CDC's Nopharmacologic Flu Preparedness Plan

ATLANTA—The CDC, in cooperation with other federal agencies, has announced new efforts to improve state, local, and community preparedness for an influenza pandemic via community planning guidance and public service announcements (PSAs).

According to the CDC, community strategies, or nonpharmaceutical interventions, are important because a vaccine—the best protection against pandemic influenza—is not likely to be available at the outset. These strategies may help reduce the spread of disease until a vaccine that is well matched to the virus is available.

“The threat of a pandemic continues to be real. We need to continue helping state and local decision makers determine some of the specific actions they could take during the course of a pandemic to reduce illness and save lives,” said Mike Leavitt, Secretary of the US Department of Health and Human Services (HHS). “An important consideration for action is the severity of a pandemic once it emerges. The new CDC guidelines are a step forward in that direction.”

Assessing Pandemic Severity

In order to help authorities determine the most appropriate actions to take in the face of an influenza pandemic, the guidelines incorporate a new planning tool for use by states, communities, businesses, schools, and others. The tool, a Pandemic Severity Index (PSI), takes into account the fact that the amount of harm caused by pandemics can vary greatly.

The PSI, modeled after the approach used to characterize hurricanes, has five different categories of pandemics. A category 1 pandemic is one of moderate severity (ie, as harmful as a severe seasonal influenza season), and a category 5 pandemic is the most severe (with the same or worse intensity as the 1918 flu pandemic). Pandemic severity is determined primarily by the attributable death rate, or the percentage of infected people who die due to the pandemic.

 “I’m proud of CDC’s efforts to guide federal and state partners to develop the severity index—and to then link severity with potential actions,” said Julie L. Gerberding, MD, MPH, Director of the CDC. “We recognize that much work remains, but this new approach should help communities, schools, businesses, and others strengthen their pandemic influenza plans.”

Possible Recommended Actions

Based on the projected severity of a pandemic, government and health officials may recommend different actions in order to limit the spread of disease. These actions, which are designed to reduce contact between people, may include:

• Asking ill persons to remain at home and/or not go to work until they are no longer contagious (seven to 10 days). Ill persons will be treated with antiviral medication, if drugs are available and effective, against the pandemic strain

• Asking household members of ill persons to stay at home for seven days

• Dismissing students from schools and closing child care programs for up to three months for the most severe pandemics, and reducing contact among children and teens in the community

• Recommending social distancing of adults in the community and at work, which may include closing large public gatherings, changing workplace environments, and shifting work schedules without disrupting essential services.

While these actions could significantly reduce the number of persons who become ill during a flu pandemic, they each carry potentially adverse consequences that community planners should anticipate and address in their planning efforts. The guidance describes many of these consequences and provides planners with initial recommendations on strategies to address them. These recommendations may be revised in the coming months based on feedback that the government will seek from a variety of specific communities, including the private sector, the education community, faith-based and community-based organizations, and the public health community.

Planning guides for businesses and other employers, child care programs, elementary and secondary schools, colleges and universities, faith-based and community-based organizations, and individuals and families are included in the appendix of the guidance.

As part of the continuing effort to raise awareness and educate the public about pandemic influenza and the need to prepare in advance, HHS unveiled a number of new radio and television PSAs. The PSAs encourage people to learn more about pandemic influenza and to know more about their state and local community’s efforts to prepare for a potential pandemic. “We need to keep up our efforts to educate the public before a pandemic emerges, and these PSAs will help people know what do to about pandemic flu,” Secretary Leavitt said.

Reference
1. Wang G, Bunnell BA, Painter RG, et al. Adult stem cells from bone marrow stroma differentiate into airway epithelial cells: potential therapy for cystic fibrosis. PNAS. 2005;102:186-191.

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