P an influenza pandemic is an epidemic of influenza virus that spreads on a world scale and infects the majority of the world's population. Unlike the seasonal epidemic of ordinary influenza, this pandemic occurs irregularly - there are about 9 influenza pandemic over the last 300 years. Pandemic can cause a high mortality rate, with the 1918 Spanish pandemic influenza being the worst in recorded history; The pandemic is thought to be responsible for the deaths of about 50-100 million people. There are about three influenza pandemics in each century for the past 300 years, most recently the 2009 flu pandemic.
An influenza pandemic occurs when new strains of influenza virus are transmitted to humans from other animal species. Species that are considered important in the emergence of new human strains are pigs, chickens and ducks. This new strain is unaffected by human immunity that may have older types of human influenza and can therefore spread very rapidly and infect large numbers of people. Influenza A viruses can sometimes be transmitted from wild birds to other species causing an outbreak in domestic poultry and can cause a human influenza pandemic. Spread of influenza viruses around the world is considered partly by migratory birds, although commercial shipments of live bird products may also be involved, as well as patterns of human travel.
The World Health Organization (WHO) has produced a six-step classification describing the process by which new influenza viruses move from the first few infections in humans to the pandemic. It begins with a virus that mostly infects animals, with some cases where animals infect people, then moves through the stage where the virus begins to spread directly among people, and ends with a pandemic when infection from a new virus has spread throughout the world.
Video Influenza pandemic
Influenza
Influenza, commonly known as flu, is a contagious disease of birds and mammals caused by RNA viruses from the Orthomyxoviridae family (influenza virus). In humans, the common symptoms of influenza infection are fever, sore throat, muscle aches, severe headache, cough, and weakness and fatigue. In more serious cases, influenza causes pneumonia, which can be fatal, especially in children and the elderly. Although sometimes confused with the common cold, influenza is a much more severe disease and is caused by different types of viruses. Although nausea and vomiting can be produced, especially in children, these symptoms are more typical of unrelated gastroenteritis, which is sometimes called "stomach flu" or "24 hour flu."
Typically, influenza is transmitted from infected mammals by air by coughing or sneezing, creating aerosols containing viruses, and from infected birds through their feces. Influenza can also be transmitted through saliva, nasal secretions, feces and blood. Healthy individuals can become infected if they are breathing with aerosol containing the virus directly, or if they touch their eyes, nose or mouth after touching the above-mentioned body fluids (or surfaces contaminated with the fluid). The flu virus can remain infectious for about a week at a human body temperature, over 30 days at 0 ° C (32 ° F), and indefinitely at very low temperatures (such as lakes in northeastern Siberia). Most strains of influenza can be easily deactivated by disinfectants and detergents.
Flu spreads throughout the world in seasonal epidemics. Three influenza pandemics occurred in the 20th century and killed tens of millions of people, with each of these pandemics caused by the emergence of new strains of the virus in humans. Often, these new strains result from the spread of flu viruses that exist to humans from other animal species. When it first killed humans in Asia in the 1990s, the deadly H5N1 strain of birds posed a major risk to a new influenza pandemic; However, this virus does not mutate easily among people.
Vaccination against influenza is most often given to high-risk humans in industrialized countries and poultry farms. The most common human vaccine is a trivalent influenza vaccine containing purified and inactive ingredients from three strains of the virus. Usually this vaccine includes material from two influenza A virus subtypes and one strain of influenza B virus. Vaccines formulated for one year may be ineffective in the next year, as influenza viruses change rapidly over time and different strains become dominant. Antiviral drugs can be used to treat influenza, with highly effective neuraminidase inhibitors.
Maps Influenza pandemic
Variants and subtypes of Influenzavirus A
Influenzavirus A variant was identified and named according to the isolates they liked and thus considered to share bloodlines (eg Fujian flu virus like); according to their typical host (eg human flu virus); according to their subtype (eg H3N2); and according to their ugliness (eg LP). So the flu from a virus similar to the A/Fujian/411/2002 (H3N2) isolate is called Fujian flu, human flu, and H3N2 flu.
Variants are sometimes named according to species (host) strains are endemic or adapted. Some of the variants named by this convention are:
- Bird Flu
- Human Flu
- Swine Flu
- Horse Flu
- Dog Flu
The Avian variants are also sometimes named according to their deaths in poultry, in particular chicken:
- Low Pathogenic Avian Influenza (LPAI)
- Highly Pathogenic Avian Influenza (HPAI), also called: deadly flu or flu death
Influenza A virus subtypes are labeled according to number H (for hemagglutinin) and N number (for neuraminidase). Each viral subtype has mutated into various strains with different pathogen profiles; some pathogenic to one species but not another, some pathogens to some species. The most recognizable strain is the extinct strain. For example, the H3N2 annual flu subtype no longer contains strains that cause Hong Kong flu.
Influenza A virus is a negative sensory, single-stranded, segmented RNA virus. "There are 16 different HA antigens (H1 to H16) and nine different NA antigens (N1 to N9) for influenza A. To date, 15 HA types have been recognized, but recently two new types were isolated: new types (H16 ) was isolated from the black-headed gulls caught in Sweden and the Netherlands in 1999 and reported in the literature in 2005. " "Others, H17, were isolated from bats of fruit caught in Guatemala and reported in literature in 2013."
The nature of the flu pandemic
Some relatively small pandemics such as those in 1957 were called "Asian flu" (1-4 million people died, depending on the source). Others have a higher Pandemic Severity Index whose severity demands a more comprehensive social isolation action.
The 1918 pandemic killed tens of millions and made hundreds of millions sick; The loss of many people in this population causes psychological upheaval and damage for many people. There are not enough doctors, hospital rooms, or medical supplies for those who live when they get sick. Bodies are often left unencryged because few people are available to deal with them. There may be major social disturbances and fear. Efforts to deal with a pandemic can leave much to be desired due to human selfishness, lack of trust, illegal behavior, and ignorance. For example, in the 1918 pandemic: "This terrible mutilation between warranties and reality destroys the credibility of those in power, people feel they have no one to aim for, nothing reliable, nothing to be trusted."
A letter from a doctor at a US Army camp in the 1918 pandemic said:
- Just a few hours until death comes [...]. It was horrible. One can stand to see one, two or twenty dead, but to see this poor demon fall like a fly [...]. We have averaged about 100 deaths per day [...]. Pneumonia means in all cases of death [...]. We have lost the number of nurses and Drs who are embarrassing. It takes a special train to bring the dead. For a few days there were no coffins and corpses piled something malignant [...].
Wave properties
A flu pandemic usually comes in waves. The flu pandemics of 1889-1890 and 1918-1919 each came in three or four waves that increased death. But in waves, death is greater at the beginning of the wave.
Death variable
Deaths vary greatly in a pandemic. In the 1918 pandemic:
- In US Army camps where statistics are fairly reliably stored, death cases often exceed 5 percent, and in some cases exceed 10 percent. In the British Army in India, the mortality rate for white troops is 9.6 percent, for Indian troops 21.9 percent. In isolated human populations, the virus kills at a higher rate. In the Fiji Islands, it kills 14 percent of the entire population in 16 days. In Labrador and Alaska, it killed at least a third of the total indigenous population.
Influenza Pandemic
Spanish Flu (1918-1920)The 1918 flu pandemic, commonly referred to as the Spanish flu, is a category 5 influenza pandemic caused by the severe and deadly strain of the Influenza A virus from the H1N1 subtype.
The Spanish flu pandemic lasted from 1918 to 1920. An older estimate says it killed 40-50 million people while current estimates say 50 million to 100 million people worldwide are killed. The pandemic has been described as "the greatest medical massacre in history" and may have killed many people like the Black Death, although the Black Death is thought to have killed more than a fifth of the world's population at that time, a much higher proportion.. This enormous casualty is caused by a very high infection rate of up to 50% and the severity of extreme symptoms, thought to be caused by cytokine storms. Indeed, the symptoms in 1918 were so unusual that initially influenza was misdiagnosed as dengue, cholera, or typhoid. An observer writes, "One of the most striking of these complications is bleeding from the mucous membranes, especially from the nose, stomach, and intestines.Bleeding from the ears and petechal bleeding in the skin also occurs." The majority of deaths come from bacterial pneumonia, secondary infections caused by influenza, but the virus also kills people directly, causing massive bleeding and edema in the lungs.
Spanish flu pandemic is truly global, spreading even to the islands of the Arctic and remote Pacific islands. Extremely severe disease kills between 2 and 20% of those infected, compared with a normal epidemic death rate of over 0.1%. Another unusual feature of this pandemic is that most kills young adults, with 99% of pandemic influenza deaths occurring in people under 65, and over half in young adults 20 to 40 years old. This is unusual because influenza is usually the most lethal for very young (under age 2) and very old (over the age of 70). The total pandemic death of 1918-1919 is unknown, but it is estimated that up to 1% of the world's population is killed. A total of 25 million may have been killed in the first 25 weeks; on the contrary, HIV/AIDS has killed 25 million in the first 25 years.
Asian Flu (1957-1958)
The "Asian Flu" is a category 2 outbreak of avian influenza pandemic influenza originating in China in early 1956 that lasted until 1958. It originated from mutations in wild ducks combined with pre-existing human strains. The virus was first identified in Guizhou. It spread to Singapore in February 1957, reaching Hong Kong in April, and the US in June. The death toll in the US is around 69,800. Parents are very vulnerable. Estimates of death worldwide vary widely depending on the source, ranging from 1 million to 4 million.
Hong Kong Flu (1968-1969)
The Hong Kong flu is a category 2 flu pandemic caused by H3N2 strains derived from H2N2 by an antigenic shift, in which the genes of some subtypes are reinforced to form a new virus. The Hong Kong flu pandemic of 1968 and 1969 killed one million people worldwide. Those over the age of 65 years have the greatest death rate. In the US, there are about 33,800 deaths. Russian influenza (1977-1978) >
In 1977, the H1N1 strain appeared. It was a "benign" pandemic, mainly attacking people born after 1950, as older generations had protective immunity resulting from previous experience with H1N1 strains. The 1977 virus was similar to other A/H1N1 viruses that had circulated before 1957. The virus was included in the 1978-79 vaccine.
Flu Pandemic H1N1/09 (2009-2010)
The epidemic of unknown influenza-like illness occurred in Mexico in March-April 2009. On April 24, 2009, after isolation of influenza A/H1N1 in 7 sick patients in the southwestern US. WHO issued a statement about the outbreak "influenza like illness" in confirmed cases of influenza A/H1N1 has been reported in Mexico, and that 20 confirmed cases of illness have been reported in the US. The next day, the number of confirmed cases rose to 40 in the US, 26 in Mexico, 6 in Canada, and 1 in Spain. The disease spread rapidly through the rest of the spring, and on May 3, a total of 787 confirmed cases have been reported worldwide. On June 11, 2009, the ongoing outbreak of ongoing A/H1N1 influenza, commonly referred to as "swine flu", was officially declared by the WHO to become the first influenza pandemic of the 21st century and a new strain of the first H1N1 Influenza A subtype virus identified in months April 2009. This is considered as a reassortment of four strains of influenza A virus known as H1N1 subtype: one endemic to humans, one endemic to birds, and two endemic to pigs (pigs). The rapid spread of this new virus is likely due to a lack of immune-mediated antibodies already present in the human population.
On 1 November 2009, worldwide updates by the WHO stated that "199 countries and overseas/community areas have officially reported a total of over 482,300 laboratories confirmed cases of influenza pandemic H1N1 infection, which included 6,071 deaths." At the end of the pandemic, there were more than 18,000 confirmed laboratory deaths from H1N1. Due to inadequate supervision and lack of health care in many countries, the actual number of cases and deaths may be much higher than reported. Experts, including the WHO, have agreed that an estimated 284,500 people were killed by the disease, about 15 times the number of deaths in the initial death toll.
Subtext of other pandemic threats
"Human influenza virus" usually refers to a widespread subtype among humans. H1N1, H1N2, and H3N2 are the only Influenza A virus subtypes currently circulating among humans.
Genetic factors in distinguishing between "human flu virus" and "bird flu virus" include:
"Around 52 major genetic changes distinguish bird flu strains from spreading easily among people, according to researchers in Taiwan, who analyzed the genes of more than 400 variants of the flu virus." "How many mutations will make the avian virus capable of infecting humans efficiently, or how many mutations will make the influenza virus into a pandemic strain, unpredictable.We have examined the sequence of the 1918 strain, which is the only fully-fledged pandemic influenza virus derived from poultry strains. Of the 52 associated species positions, 16 have a distinctive residue for human strains, others remain as a bird's signature. The results support the hypothesis that the 1918 pandemic virus is more closely related to avian influenza A virus than any other human influenza virus. "
Highly pathogenic H5N1 bird flu kills 50% of humans who catch it. In one case, a child with H5N1 had diarrhea followed rapidly by a coma without developing respiratory symptoms or flu.
The confirmed subtype of influenza A virus in humans, ordered by known human pandemic deaths, is:
- H1N1 causes "Spanish flu" and swine flu outbreak 2009 (H1N1 novel)
- H2N2 causes "Asian Flu"
- H3N2 causes "Hong Kong Flu"
- H5N1 is "bird flu", endemic in avians
- H7N7 has an unusual zoonotic potential
- H1N2 is currently endemic to humans and pigs
- H9N2, H7N2, H7N3, H10N7
- H1N1
H1N1 is currently endemic in both human and pig populations. The H1N1 variant is responsible for a Spanish flu pandemic that killed about 50 million to 100 million people worldwide for about a year in 1918 and 1919. Controversy surfaced in October 2005, after the H1N1 genome was published in the journal Science Many fear this information can be used for bioterrorism.
"When he compared the 1918 virus to the current human flu virus, Dr. Taubenberger realizes that it only changes 25 to 30 of the 4,400 amino viral acids, some of which change the bird virus into a killer that can spread from person to person."
In mid-April 2009, the H1N1 variant appeared in Mexico, with its center in Mexico City. On April 26, the variant has become widespread; with cases reported in Canada, the US, New Zealand, the UK, France, Spain and Israel. On April 29, WHO raised the worldwide pandemic phase to 5. On June 11, 2009 the WHO raised the worldwide pandemic phase to 6, meaning that H1N1 swine flu has reached pandemic proportions, with nearly 30,000 confirmed cases worldwide. November 8, 2009 world renewal by the United Nations World Health Organization (WHO) states that "206 countries and regions overseas/community have officially reported more than 503,536 laboratories confirmed cases of H1N1 influenza pandemic infections, including 6,250 deaths." [5]
- The microscopic image of the H1N1 virus
- The microscopic image of the H1N1 virus
- H2N2
The Asian flu was an outbreak of the H2N2 avian influenza pandemic originating in China in 1957, spreading around the world in the same year as influenza vaccines developed, lasting until 1958 and causing between one and four million deaths.
- H3N2
H3N2 is currently endemic in both human and pig populations. It evolved from H2N2 by an antigenic shift and caused the Hong Kong flu pandemic of 1968 and 1969 that killed up to 750,000. "The early and severe form of influenza A H3N2 made headlines when he claimed the lives of several children in the United States by the end of 2003."
The dominant flu strain in January 2006 was H3N2. The measured resistance to standard antiviral drugs amantadine and rimantadine in H3N2 has increased from 1% in 1994 to 12% in 2003 to 91% in 2005.
"[C] in human H3N2 influenza virus is now endemic to pigs in southern China and can reassort with avian H5N1 virus in this intermediate host."
- H7N7
H7N7 has an unusual zoonotic potential. In 2003 in the Netherlands, 89 people were confirmed to have H7N7 influenza virus infection after an outbreak in poultry on some farms. One death recorded.
- H1N2
H1N2 is currently endemic in both human and pig populations. The new H1N2 strain appears to have resulted from reassortment of the currently circulating H1N1 and H3N2 influenza subtype genes. The hemagglutinin protein of the H1N2 virus is similar to the current circulating H1N1 virus and the neuraminidase protein is similar to the current H3N2 virus.
Strategy to prevent a flu pandemic
This section contains strategies to prevent a flu pandemic by a panel of the Council on Foreign Relations.
If influenza is still an animal problem with limited human-to-human transmission, it is not a pandemic, although it continues to pose a risk. To prevent the situation from developing into a pandemic, the following short-term strategy has been put forward:
- Destroy and vaccinate cattle
- Vaccination of poultry workers against common cold
- Restrict travel in the area where the virus was found
The rationale for vaccinating poultry workers against the common cold is that it reduces the likelihood of common influenza virus rejoining the avian H5N1 virus to form a pandemic strain. Long-term strategies proposed for areas where H5N1 is highly pathogenic endemic to wild birds include:
- change local farming practices to improve farm hygiene and reduce contact between wild animals and birds.
- change farming practices in areas where animals live in close, unhealthy residences with people, and change the practice of open "wet markets" where birds are stored for sale and slaughter on the spot. The challenge of implementing these measures is widespread poverty, often in rural areas, coupled with dependence on poultry raising for subsistence or income farming without measures to prevent the spread of disease.
- change local shopping practices from direct poultry purchases to purchases of slaughtered and pre-packed poultry.
- increase the availability and cost of veterinary vaccines.
Strategy to slow the flu pandemic
Public response actions
The main way available to deal with a flu pandemic is initially behavioral. It requires a sound public health communication strategy and the ability to track public attentions, attitudes, and behaviors. For example, the TElephone Flu Surveillance Template (FluTEST) was developed for the UK Department of Health as a series of questions to be used in a national survey during the flu pandemic.
- Social distance: By traveling less, working from home or closing school, there is little chance for the virus to spread. Reduce time spent in crowded settings if possible. And keep your distance (preferably at least 1 meter) from people who show symptoms like influenza, such as coughing and sneezing.
- Respiratory hygiene: Suggests people to cover coughs and sneezes. If using a tissue, make sure you throw it carefully and then wipe your hands immediately afterwards. (See "Cleaning Hands" below.) If you do not have a handy tissue when you cough or sneeze, cover your mouth as much as possible with the curve of your elbows.
- Hand Washing Hygiene: Frequent handwashing with soap and water (or with alcohol-based hand sanitizers) is essential, especially after coughing or sneezing, and after contact with others or with contaminated surfaces. (such as handrails, shared equipment, etc.)
- Other hygiene: Avoid touching your eyes, nose, and mouth as much as possible.
- Masks: No mask can provide a perfect barrier but products that meet or exceed the NIOSH N95 standard recommended by the World Health Organization are considered to provide good protection. WHO recommends that health care workers wear N95 masks and that patients wear surgical masks (which can prevent airborne respiratory secretions). Any mask may be useful to remind the wearer not to touch the face. This can reduce the infection due to contact with contaminated surfaces, especially in crowded public places where coughing or sneezing people have no way of washing their hands. The mask itself can become contaminated and should be treated as medical waste when disposed of.
- Risk communication: To encourage the public to adhere to strategies to reduce the spread of disease, "communication about possible community intervention [such as requiring sick people to stay home from work, closing school] for pandemic influenza that flows from the federal government to the community and from public figures to the public does not exaggerate the level of trust or certainty in the effectiveness of this action. "
The Institute of Medicine has published a number of reports and workshop summaries on public policy issues related to influenza pandemic. They are collected in the Influenza Pandemic: A Guide to the latest Institute of Medical Studies and Workshops and some of the strategies from this report are included in the above list. Relevant learning from the 2009 flu pandemic in the United Kingdom was published in Health Technology Assessment, volume 14, issue 34.
There are two groups of antiviral drugs available for the treatment and prophylaxis of influenza neuraminidase inhibitors such as Oseltamivir (trade name Tamiflu) and Zanamivir (trade name Relenza) as well as adamantanes such as amantadine and rimantadine. Because of the high rates of adverse events and the risk of antiviral resistance, the use of adamantanes to fight influenza is limited.
Many countries, as well as the World Health Organization, are working to keep anti-viral drugs in preparation for a possible pandemic. Oseltamivir is the most commonly sought after drug, as it is available in pill form. Zanamivir is also considered for use, but should be inhaled. Other anti-viral drugs are less effective against pandemic influenza.
Both Tamiflu and Relenza are in short supply, and production capability is limited in the medium term. Some doctors say that giving together Tamiflu with probenecid can double supply.
There is also the potential of viruses to develop drug resistance. Some people infected with H5N1 treated with oseltamivir have developed a resistant strain of the virus.
Tamiflu was originally discovered by Gilead Sciences and licensed to Roche for the development and marketing of the final stages.
Vaccines
The vaccine may not be available in the early stages of population infection. Vaccines can not be developed to protect against non-existent viruses. The H5N1 bird flu virus has the potential to mutate into a pandemic strain, but so do other types of flu viruses. Once a potential virus is identified and the vaccine is approved, it usually takes five to six months before the vaccine is available.
The ability to produce vaccines varies greatly from country to country; only 19 countries are listed as "influenza vaccine manufacturers" according to the World Health Organization. It is estimated, under the best scenario scenario, 750 million doses can be produced each year, whereas it is possible that each individual will need two doses of vaccine to become immuno competent. Distribution to and within the country may be problematic. Some countries, however, have well-developed plans to produce vaccines in large quantities. For example, Canadian health authorities say they are developing the capacity to produce 32 million doses in four months, enough vaccines to inject everyone in the country.
Another concern is whether countries that do not produce the vaccine itself, including where the pandemic strain is likely to originate, will be able to buy vaccines to protect their populations. In addition to cost considerations, they fear that countries with vaccine-making capabilities will order production to protect their own populations and not release vaccines to other countries until their own populations are protected. Indonesia refused to share samples of H5N1 strains that had infected and killed its citizens until it received assurances that they would have access to the vaccine produced with the sample. So far, have not received the guarantee. However, in September 2009, the United States and France agreed to make 10 percent of their H1N1 vaccine supply available to other countries through the World Health Organization.
There are two serious technical issues related to the development of the vaccine against H5N1. The first problem is this: seasonal influenza vaccine requires an injection of 15 g haemagluttinin to provide protection; H5 appears to cause only a weak immune response and large multicenter trials have found that two injections of 90 Ã,Âμg H5 given 28 separate days provide protection only in 54% of people (Treanor 2006). Even if it is assumed that 54% is an acceptable level of protection, the world today is capable of producing only 900 million doses of 15 Îμg (assuming that all production is immediately converted to H5 vaccine production); if two injection 90? g is required then this capacity drops to only 70 million (Poland 2006). Trials using adjuvants such as alum, AS03, AS04 or MF59 to try and lower the dose of vaccine are urgently needed. The second problem is this: there are two circulating viruses, clade 1 is a virus originally isolated in Vietnam, clade 2 is a virus isolated in Indonesia. Vaccine research is mostly focused on clade 1 viruses, but clade 2 viruses are antigenically different and clade 1 vaccine probably will not protect against a pandemic caused by clade 2 virus.
Since 2009, most vaccine development efforts have focused on the current pandemic influenza virus H1N1. As of July 2009, more than 70 known clinical trials have been completed or are underway for the influenza pandemic vaccine. In September 2009, the US Food and Drug Administration approved four vaccines against the 2009 H1N1 influenza virus, and expects many initial vaccines to be available within the next month.
Phase
The World Health Organization (WHO) has developed a global influenza preparedness plan, which defines the pandemic stages, outlines the WHO's role and makes recommendations for national actions before and during the pandemic.
In the 2009 revision of the phase description, WHO has maintained the use of a six-phase approach to facilitate the incorporation of new recommendations and approaches into existing national preparedness and response plans. The grouping and description of the pandemic phase has been revised to make it easier to understand, more precisely, and based on observable phenomena. Phases 1-3 correlate with preparedness, including capacity building activities and response planning, while phase 4-6 clearly indicates the need for response and mitigation efforts. Furthermore, the period after the first pandemic wave was elaborated to facilitate post-pandemic recovery activities.
Phases are defined below.
In nature, influenza viruses circulate continuously among animals, especially birds. Although the virus may theoretically develop into a pandemic virus, in Phase 1 no virus circulating among animals has been reported to cause infection in humans.
In Phase 2 the animal influenza virus circulating among pets or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.
In Phase 3 , animal or human-animal influenza viruses have led to sporadic cases or a small group of diseases in humans, but have not produced sufficient human-to-human transmission to maintain community-level outbreaks.. Limited human-to-human transmission can occur in some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver. However, limited transmission in such limited circumstances does not indicate that the virus has reached the level of infectious ability among humans required to cause a pandemic.
Phase 4 is characterized by human-to-human transmission of human or human animal influenza viruses or viruses that can cause "community-level outbreaks". The ability to cause an ongoing disease outbreak in a community marks a significant upward shift in pandemic risk. Any country that suspects or has verified such an event shall immediately consult the WHO so that the situation may be mutually assessed and the decisions made by the affected country if the implementation of a rapid pandemic detention operation is justified. Phase 4 shows a significant increase in pandemic risk but does not necessarily mean that a pandemic is a foregone conclusion.
Phase 5 is characterized by the spread of the virus from human to human to at least two countries in one WHO region. While most countries will not be affected at this stage, the Phase 5 declaration is a strong signal that the pandemic is imminent and that the time to complete the organization, communication, and implementation of the planned mitigation measures is short.
Phase 6 , the pandemic phase, is characterized by community-level outbreaks in at least one other country in different WHO regions in addition to the criteria set out in Phase 5. The designation of this phase will indicate that a global pandemic is underway.
During the post-peak period, pandemic disease rates in most countries with adequate supervision will decline below the observed level. The post-peak period indicates that pandemic activity appears to be declining; However, it is uncertain whether additional waves will occur and countries need to be prepared for the second wave.
The previous pandemic has been characterized by a wave of activity spread over months. After the disease activity level decreases, the important communication task is to balance this information with other possible waves. The pandemic wave can be separated for months and the "relaxed moment" signal may be premature.
In the post-pandemic period , influenza disease activity will return to levels normally seen for seasonal influenza. It is hoped that the pandemic virus will behave as a seasonal influenza A virus. At this stage, it is important to maintain monitoring and updating of pandemic preparedness and plans. An intensive recovery and evaluation phase is required.
Government preparation for potential H5N1 pandemic (2003-2009)
According to The New York Times in March 2006, "governments around the world have spent billions on planning for potential influenza pandemics: buying drugs, conducting disaster drills, [and] developing strategies for tighter border controls "because of the H5N1 threat.
[T] he United States works closely with eight international organizations, including the World Health Organization (WHO), the United Nations Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE), and 88 foreign governments to address the situation through planning, greater monitoring, and full transparency in the reporting and investigation of avian influenza. The United States and international partners have led a global effort to encourage countries to increase surveillance of outbreaks in poultry and large numbers of deaths in migratory birds and rapidly introduce countermeasures. The US Agency for International Development (USAID) and the US Department of State, Health and Human Services (HHS), and Agriculture (USDA) are coordinating future international response actions on behalf of the White House with ministries and agencies throughout the federal government.
Shared measures are taken to "minimize the risk of further spread in the animal population", "reduce the risk of human infection", and "further support pandemic planning and readiness".
Ongoing and ongoing coordinated on-site surveillance and analysis of H5N1 avian influenza in humans and animals is underway and reported by the USGS National Wildlife Health Center, CDC, ECDC, World Health Organization, the European Commission, National Influenza Center, and others.
The United Nations
In September 2005, David Nabarro, a leading UN health official warned that an avian flu epidemic could happen at any time and has the potential to kill 5-150 million people.
World Health Organization
The World Health Organization (WHO), believes that the world is closer to an influenza pandemic than ever since 1968, when the third pandemic of the 20th century swept the world, has developed guidelines on pandemic influenza preparedness and response. The March 2005 plan includes guidance on roles and responsibilities in preparedness and response; information about the pandemic phase; and recommended actions for before, during, and after the pandemic.
United States
"[E] fforts by the federal government to prepare an influenza pandemic at the national level including a $ 100 million DHHS initiative in 2003 to build a US vaccine production Some institutions within the Department of Health and Human Services (DHHS) - including the Office of the Secretary, Food and Drug Administration (FDA), the CDC and the National Institute of Allergy and Infectious Diseases (NIAID) - are in the process of working with vaccine manufacturers to facilitate the production of many pilot vaccines for both H5N1 and H9N2 as well as contracting for the production of 2 million doses of H5N1 vaccine. The H5N1 will provide critical pilot testing of the pandemic vaccine system, will also be used for clinical trials to evaluate dosage and immunogenicity and may provide early vaccines for early use in the event of an emerging pandemic. "
Every State and Territory of the United States has a Special Flu Pandemic Plan that includes Avian Flu, Swine Flu (H1N1) and other potential influenza outbreaks. The Country Plan together with the search engines of flu available professionally available research, policies and plans are available on the current portal: Pandemic Flu Search.
On August 26, 2004, Secretary of Health and Human Services, Tommy Thompson released the design of the Pandemic Influenza Response and Preparedness Plan, which outlines a coordinated national strategy for preparing and responding to influenza pandemic. Public comments received for 60 days.
In a speech to the UN General Assembly on September 14, 2005, President George W. Bush announced the creation of an International Partnership on Bird Flu and the Influenza Pandemic. The Partnership brings together nations and international organizations to enhance global preparedness by:
- raises issues on the national agenda;
- coordinate efforts between donor and affected countries;
- mobilize and utilize resources;
- increase transparency in disease reporting and control; and
- build capacity to identify, retain and respond to pandemic influenza.
On October 5, 2005, Democratic Senators Harry Reid, Evan Bayh, Dick Durbin, Ted Kennedy, Barack Obama, and Tom Harkin introduced the Pandemic Alert and Response Act as a proposal to face the possibility of an outbreak.
On October 27, 2005, the Department of Health and Human Services awarded a $ 62.5 million contract to Chiron Corporation to produce a bird flu vaccine designed to protect against strains of H5N1 influenza virus. It follows a previous $ 100 million contract for sanofi pasteur, the vaccine business of the sanofi-aventis Group, for the bird flu vaccine.
In October 2005, President Bush urged bird flu vaccine manufacturers to increase their production.
On November 1, 2005 President Bush launched a National Strategy to Protect Against the Danger of the Influenza Pandemic. He also made a request to Congress for $ 7.1 billion to begin implementing the plan. Demand includes $ 251 million to detect and contain epidemics before spreading around the world; $ 2.8 billion to accelerate the development of cell culture technology; $ 800 million for the development of new treatments and vaccines; $ 1.519 billion for the Department of Health and Human Services (HHS) and Defense to buy influenza vaccines; $ 1.029 billion for antiviral drug supplies; and $ 644 million to ensure that all levels of government are prepared to respond to the pandemic outbreak.
On March 6, 2006, Mike Leavitt, Secretary of Health and Human Services, said the US health agency is continuing to develop an alternative vaccine that will protect against the growing avian flu virus.
The US government, which supports the possibility that migrating birds could bring deadly bird flu to North America, plans to test nearly eight times as many wild birds beginning in April 2006 as tested in the last decade.
On March 8, 2006, Dr. David Nabarro, senior UN coordinator for bird flu and humans, said that given the wild bird fly pattern that has spread avian influenza from Asia to Europe and Africa, birds infected with H5N1 virus could reach the United States within the next six to 12 months.
"5 Jul 2006 (Berita CIDRAP) - In an update on influenza pandemic preparedness efforts, the federal government said last week that it has stockpiled enough vaccines against the H5N1 bird flu virus to inject around 4 million people and enough antiviral drugs to treat about 6, 3 million.. "
Canada
The Public Health Agency of Canada follows the WHO category, but has expanded it. The Bird Flu Threat of 2006 prompted the Public Health Agency of Canada to release an updated Influenza Pandemic Plan for Health Officials. This document was created to address growing concerns over the dangers faced by public health officials when exposed to sick or dying patients.
Malaysia
Since the outbreak of the Nipah virus in 1999, the Malaysian Ministry of Health has put the process to be better prepared to protect Malaysians from the threat of infectious diseases. Malaysia is fully prepared during the severe acute respiratory syndrome (SARS) (Malaysia is not a SARS-affected country) and epidemic of the H5N1 (bird flu) outbreak in 2004.
The Malaysian government has developed a National Influenza Pandemic Preparation Plan (NIPPP) that serves as a time-bound guide to preparedness and response plans for influenza pandemic. It provides strategic policies and frameworks for multisectoral responses and contains specific recommendations and actions to be undertaken by MoH at various levels, departments and other government agencies and non-governmental organizations to ensure that resources are mobilized and used most efficiently before, during and after pandemic episode.
See also
- 1889-90 flu pandemic
- Spanish flu
- Influenza vaccine
- Influenza timeline
- List of epidemics - contained in it, influenza epidemic
References
Source
External resources
- The Great Pandemic: United States in 1918
- PandemicFlu.gov
- Virus Pandemic in Influenza Research Database
- The book "A Cruel Wind: Pandemic Flu in America, 1918-1920," by Dorothy A. Pettit, PhD and Janice Bailie, PhD (Timberlane Books, 2009)
External links
- Health-EU portal EU response to influenza
- WHO European influenza pandemic website
- European Commission - EU Community Health Coordination on Pandemic (H1N1) 2009
Source of the article : Wikipedia
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