U.S. Issues Guidelines in Preparation for Flu Pandemic

The Department of Health and Human Services (HHS) and its Centers for Disease Control and Prevention (CDC), in cooperation with departments and agencies across the Federal Government, announced yesterday two new efforts designed to improve state, local and community preparedness for an influenza pandemic, which can occur when a new strain of flu appears for which people have no immunity, and disease spreads rapidly around the world.

CDC released new guidance on community planning strategies that state and local community decision-makers, as well as individuals, need to consider based on the severity of an influenza pandemic. These strategies are important because the best protection against pandemic influenza -- a vaccine -- is not likely to be available at the outset of a pandemic. Community strategies that delay or reduce the impact of a pandemic (also called non-pharmaceutical interventions) may help reduce the spread of disease until a vaccine that is well-matched to the virus is available.

The CDC guidance was developed in collaboration with other federal agencies and public health and private partners. The federal government has undertaken many efforts in the last few years to encourage and strengthen the nation's pandemic influenza preparedness, and this guidance builds upon previously released planning documents and guidelines.

"The threat of a pandemic continues to be real. We need to continue helping state and local decision-makers determine some of the specific actions they could take during the course of a pandemic to reduce illness and save lives," said HHS Secretary Mike Leavitt. "An important consideration for action is the severity of a pandemic once it emerges. The new CDC guidelines are a step forward in that direction."

The new guidelines focus primarily on community-level measures that could be used during an influenza pandemic in an effort to reduce the spread of infection. In order to help authorities determine the most appropriate actions to take, the guidelines incorporate a new pandemic influenza planning tool for use by states, communities, businesses, schools and others. The tool, a Pandemic Severity Index (PSI), takes into account the fact that the amount of harm caused by pandemics can vary greatly, with that variability having an impact on recommended public health, school and business actions.

The PSI, which is modeled after the approach used to characterize hurricanes, has five different categories of pandemics, with a category 1 representing moderate severity and a category 5 representing the most severe. The severity of pandemic is primarily determined by its death rate, or the percentage of infected people who die. A category 1 pandemic is as harmful as a severe seasonal influenza season, while a pandemic with the same intensity of the 1918 flu pandemic, or worse, would be classified as category 5.

"It's important that we try in advance to imagine and evaluate some of the steps that could be taken to slow the spread of pandemic influenza in communities," said Dr. Julie Gerberding, CDC director. "That requires a great deal of forethought, vision, and collaboration. I'm proud of CDC's efforts to guide the efforts of many federal and state partners to develop the severity index -- and to then link severity with potential actions. We recognize that much work remains, but this new approach should help communities, schools, businesses, and others strengthen their pandemic influenza plans."

Based on the projected severity of the pandemic, government and health officials may recommend different actions communities can take in order to try to limit the spread of disease. These actions, which are designed primarily to reduce contact between people, may include:

1. Asking ill persons to remain at home or not go to work until they are no longer contagious (seven to 10 days). Ill persons will be treated with antiviral medication if drugs are available and effective against the pandemic strain.
2. Asking household members of ill persons to stay at home for