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-------- Original Message --------
27 April
2009
IDIN:
Pathobiologics
International: Biodefense
Threat Analysis & Communication Center
Subject: Pandemic Influenza: Contingency Planning Discussion
Dear Colleagues:
We are now into the "5th week" of an infectious disease
outbreak of a zoonotic pathogen that presented a pandemic threat
to
the international community, in a world where a high consequence
pathogen can spread across the globe in 12-24 hours (IHR).
Epidemiological analysis of travel and population exposure, from March
18 when the Government of Mexico began detecting cases,
encompasses our current challenge.
In the context of international economic emergency
stabilization, immuncompetance of a population that is in the midst of
a economic downturn that has devastated developing countries, is a key
variable. I have always been focused on the importance of
impoverished populations, in the context of emerging infectious
diseases, serving as an incubator for high consequence strains.
This is the reason for my infrastructure development focus on
geographic regions that encompass extreme poverty (India, China,
Africa, etc., etc.).
Two and a half billion people have no access to basic sanitation and
900 million people no clean water. -- UK Department for International Development.
Since the high consequence strain in question is noted as resistant to
the antiviral drugs amantadine and rimantadine,
caution must
be exercised regarding the use oseltamivir or zanamivir, since we could
find
ourselves confronted with full resistance to these drugs in short
order. In
the context of populations impacted by exposure to this pathogen (again
5
weeks into a global spread scenario), it would be prudent to remember
the co-infection variable:
While much has been made of the fulminant cases of
presumed viral pneumonia in 1918, Dr. Brundage's research indicates
that the majority of pneumonia cases, even in 1918, were either
secondary bacterial pneumonias following an influenza infection or
mixed viral and bacterial pneumonias. In the
pre-antibiotic era, these cases of bacterial pneumonia carried a very
high
mortality rate; however, with appropriate antibiotic therapy, many such
patients may be saved. -- Avian influenza, human (140): atypical infections:
ProMED: 20060905.2522.
Related:
I have provided the following update from the Clinicians Biodefense
Network, for your reference.
Stephen M. Apatow
Founder, Director of Research & Development
Humanitarian Resource Institute
Humanitarian University Consortium Graduate Studies
Center for Medicine, Veterinary Medicine & Law
Phone: 203-668-0282
Email: s.m.apatow@humanitarian.net
Internet: www.humanitarian.net
Clinicians Biodefense Network Report: 26 April 2009: 7:00 PM
CDC/DHS Press Conference; WHO Pandemic Alert Level;
Epidemiology Update
By the Staff of the Center for
Biosecurity
•
Joint CDC/DHS
Press Conference, 12:30 PM, Sunday, April 26
Case Updates: At a joint Centers for
Disease
Control and Prevention (CDC)/Department of Homeland Security (DHS)
held
at the White House this afternoon, Acting Director Richard Besser
announced that the CDC had 20
cases of swine flu in the United States: 7 in California, 2 in Texas, 2
in Kansas, 8 in New York City, and 1 in Ohio. Dr. Besser noted that
although human-to-human transmission is still suspected, to date, there
has only been only 1 case documented, by viral isolate, of
person-to-person spread (an individual in California who went to Mexico
and subsequently transmitted the virus to
his/her spouse).
Strategic National Stockpile: DHS Secretary Janet Napolitano announced the release
of 25% of the 50 million treatment courses of antivirals in the
Strategic National Stockpile (SNS) to states and cities. Priority for
receipt of antivirals will be awarded to those states with confirmed
cases to supplement that state’s stockpile. In addition, the Department
of Defense has prepositioned 7 million courses of antivirals (the
locations were not announced in the press conference).
Surveillance: DHS
is implementing passive surveillance for symptoms among individuals who
are
arriving at U.S. borders. This means that individuals arriving in this
country
will be asked if they are or have been sick. Any travelers who present
with
symptoms will be isolated and medically evaluated according to existing
federal
procedure. DHS is also conducting an inventory of resources, such as
personal
protective equipment, that are available for Customs and Border
Protection
personnel. Increased surveillance undertaken by the United States
Department
of Agriculture (USDA) has not indicated any problems with either the
U.S.
food supply or with U.S. livestock health.
HHS Public Health Emergency Declaration:
During the press conference, DHS
Secretary Napolitano also announced that the Department of Health and
Human Services (HHS) has declared a “public health emergency.”
Specifically, HHS Acting Secretary, Charles Johnson declared a public
health emergency under section 319 of the Public Health Service Act (42
U.S.C. § 247d) for the swine flu outbreak
“as a consequence of confirmed cases of Swine Influenza A (swH1N1) in
California, Texas, Kansas, and New York . . . and after consultation
with public health officials as necessary.”1 Through the
declaration, the Acting Secretary determined “that a public health
emergency exists nationwide involving Swine Influenza A that affects or
has significant potential to affect national security.”
This type of emergency declaration is standard procedure for HHS during
a significant event.2 As Secretary Napolitano explained, the declaration
enables HHS agency officials to take steps to prepare for and respond
to an emergency, such as gaining access to federal assets (e.g.,
funding, medicines through the SNS, etc.) and implementing certain
liability or regulatory protections (e.g., waivers of (EMTALA), sanctions for hospital emergency
departments),3 if needed.
•
World Health
Organization (WHO) Will Reconvene Expert Panel to Determine Pandemic
Alert
Level
Yesterday (4-25-09), the WHO convened an expert panel
to
discuss the possibility of raising the from its current level 3, but decided against such an
adjustment. The rationale for this decision was not publicly reported.
Today, that WHO spokesman Gregory Hartl indicated that the
panel will reconvene on Tuesday after gathering more epidemiological
evidence from Mexico.
•
Epidemiology Update: Cases in the U.S. and Other Countries
New York City: New
York City (NYC) Mayor Michael Bloomberg announced today that the 8
probable cases of swine flu from students at St. Francis Preparatory
School in Queens, NY, have been confirmed by CDC laboratory tests as
swine influenza.4 At a press conference today, Mayor Bloomberg and NYC
Health Commissioner Thomas Frieden reported that all 8 students with
confirmed swine flu have recovered. Some students at the school
apparently had recently been in Mexico.5
News reports indicate that NYC health officials are
also investigating 30 reported cases of possible flu at a day-care
center in the
Bronx. At a press conference today, it was announced that 6 clinical
samples
from the day-care center came back negative; one was inconclusive and
will
be re-tested.6
Yesterday, the New York State Department of Health
announced that it had shipped 1,500 treatment courses of oseltamivir to
NYC to treat probable cases as well as individuals with underlying
chronic health conditions who had been in contact with probable swine
flu patients.7
Ohio: The Ohio Department of Health
(ODH) announced and the CDC confirmed today a case of swine flu in a
9-year-old boy from Lorain County. According to the ODH, the patient
“is considered to have a mild case of the disease and is recovering at
home.”8
Mexico:
The BBC reports that Mexico's Health
Secretary, Jose Cordova, said a total of 1,324 people had been admitted
to hospital with suspected symptoms since April 13 and were being
tested for the virus. "In that same period, 81 deaths were recorded
probably linked to the virus, but only in 20 cases we have the
laboratory tests to confirm it," he said.9
New
Zealand: reported
at 6:04 a.m. EDT this morning that New Zealand's health minister said
that
10 students who just returned from Mexico had tested positive for
influenza
and that the cases are "likely" to be swine flu. A 11:36 EDT, CNN reported that officials in New Zealand said 25 students and
teachers at Auckland's Rangitoto College returned from a 3-week-long
trip to Mexico via Los Angeles on Saturday (April 25). Fourteen have
shown flu-like symptoms. It is not clear whether anyone else who was on
the plane with them has shown signs of the disease.
Canada:
At 4:40 PM EDT, the reported that Canadian health officials have
confirmed 6
cases of swine flu in British Columbia and Nova Scotia. None have
required hospitalization.
Other
countries: Unconfirmed cases
in several other countries,
including France,
Spain, and Israel.
References
- U.S. Department of Health and Human Services.
Determination that a Public Health Emergency Exists. . April 26, 2009.
- Bradsher K, Healy J. U.S. declares public health
emergency over swine flu. New York Times. April 26, 2009.
- Courtney B. Waiving EMTALA sanctions in response to
public health emergencies. Biosecur Bioterror
2008;6(3):213-217.
- New U.S. swine flu cases spread pandemic fears. MSNBC.
April 26, 2009. . Accessed April 26, 2009.
- Students fall ill in New York, and swine flu is
likely cause. New York Times. April 25, 2009.. Accessed April 26, 2009.
- CDC confirms cases of swine flu at Queens school. New
York One. April 26, 2009.. Accessed April 26, 2009.
- New York State Department of Health. Governor
Paterson Directs State Health Department to Monitor Possible Swine Flu
Cases. April 25, 2009. Accessed April
26, 2009.
- Ohioan tests positive for swine flu [news release].
Columbus, OH; Ohio Department of Health. April 26, 2009. /. Accessed April
26, 2009.
- Mexico flu sparks worldwide fear. BBC News.
April 26, 2009. . Accessed April 26, 2009.
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