Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

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



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……….”


‘……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”……’


“…..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


“……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:
“…..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….”


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.

CDC: 1918 Pandemic Video

This image shows the order of events leading up to the reconstruction of the 1918 virus by Dr. Terrence Tumpey within CDC’s biosecurity level 3 enhanced laboratory.

This image lists lessons learned from the study of the reconstructed 1918 virus at CDC and why it was so deadly.

1918 Flu Pandemic Commemoration

Is the influenza A(H5N1) vaccine still effective even after 12 years of storage in the National Pre-Pandemic Influenza Vaccine Stockpile (NPIVS)?

Science Direct


Safety and immunogenicity of influenza A(H5N1) vaccine stored up to twelve years in the National Pre-Pandemic Influenza Vaccine Stockpile (NPIVS)
Volume 37, Issue 3, 14 January 2019, Pages 435-443

Stockpiled vaccines were well-tolerated, adverse events were generally mild, and there was no drop in immunogenicity to the oldest stockpiled A(H5N1) vaccine. Compared to unadjuvanted vaccine, greater peak antibody responses were observed in subjects who were vaccinated with MF59-adjuvanted vaccines, regardless of antigen dose. Vaccination with the A(H5N1) vaccine antigen also results in cross-reactive antibody responses to contemporary circulating strains of A(H5) influenza viruses.


The frequency, type, and severity of AEs observed during this study are similar to historical clinical study data with A(H5N1) vaccines and MF59 adjuvant indicating that a stockpiled A(H5N1) vaccine appears to remain safe and tolerable. The vaccines were immunogenic when administered as a two-dose vaccine regimen in healthy adults, despite extended storage of HA antigen or MF59 adjuvant within the NPIVS…..”


Interim Updated Planning Guidance on Allocating and Targeting Pandemic Influenza Vaccine during an Influenza Pandemic


“Effective allocation and administration of pandemic influenza vaccine will play a critical role in preventing influenza and reducing its effects on health and society during a future pandemic. Although the timing and severity of a future pandemic and characteristics of the next pandemic influenza virus strain are not known, it is important to plan and prepare. The overarching aim of the national pandemic influenza vaccination program is to vaccinate all persons in the United States (U.S.) who choose to be vaccinated, prior to the peak of disease. The U.S. government’s  goal is to have sufficient pandemic influenza vaccine available for an effective domestic response within four months of a pandemic declaration. Additionally, plans are to have first doses available within 12 weeks of the President or the Secretary of Health and Human Services declaring a pandemic 1. To meet these timelines, the U.S. government is investing significant resources to create and evaluate new vaccine development approaches and production technologies. Pre-pandemic influenza vaccine stockpiles of bulk vaccine against viruses with pandemic potential are also being established and maintained.

Despite these investments, there are other issues to consider. Stockpiled pandemic vaccine availability will depend on the degree to which they match the circulating pandemic strain and other properties, and manufacturing capacity.  In a pandemic, a novel virus has not circulated in humans, and it is assumed that the majority of the population may not have immunity to the virus, causing more people to become ill. Rates of severe illness, complications, and death may be much higher than seasonal flu and more widely distributed. The greater frequency and severity of disease will increase the burden on the health care system, the risk of ongoing transmission in the community, and may increase rates of absenteeism and disruptions in the availability of critical products and services in health care and other sectors. Similarly, homeland and national security and critical infrastructure (e.g., transportation and power supply) could be threatened if illness among critical personnel reduces their capabilities.

Given that influenza vaccine supply will increase incrementally as vaccine is produced during a pandemic, targeting decisions may have to be made. Such decisions should be based on vaccine supply, pandemic severity and impact, potential for disruption of community critical infrastructure, operational considerations, and publicly articulated pandemic vaccination program objectives and principles. The overarching objectives guiding vaccine allocation and use during a pandemic are to reduce the impact of the pandemic on health and minimize disruption to society and the economy. Specifically, the targeting strategy aims to protect those who will: maintain homeland and national security, are essential to the pandemic response and provide care for persons who are ill, maintain essential community services, be at greater risk of infection due to their job, and those who are most medically vulnerable to severe illness such as young children and pregnant women.

Recognizing that demand may exceed supply at the onset of a pandemic, federal, state, tribal, and local governments, communities, and the private sector have asked for updated planning guidance on who should receive vaccination early in a pandemic.  This document uses pandemic severity categories based on the current CDC Pandemic Severity Assessment Framework1.  Several new elements have been incorporated into the 2018 guidelines to update and provide interim guidance for planning purposes, and to provide the rationale for a new vaccination program during a pandemic allowing for local adjustment where appropriate.  These guidelines replace the 2008 Guidance on Allocating and Targeting Pandemic Influenza Vaccine.”

Paying respect to the pandemic influenza of 100 years ago


“……This month is another centennial of death and destruction; the influenza epidemic was raging, killing around 195,000 Americans in October alone (for reference, about 116,500 American soldiers died in the whole war, with more than half of those deaths from disease, mostly influenza).

Many of the most haunting images of the 1918 influenza pandemic come from October 1918, when the disease was particularly severe in Philadelphia, with corpses piled up awaiting burial, and bodies buried in packing crates because there weren’t enough coffins. Many cities closed their movie theaters and prohibited public gatherings.

It is estimated that the pandemic killed 50 million to 100 million people worldwide………”


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