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News
21 August 2007
- Editorial: Close airports or pandemic influenza will fly in
- Australian flu season increases demand for anti-virals
- Pandemic Influenza reality show
- Financial Sector Pandemic Exercise
- NIH Scientists Target Future Pandemic Strains of H5N1
- WHO updates influenza timeline
- Non-pharmaceutical interventions in the 1918-19 pandemic
- Wildlife segregation vs culling
- Space technology to fight avian influenza
- Pandemic Influenza and Pregnancy
- Pandemic modelling
- National Strategy for Pandemic Influenza Implementation Plan One Year Summary
Editorial: Close airports or pandemic influenza will fly in
Two pieces of evidence have emerged which may indicate that border control measures designed to slow a strain of pandemic influenza from entering Australia may be ineffectual.
As identified in Australia’s National Action Plan for Human Influenza Pandemic, if a pandemic influenza strain did appear overseas, one of the key action Australia could take would be to stop it from entering the country.
This would buy the time needed to mobilise health resources, create influenza clinics, and distribute personal protective equipment. So when mass sickness does occur, deaths will be minimised.
Border control measures will include requiring aircraft captains to declare the health of all people on board, requiring passengers to fill in health declaration cards, scanning passengers with thermal cameras to locate those with temperatures above 38C, deploying border nurses to make assessments of passengers, and transferring suspect cases to hospitals.
If you pass through the screening and return to your home and family but have come into contact with a person later identified as infected, health authorities will instigate contract tracing. This involves rapidly locating you, educating you about the disease, isolating you, and treating you as appropriate.
However the evidence from two recent experiences indicates that this list of border security measures will not be effective in keeping out the disease.
This means that Australia’s health officials will be faced with only one effective way to keep out the infection. That is, to stop international flights from arriving.
On 2 July, a passenger infected with polio arrived in Melbourne from Bangkok. The majority of the 238 people on the flight were tracked down quickly and given polio shots or placed in home quarantine.
However 15 passengers were never located. If the passenger was carrying the pandemic influenza variant, then these unlocatable people would have already introduced the virus into the Australian population.
A few months ago, Australia’s largest ever health simulation exercise was held at Brisbane airport and at several other locations.
The exercise included the arrival of a plane carrying 155 passengers from a fictitious country where pandemic influenza outbreaks had occurred. Passengers were screened, and where appropriate, quarantined, hospitalized and treated.
The lessons learnt from contract tracing were sobering. These included that there were difficulties in explaining to non-English speaking contacts, that the effort of tracking down passengers placed significant demands on staff who had to locate the contacts, and there were problems sustaining these efforts over several days.
These two incidents highlight the problems of dealing with just one infected person or one planeload. Imagine the effort required when there are multiple planes arriving from different infected countries simultaneously.
Given that there are about 50,000 inbound and outbound passengers a day in Australia, it is an almost certainty that infected people would slip through border control measures. And locating infected people before they had the time to introduce the virus into our cities, would be near impossible.
Consequently, the Australian Government’s expectation that border control would contain the virus at the borders for a reasonable period of time is completely unrealistic. The only practical way of significantly delaying the spread of pandemic influenza is to suspend all air travel to Australia.
To be effective, a decision would have to be made within hours of an outbreak of a highly transmittable human to human infection occurring and where it is believed that the disease is not contained in quarantined areas.
Closing the airports would leave about 1 million Australians stranded overseas but it would save tens of thousands of Australian lives at home.
Athol Yates is the Executive Director of the Australian Homeland Security Research Centre and editor of three books on influenza pandemics in Australia.
Ensuring your organisation and staff are prepared for a pandemic influenza outbeak. For a demonstration, please contact Keanne Stephenson on 0412 472 766 or email keanne.stephenson@pandemic.net.au
Australia is experiencing a particularly bad flu season this year with 3084 cases reported to health authorities already, compared to 1213 in 2006, which has seen an increase in demand for antiviral medications such as Relenza and Tamiflu
These antiviral medications are available on prescription for people with influenza, and if taken within 48 hours of onset of symptoms, can shorten the duration and lessen the severity of the illness. In addition, these medications can be taken prophylactically by people to protect themselves from infected family members.
A problem has arisen in accessing the medication within the 48 hour window of opportunity. As people normally go to the doctor at least 24 hours after the onset of symptoms, and then if the pharmacist does not have the anti-virals on the shelve, it typically takes 24 hours for the backorder to be filled. Consequently a number of people will not be able to get the anti-virals in time.
Samantha Winter from GlaxoSmithKline Australia said there has been a significant increase in the demand for its influenza antiviral products this flu season, particularly as the number of cases has increased.
While higher demand has been experienced, the suppliers of these medicines have advised that stocks are available nationally and urgent pharmacy orders can be fulfilled within 24 hours where required.
The Jefferson County Department of Health and Environment and the Colorado Department of Public Health and Environment in the United States of America are organising a reality show designed to emphasise the importance of pandemic planning.
The What If? Colorado campaign aims to educate residents about the importance of having a home emergency kit, getting an annual flu shot, and preparing for an outbreak of pandemic influenza by asking the following questions:
What if pandemic influenza strikes Colorado again? What if an emergency forces you and your family to "shelter in place" for an extended period of time? What if you had to live without power for a week or more?
Contestants will live in the What If? house for three and a half days from September 20- September 23 as they learn how to prepare for and survive a variety of "disasters" in an effort to become the What If? Colorado Champion and win $2500.
Advice on preparing a home emergency kit and other pandemic planning measures can be found at www.whatifcolorado.com
The Financial Banking Information Infrastructure Committee (FBIIC) and the Financial Services Sector Coordinating Council (FSSCC) in the USA will be conducting a exercise to test the financial sector's response to a pandemic emergency.
The exercise will be run from September 24 to October 12 through a secure website.
The US Treasury has encouraged financial institutions to participate as it is a key opportunity to test pandemic plans and identify room for improvement.
More information about the exercise is available here .
A team of scientists from the National Institute of Allergy and Infectious Diseases in the USA have developed a strategy to generate vaccines and antibodies to target predicted strains of H5N1 avian influenza before they evolve naturally.
The research led by Dr Gary Nabel was published in the August 10, 2007 issue of the journal Science.
According to Dr. Nabel, their findings should contribute to better surveillance of naturally occurring avian flu outbreaks by making it easier to recognise dangerous mutants and identify vaccine candidates that might provide greater efficacy against such a virus before it emerges.
A copy of the paper can be found here.
The World Health Organisation has released its regular update of its H5N1 avian influenza timeline.
The timeline chronicles both animal and human infections starting from the original poultry infections in 1996 and human infections in 1997.
The timeline is available here.
Non-pharmaceutical interventions such as school closures and quarantine reduced the impact of the 1918-19 influenza pandemic according to a study published in the August 8 issue of the Journal of the American Medical Association .
The study involved scientists from the Centers for Disease Control and Prevention (CDC) and the University of Michigan Medical School's Center for the History of Medicine who completed an exhaustive review of public records such as health department reports, U.S. Census mortality data and newspaper archives to determine whether public health measures such as school closures and cancellation of public events impacted death rates during the pandemic.
The findings concluded cities that began interventions earlier had more success in decreasing excess deaths than those that implemented the measures later, regardless of how long the later interventions were in place or how they were executed.
Full text of the study can be found here.
Wildlife segregation vs culling
Wildlife experts from the Wildlife Conservation Society and the United Nations Food and Agriculture Organisation have spoken out against culling wild birds to prevent pandemics.
In the paper published in the Journal of Wildlife Diseases , Dr William Karesh from the Wildlife Conservation Society suggests separating animals in places where they often commingle, such as market-places, is a far more cost effective approach than having to cull them after diseases have mutated in the dirty environments.
The suggested control strategies at these trade hubs include strengthening and enforcing of disease-control and trade regulations, developing and implementing quarantine procedures, shifting the costs of controlling outbreaks to the animal suppliers and vendors, and ending trade that is unsustainable.
Last Pandemic Courses for 2007
AHSRC will be running its last pandemic courses for the year in August.
- Working as your Organisation's Pandemic Officer will be held on Tuesday 28 August in Canberra.
- Pandemic Influenza Exercise Day for Workplace Officers will be held on Wednesday 29 August in Canberra.
Visit the AHSRC Events page for more information (including information on accommodation options close to the Centre).
Remember: the tools and methods used to prevent Pandemic Influenza can be utilised to prevent other infectious diseases that often
debilitate
an organisations workforce.
This is your last opportunity to participate in Pandemic training with the AHSRC.
For information on holding in-house pandemic training please contact Eleonor on 02 6161 5143 or events@homelandsecurity.org.au
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The Information, Communication and Space Technology Division of the Economic and Social Commission for Asia and the Pacific (UNESCAP) hosted a meeting on space technology and avian influenza from 1 to 3 August in Bangkok .
The meeting discussed a variety of ways to use space-based technologies in the fight against avian influenza including geographic information systems (GIS), remote sensing (RS) and the Global Positioning System (GPS), which could help to monitor and determine the migratory routes of wild birds which are believed to play a role in spreading the disease.
Participants also discussed ways for countries to cooperate space technology and develop global influenza monitoring and effective early warning systems. More information.
Providers of obstetric services have an important pandemic planning role, according to a report in the May issue of Obstetrics & Gynecology.
Obstetric services and facilities will be disproportionately hit during an influenza pandemic due to increased morbidity and mortality experienced by pregnant women.
The article by Dr Richard Beigi summarises the current pandemic threat to obstetric providers and facilities and provides suggestions for basic pandemic planning efforts.
A copy of the article can be purchased here: http://www.greenjournal.org/cgi/content/abstract/109/5/1193
A variety of developments have occurred in the field of pandemic modelling, including forecasting models and artificial immune systems.
Researchers at Los Alamos National Laboratory have created an epidemiological forecasting simulation model called EpiCast which examines the spread of pandemic influenza should it become transmissible between humans.
Unlike other models, EpiCast accounts for the natural variability in any population, taking into account factors such as age, household size demographics, population density, immunity status (i.e. vaccinated or immunocompromised), and worker mobility.
Additionally, researchers at VaxDesign in collaboration with a variety of universities and research institutes have developed a hard-ware based artificial immune system which mimics the human responses to drug candidates.
It can rapidly simulate clinical trials including the effect of a vaccine on human population subgroups where responses can be clustered into groups that capture genetic diversity and other important population characteristics such as age, gender, and disease.
National Strategy for Pandemic Influenza Implementation Plan One Year Summary
The US Homeland Security Council has issued the National Strategy for Pandemic Influenza Implementation Plan One Year Summary, to give an overview of the goals achieved since the plan was released one year ago.
According to the report, the USA now has anti-viral medications stockpiled to treat nearly 50 million people, vaccine available for about 6 million people with plans in the works to stockpile enough for 20 million people, and plans to invest in more anti-viral and vaccination development in the future.
The summary reiterates that pandemic planning is still crucial and "the stakes are high, and our greatest enemy is complacency."
The summary is available here.
http://www.whitehouse.gov/homeland/nspi_oneyear.pdf
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