January 2008 — News
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Planning for the Next Disaster: Pandemic
Concern about a new influenza pandemic is based upon the emergence in 1996 of a new strain of avian influenza, H5N1, in Guangdong Province, China. The virus quickly spread, and, to date, more than 200 million domestic birds have died or been killed in an effort to halt the disease. Fortunately, although there have been hundreds of documented human infections with a 60 percent mortality rate, H5N1 is not easily transmitted from human to human. So far human cases have been largely confined to individuals who worked closely with infected poultry.
In short, H5N1 meets two of the World Health Organization’s conditions for a pandemic. All it lacks is the ability to spread easily between humans.
How Probable Is an Influenza Pandemic?
After a surge of publicity in 2006, avian flu has largely dropped out of the news. That does not mean, however, that the threat has gone away. New avian flu outbreaks continue although the mutation that would support human-to-human transmission has yet to occur. (See for example, www.who.int/csr/don/2008_01_03/en/index.html.)
With the H5N1 virus now firmly entrenched throughout the world, the probability of human cases has increased. Each additional human case gives the virus an opportunity to improve its transmissibility in humans and develop into a pandemic strain.
While they are careful to point out that the timing and severity of the next pandemic cannot be predicted, many scientists believe it is a matter of time until the next influenza pandemic occurs.
What Would a Pandemic Mean to My Institution?
During past pandemics, attack rates reached 25 percent to 35 percent of the total population. Under the best circumstances, assuming that the new virus causes mild disease, the world could still experience an estimated 2 million to 7.4 million deaths based on data from the 1957 pandemic.
In short, a pandemic would mean many (if not most) employees would not show up for work either because they are sick, are caring for sick family members, or are staying at home to avoid infection.
What Can My Organization Do About It?
While drug companies push antiviral immunizations as the cornerstone of a pandemic plan, the article “Strategies for mitigating an influenza pandemic” which appeared in the scientific magazine Nature (Nature 442, 448-452, 27 July 2006) argues that influenza prevention and containment strategies can be considered under the broad categories of antiviral, vaccine, and non-pharmaceutical (case isolation, household quarantine, school or workplace closure, restrictions on travel).
Unfortunately, although clinical trials are underway, vaccines effective against a pandemic virus are not yet generally available.
