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Volume 12, Number 7—July 2006
Peer Reviewed Report Available Online Only

Critical Issues in Responding to Pandemic Influenza

James W. Buehler*Comments to Author , Allen Craig†, Carlos Del Rio‡, Jeffrey P. Koplan§, David S. Stephens‡§, and Walter A. Orenstein‡
Author affiliations: *Emory University Rollins School of Public Health, Atlanta, Georgia, USA; †Tennessee Department of Health; Nashville, Tennessee, USA; ‡Emory University School of Medicine, Atlanta, Georgia, USA; §Emory University Woodruff Health Sciences Center, Atlanta, Georgia, USA

Main Article


Key challenges, recommendations, and summary of deliberations of 4 workgroups for pandemic influenza planning*

Challenge or issue Recommendations or points of consensus
Surveillance and Containment Workgroup
Role of individual case finding/reporting and isolation/quarantine Most likely to be useful in response to initial case reports in an area. May be difficult to determine when such measures should be abandoned.
Role of social distancing measures, such as school closures and cancellation of public events Participants anticipated that such measures would likely be invoked, but no consensus was reached on optimal timing of such measures, reflecting paucity of relevant evidence regarding effectiveness.
Whether to recommend or mandate mask use in public settings No consensus, reflecting uncertainties about effectiveness.
Vaccination Workgroup
How to deliver vaccine and shift delivery methods during periods when vaccine is initially scarce but eventually more widely available This will require an evolving logistics plan involving multiple partners at state and local levels, including healthcare providers, volunteer organizations, and businesses. Strategy will evolve from tight health department control of administration outlets (during period of scarcity) to involvement of multiple partners and vaccination sites, including mass vaccination facilities (during period of ready availability).
Translating federal guidelines for prioritization of vaccine use into actual practice Participants concurred with priorities described in the DHHS plan, with a proviso that heightened priority should be given to law enforcement and security officials. Priorities may need revision depending on epidemiology of pandemic and vaccine availability. Subpriorities may be necessary at early stage if vaccine supply is insufficient even for those in highest priority group(s).
Healthcare and Antiviral Drugs Workgroup
Meeting anticipated surges in demands for healthcare services may be our nation's greatest vulnerability in an influenza pandemic, including needs for facilities, medications, equipment, supplies, and staff. Participants agreed on overall strategy but recognized need for substantial effort to develop following capabilities:
     •Facilities: A multitiered, multpartner approach will be required to stretch existing hospital and clinic resources, identify alternative care sites for those who require an intermediate level of care, and encourage and support home healthcare.
     •Staff: Assuring sustainability of currently licensed healthcare workforce and support personnel will require attention to personal and family health concerns, redirection of staff resources to care of influenza patients, and appeals to professional values.
     •Volunteers: Developing, maintaining, and credentialing a ready volunteer workforce will require collaboration with volunteer and community-based organizations and businesses.
     •Medications/supplies: Variations among facilities in availability of stockpiled medications and supplies will raise complex ethical questions that were identified but not resolved.
Current standards of care will not be sustainable Guidelines for relaxing standards of care, such as those developed by the Agency for Healthcare Quality and Research, will be necessary, including procedures for defining responsibility within a region for enacting altered care standards. These standards should be accompanied by triage policies to ensure that patients are directed to appropriate levels of care based on need.
Communication between public health and healthcare providers will be critical. Channels of communication and necessary relationships should be established in advance of crises. Panel recommended joint participation of public health officials and healthcare providers in tabletop exercises and drills, including exercising incident command procedures.
Animal-Human Health Interface Workgroup
Responding to outbreak of avian influenza in commercial poultry will require unprecedented collaboration between animal and human health officials Relationships among animal health agencies, public health agencies, and industry must be strengthened, and models of successful collaboration in planning and conducting exercises must be expanded.
Birds outside the commercial poultry industry (e.g., backyard flocks, smuggled birds) may be at risk for exposure to avian influenza, but capacity is limited to detect outbreaks among birds in these less visible settings. Provide training on recognition of avian disease as part of preparedness training provided to community service workers (e.g., police, fire, social services, agricultural extension services); include natural resource or wildlife agencies in public health and agricultural emergency planning.
Veterinary research and research into the animal-human interface of infectious disease is under-developed, leading to critical gaps in information relevant to prevention and control of zoonotic diseases. Avian influenza research should address
     •Prevalence and risk for occupational exposure to "low-pathogenic" avian influenza strains among poultry workers
     •For those involved in depopulation and other outbreak response:
     •Risk for occupational exposure to avian pathogens
     •Effectiveness of various forms of personal protective equipment
     •Effectiveness and role of environmental sampling for animal pathogens for surveillance and outbreak management
     •Development of rapid tests for animal pathogens, including tests that can be used in field settings
Additional attention to the health of poultry industry workers and avian outbreak response workers is warranted.      •Improve interventions for poultry industry workers and outbreak response workers
     •Improve use of seasonal influenza vaccination among poultry industry workers
     •Improve training of outbreak response workers, including pre-event fit testing and training in use of personal protective equipment
     •Increase consideration of poultry industry workers in defining priority groups for pandemic strain and antiviral use

*DHHS, Department of Health and Human Services.

Main Article

Page created: December 19, 2011
Page updated: December 19, 2011
Page reviewed: December 19, 2011
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