Six Phases of Pandemic Alert—W.H.O.

26 May 2006 (Reuters)—The World Health Organization (WHO) is not considering raising its global bird flu alert level, although its investigation into a family cluster in Indonesia continues, a senior WHO official said.

Paul Gully, senior adviser to the WHO's top bird flu official, Margaret Chan, told Reuters in an interview in Geneva: “Our feeling now is there is nothing new that has happened which would make us want to consider moving to level 4.”

The WHO, a United Nations agency, uses 6 phases of pandemic alert to inform its 192 member states of the seriousness of the threat and the need to step up preparations.

It says that the world is currently in phase 3: “a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.”

Phase 4 is an important warning signal when “clusters” of infected people are detected, whereas phase 6 marks the start of a pandemic.

The decision to move from one phase to another is made by the WHO leader, after consultations with an external board of experts. The following is a description of the 6 phases.

Phase 1: interpandemic phase, low risk of human cases.

Phase 2: new virus in animals, but no human cases, higher risk of human cases.

Phase 3: pandemic alert, no or very limited human-to-human transmission.

Phase 4: clusters of human cases suggesting increased adaptability of the virus, evidence of increased human-to-human transmission.

Phase 5: larger clusters of human cases over longer periods, evidence of significant human-to-human transmission.

Phase 6: pandemic, efficient and sustained human-to-human transmission.

W.H.O. Delays Decision on Smallpox Virus Destruction

29 May 2006 (Reuters)—The World Health Organization (WHO) decided to defer recommending a new date for destroying the world's last known stockpiles of smallpox.

Smallpox was officially eradicated in 1979, after a worldwide vaccination campaign.

The United States and Russia, which have since stored the remaining virus samples in high-security laboratories, have long resisted calls to destroy them, in case smallpox is found to exist elsewhere.

Others fear the live cultures could trigger an epidemic if released and have sought tighter controls on their use.

At the WHO's annual assembly, countries were stuck on the text of a resolution to set a date for destroying existing smallpox stocks and to limit tests done on the virus.

A previous 2002 deadline for destroying smallpox had been waived by the WHO until new vaccines or treatments for smallpox were found, after the United States said that it would keep stocks on hand to combat any reemergence of the disease.

The US Health and Human Services Secretary, Mike Leavitt, told journalists in Geneva on Monday [29 May] that scientists at the Centers for Disease Control and Prevention in Atlanta were analyzing the smallpox virus to find improved ways to respond to any outbreak.

F.D.A. Approves Shingles Vaccine

26 May 2006 (Reuters)—US regulators have approved a new vaccine, Zostavax, to prevent shingles in people 160 years old, Merck announced.

The approval comes after a Merck study of 140,000 subjects, of whom 121,000 received the vaccine.

Approximately 90% of American adults are at risk of developing shingles, the company said. Of the approximately 1 million cases of shingles that occur in the United States each year, 40%–50% affect people 160 years old.

Editor's comment. This is a vaccine that should be indicated for virtually all older Americans. However, it is estimated to sell for $150 per dose, which may be a deterrent to widespread use.

W.H.O. Issues Plan to Limit Bird Flu Outbreak in Humans

30 May 2006 (Reuters [Stephanie Nebehay])— The World Health Organization (WHO) issued a step-by-step plan, including rapid mass use of the antiviral Tamiflu, for containing a birdflu outbreak if the virus starts to spread rapidly among humans.

The “rapid response and containment strategy” has a chance of quashing the deadly H5N1 virus, only if people in the zone at risk receive massive doses of the drug within 3 weeks of a confirmed outbreak, it said.

“The success of a strategy for containing an emerging pandemic virus is strictly time dependent,” the WHO said in its latest containment report, based on recommendations by 70 international experts who held closed-door talks in March.

“Mathematical models have indicated that a containment strategy, based on the mass administration of antiviral drugs, has a chance of success only when drugs are administered within 21 days following the timely detection of the first case representing improved human-to-human transmission of the virus.”

Under the detailed timeline set forth, a country should notify the WHO of a cluster of suspicious cases that suggest sustained human-to-human spread of the virus within 24 h of detection.

A WHO-approved laboratory has another 24 h to confirm that the H5N1 bird flu virus has changed, either by mutation or by reassortment with human influenza.

The strategy relies on the WHO's global stockpile for rapid containment, 3 million treatment courses of Tamiflu donated by Swiss drugmaker Roche. Quarantine, infection control measures, and contact tracing must also be carried out.

Once the WHO officially asks Roche for Tamiflu doses to be sent, they should arrive at the international airport nearest the outbreak within 24 h, the Geneva-based agency said.

The WHO said on Saturday [27 May] that it had for the first time asked Roche to be prepared to ship Tamiflu to Sumatra, Indonesia, where a family of 7 people was infected, possibly with some limited human- to-human transmission.

In the end, the WHO did not ask for the drugs to be sent.

The WHO considers Tamiflu to be the frontline drug against the H5N1 bird flu strain but says that more clinical studies are needed.

U.S. States Plan How to Handle Pandemic Flu Threat

7 June 2006 (Reuters [Carey Gillam])— Kansans are practicing using a football field–sized tent as a portable hospital. Hawaii plans to find sick people by performing nasal swab tests on tourists, and Seattle is issuing instructions on how to bury the dead.

Across the United States, local and state officials are spending millions of dollars to plot strategies for dealing with a stillhypothetical— but experts say inevitable— pandemic flu crisis.

The Health and Human Services (HHS) Deputy Secretary, Alex Azar, said that the federal government will not be able to provide a safety net if a pandemic hits. States will have to rely on their own ingenuity to provide health care, keep essential services operating, and distribute food and medicines.

State efforts have been augmented with $100 million in federal money so far, in cluding $1.2 million earmarked for Kansas. HHS will distribute another $250 million to states later this year, according to Azar.

In Hawaii, officials at the Honolulu airport are planning to have nurses obtain nasal swab specimens from airline passengers who appear ill to screen them for flu, and a jetload of people could be quarantined if any one passenger tested positive for the H5N1 strain, according to the Hawaii State Department of Health.

In Boston, thousands of health care professionals are being asked to sign up as volunteers for a “Medical Reserve Corps” that could help treat flu victims.

In Illinois, the DuPage County Health Department, which encompasses 1 million people in suburbs west of Chicago, last month sent out a mailer to 350,000 homes warning residents of pandemic flu and offering tips on how to personally prepare, including stocking up on food and water.

The county is also planning outreach kits to businesses, churches, and schools, along with a series of conferences in the fall, and it is launching a bird flu Web site.

In South Carolina, representatives from all state agencies are meeting monthly with American Red Cross volunteers and other volunteer organizations to develop a plan of action.

The Muhlenberg College in Allentown, Pennsylvania, is readying technology and personnel to transform the college quickly into a command center capable of handling hundreds of hotline calls, should pandemic hit.

And in Washington state, the King County public health department in Seattle has warned people that if body bags and refrigerated trucks are in short supply, flu victims should be buried in backyards, provided that the graves are far from septic systems.

In Kansas, military units in Topeka spent last weekend practicing an emergency setup of the state's “EMEDS” (expeditionary medical support system), a portable system of tents that was deployed for use along the Gulf Coast after Hurricane Katrina.