Wednesday, November 15, 2006

Influenza Pandemic "Inevitable"

Monday, November 13, 2006
Influenza Pandemic "Inevitable"

Influenza pandemics are considered inevitable, and the expected worldwide mortality from a severe pandemic is 45 million people, according to Dr David Bradt, from the Department of Emergency Medicine at Royal Melbourne Hospital and the Centre for Refugee and the Disaster Response at Johns Hopkins Medical Institutions in the United States, and Dr Christina Drummond, from the Infectious Diseases Unit at Monash Medical Centre.

Melbourne, Australia - infoZine - Writing in the October/December issue of Emergency Medicine Australasia, the journal of the Australasian College for Emergency Medicine, they say that despite mathematical models suggesting that an emerging pandemic could be contained at its source, this conclusion is not entirely accepted by public health experts.

"Consequences of a pandemic have been widely predicted in the biomedical literature to include overwhelmed healthcare systems, interrupted logistics chains, collapse of economies and destabilized governments," the authors say.

According to Dr Bradt and Dr Drummond, of the 58 countries with animal disease from H5 virus, most are in developing areas.

"In effect the very countries that are the most epidemiologically burdened by avian influenza are also the most developmentally challenged to manage it."

Control strategies such as culling generally result in financial loss to the owner of the birds, which creates an economic disincentive to report bird illness or flock death, the authors say.

They urge governments and health authorities to stay abreast of rapidly evolving technical guidance.

"Personal protective equipment kits, decontamination kits and specimen collection kits in lightweight, portable packages are becoming standardized."

However, air transport border control measures purporting to delay importation and spread of human avian influenza "are scientifically controversial", they say.

"Prehospital care, triage and acute care all require additional professional standardization for the high patient volumes anticipated in a pandemic."

Writing in the same issue of Emergency Medicine Australasia, Mr Alan Hampson, from the Australian Influenza Specialist Group in Melbourne, says that although there is no certainty an avian influenza (H5N1) pandemic will occur, history suggests that there will be future influenza pandemics.

Although such a pandemic is beyond our control, we can try to minimize its impact through planning and research, he suggests.

Recent widespread outbreaks of avian influenza and, associated with these, a growing number of human infections with a high mortality rate have raised concerns that this might be the prelude to a severe pandemic of human influenza, he says.

Recent improvements in scientific testing have revealed that influenza viruses have evolved in an avian host, probably waterfowl.

According to Mr Hampson, there is now little doubt that migratory birds have contributed to the global spread of avian influenza, although it appears that in some areas spread might have been by trade in domestic poultry.

Dr Peter Ritchie, Chair of the Public Health committee of the Australasian College for Emergency Medicine, said preparation for influenza outbreaks is an important public health issue, and emergency physicians are involved in such preparation both within their own emergency departments and at state and federal health department level...

"In the hospital setting, simple measures of infection control including hand-washing, use of appropriate surgical masks, not using nebulisers in patients with suspected influenza-like illness, and simple isolation of these patients are most important," he said.

"In some circumstances the use of more elaborate personal protective equipment and negative pressure room isolation may be required."

This study is published in the October/ December 2006 issue of Emergency Medicine Australasia.


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