Global & Disaster Medicine

Archive for the ‘Pandemic’ Category

The US House of Representatives yesterday passed bipartisan legislation reauthorizing the Pandemic and All-Hazards Preparedness and Advancing Innovations Act (PAHPA)

Pandemic legislation

Today, the House of Representatives passed bipartisan legislation, the Pandemic and All Hazards Preparedness and Advancing Innovation Act (PAHPA), authored by Reps. Susan W. Brooks (R-IN05) and Anna G. Eshoo (D-CA18) to strengthen the country’s existing preparedness and response programs. The bill now heads to the President’s desk to be signed into law.

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act is critically important legislation that works to make our nation better prepared for and able to keep Americans safer in response to natural disasters or biological, chemical, radiological or nuclear threats to our public health and national security,” Brooks said. “I am proud this bipartisan legislation is now on its way to the President’s desk to be signed into law because it will ensure our health care professionals are trained to respond to possible pandemic outbreaks, prioritize the further development of our national stockpile of vaccines, medical equipment and diagnostics, and establish new advisory groups focused on protecting vulnerable populations such as senior citizens and people with disabilities during public health threats and emergencies.”

The Pandemic and All-Hazards Preparedness and Advancing Innovation Act better equips our federal agencies to respond to new and emerging threats that jeopardize our national security and public health,” Eshoo said. “I applaud the House and Senate’s bipartisan commitment to strengthening our nation’s existing preparedness and response programs, and I look forward to the President signing this important bill into law.”

BACKGROUND

The Pandemic and All Hazards Preparedness and Advancing Innovation Act (PAHPA) ensures our nation is prepared to respond to a wide range of public health emergencies, whether man-made or occurring through a natural disaster or infectious disease. PAHPA strengthens and improves our national preparedness and response for public health emergencies through our hospitals, state and local health providers, and by accelerating medical countermeasure research and development. Specifically, the legislation focuses on the needs of special populations including children, people with disabilities and seniors before and during a public health emergency. It codifies the Public Health Emergency Medical Countermeasure Enterprise and the duties of the Assistant Secretary for Preparedness and Response (ASPR), while maintaining the important role of the Centers for Disease Control in emergency and response activities. The legislation also provides the authorization and federal resources to invest in programs related to Pandemic Influenza and Emerging Infectious Diseases.

In addition, PAHPA reauthorizes funding to improve bioterrorism and other public health emergency preparedness and response activities such as the Hospital Preparedness Program, the Public Health Emergency Preparedness Cooperative Agreement, Project BioShield, and BARDA for the advanced research and development of medical countermeasures (MCMs). PAHPA previously expired on September 30, 2018.

Brooks and Eshoo are co-founders of the Congressional Biodefense Caucus. The Caucus serves as a platform to educate Members of Congress and their staff on the very real threats our nation faces from a chemical, biological, radiological or nuclear attack or pandemic outbreak. It also aims to identify the existing gaps in our preparedness and response capabilities.


Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism, 2019

Trust For America’s Health

One lesson from recent events is that emergencies happen. And happen often. From disease outbreaks to natural disasters to man-made crises, the stakes are high: Americans face serious health risks and even death with increasing regularity. Therefore, as a nation, it’s critical to ask, “Are we prepared?”

Executive Summary

The public health emergencies of the past year—an unusually severe flu season, confounding cases of acute flaccid myelitis, two major hurricanes, and the deadliest fire season in California’s history reinforce the need for every jurisdiction to be vigilant about preparing for emergencies in order to safeguard the public’s health.

A fundamental role of the public health community is to protect communities from disasters and disease outbreaks. To this end, the nation’s health security infrastructure has made tremendous strides since 2001 by building modern laboratories, maintaining a pipeline of medical countermeasures, and recruiting and retaining a workforce trained in emergency operations. Yet, unstable and insufficient funding puts this progress at risk, and a familiar pattern takes shape: underfunding, followed by a disaster or outbreak, then an infusion of onetime supplemental funds, and finally a retrenchment of money once attention wanes. What’s more, states are uneven in their levels of preparedness. Some—often those that most frequently face emergencies—have the personnel, systems, and resources needed to protect the public. But others are less prepared and less experienced, elevating the likelihood of preventable harms. This unstable funding and uneven preparation undermines America’s health security.

The Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism series, produced by Trust for America’s Health (TFAH), has tracked public health emergency preparedness in the United States since 2003. The series has documented significant progress in the nation’s level of preparedness as well as those areas still in need of improvement.

Ready or Not examines the country’s level of public health emergency preparedness on a state-by-state basis using 10 priority indicators. (See Table 1.) Taken together, the indicators are a checklist of priority aspects of states’ readiness for public health emergencies. However, these indicators do not necessarily reflect the effectiveness of states’ public health departments. Improvement in these priority areas often requires action from other agencies, elected officials or the private sector.

The 2019 report finds that states have made progress in key areas, including public health funding and participation in provider compacts and coalitions. However, performance in other areas—such as flu vaccination, hospital patient safety, and paid time off for workers—has stalled or lost ground.

Table 1: Top-Priority Indicators of State Public Health Preparedness

Indicators
1 Incident Management: Adoption of the Nurse Licensure Compact. 6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community Collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (Grade A) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six- to eight-week surge in testing capacity.

Notes: The National Council of State Boards of Nursing organizes the Nurse Licensure Compact. The federal Hospital Preparedness Program of the U.S. Office of the Assistant Secretary for Preparedness and Response supports healthcare coalitions. The U.S. Environmental Protection Agency assesses community water systems. Paid time off includes sick leave, vacation time, or holidays, among other types of leave. The Leapfrog Group is an independent nonprofit organization. Every indicator, and some categorical descriptions, were drawn from the NHSPI, with one exception: public health funding. See “Appendix A: Methodology” for a description of TFAH’s funding data-collection process, including its definition.

Source: National Health Security Preparedness Index.

For the first time, Ready or Not groups states and the District of Columbia into one of three tiers based on their performance across the 10 indicators. This year, 17 states scored in the top tier, 20 and the District of Columbia placed in the middle tier, and 13 were in the bottom tier. (See Table 2).

By gathering together timely data on all 50 states and the District of Columbia, the report assists states in benchmarking their performance against comparable jurisdictions. To help states track their own progress, TFAH will strive to maintain continuity among the indicators tracked in this edition of the report for the next several years.

Table 2: State Public Health Emergency Preparedness

State performance, by scoring tier, 2018

 Performance Tier States Number of States
Top Tier AL, CO, CT, FL, ID, KS, MA, MD, MO, MS, NC, NE, NJ, RI, VA, WA, WI 17 states
Middle Tier CA, DC, GA, HI, IA, IL, LA, ME, MI, MN, MT, ND, NH, NM, NV, OK, OR, SC, TX, VT, WV 20 states and DC
Bottom Tier AK, AR, AZ, DE, IN, KY, NY, OH, PA, SD, TN, UT, WY 13 states

Report Findings

A majority of states have made preparations to expand capabilities in an emergency, often through collaboration. In 2018, 31 states participated in the Nurse Licensure Compact, which allows registered nurses and licensed practical or vocational nurses to practice in multiple jurisdictions with a single license. In an emergency, this enables health officials to quickly increase their staffing levels. For example, nurses may cross state lines to lend their support at evacuation sites or other healthcare facilities. The number of states participating in the compact is up by five from 26 in 2017.

In addition, hospitals in most states have a high degree of participation in healthcare coalitions. On average, 89 percent of hospitals were in a coalition and 18 states had universal coalition participation, meaning every hospital in the state was part of a coalition. Such coalitions bring hospitals and other healthcare facilities together with emergency management and public health officials to plan for, and respond to, events requiring extraordinary action. This increases the likelihood that patients are served in a coordinated and efficient manner during an emergency.

Finally, 44 states and the District of Columbia had a plan to surge public health laboratory capacity for six to eight weeks as necessary during overlapping emergencies or large outbreaks.

Most residents who got their household water through a community water system had access to safe water.  On average, just 6 percent of state residents used a community water system in 2017 that did not meet all applicable health-based standards. Water systems with such violations increase the chances of water-based emergencies in which contaminated water supplies place the public at risk.

Most states are accredited in the areas of public health, emergency management, or both. In 2018, the Public Health Accreditation Board or the Emergency Management Accreditation Program accredited 42 states and the District of Columbia; 26 states were accredited by both groups. Eight states (Alaska, Hawaii, Indiana, New Hampshire, South Dakota, Texas, West Virginia, and Wyoming) were accredited by neither. Both programs help ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.

Seasonal flu vaccination rate, already too low, fell further. The seasonal flu vaccination rate among Americans ages 6 months or older dropped from 47 percent in the 2016–2017 season to 42 percent in the 2017–2018 season. This drop-in coverage may have exacerbated the severity of the 2017-2018 influenza season and the high number of illnesses, hospitalizations and deaths due to flu. Healthy People 2020, a set of federal 10-year objectives and benchmarks for improving the health of all Americans by 2020, set a seasonal influenza vaccination-rate target of 70 percent annually.

In 2018, only 55 percent of employed state residents, on average, had access to paid time off. Those without such leave are more likely to work when they are sick and risk spreading infection. In the past, some infectious disease outbreaks have been linked to or exacerbated by the absence of paid sick leave.

Only 28 percent of hospitals, on average, earned a top-quality patient safety grade. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, nursing staff volume, and an overall culture of error prevention. In the absence of diligent actions to protect patient safety, deadly infectious diseases can take hold or strengthen.

Climate Change Increases Likelihood of Extreme Weather

According to the Center for Climate and Energy Solutions, a nonprofit advocacy group, climate change is expected to increase the frequency, intensity, and consequences of some types of extreme weather events, including:

  • Drought, which can contribute to food insecurity and exacerbate wildfires.
  • Extreme heat, which in a typical year already kills more people in the United States than hurricanes, lightning, tornadoes, earthquakes, and floods combined. Extreme heat is especially dangerous for medically vulnerable people. It also worsens droughts and increases the risk of wildfires.
  • Heavy rains, which cause catastrophic flooding, landslides, and contaminated waterways.
  • Hurricanes, which sometimes have more destructive wind speeds, precipitation, and storm surges.
  • Wildfires, which can now burn more land and are more difficult to extinguish.

In 2017 alone, at least 15 extreme weather events across the globe were made more likely by climate change, according to studies published by the American Meteorological Society.

On top of possible federal action, states and localities can act to mitigate these threats, particularly the dangers they pose to people with health ailments or in poor living conditions. For example, land-use planning can reduce loss of life and property from wildfires. Zoning rules that limit building in flood-prone areas reduces the dangers from floods, and replacing nonpermeable surfaces with “green infrastructure,” such as rain gardens and bioswales, reduces stormwater runoff and subsequent flooding. In drought-prone areas, green infrastructure can retain stormwater for later use. Cooling centers can keep vulnerable populations safe during heat waves, and green roofs can reduce the urban heat island effect. Finally, preserving coastal wetlands, dunes, and reefs can help absorb storm surges from hurricanes.

Report Recommendations

There are a host of concrete actions to further protect the public’s health that TFAH recommends be taken by federal, state, and local officials; the healthcare system; academia; and the private or nongovernmental sectors.

Those that are of highest priority include:

  • Providing stable, dedicated, and sufficient funding for preparedness activities and a significant funding increase for core public health capabilities.
  • Establishing a complementary emergency response fund to accelerate crisis responses.
  • Maintaining a long-term investment in the Global Health Security Agenda framework and global preparedness and response programs to help prevent infectious disease threats from becoming global crises.
  • Fully implementing the National Biodefense Strategy including with transparent goals, implementation plans, and budgets for all relevant agencies.
  • Monitoring and addressing any potential challenges caused by the transition of the Strategic National Stockpile and significantly strengthening the “last mile” of distribution and dispensing.
  • Developing a multiyear strategic vision, and fully funding surveillance infrastructure, for fast, accurate outbreak detection at all levels of government.
  • Bolstering the Hospital Preparedness Program and multisector healthcare collaboration as well as adopting state policies to improve healthcare delivery during disasters.
  • Adopting comprehensive climate change adaptation plans, including a public health assessment and response.
  • Increasing public and private investments in efforts to combat antimicrobial resistance, including through diagnostic, stewardship, detection, and treatment methods.
  • Supporting vaccine infrastructure and first-dollar coverage of recommended vaccines.
  • Promoting health equity in emergency preparedness planning, response, and recovery, including through the appointment of a chief equity or resilience officer.

Taken together, action on TFAH’s recommendations would make the United States safer for all its residents.


H1ssF_3928: The universal flu vaccine?

NIH

“The first clinical trial of an innovative universal influenza vaccine candidate is examining the vaccine’s safety and tolerability as well as its ability to induce an immune response in healthy volunteers. Scientists at the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, developed the experimental vaccine, known as H1ssF_3928.

H1ssF_3928 is designed to teach the body to make protective immune responses against diverse influenza subtypes by focusing the immune system on a portion of the virus that varies relatively little from strain to strain. ….

Image of a volunteer receiving a shot

 

The clinical trial is being conducted at the NIH Clinical Center in Bethesda, Maryland. It is being led by Grace Chen, M.D., of NIAID’s Vaccine Research Center (VRC) Clinical Trials Program. The trial will gradually enroll at least 53 healthy adults aged 18 to 70 years. The first five participants will be aged 18 to 40 years and will receive a single 20-microgram (mcg) intramuscular injection of the experimental vaccine. The remaining 48 participants will receive two 60-mcg vaccinations spaced 16 weeks apart. They will be stratified by age into four groups of 12 people each: 18 to 40 years, 41 to 49 years, 50 to 59 years, and 60 to 70 years. Investigators hope to understand how participants’ immune responses to the experimental vaccine may vary based on age and the likelihood of their previous exposure to different influenza variants.

Study participants will be asked to record their temperature and any symptoms on a diary card for one week after each injection. They also will be asked to visit the clinic to provide blood samples at various time points. Investigators will test the samples in the laboratory to characterize and measure levels of anti-influenza antibodies, which are potentially indicative of immunity against influenza. Participants will return for nine to 11 follow-up visits over 12 to 15 months. They will not be exposed to any influenza virus as part of the clinical trial…..”

 


HHS: A Global Response to a Global Threat

HHS

The very word ‘pandemic’ conjures images of global disease and death. Educational campaigns highlighting the centennial of the 1918 Influenza pandemic are a jarring reminder that more than 50 million people died due to a previously unknown influenza strain against which very few people had immunity. However, few people today understand that every year over one billion people worldwide are infected by seasonal influenza viruses resulting in as many as 650,000 deaths. This global threat requires a global response.

exit disclaimer icon

On Monday, March 11th the World Health Organization (WHO) released the Global Influenza Strategy 2019-2030 – PDF . The Strategy signifies a holistic effort to strengthen national capacities to detect, prevent, and respond to seasonal and pandemic influenzas on a global scale, and to capitalize on recent influenza preparedness gains. The new strategy strengthens our work with WHO to fight influenza and prevent or slow any worldwide outbreak of the viral disease. This plan leverages expertise from across HHS, including the U.S. Food and Drug Administration, the National Institutes of Health, the Office of the Assistant Secretary for Preparedness and Response, Centers for Disease Control and Prevention and the Office of Global Affairs. Our proven domestic preparedness efforts coupled with a more seamless and global commitment will help quickly combat the most dangerous and persistent infectious disease threats.

Last year in the U.S., there were 49 million influenza infections, 960,000 hospitalizations, and 79,000 deaths, despite the availability of a seasonal vaccine. Influenza vaccination prevented approximately seven million illnesses, and 8,000 deaths during the 2017-2018 U.S. flu season. The yearly occurrence of seasonal influenza oftentimes means that this disease is not taken seriously, but complacency should never undermine our vigilance in prevention efforts. Continued innovation in our domestic medical countermeasures, surveillance and response capabilities as well as increased public awareness about the importance of vaccines are essential in the fight against seasonal influenza and another global pandemic.

The launch of the WHO Strategy builds upon its nearly 80-year history in seasonal and pandemic influenza preparedness. It sets forth a vision aimed at providing nations, industry, and civil society with a framework allowing better global influenza surveillance, disease prevention and control. It sharpens countries’ preparedness efforts, and promotes basic and applied research that will produce better diagnostics, antivirals, and vaccines.

In an increasingly mobile society, this global strategy is more important than ever. Pathogens do not respect borders; all it takes is a plane ticket to transport these invisible germs around the world in hours. The US must lead by example, our domestic disease prevention efforts are a model for the rest of the world. International collaboration is the only way to prevent mobile viruses from quickly spreading.

The U.S. Centers for Disease Control and Prevention (CDC) is one of the six premier WHO Influenza Collaborating Centers monitoring the evolution and emergence of influenza viruses. CDC provides data and recommendations for diagnostics, vaccines, antiviral drugs, and risk assessment that directly inform our global preparedness in addition to preparing candidate vaccine viruses for use in vaccine production. CDC also works with more than 50 nations to enhance their capacity to detect, prevent and respond to both seasonal and pandemic influenza. These collaborations lead to sharing information between nations, including knowledge of outbreaks of novel virus detections, and lead to earlier prevention and control at home and abroad. Combating influenza is not done in a vacuum; all nations must work together.

exit disclaimer icon

In 2006, WHO created the Global Action Plan for influenza vaccines (GAP) . With the technical expertise of HHS’s Biomedical Advanced Research and Development Authority (BARDA), the plan introduced influenza vaccine manufacturing to areas of the world where none or very few vaccines existed. One of the program’s many success stories is the Institute of Vaccines and Medical Biologicals (IVAC) in Vietnam. Just this year, IVAC licensed its first seasonal trivalent influenza vaccine. Vietnam now has the ability to provide influenza vaccines to the people of Vietnam and help the global community with surveillance and manufacturing. The 15 companies, from 13 low and middle income countries, supported by BARDA and WHO in this program expanded their pandemic influenza vaccine production capacity from less than 1 million doses in 2006 to over 600 million doses in 2018. Since its creation, GAP has contributed to an increased global vaccine capacity from an estimated 500 million doses in 2006, to a predicted ability to produce over six billion doses for the next influenza pandemic. This is a major global preparedness milestone. Domestically, ASPR/BARDA is also working with industry to improve seasonal and pandemic influenza vaccines by utilizing new technology to improve production methods that reduce the time needed to produce and administer vaccines in response to a pandemic.

HHS has other major initiatives dedicated to understanding and improving influenza preparedness, surveillance, and response. The National Institutes of Health’s (NIH) National Institute of Allergy and Infectious Disease is involved with innovative work investigating universal influenza vaccines and next generation diagnostics, antiviral agents and other research that provides valuable information about the influenza virus and host response. Much of this research is generated by NIAID’s network of Centers for Excellence for Influenza Research and Surveillance (CEIRS).

The Food and Drug Administration (FDA) is an Essential Regulatory Laboratory within the WHO system and works directly with key partner nations to strengthen regulatory systems that support influenza vaccine manufacturing capacity through WHO’s GAP program. In collaboration with other Essential Regulatory Laboratories in the United Kingdom, Australia, and Japan, FDA contributes to a range of activities each year for the production of influenza vaccines, including strain selection for seasonal and pandemic influenza vaccines, preparing virus stocks, and calibrating vaccine reagents.

HHS will continue to work every day to prevent and contain the threat of disease. We are a committed partner in the WHO Global Influenza Strategy. We collaborate with academia and the private sector to advance influenza preparedness. Influenza is an international problem that necessitates global collaboration and an infrastructure ready for worldwide response. We are proud that HHS is working hand in hand with WHO to lead global efforts to prevent the next pandemic.

Garrett Grigsby is the Director of the HHS Office of Global Affairs and Dr. Robert Kadlec is the Assistant Secretary of Preparedness and Response.


Research that could make flu viruses more dangerous, and that the government suspended in 2014 because of safety concerns, has been approved to begin again.

NYT

“…..some scientists…oppose the research because they say it could create mutant viruses that might cause deadly pandemics if they were unleashed by lab accidents or terrorism……”

 


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……”


Categories

Recent Posts

Archives

Admin