focuses on: (1) Leadership development. We support the next generation of leaders through institutional and on site training along with access to a network of mentors in their field. (2) Community development & education. We enable communities in the developing world to better manage their own challenges through scientific capacity development and health education. (3) Exploratory research. We organize and initiate research in the interest of scientific advancement and public health."

This is an archived version of the website on the "Great Pandemic: The United States in 1918-1919" published by the U.S. Dept. of Health and Human Services (HHS), Office of the Public Health Historian. The website provides historical information via selected photos and documents related to the Great Pandemic of 1918. The site includes section on Life in 1918; The Influenza Pandemic; Your State; Documents & Media; Biographies; and Learn More.

" The influenza (flu) epidemics that happen nearly every year are important events. Influenza is a respiratory illness that makes hundreds of thousands of people sick each year. The illness can cause severe health problems for the elderly and younger people with diseases, such as diabetes, heart or lung disease, and illness that can weaken the immune system. Typical primary influenza illness lasts about a week and is characterized by abrupt onset of fever, muscle aches, sore throat, and nonproductive cough. In some persons, severe malaise and cough can persist for several days or weeks. Influenza infection not only causes primary illness but also can lead to severe secondary medical complications, including influenza viral pneumonia, secondary bacterial pneumonia, worsening of underlying medical conditions, such as congestive heart failure, asthma, or diabetes, or other complications such as ear infections (i.e., otitis media) in children."