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Pandemic Response
Plans to manage disease outbreaks progress from international agencies to local health departments.
By Elaine Blasso Lyons, MSN, RN, CIC
To view the Course Outline and take the test online, click here.
For a printer-friendly version of the test you can print out, complete and mail into ADVANCE, click here.
Learning Scope #325
1 contact hour
Expires Feb. 1, 2012
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Right Click Here to download the mp3 file, Pandemic Response
Right Click Here to download the mp3 file, Federal Mobilization
Right Click Here to download the mp3 file, State, Local, Individual Roles
The goal of this CE offering is to provide nurses with current information on pandemic response. After reading this article, you will be able to:
1. Identify the difference between an epidemic and pandemic.
2. Describe and discuss the agencies that are involved in a pandemic response.
3. List three actions an individual can take as part of a pandemic response.
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate; take the test online; grade and certificate are available immediately after taking the test. 2) Mail your completed exam (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the completed exam to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
An endemic refers to infectious diseases normally found in a particular area or population. An example is HIV/AIDS in several of the African countries. An epidemic is the spread of disease from person to person over a large area affecting many people. It is disease occurrence is in excess of what investigators might expect to see reported at that point in time.
A pandemic is a worldwide epidemic of a disease.1 The 1918 influenza pandemic killed between 50 million and 100 million people around the world. In the U.S., approximately 675,000 people died. This pandemic occurred near the end of World War I and lasted almost 2 years. More people died of that flu than were killed during the entire war.
Travel Factor
In 1957, the influenza death rate was approximately 1 million to 2 million around the world, with 70,000 in the U.S.2 With the ease and increase of global travel, as well as overcrowding in urban areas, epidemics can become pandemics faster than in the past. Epidemiologic models estimate that a pandemic today can lead to 2 million to 7.4 million deaths around the world.1
International Resources
According to the World Health Organization (WHO), pandemics and epidemics can wreak havoc by creating acute and urgent demands on healthcare systems. Any weakness in a healthcare system will soon be exposed. The mortality and morbidity can interfere with economic activity and development.3
There are three necessary pieces to be in place for a pandemic to occur, according to the WHO. First is the appearance of a new or novel virus. For instance, novel H1N1, the 2009 pandemic, is new and the population has been susceptible to it. Second, the new virus can reproduce and cause illness in man. Third, the new virus can spread easily from person to person.
The WHO has been tracking the avian flu (H5N1) for more than 5 years, and the third parameter has not yet been met. In order to prevent the spread to humans, more than 250 million birds have been destroyed. As of June 2007, the H5N1 had been found in birds in 62 countries. The economic cost to those countries was more than $12 billion.4
The WHO has a six-phase Global Alert and Response preparedness plan. The initial phase monitors virus circulation in animals, especially birds. In this phase, no animal virus is reported to infect humans. In second phase, a virus in domestic or wild animals has caused disease in humans. This is now considered a possible pandemic risk. Phase 3 occurs when animal or human-animal virus causes some cases or small groups of disease in people. However, person-to-person transmission is not adequate to create larger outbreaks. In some cases, human-to-human transmission can occur with unprotected close contact of a caregiver, but it is limited.5
Phases of Plan
Phases 1-3 of the Global Alert and Response plan correspond with preparedness. In these phases, response planning is taking place, as well as capacity development. H5N1 has been halted in phase 3. However, plans continue to prepare the global community for phase 4.
In phase 4, human-to-human transmission continues. In phase 5, the virus is spread to at least two countries in one WHO region. This is not considered a pandemic yet, but this information sends the alarm one is impending. It is time to finalize plans, organize, communicate and implement. The pandemic phase is phase 6. There are community outbreaks in the identified countries and an additional country is reported in a different WHO region.
In the post-peak period for pandemics, most countries see a decline in disease. However, that is not the time to decrease precautions and surveillance, according to the WHO. Pandemics can come in waves of activity over many months.5 For example, in 2009, there was high activity in H1N1 at the start in April that continued for months. Then the number of cases dropped off, only to see a resurgence in September and October.
When the post-pandemic period disease activity drops to normal levels, it is time to evaluate the implementation of the plan - what went right and what needs to be improved.5
Federal Mobilization
The FDA works closely with the WHO in the development of yearly influenza vaccine. The WHO and FDA review scientific information to decide the composition for the vaccine each year. The FDA ensures the vaccine is safe and effective. Ineffective vaccine can inhibit the development of effective therapy.
According to the FDA, sometimes no vaccine is better than an ineffective one. Before a vaccine is developed, the FDA evaluates risk versus benefit and current events. Development of a vaccine is ideal if it can be done prior to a pandemic (a vaccine for H5N1 is ready if it should be needed).
Before a vaccine can come to market, it must be produced and tested, and be a quality vaccine. If it is a disease the FDA is familiar with, such as influenza, development and production can be a little faster than with an unfamiliar virus. Even under the best of circumstances, it takes months from the discovery of a new virus to vaccine development.6
The WHO has a Global Outbreak Alert and Response Network, which works in cooperation with organizations around the world that combine human and technical resources to rapidly identify, confirm and respond to an outbreak. In the U.S., the cooperative organization is the CDC.7
The CDC works with local state and public health departments, which are the first responders. The CDC's Public Health Emergency Preparedness cooperative agreement works with health departments by providing scientific expertise (surveillance, epidemiology, lab testing) as well as countermeasure delivery, incident management and communication to both the public and health practitioners. Their priority is to support the response of the state on a local level.
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