Pandemic

A pandemic caused by influenza A/H5N1 or another novel strain could kill millions of people and devastate economies worldwide. Recent computer simulations suggest that an emerging influenza pandemic might be contained in Southeast Asia through rapid detection, antiviral distribution, and other interventions [1]. To facilitate containment, the World Health Organization (WHO) has established large, global antiviral stockpiles and called on countries to develop rapid pandemic detection and response protocols [2]. However, developing countries in Southeast Asia would face significant challenges in containing an emerging pandemic. Limited surveillance coverage and diagnostic capabilities; poor communication and transportation infrastructure; and lack of resources to investigate outbreaks could cause critical delays in pandemic recognition. Wealthy countries have committed substantial funds to improve pandemic detection and response in developing countries, but tools to guide system planning, evaluation, and enhancement in such places are lacking.

Objective

We propose a framework for evaluating the ability of syndromic, laboratory-based, and other public health surveillance systems to contain an emerging influenza pandemic influenza in developing countries, and apply the framework to systems in Laos.

Four waves of pandemic influenza from 1918-1920 in New York City caused ~40,000 deaths, primarily of young-adults and children. The explosiveness of the autumn 1918 wave has led many to believe that in the event of a similar pandemic today early detection and intervention strategies may not be effective. Recent historical studies of the 1918 pandemic, however, provide evidence of controllable transmissibility, of a limited early wave4, and of social distancing measures significantly reducing pandemic impact in many US cities. Importantly, mitigation efforts initiated after the beginning of community-wide transmission (even up to the point of 3-6% of a population being infected) significantly reduced the total impact in 1918.

Objective

In response to an Institute of Medicine report recommending community-based pandemic influenza mitigation strategies be informed by surveillance and disease modeling, we aimed to assess the feasibility of using emergency department data to identify model derived threshold triggers for initiating intervention efforts in the event of a 1918-like pandemic.

In response to increasing reports of avian influenza being identified throughout the eastern hemisphere, the U.S. Homeland Security Council, the Infectious Disease Society of America, and others have called for expansion of enhanced, real-time electronic syndromic and other advanced surveillance systems to supplement the traditional surveillance systems recommended in U.S. Department of Health & Human Services pandemic influenza preparedness plan guidance. Like many states, the Connecticut Department of Public Health, has updated its own Pandemic Influenza Response Plan to reflect its expanding arsenal of surveillance systems. These systems include a syndromic surveillance system, known as the Hospital Admissions Surveillance System (HASS), developed in September 2001 to monitor for possible bioterrorism events and emerging infections. HASS data has been utilized to supplement information received from laboratoryconfirmed influenza test results, influenza-like-illness reporting, and pneumonia influenza mortality to track seasonal influenza since 2003.

Objective

This paper summarizes the results of a continued review of state pandemic influenza preparedness plans and compares various approaches for routine influenza surveillance during interpandemic periods with approaches for enhanced surveillance during pandemic alerts. The increased reliance of syndromic and other advanced surveillance systems by U.S. states for seasonal influenza tracking and pandemic preparedness planning is documented.

In response to increasing reports of avian influenza being identified throughout the eastern hemisphere, the World Health Organization and the U.S. Department of Health and Human Services have published pandemic influenza preparedness plans. These plans include detailed recommendations for routine influenza surveillance during ongoing interpandemic periods as well as recommendations for enhanced influenza surveillance during episodes of international, national, and local pandemic alerts. Like many states, the Connecticut Department of Public Health (DPH), prepared its own Pandemic Influenza Response Plan. The DPH has also been expanding its arsenal of surveillance systems. These systems include a syndromic surveillance system, known as the Hospital Admissions Surveillance System (HASS), developed in September 2001 to monitor for possible bioterrorism events and emerging infections. HASS data has been utilized to supplement information received from laboratoryconfirmed influenza test, influenza-like-illness reporting, and pneumonia influenza mortality to track seasonal influenza.

Objective

This paper examines the results of a review of state pandemic influenza preparedness plans and compares various approaches for routine influenza surveillance during interpandemic periods with approaches for enhanced surveillance during pandemic alerts. The results of this review are compared with the experience of using a hospital-based syndromic surveillance system as a supplement to laboratory and clinical influenza surveillance systems.

To estimate diagnostic demand in case of pandemic threat using trends in respiratory syndromes (as input for a laboratory preparedness program).

This paper examines the continued usefulness, through the 2005-06 influenza season, of a hospital admissions-based syndromic surveillance system as a supplement to laboratory and clinical influenza surveillance in preparation for pandemic influenza.

If the next influenza pandemic emerges in Southeast Asia, the identification of early detection strategies in this region could enable public health officials to respond rapidly. Accurate, real-time influenza surveillance is therefore crucial. Novel approaches to the monitoring of infectious disease, especially respiratory disease, are increasingly under evaluation in an effort to avoid the cost- and timeintensive nature of active surveillance, as well as the processing time lag of traditional passive surveillance. In response to these issues, we have developed an indications and warning (I&W) taxonomy of pandemic influenza based on social disruption indicators reported in news media.

Objective

Our aim is to analyze news media for I&W of influenza to determine if the signals they create differ significantly between seasonal and pandemic influenza years.

In the past, the media has served a source of data for syndromic surveillance of infectious disease, whether it is outbreaks of disease in animals or humans resulting in illness or death.  More often than not, the reverse is true; data based on analyses of   syndromic surveillance often flows from hospital to local health departments and federal governmental agencies such as the CDC to the media which then relays it to the public. In both instances, the media may serve as a purveyor of vital information.  But, sometimes the media reports are less than ideal; the public may become fearful and panic at the news of a potential outbreak of an emerging infectious disease such as bird flu for which there is a high fatality case rate and no proven available vaccine, or curative therapy. Moreover, supplies of vaccine may be limited, and news of a shortage of antiviral medications such as Tamiflu may lead to stockpiling similar to what occurred with Cipro during the anthrax  ‘scare.’  

Objective:

This paper explores how the mass media covered bird flu outbreaks overseas in the Fall of 2005, and the nationís preparations for a possible bird flu pandemic, and how this period of intense media activity affected sales of antivirals in New City and New York State as monitored by syndromic surveillance techniques.

Public health agencies worldwide all enjoy the same mission—providing healthcare warnings, guidance, and support to the public and healthcare professionals they represent. A critical element in achieving this mission is accessing timely and comprehensive surveillance information about disease in their regions of responsibility. Advances in diagnostic technologies for infectious disease and in the wireless conveyance of information hold great promise for advancing the quality of surveillance information and in facilitating the delivery of timely, accurate, and impactful public health information. Quidel Corporation has developed a cloud–based, wireless communications system that is fully integrated with its Sofia fluorescence immunoassay (FIA) platform for rapid, point-of-care diagnosis of infectious disease. The system, called the Virena Global Wireless Surveillance System (hereinafter, Virena) provides test results to public health organizations and other appropriate entities in near-real time. Currently, more than 4,000 Sofia instruments are transmitting results automatically by Virena. This presentation describes the use of Virena in surveilling influenza in the U.S. in the 2016-2017 influenza season, when over 700,000 influenza-like-illness (ILI) patient results were transmitted. The methods employed, results, and the promise of this innovative system will be discussed.

Objective:

Demonstrate performance of the Virena Global Wireless Surveillance System, an automated platform utilized in conjunction with the Sofia FIA Analyzer, for near real-time transmission of infectious disease test results to public health and other healthcare organizations.