Disaster/Pandemic preparedness

indigo girl · Oct 11, 2007

Can We Stand The Truth?

http://afludiary.blogspot.com/2007/10/can-we-stand-truth.html

indigo girl · Oct 11, 2007

http://crofsblogs.typepad.com/h5n1/2007/10/intensifying-th.html

Confronting Potential Influenza A (H5N1) Pandemic with Better Vaccines

Azizul Haque,*†‡ Didier Hober,† and Lloyd H. Kasper†

*Centre National de la Recherche Scientifique, Paris, France; †Dartmouth

Medical School, Lebanon, New Hampshire, USA; and ‡Université Lille 2,

Lille, France

http://www.cdc.gov/eid/content/13/10/1512.htm

Not an easy read even for those familiar with the terminology so I do

expect some commentary from the flu blogs that might make this information

easier to take in, and will add it to this post as it becomes available.

This work asks more questions than it answers reflecting all of the

unknowns about H5N1 and the human immune response.

The fact that this abstract is on the CDC site says much about the importance

of finding the answers to these questions. They are expecting that a pandemic

will occur at some not so distant point in the future, and they are very

concerned that H5N1 will be the cause.

indigo girl · Oct 11, 2007

Clues from the past may influence preparations for the future

http://www.flutrackers.com/forum/showpost.php?p=104306&postcount=5

The incredible lethality of the 1918 flu strain is not well understood, despite having been under intense scrutiny for many years. Now, a new study published by Cell Press in the October issue of the journal Cell Host & Microbe unravels some of the mystery surrounding the devastating 1918 pandemic and provides key information that will help prepare for future pandemics.
It is relatively rare for an influenza virus to be virulent enough to cause death in healthy humans. Many deaths associated with influenza are caused by the combined influence of viral disease and the following secondary bacterial infection. Although the 1918 pandemic strain was one of the few influenza viruses capable of killing healthy victims on its own,the majority of fatal cases from the “Spanish Flu” can be attributed to secondary bacterial pathogens rather than primary viral disease.This important interaction between influenza viruses and bacteria is not well understood.
Dr. Jonathan A. McCullers from the Department of Infectious Diseases at St. Jude Children’s Research Hospital in Memphis, Tennessee and colleagues examined this interaction by studying a newly discovered influenza A virus (IAV) protein, called PB1-F2. The gene encoding PB1-F2 is present in nearly all IAVs, including highly pathogenic avian IAVs that have infected humans and the IAV associated with the 1918 pandemic. “PB1-F2 was recently shown to enhance viral pathogenicity in a mouse infection model, raising questions about its effects on the secondary bacterial infections associated with high levels of influenza morbidity and mortality,” explains Dr. McCullers.
The finding that PB1-F2 promotes lung pathology in primary viral infection and secondary bacterial infection also provides critical information for the future. “Given the importance of IAV as a leading cause of virus-induced morbidity and mortality year in and year out, and its potential to kill tens of millions in the inevitable pandemic that may have its genesis in the viruses currently circulating in southeast Asia, it is imperative to understand the role of PB1-F2 in IAV pathogenicity in humans and animals,” says Dr. McCullers. “These findings also reinforce the recent suggestion of the American Society for Microbiology that nations should stockpile antibiotics for the next pandemic, since many of the deaths during this event are likely to be caused by bacterial super-infections.”

Stockpile antibiotics and offer the pneumonia vaccine to everyone not just the

elderly, the immuno compromised, or those with pre-existing lung pathology...

indigo girl · Oct 16, 2007

An influential voice weighs in on pandemic preparedness

http://www.scottmcpherson.net/journal/2007/10/16/an-influential-voice-weighs-in-on-pandemic-preparedness.html

Thomas P.M. Barnett has written an excellent opinion piece for the Scripps-Howard News Service. Titled "In the future: health screening at airports," the piece clearly and plainly lays out the enormous difficulties nations and the aviation industry in general will face when the next pandemic arrives (via a scheduled passenger airline flight).
Barnett is no stranger to planning. In fact, if you have not heard of him, let me condense his story. Barnett was in the Pentagon in the late 1980s...

The White House recently released its new homeland security strategy and, unlike the initial 2002 version, this one focuses far more on natural disasters as opposed to terrorist strikes. That's a welcome change not simply because Hurricane Katrina was a humbling experience, but because globalization's growing connectivity means a naturally occurring pandemic is the most likely mega-disaster we'll face in the near term.
A bird flu-triggered pandemic could easily become the most deadly global outbreak since the 1918 Spanish Flu, which killed at least 20 million people worldwide. In the United States alone, over one-quarter of the population became sick, with approximately 600,000 people succumbing to the virus. Extrapolated to today's American population of 300 million, that yields a potential death count of 1.5 million to 2 million.

indigo girl · Oct 17, 2007

Report: Children Overlooked In Pandemic Preps

http://afludiary.blogspot.com/2007/10/report-children-overlooked

-in-pandemic.html

[quote name=//afludiary.blogspot.com/2007/10/report-children-overlooked-

in-pandemic.html]

...the H5N1 virus has primarily attacked those under the age of 40.

Children have been particularly hard hit.

But currently our ability to protect children during a pandemic, with

antiviral medications and PPE's (Personal Protective Equipment) is

limited.

A disturbing report from The Trust For America's Health and the

American Academy of Pediatrics.

The American Academy of Pediatrics (AAP) and Trust for America's Health (TFAH) issued a report in October 2007, Pandemic Influenza: Warning, Children At-Risk, which finds that children and teens between the ages of 0-19 account for nearly 46 percent of all H5N1 "bird" flu deaths. The report also identifies gaps in U.S. preparedness for treating and caring for children during a possible pandemic flu outbreak.
Four key areas of concern raised in the report include: child-appropriate doses of vaccine and medications; management and treatment of children who become ill; including children in strategies to slow the spread of influenza in communities; and caring for and supervising the health of children if schools and childcare facilities are closed for extended periods of time.

http://crofsblogs.typepad.com/h5n1/2007/10/us-bird-flu-pla.html

My grandfather, an actor for 70 years, told me that the slogan in the business was, "The show must not go on"--not if someone's hurt or ill.
And if a pandemic breaks out, the vast majority of us should forget about school and work. Some workers will be essential, especially those providing electricity and clean water. The rest of us, for a couple of weeks at least, can consider outselves locked down.
So how do we pay the rent and buy the groceries? We don't. Suspend most business transactions, and worry later about compensation. Designate the military, or neighbourhood volunteers, to distribute emergency rations door to door.

indigo girl · Oct 19, 2007

Margaret Chan MD, Director-General of the World Health Organization

I did not attend the CIDRAP Conference in February, 2007 where this video

was shown. I almost got there, but changed my plans at the last minute.

Dr. Chan will appear in a screen to your right. You do not have to press

any buttons, just wait for the screen to appear, and for her presentation

to begin. You do not have to be a subscriber for the video to play.

Just be patient for a few seconds and view it.

I have to say that even though everything Dr. Chan is saying in this

presentation is well known to me, just hearing her speak so

clearly and honestly of what might occur, has shaken me. Though

many who research this information will say that her estimates

of the possible future cases may be too conservative, the numbers are

still hugh. This event will change the world, and challenge all of us.

The video will take 16 minutes of your time. I hope that the

very serious nature of Dr. Chan's message will cut thru the apathy and

disbelief about the possibility of H5N1 triggering the next pandemic,

and encourage some individual planning and family preparation.

Share it with people that you care about.

https://umconnect.umn.edu/chan

(hat tip crofsblog)

indigo girl · Oct 20, 2007

Kids Are Most at Risk

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

With permission from Effect Measure:

Children and flu: the little engines that could?
Category: Bird flu * Pandemic preparedness * Public health preparedness
Posted on: October 19, 2007 7:12 AM, by revere
The President vetoes health care for kids, the Congress almost overrides it but not quite, and the American Academy for Pediatrics says the next likely pandemic flu bug, influenza A/H5N1, targets children and is being overlooked as the country whistles past the pandemic graveyard:
"Right now, we are behind the curve in finding ways to limit the spread of a pandemic in children even though they are among the most at risk," said Dr. John Bradley of the American Academy of Pediatrics, which co-authored the report with the Trust for America's Health.
[snip]
Children have long seemed particularly vulnerable to H5N1, possibly because they are more likely to touch or play with the diseased birds who spread it. Wednesday's report says nearly 46 percent of bird flu deaths since 2003 were among people 19 or younger. (AP)
This is an important handle for flu planners. In doing environmental and occupational cancer work for many years I observed that telling a worker he might get cancer in 30 years because of an exposure at work as often as not is met with the reaction that he will certainly have to pay the rent in thirty days. But suggest to him his children or family will be harmed and he walks off the job in 7 seconds. Concern for the next generation (our children) is hardwired into the human brain. Without it we wouldn't have survived as a species.

The concern in this case is entirely legitimate. It is not a scare tactic. The trick will be to turn it into something constructive to use as an engine for getting the community to prepare.

indigo girl · Oct 22, 2007

Making the 'V' List

This is important information for all of us.

A draft federal plan will be outlined Tuesday in Washington on

how the distribution of a pandemic-strain specific vaccine will be prioritized.

It is unlikely that there will be a specific vaccine developed until after

some months into the actual pandemic event. Most of our

citizens will have to try to survive without the protection of a vaccine

for quite some time, and the average person on the street, is not

likely to be aware of this information even after this report comes

out. There is so much faith in our modern medical system that

this is going to come as a great shock to many.

http://afludiary.blogspot.com/2007/10/making-v-list.html

The first pandemic-strain specific vaccine will likely take 4 to 6 months to begin rolling off the manufacturing lines, and then, only in limited quantities. Each month we may see a few million more doses of vaccine made available, but many people may find themselves waiting for more than a year to receive an inoculation.

In the early weeks of a flu pandemic, the first to receive scarce supplies of vaccine will include the military, medical and emergency workers, pregnant women and babies -- nearly 23 million people-under a draft federal plan to be outlined Tuesday in Washington.
At the back of the pack, in a pandemic of the sort that killed 20 million Americans in 1918, would be 74 million sick and elderly adults and 122 million healthy people ages 19-64.
"The committee tried to identify those who would be critical to national and homeland security, critical to fighting the flu itself, and critical to maintaining a functioning society."
In meetings, the working group and other participants highlighted pregnant women and children as a priority, the report says. This also is an efficient use of vaccine, it says, because immunizing pregnant women protects their newborns, too, and children need lower doses, stretching limited supplies.
"The more severe the pandemic, the more aggressive people would be in trying to protect critical workers," Raub says. "But if it's at the milder end, critical workers would be a smaller group, so there would be more emphasis on getting everyone vaccinated. The disruption of society wouldn't be the same."
Since 2003, WHO has documented 331 human cases, including 203 deaths from the virus, most of them in Southeast Asia.

indigo girl · Oct 25, 2007

Draft Guidance on Allocating and Targeting Pandemic Influenza Vaccine

Should be required reading for all citizens. This document is important.

http://pandemicflu.gov/vaccine/prioritization.html

One of the most important findings of the working group analysis, and the strongest message from the public and stakeholder meetings, was that there is no single, overriding objective for pandemic vaccination and no single target group to protect at the exclusion of others. Rather, there are several important objectives and, thus, vaccine should be allocated simultaneously to several groups. Each of the meetings came to the same conclusions about which program objectives are most important:

Protecting those who are essential to the pandemic response and provide care for persons who are ill,

Protecting those who maintain essential community services,

Protecting children, and

Protecting workers who are at greater risk of infection due to their job.

In addition to these, working group discussions highlighted the important Federal objective of maintaining homeland and national security.

indigo girl · Oct 25, 2007

From Effect Measure with permission:

The Editors of Effect Measure are senior public health scientists and practitioners. Paul Revere was a member of the first local Board of Health in the United States (Boston, 1799). The Editors sign their posts "Revere" to recognize the public service of a professional forerunner better known for other things.

Pandemic flu vaccine capacity: enough? too much? just right?

Category: Big Pharma * Bird flu * Pandemic preparedness * Vaccines

Posted on: October 25, 2007 7:18 AM, by revere

The "experts" have spoken to WHO and WHO has spoken to us: because of the march of science, there's been a large upswing in the estimates of how much vaccine the world could produce in a pandemic -- if such a vaccine existed and there was a way to deliver it. But if there was one and it could be delivered, then WHO thinks we could produce up to a 4.5 billion doses by 2010 as a result of new manufacturing technologies and techniques to make the produced antigen go farther. A lot of "ifs," to be sure, but without the ability to make the stuff the rest doesn't matter.
At the moment we make a half billion doses of seasonal flu vaccine a year (up from half that), but this capacity would have to double to a billion and be diverted entirely to the pandemic strain. WHO's Press Release, lightly but faithfully edited by news outlets like Dow Jones Online, is still upbeat. Press release stenography is no substitute for reporting (although it has become the norm for the American press), so it's good to have excellent reporters like Canadian Press's Helen Branwell around who ask the right questions and knows the right people to ask them of:
The World Health Organization issued an optimistic update on prospects for pandemic influenza vaccine Tuesday. But industry insiders and public health experts wondered if tinted glasses were casting an overly rosy glow over the global vaccine production situation.
And some openly admitted the efforts to grow production potential could soon lead to a glut in seasonal flu vaccine stockpiles.
"We are very concerned about an overcapacity situation," said Len Lavenda, a spokesperson for the industry's biggest player, sanofi pasteur.
At a news conference in Geneva, the senior WHO official in charge of the pandemic vaccine file said the effect of expanded manufacturing capacity for seasonal flu vaccine, coupled with the success of vaccine-stretching compounds known as adjuvants, means several billion more people could be vaccinated if a pandemic occurs in the next few years. (Helen Branswell, Canadian Press)
Here's the problem. Our current capacity to produce the trivalent seasonal influenza vaccine is nowhere near sufficient to supply the demand during a pandemic, even assuming that the current plants would be quickly and completely switched to the new pandemic strain. In terms of demand for seasonal flu vaccine, however, there is insufficient demand. Every year unused doses are destroyed. Thus the "market" doesn't work to assure us sufficient productive capacity for a pandemic that hasn't occurred yet and whose timing, severity and very existence is in doubt. And Big Pharma has noticed:
"I can only speak for sanofi pasteur. But we're the largest supplier. We're producing over 40 per cent of the world's flu vaccine. And we are very concerned about an overcapacity situation."
"That's not healthy for industry."
He said overproduction could drive some producers out of the field. He pointed to the recent past, when Wyeth Pharmaceuticals withdrew from the flu vaccine production market in 2002 rather than incur the cost of upgrading an aging plant.
"You don't have to turn the history book back too many chapters to see that that's real, that's not idle, that's not just a theoretical possibility. That's reality," Lavenda said.
An industry association director also questioned the sustainability of a one billion dose a year flu vaccine market.
"If there is enough demand they are ready to increase it up to about one billion - that's max, max, max. You're talking about 24 hours, seven days a week, 12 month whole production," said Dr. Ryoko Krause, of the International Federation of Pharmaceutical Manufacturers and Associations.
"But if there's no demand it's not going to increase," she said from Geneva. "We have always said that there's no way that the industry is going to keep producing or keep the capacity unused just for the potential of creating one billion doses."
The obvious conclusion is that keeping the influenza vaccine business in private hands and letting The Market takes its course is a recipe for failure. Big Pharma won't do the overbuilding required. That's a public function. Sometimes inefficiency and redundancy are the only solutions for sufficient stand-by capacity to produce vaccine in a pandemic -- should an effective vaccine exist.
That means international cooperation to build a network of Regional Influenza Vaccine Institutes, perhaps ten to twelve, globally distributed and each with sufficient capacity to fulfill all regional seasonal influenza vaccine needs and enough reserve capacity to ramp up to supply its region, at cost, with a pandemic strain vaccine. This would also address the inequity issue that is threatening to scuttle the current surveillance system. A lot of vaccine will be go unused in this scenario, too. But it will at least be there when and if needed.
Big Pharma has a good point. We should listen to them. They aren't the ones to do the job. And they won't.

I wonder what the population of Planet Earth is right now.

indigo girl · Oct 25, 2007

Perspective needed on HHS Flu Vaccine Allocation Plan

http://www.scottmcpherson.net/journal/perspective-needed-on-hhs-flu-vaccine-allocation-plan.html

Scott McPherson is the CIO of the Florida House of Representatives.

A vaccine ...will not be in your arm for at least six to eight months following the start of an influenza pandemic. That is Wave Two, maybe even Wave Three of the pandemic, since we have no idea whatsoever how many waves the Next Pandemic will be, or how long it will take each wave to travel. Even that six to eight month vaccine timeframe is for Tier A and B recipients. Forget about the general public. Vaccine will be trickling out with agonizing slowness.
So any organization that is seriously concerned about its place in the pecking order for vaccine is decidedly missing the point. That point is that there will be a six to eight month window of incredible suffering, lost wages, declining economic news, hunger -- and death -- for many months prior to the availibility of vaccine. That means organizations need to focus NOW on such basic things as hand sanitizer, gloves and masks. They need to focus on Tamiflu if they can get it, but if they can't, then they need to focus elsewhere. All need to focus on the things that Momma taught us -- hand washing, personal hygiene, and keeping a respectable distance from strangers.

indigo girl · Oct 25, 2007

Perspective needed on HHS Flu Vaccine Allocation Plan

http://www.scottmcpherson.net/journal/perspective-needed-on-hhs-flu-vaccine-allocation-plan.html

A vaccine ...will not be in your arm for at least six to eight months following the start of an influenza pandemic. That is Wave Two, maybe even Wave Three of the pandemic, since we have no idea whatsoever how many waves the Next Pandemic will be, or how long it will take each wave to travel. Even that six to eight month vaccine timeframe is for Tier A and B recipients. Forget about the general public. Vaccine will be trickling out with agonizing slowness.
So any organization that is seriously concerned about its place in the pecking order for vaccine is decidedly missing the point. That point is that there will be a six to eight month window of incredible suffering, lost wages, declining economic news, hunger -- and death -- for many months prior to the availibility of vaccine. That means organizations need to focus NOW on such basic things as hand sanitizer, gloves and masks. They need to focus on Tamiflu if they can get it, but if they can't, then they need to focus elsewhere. All need to focus on the things that Momma taught us -- hand washing, personal hygiene, and keeping a respectable distance from strangers.

Having a difficult time believing any of this? Take off the rose colored glasses, and listen again to Dr. Margaret Chan, Director General of the World Health Organization:

https://umconnect.umn.edu/chan