Inluenza Pandemic Operations and Response Plan

Introduction

Michael Leavitt, then Health and Human Services Secretary, stated on March 30, 2006, “Pandemics happen. Anything we say in advance of a pandemic happening is alarmist; anything we say afterwards is inadequate.” We cannot ignore the warnings from WHO and CDC; we must be prudent and prepare for a pandemic.

It is expected that a pandemic will have global impact with an unpredictable timeline comprising multiple events or waves and spreading quickly from one community to another. Major disruptions are likely for health care, transportation, infrastructure, education, suppliers, and other public services. Ball State University’s crisis responses previously developed were helpful guides in preparing this plan. But unlike most “traditional” natural or man-made disasters, pandemics have a great impact on operational issues and personnel.

This Plan was developed in anticipation of a pandemic. While not all events can be predicted, the planning team utilized the most up-to-date expert information that was available. The focus of Ball State University’s plan is to respond to a pandemic in a thoughtful and compassionate way to help us return to normal operations as quickly as possible.

WHO and CDC experts have widely discussed the unpredictability of a pandemic. This plan, like other crisis plans, should be viewed as a guide that may require modification during the pandemic to appropriately respond to the events. We expect that there will be modifications and improvements to the plan as we move forward. Marketing and Communications staff developed a website that provides the latest information regarding a pandemic. The website address is www.bsu.edu/fluinfo.

Background

A pandemic virus occurs when an antigenic shift takes place in the virus. These changes can either reduce the virus’ pathogenic form or increase its pathogenic form increasing its virulence. A virus will mutate in order to adapt; mutating is a virus defense mechanism. The following three conditions must be met for a pandemic to occur:

a new influenza virus subtype emerges;
the virus infects humans;
the virus gains efficient and sustainable transmission from human to human.

The U.S. Department of Health and Human Services offers the following comparison between seasonal flu and pandemic flu. Seasonal flu follows predictable patterns and occurs usually in the winter months. Because of previous exposure, people usually have some immunity to seasonal flu. People will have no previous exposure to a pandemic flu; healthy people will be as likely at risk for serious complications. Vaccines have been developed for known flu strains and in the U.S. have been available during the annual flu season. It is not likely that a vaccine will be available in the early stages of a pandemic. However, vaccines are currently under development and aggressive research is taking place to create methods to deliver large quantities of vaccine more quickly.

The following table provided by the Indiana State Department of Health illustrates the differences between pandemic influenza and typical seasonal influenza.

PANDEMIC INFLUENZA	TYPICAL SEASONAL FLU
Comes from a novel virus to which no one, or few people, have any immunity	Circulating viruses slightly mutate year to year
Attack rate may be as high as 30% of population
Patients are sicker for a longer period time	Illness usually lasts 1 to 2 weeks
Limited vaccine availability	Vaccine available prior to illness in population
May be resistant to some antivirals	Several antiviral medications are available
Excess mortality (3 to 7 times normal rate	Normal flu mortality – 36,000/year in U.S.
Patients may present with primary viral pneumonia	Pneumonia is usually a later complication
May be severe in all ages	Severe in the very old and the very young
Can occur at any time of the year	Seasonal – occurs in the winter
May have more than one wave of illness	Usually just one wave of illness
Spreads rapidly throughout the world

To monitor and detect influenza activity, the CDC and WHO employ surveillance programs around the world. Combined, there are 113 national centers in 84 countries analyzing and tracking changes.

The World Health Organization (WHO) developed Six Phases for Influenza Planning as outlined below. The U.S. Federal Government response stages are identified on the right side of the following grid.

WHO Phases

Federal Government Response Stages

INTER-PANDEMIC PERIOD

No new virus subtypes detected in humans. A virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human disease is considered to be low.

New domestic animal outbreak in at risk country

No new influenza virus subtypes have been detected in humans. However, a circulating animal virus subtype poses a substantial risk of human disease.

PANDEMIC ALERT PERIOD

Human infection with a new subtype, but no human-to-human spread, or at most rare instances of spread to close contact.

New domestic animal outbreak in at-risk country

Suspected human outbreak overseas

Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans.

Confirmed human outbreak overseas

Larger clusters but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).

PANDEMIC PERIOD

Pandemic phase: Increased and sustained transmission in general population.

Widespread human outbreaks in multiple locations overseas

First human case in North America

Spread throughout the U.S.

Recovery and preparation for subsequent waves