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Influenza pandemics occur inevitably but at unpredictable intervals. When the next flu pandemic strikes, an outbreak is expected to last about six to eight weeks in each affected community, although multiple waves could occur. High employee absenteeism rates are expected that could disrupt businesses and essential services such as hospitals, police, fire, utilities (water, electricity, communications), garbage pickup and food distribution.[1]

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[edit] Other pandemic threat subtypes

"Human influenza virus" usually refers to those subtypes that spread widely among humans. H1N1, H1N2, and H3N2 are the only known Influenza A virus subtypes currently circulating among humans. [2]

Genetic factors in distinguishing between "human flu viruses" and "avian flu viruses" include:

PB2: (RNA polymerase): Amino acid (or residue) position 627 in the PB2 protein encoded by the PB2 RNA gene. Until H5N1, all known avian influenza viruses had a Glu at position 627, while all human influenza viruses had a lysine.
HA: (hemagglutinin): Avian influenza HA bind alpha 2-3 sialic acid receptors while human influenza HA bind alpha 2-6 sialic acid receptors. Swine influenza viruses have the ability to bind both types of sialic acid receptors.

"About 52 key genetic changes distinguish avian influenza strains from those that spread easily among people, according to researchers in Taiwan, who analyzed the genes of more than 400 A type flu viruses."[3] "How many mutations would make an avian virus capable of infecting humans efficiently, or how many mutations would render an influenza virus a pandemic strain, is difficult to predict. We have examined sequences from the 1918 strain, which is the only pandemic influenza virus that could be entirely derived from avian strains. Of the 52 species-associated positions, 16 have residues typical for human strains; the others remained as avian signatures. The result supports the hypothesis that the 1918 pandemic virus is more closely related to the avian influenza A virus than are other human influenza viruses."[4]

Human flu symptoms usually include fever, cough, sore throat, muscle aches, conjunctivitis and, in severe cases, severe breathing problems and pneumonia that may be fatal. The severity of the infection will depend to a large part on the state of the infected person's immune system and if the victim has been exposed to the strain before, and is therefore partially immune.

Highly pathogenic H5N1 avian flu in a human is far worse, killing 50% of humans that catch it. In one case, a boy with H5N1 experienced diarrhea followed rapidly by a coma without developing respiratory or flu-like symptoms. [5]

The Influenza A virus subtypes that have been confirmed in humans, ordered by the number of known human pandemic deaths, are:

H1N1
Main article: H1N1
H1N1 is currently endemic in both human and pig populations. A variant of H1N1 was responsible for the Spanish flu pandemic that killed some 50 million to 100 million people worldwide over about a year in 1918 and 1919. [6] Controversy arose in October, 2005, after the H1N1 genome was published in the journal, Science. Many fear that this information could be used for bioterrorism.
"When he compared the 1918 virus with today's human flu viruses, Dr. Taubenberger noticed that it had alterations in just 25 to 30 of the virus's 4,400 amino acids. Those few changes turned a bird virus into a killer that could spread from person to person." [7]
H2N2
Main article: H2N2
The Asian Flu was a pandemic outbreak of H2N2 avian influenza that originated in China in 1957, spread worldwide that same year during which a flu vaccine was developed, lasted until 1958 and caused between one and four million deaths.
H3N2
Main article: H3N2
H3N2 is currently endemic in both human and pig populations. It evolved from H2N2 by antigenic shift and caused the Hong Kong Flu pandemic of 1968 and 1969 that killed up to 750,000. [8] "An early-onset, severe form of influenza A H3N2 made headlines when it claimed the lives of several children in the United States in late 2003." [9]
The dominant strain of annual flu in January 2006 is H3N2. Measured resistance to the standard antiviral drugs amantadine and rimantadine in H3N2 has increased from 1% in 1994 to 12% in 2003 to 91% in 2005. [10]
"[C]ontemporary human H3N2 influenza viruses are now endemic in pigs in southern China and can reassort with avian H5N1 viruses in this intermediate host." [11]
H7N7
Main article: H7N7
H7N7 has unusual zoonotic potential. In 2003 in Netherlands 89 people were confirmed to have H7N7 influenza virus infection following an outbreak in poultry on several farms. One death was recorded.
H1N2
Main article: H1N2
H1N2 is currently endemic in both human and pig populations. The new H1N2 strain appears to have resulted from the reassortment of the genes of the currently circulating influenza H1N1 and H3N2 subtypes. The hemagglutinin protein of the H1N2 virus is similar to that of the currently circulating H1N1 viruses and the neuraminidase protein is similar to that of the current H3N2 viruses.


[edit] International government sponsored scientific seminars on H5N1 pandemic prevention

AEWA MOP-3: The third Meeting of the Parties to AEWA met from 23 October-27 October 2005 in Dakar, Senegal. Participants adopted Resolution 3.18, which calls for, inter alia: urgent responses to the spread of HPAI including the development of national surveillance schemes and contingency planning, involving immediate and long-term measures; increased focus on education and awareness programmes and capacity building, particularly in Africa; increased cooperation between relevant bodies; and additional scientific research.

MEETING ON AVIAN INFLUENZA AND HUMAN PANDEMIC INFLUENZA: This meeting was held from 7 November-9 November 2005 in Geneva, Switzerland and was co-sponsored by WHO, FAO and OIE. Participants identified key steps to be taken to contain the spread of HPAI, including source control, surveillance, rapid containment, pandemic preparedness, integrated country plans, and communications.

RAMSAR COP-9: The ninth Conference of the Parties to the Ramsar Convention was held from 8 November-15 November 2005 in Kampala, Uganda. Participants adopted Resolution IX.23, which calls for fully integrated approaches, at both national and international levels, to address HPAI by bringing ornithological, wildlife, and wetland management expertise together with those traditionally responsible for public health and zoonoses. It emphasizes that destruction or substantive modification of wetland habitats with the objective of reducing contact between domesticated and wild birds may exacerbate the problem by causing further dispersal of infected birds.

CMS COP-8: The eighth Conference of the Parties to CMS convened from 20 November-25 November 2005 in Nairobi, Kenya. Participants adopted Resolution 8.27, which calls for support and capacity building for research related to disease processes in migratory bird species, long-term monitoring of their movements and populations, and rapid development of surveillance programmes for HPAI in populations of wild birds. An Annex to the Resolution lists key research needs related to the spread of HPAI in relation to migratory birds and their habitats.

INTERNATIONAL PLEDGING CONFERENCE ON AVIAN AND HUMAN INFLUENZA: This event, held from 17 January-18 January 2006 in Beijing, China, was co-sponsored by the Government of China, the European Commission and the World Bank. During this event the international community pledged US$ 1.9 billion in financial support and discussed coordination mechanisms. Participants adopted the Beijing Declaration, in which they commit themselves to effective development and implementation of integrated national action plans, long-term strategic partnerships, information sharing, increased cooperation on global research, and periodic evaluation of national pandemic influenza preparedness and action plans.

CBD COP-8: The eighth Conference of the Parties to the Convention on Biological Diversity (CBD) was held in Curitiba, Brazil from 20 March-31 March 2006. A brainstorming session on HPAI preceded the meeting. Participants at this session: highlighted threats to migratory species and wetlands, knowledge gaps and the need for capacity building; welcomed the participation of the CBD in the Scientific Task Force on Avian Influenza; and suggested that CBD’s Subsidiary Body on Scientific, Technical and Technological Advice (SBSTTA) further assess the interlinkages between ecosystems and health on matters including climate change and avian flu. Participants adopted a Decision on Avian Flu (UNEP/CBD/COP/8/L.35), in which they take note of the brainstorming meeting report and encourage similar consultations as and when emerging issues that may impact CBD implementation arise.

6TH INTERNATIONAL SYMPOSIUM ON AVIAN INFLUENZA: This event was held from 3 April-6 April 2006 in Cambridge, UK. Participants addressed lessons learned from recent outbreaks in Asia, Africa and Europe and recent epidemiological and virological information. They identified short- and long-term needs, including enhanced scientific information, cross-sectoral and international cooperation, and improved awareness among decision makers and the general public.

[edit] Strategies for individuals in a flu pandemic

In the case of a flu pandemic, to avoid the risk of contracting H5N1 (or indeed, any other strain of the flu virus) people may have to take certain precautions, and make changes to their routine, to minimize the risk of infection. They may also have to prepare for the possibility of their lives being disrupted in a significant way, even if they do not actually become ill.

[edit] Social disruption

A flu pandemic could cause major disruption to everyday life, with footpaths and the countryside being partially or even totally off-limits, and even restrictions on public gatherings (such as public meetings, parties, services at places of worship), quarantine, and bans on individuals travelling to certain locations. However, there are a number of things people could do to prepare themselves:

  • Plan for the possibility that usual services may be disrupted. These could include services provided by hospitals and other health care facilities, banks, stores, restaurants, government offices, and post offices. Think of a back-up plan - what would you do, for example, if you could not buy food from the supermarket, because it was closed?
  • Think about the possibility of having to grow your own food, and if it is possible, "stock up" on essentials.
  • Prepare backup plans in case public gatherings are cancelled - keep in touch via telephone, for instance.
  • Consider how to care for people with special needs or with severe illnesses or disabilities in case the services they rely on are not available - could medicine be delivered to the house, for instance?

[edit] Work

  • Find out if you can work from home.
  • Ask your employer about how business will continue during a pandemic. [12]
  • Plan for the possible reduction or loss of income if you are unable to work or your place of employment is closed.
  • Check with your employer or union about sick leave policies.

[edit] Education

  • Help your child's school plan for pandemic influenza. Talk to the school nurse or the health center. Talk to your teachers, administrators, and parent-teacher organizations, and help them put together a strategy if they have not already done so.
  • Be prepared for the idea that you might have to teach your kids at home. Have textbooks, audiotapes etc on hand, and prepare some exercises for the children to do so that their education doesn't suffer. Also plan recreational activities that your children can do at home, so that they do not begin to suffer from boredom. Video games, the Internet, and your home library are three forms of entertainment that are still easily accessible during a quarantine.
  • Be prepared for the possibility of your child's school being closed for a prolonged period of time, meaning that your child, and probably you, will be stuck at home.

[edit] Transport

  • Think about how you can rely less on public transport during a pandemic. For example, store or grow food and other essential supplies so you can make fewer trips to the store. Stock up on gas so that you don't have to use the bus or train.
  • Prepare backup plans for taking care of loved ones who are far away. Make sure you keep in touch with these people on a regular basis.

[edit] Organizing

  • Think about what information the people in your workplace will need if you are a manager. This may include information about insurance, leave policies, working from home, possible loss of income, and when not to come to work if sick. [13]
  • Meet with your colleagues and make lists of things that you will need to know and what actions can be taken. For example, does everyone have access to a computer or a fax machine in the event that the business has to close?
  • Find volunteers who want to help people in need, such as elderly neighbors, single parents of small children, or people without the resources to get the medical help they will need. You could become a volunteer yourself as there are plenty of people who will need your help.
  • Make sure that those close to you know the risks and are safe and sensible, not putting themselves in danger of infection.
  • Provide support to friends, family and others in your community who need it.

[edit] Food storage

Keep a supply of water and food. During a pandemic you may not be able to get to a store. Even if you can get to a store, it may be out of supplies or it may not be safe to enter it. Public waterworks services may also be interrupted. Stocking supplies can be useful in other types of emergencies. Store foods that:

  • are nonperishable (will keep for a long time) and don’t require refrigeration - such as tinned fruit, condensed milk, etc
  • are easy to prepare in case you are unable to cook
  • require little or no water, so you can conserve water for drinking

[edit] Personal health and hygiene

Will the seasonal flu shot protect me against pandemic influenza?

  • No, it won't protect you against pandemic influenza. But flu shots can help you to stay healthy.
  • Get a flu shot to help protect yourself from seasonal flu.
  • Get a pneumonia shot to prevent secondary infection if you are over the age of 65 or have a chronic illness such as diabetes or asthma.
  • For specific guidelines, talk to your GP or another healthcare provider.
  • Make sure that your family's immunizations are up-to-date.

Take common-sense steps to limit the spread of germs. Make good hygiene a habit.

  • Wash hands frequently. Touching your face with contaminated hands can infect you with human-adapted flu viruses.
  • Cover your mouth and nose with a tissue when you cough or sneeze. Put used tissues in a waste basket. Do not use cloth or other reuseable methods. Reuseables spread flu.
  • Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.
  • Stay at home if you are sick.

It is always a good idea to practice good health habits.

  • Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat dairy products, lean meats, poultry, fish, and beans. Drink lots of water and go easy on salt, sugar, alcohol, and saturated fat.
  • Exercise on a regular basis and get plenty of rest.

[edit] Stocks and investments

Experts agree that a lethal pandemic will have a negative effect on the world and local economies.

  • Review your portfolio for vulnerabilities. While some sectors of the economy might benefit, most will suffer from absenteeism and lost productivity, lost sales and potentially higher prices for some commodities. Some businesses may be forced to cut hours or close.
  • Travel, tourism and the hospitality industry will be directly impacted as people avoid unnecessary contact with strangers.
  • Modern just-in-time inventory management makes manufacturers and retailers more vulnerable to disruptions in the supply chain. Even companies whose products and services are in demand during a pandemic (hospitals, supermarkets) could suffer supply shortfalls.
  • You may not have the option of waiting out a downturn. You or family members may suffer loss of income and be forced to liquidate investments at a disadvantageous time. Cash-equivalent investments such as money market funds or treasury bills offer relatively higher safety and liquidity.
  • Bear market mutual funds offer a hedge or an investment strategy in down markets.
  • Have some cash on hand for emergencies. Banks may not maintain normal hours and ATMs may not be restocked.


[edit] See also

[edit] Further reading

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