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February 2, 2006

Planning for a Pandemic

Experts Gather to Strategize about Avian Flu

Although the current risk of contracting the avian flu virus in the U.S. is low, public health leaders who spoke at a Dean’s Symposium at the Johns Hopkins Bloomberg School of Public Health cautioned that critical gaps exist in prevention and protection plans, as the threat of a pandemic becomes increasingly real.

“I see this as a call to arms; I think we have a lot of work to do,” said Trish Perl, MD, MSc, an  associate professor of Medicine and Pathology at the Johns Hopkins School of Medicine and senior house epidemiologist at Johns Hopkins Hospital. “The burden on health care settings could be overwhelming,” said Perl, who noted that the number of acute care hospital beds is decreasing across the country.  

To convey a sense of the scope of an influenza pandemic, Perl presented a hypothetical scenario in which 35 percent of the U.S. population is affected. Maryland is projected to have 4,647 deaths and 20,767 hospitalizations, while deaths in Washington, D.C., are expected to number 539, and hospitalizations totaling 2,321.

In the past two years, the H5N1 avian flu virus has spread rapidly across Southeast Asia?infecting domestic poultry flocks and wildfowl?and is making its way into Europe and Russia. According to the World Health Organization there have been 160 confirmed human cases of the virus, and 85 deaths, as of Jan. 30, 2006. In all cases the source of infection was determined to be direct contact with diseased poultry. Evidence suggests that the virus hasn’t acquired the ability to spread easily from person to person.

Perl said the response of health care facilities in this country to a global flu pandemic would likely be similar to the measures put in place by Toronto hospitals during an outbreak of severe acute respiratory syndrome (SARS) in 2003. They include the screening of all people entering health care institutions, identification of high-risk patients, implementation of infection-control priorities and the use of protective gear such as masks and ventilators.  

“I don’t think there’s any excuse for us not being prepared after what happened with SARS,” said Perl.

Jean Taylor, MD, DrPH, an epidemiologist with the Maryland Department of Health and Mental Hygiene, said that while there is little risk of being infected with avian flu in the U.S. right now, certain groups are more susceptible to infection in the event of an outbreak. Taylor said the U.S. Centers for Disease Control (CDC) has identified health care employees and workers who have direct contact with poultry as groups that should follow CDC’s protection guidelines.

Suggested measures include the use of gloves, masks and eye protection, seasonal influenza vaccinations and regular monitoring of workers by health officials. In addition, poultry processing houses in the Delmarva region?one of the world’s largest poultry production sites?are working with local and state governments to prevent contamination of their flocks and to maintain the health of workers.

Taylor said that travelers to areas affected by avian influenza are not considered to be at elevated risk unless they are exposed directly to poultry, although the CDC recommends monitoring the health of returning travelers for ten days.

Georges C. Benjamin, MD, FACP, executive director of the American Public Health Association, maintained that health officials must approach the development of preparation and response strategies with a sense of urgency. “We have to have a very clear plan to deal with the first positive [infected] bird,” he said, “and we can anticipate that’s going to happen in the next 12 months.”

A former Maryland health secretary, Benjamin said he found it instructive to review the history of the 1918 flu pandemic, which claimed the lives of 675,000 American and killed 40 million people worldwide. He called for improvement of vaccine production and distribution, vaccinations of all at-risk groups and increased use of non-pharmacological interventions. “Wouldn’t it be wonderful if we could get people to wash their hands?” he asked.

Benjamin raised the question of what effect an influenza outbreak would have on critical institutions and services—including schools, sanitation and law enforcement—as well as  public events and activities. “I certainly don’t want to be the person who has to make the decision to cancel the Superbowl,” he said, “but those are the kinds of tough decisions that are going to have to be made.”

On the local front, the commissioner of Baltimore’s Health Department, Joshua Sharfstein, MD, voiced concerns about the city’s capability to respond adequately to an influenza crisis, in light of federal budget cuts to his agency.

“If a pandemic hits, the local health departments are on the front lines,” Sharfstein said. “Our funding is getting cut, not just for preparedness, but for everything.” —Jackie Powder Frank