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-------- Original Message
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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 and Development
Pathobiologics
International
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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