Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

Video: Perspectives on Federal, State, and Local Pandemic Influenza Preparedness and Response

This one-hour and 56-minute symposium, cosponsored with George Washington University’s Milken Institute School of Public Health and the Association of State, Health, and Territorial Officials (ASTHO), features a discussion with national leaders on the emerging issues, trends, and areas of continued challenges and opportunities for success in preparing to respond to the emergence of the next influenza pandemic. Speakers discuss the state of preparedness today, and current perspectives on America’s biosecurity.


WHO launches new global influenza strategy

WHO

WHO launches new global influenza strategy

11 March 2019

News Release
Geneva

WHO today released a Global Influenza Strategy for 2019-2030 aimed at protecting people in all countries from the threat of influenza. The goal of the strategy is to prevent seasonal influenza, control the spread of influenza from animals to humans, and prepare for the next influenza pandemic.

“The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals to humans and potentially causing a pandemic is real.   The question is not if we will have another pandemic, but when.  We must be vigilant and prepared – the cost of a major influenza outbreak will far outweigh the price of prevention.”

Influenza remains one of the world’s greatest public health challenges. Every year across the globe, there are an estimated 1 billion cases, of which 3 to 5 million are severe cases, resulting in 290 000 to 650 000 influenza-related respiratory deaths. WHO recommends annual influenza vaccination as the most effective way to prevent influenza. Vaccination is especially important for people at higher risk of serious influenza complications and for health care workers.

The new strategy is the most comprehensive and far-reaching that WHO has ever developed for influenza.  It outlines a path to protect populations every year and helps prepare for a pandemic through strengthening routine programmes. It has two overarching goals:
 

  1. Build stronger country capacities for disease surveillance and response, prevention and control, and preparedness. To achieve this, it calls for every country to have a tailored influenza programme that contributes to national and global preparedness and health security.
  2. Develop better tools to prevent, detect, control and treat influenza, such as more effective vaccines, antivirals and treatments, with the goal of making these accessible for all countries.

“With the partnerships and country-specific work we have been doing over the years, the world is better prepared than ever before for the next big outbreak, but we are still not prepared enough,” said Dr Tedros. “This strategy aims to get us to that point. Fundamentally, it is about preparing health systems to manage shocks, and this only happens when health systems are strong and healthy themselves.”

To successfully implement this strategy, effective partnerships are essential.  WHO will expand partnerships to increase research, innovation and availability of new and improved global influenza tools to benefit all countries.  At the same time WHO will work closely with countries to improve their capacities to prevent and control influenza.

The new influenza strategy builds on and benefits from successful WHO programmes.  For more than 65 years, the Global Influenza Surveillance and Response System (GISRS), comprised   of WHO Collaborating Centres and national influenza centres, have worked together to monitor seasonal trends and potentially pandemic viruses. This system serves as the backbone of the global alert system for influenza.

Important to the strategy is the on-going success of the Pandemic Influenza Preparedness Framework, a unique access and benefit sharing system that supports the sharing of potentially pandemic viruses, provides access to life saving vaccines and treatments in the event of a pandemic and supports the building of pandemic preparedness capacities in countries through partnership contributions from industry.

The strategy meets one of WHO’s mandates to improve core capacities for public health, and increase global preparedness and was developed through a consultative process with input from Member States, academia, civil society, industry, and internal and external experts.

Supporting countries to strengthen their influenza capacity will have collateral benefits in detecting infection in general, since countries will be able to better identify other infectious diseases like Ebola or Middle East respiratory syndrome-related coronavirus (MERS-CoV).

Through the implementation of the new WHO global influenza strategy, the world will be closer to reducing the impact of influenza every year and be more prepared for an influenza pandemic and other public health emergencies.


Pandemics: Reusability of Facemasks

Institute of Medicine 2006. Reusability of Facemasks During an Influenza
Pandemic: Facing the Flu. Washington, DC: The National Academies Press.
https://doi.org/10.17226/11637.

“…….First, of the forms of respiratory protection the committee was asked to
consider, N95 filtering facepiece respirators that are certified by the National
Institute for Occupational Safety and Health (NIOSH) and properly
fit-tested are likely to provide the best protection against influenza to the
extent that it may be spread via an airborne route. Similarly, a closely fitting
high-efficiency medical mask is likely to provide appropriate protection
against droplets, whereas a surgical N95 will provide protection against
both droplets and aerosols. While recognizing the methodological and data
limitations regarding the efficacy of medical masks as a form of respiratory
protection against avian influenza, and in the absence of data to the contrary,
the committee concluded that masks are likely to provide far less
protection against aerosols than an N95 filtering facepiece but may offer

better protection than cotton masks, homemade alternatives such as handkerchiefs
and scarves, or no protection at all. No device is fail-safe, and its
effectiveness depends on fit, level of exposures, and appropriate use. Finally,
none of these devices protects against contact transmission, and appropriate
hand hygiene is necessary when using and after removing these devices…..”


Although antibiotic reserves are part of pandemic preparedness plans, experts may not have fully explored the value of stockpiling or conserving the effectiveness of antibiotics, despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics because of emerging antibiotic-resistant organisms.

Study weighs value of antibiotics for resistant Staph in pandemic settings

An effective antibiotic that can treat secondary Staphylococcus aureus infections in a pandemic flu outbreak is worth more than $3 billion, according to a new study by researchers from the Center for Disease Dynamics, Economics, and Policy (CDDEP) and their colleagues in Scotland and the Netherlands.

Writing in Health Economics, the authors said though antibiotic reserves are part of pandemic preparedness plans, experts haven’t explores the value of stockpiling or conserving the effectiveness of antibiotics, despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics because of emerging antibiotic-resistant organisms.

Using a mathematical framework based on UK preparedness plan assumptions the scientists estimated the value of investing in developing and conserving an antibiotic to lessen the burden of bacterial infections from resistant S aureus during a pandemic flu outbreak.

The team found that the value of withholding an effective new oral antibiotic can be positive and significant unless the pandemic is mild, with few secondary illnesses involving the resistant strain or if most patients can be treated intravenously.

Ramanan Laxminarayan, PhD, MPH, CDDEP director and the study’s senior author, said in a CDDEP press release that secondary bacterial infections are a major cause of death and disability with flu, and antibiotic resistance is a major barrier to treating those infections. “This study shows that the value of an effective antibiotic against Staph infections, as an insurance policy against future pandemics, is between $3 [billion] and 4 billion at baseline,” he said.
Feb 11 Health Econ abstract
Feb 12 CDDEP press release

Investing in antibiotics critical to saving lives during pandemic influenza outbreaks

CDDEP researchers find that the availability of an effective antibiotic that can treat Staphylococcus aureus infections effectively during a pandemic influenza outbreak is worth over $3 billion.

Center for Disease Dynamics, Economics & Policy

Washington DC – There have been roughly three global pandemic influenza outbreaks each century for the past four hundred years, each of which have resulted in larger numbers of infections and deaths. Secondary bacterial infections have been responsible for a significant proportion of deaths in previous pandemics.

Pandemic preparedness plans call for maintaining stocks of antivirals, antibiotics, and vaccines; however, the value of stockpiling or conserving the effectiveness of antibiotics remains unexplored despite the high morbidity of secondary bacterial infections and the growing ineffectiveness of antibiotics due to the emerging public health threat of antibiotic-resistant superbugs. In the event of a significant influenza pandemic, secondary infections caused by prevalent pan-drug resistant bacteria could be catastrophic. Effective antibiotics in the future are indispensable in the case of an influenza pandemic.

In a new study published in the journal Health Economics, researchers at CDDEP, the University of Strathclyde in Scotland, and Wageningen University in the Netherlands developed a mathematical framework to estimate the value of investing in developing and conserving an antibiotic to mitigate the burden of bacterial infections caused by resistant Staphylococcus aureus during a pandemic influenza outbreak. The model, which is based on UK preparedness plan assumptions, found that the value of withholding an effective novel oral antibiotic can be positive and significant unless the pandemic is mild and causes few secondary infections with the resistant strain or if most patients can be treated intravenously.

“Although influenza is caused by a virus, which cannot be treated with antibiotics, secondary bacterial infections are a major cause of death and disability and antibiotic resistance is a major barrier to treating these infections,” said Ramanan Laxminarayan, CDDEP director and senior author of the study. “This study shows that the value of an effective antibiotic against Staph infections, as an insurance policy against future pandemics, is between $3 and 4 billion at baseline”.

###

The study titled, “Investing in antibiotics to alleviate future catastrophic outcomes: What is the value of having an effective antibiotic to mitigate pandemic influenza?” was published on February 11, 2019 in the journal Health Economics and is available online here.


New research: Contamination of health care personnel during removal of contaminated gloves

AJIC

 

Alhmidi H, Gonzalez-Orta M, Cadnum JL, et al. Contamination of health care personnel during removal of contaminated gloves. Am J Infect Control 2019 (published online Jan 9)

“…..In simulations of contaminated glove removal, 37% of health care personnel using their typical doffing technique contaminated their skin with a fluorescent solution. The frequency of contamination was significantly lower when the technique recommended by the Centers for Disease Control and Prevention was used versus not used (8 of 34, 24% vs 29 of 66, 44%). In simulations in which only the palm of the glove was contaminated, a modified doffing technique, to minimize the risk for contact with contaminated surfaces, reduced contamination of personnel……”


Oxford University (Oxford University Innovation) has entered into an option agreement for a universal influenza vaccine with US-based startup Blue Water Vaccines (BWV)

Oxford University

“……there are over almost 500,000 deaths a year caused by influenza, with somewhere between three to five million severe cases of illness annually. The virus is estimated to cost $87.1 billion in absenteeism in the US alone...…

[T]he universal flu vaccine developed at Oxford University targets epitopes that are both naturally immunogenic and limited in variability, allowing for a vaccine that protects against all influenza strains and avoids the need to be regularly updated.

The vaccine, which covers all influenza A and B strains is, is approaching clinical studies and could feasibly enter Phase I trials by the end of 2019……….”

PharmaTimes

‘……The vaccine is designed to target components of the influenza virus that are common to all strains, and will therefore also be suitable to target the outbreak of a new flu pandemic caused by the emergence of a novel form of the virus at the time it moves from an animal species into humans, according to the firm.

The vaccine is 100 percent synthetic and delivers “highly conserved immunogenic peptide fragments from the flu virus to antigen presenting cells in the skin, eliciting a strong and long-lasting T-cell immune response”……’

PharmaTimes

“…..Unlike ordinary vaccines, which use proteins found on the surface of the virus that are susceptible to change, the universal vaccine uses the more stable proteins at the virus’ core. Instead of utilising antibodies, it works by stimulating the immune system to boost virus-killing T-cells, which research has shown such can help fight more than one type of flu virus...…”


The Pandemic Response Box

Pandemic Response Box

About the Pandemic Response Box

The Pandemic Response Box contains 400 diverse drug-like molecules active against bacteria, viruses or fungi.

Request the Pandemic Response Box

The Pandemic Response Box is available free of charge. In return researchers are expected to share data resulting from research on the molecules from the box in the public domain within 2 years of its generation.

Supporting information

All the details related to requesting and conducting research on compounds in the Pandemic Response Box.

Terms & conditions

The agreement between MMV and the requesting institution for the transfer, handling and use of compounds contained in the box.

 


Pandemics will be the cause of average annual economic losses of 0.7% of global GDP – or $570 billion – a threat similar in scale to that estimated for climate change in the coming decades

WEF

“……While potentially catastrophic outbreaks may occur only every few decades, highly disruptive regional and local outbreaks are becoming more common and pose a major threat to lives and livelihoods. Recent years have seen nearly 200 epidemic events per year. This trend is only expected to intensify due to increasing trade, travel, population density, human displacement, deforestation and climate change. Further, the number and diversity of epidemic events (e.g. influenza, Ebola, Zika, yellow fever, SARS, MERS-CoV and antibiotic-resistant bacteria, among other threats) have been increasing over the past 30 years.….”

 


Where will the US public go for antivirals in a pandemic?

Public Views on Alternative Methods for Antiviral Distribution and Dispensing During an Influenza Pandemic
Gillian K. SteelFisher, Hannah Caporello, Anita Patel, Lisa M. Koonin, Ericka McGowan, Eran Ben-Porath, and Robert J. Blendon
Published Online: https://doi.org/10.1089/hs.2018.0073
“…..The Centers for Disease Control and Prevention, in coordination with state health departments, has plans to distribute antiviral drugs from federal stockpiles in the case of a pandemic. These plans are currently under review and include evaluation of the benefits of pharmaceutical supply chain distribution and dispensing of antivirals through community pharmacies. ……
Overall, there was widespread support for the proposed system, and a majority predicted they would be likely to get antivirals in pharmacies compared to public health clinics. However, preference for using pharmacies dropped substantially when even modest fees were introduced. Those without insurance were less likely to say they would get antivirals and, along with those in lower income groups, were more likely than others to use public health clinics at all cost points. Further, sizable proportions expressed concerns about side effects, a desire to wait until symptoms got worse, and hesitation about using drugs beyond the labeled expiration dates. …..”

The Pandemic of 1918: “……since it happened once, analogous conditions could lead to an equally devastating pandemic….”

EID

Taubenberger JK, Morens DM. 1918 Influenza: the Mother of All Pandemics. Emerging Infectious Diseases. 2006;12(1):15-22. doi:10.3201/eid1201.050979.

The “Spanish” influenza pandemic of 1918–1919, which caused ≈50 million deaths worldwide, remains an ominous warning to public health. Many questions about its origins, its unusual epidemiologic features, and the basis of its pathogenicity remain unanswered. The public health implications of the pandemic therefore remain in doubt even as we now grapple with the feared emergence of a pandemic caused by H5N1 or other virus. However, new information about the 1918 virus is emerging, for example, sequencing of the entire genome from archival autopsy tissues. But, the viral genome alone is unlikely to provide answers to some critical questions. Understanding the 1918 pandemic and its implications for future pandemics requires careful experimentation and in-depth historical analysis.


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