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HHS Releases Draft Flu Pandemic Response Plan

Kate Traynor

The Department of Health and Human Services (HHS) this week released a draft proposal for dealing with an influenza pandemic in the United States.

In a statement, HHS Secretary Tommy G. Thompson described the proposal as a "roadmap on how we as a nation, and as a member of the global health community, respond to the next pandemic influenza outbreak, whenever that may be."

The proposal outlines general strategies for handling a pandemic but is not a detailed response plan. HHS expects the document to guide pandemic planning at the national, state, and local levels. The public has 60 days to submit comments on the proposal to HHS.

Centers for Disease Control and Prevention (CDC) Director Julie L. Gerberding said at a press conference today that if an influenza pandemic were to occur now, "we don't have enough capacity to reliably create all of the vaccine that we could need."

The influenza pandemic of 1918-19 is blamed for 675,000 deaths in the United States and killed more than 50 million people worldwide, according to HHS. The origin of the virus responsible for that pandemic is unknown.

The two most recent global influenza pandemics—1957–58, and 1968–69—were caused by viral strains that arose from genetic reassortment between human and avian influenza viruses, according to CDC.

Several human deaths in Asia this year have been attributed to avian influenza A viruses, and CDC stated that such viruses continue to pose a theoretical risk of recombination with human influenza viruses that could lead to a new influenza pandemic.

Gerberding said that none of the influenza virus strains currently circulating in the world appear likely to cause a pandemic, but she noted that "anything can happen, and we remain very vigilant for the early identification of a pandemic strain."

In its draft plan, HHS proposes collecting potentially pandemic influenza strains for possible use in vaccines. The plan notes that six to eight months typically lapse between the time a new influenza strain is identified and a corresponding vaccine is developed and licensed. Gerberding indicated that the time frame might be shorter during a pandemic, when a vaccine would need to be developed from just one influenza strain instead of the three strains that are used for the annual vaccine.

Because certain antiviral drugs can be effective against influenza, the proposal calls for maintaining a supply of these medications in Strategic National Stockpile or in state or local stockpiles.

The proposal states that the goals of antiviral prophylaxis include limiting illness and death from influenza infection and reducing "social and economic disruption" during the pandemic.

The document notes that antiviral therapy is in limited supply and is most effective in the first days after infection. HHS recommends that specific strategies be developed to make the best use of antiviral drugs during a pandemic.

Gerberding said the proposed plan is important "because it brings into play all of the other things that we need to do to protect people" during a pandemic, when supplies of influenza virus vaccine and antiviral drugs would be insufficient.

For example, she said, the proposal envisions temporary isolation of people infected with influenza and the use of "maximum protection" for health care workers who care for sick patients. Gerberding described such infection control procedures as "old fashioned but tried and true methods for protecting people." She said that "the pandemic plan includes provisions to make sure that our communities are prepared to take those kinds of steps in the short run if we were faced with a pandemic situation."

HHS stated that planning for an influenza pandemic is part of a national focus on public health that builds on bioterrorism-response plans as well as threats posed by naturally occurring diseases, such as severe acute respiratory syndrome. According to HHS, the United States has spent $3.7 billion since Sept. 11, 2001, to improve the nation's public health infrastructure.