Nation must prepare now for pandemic influenza

Improve surveillance, ready vaccine

According to a new draft influenza plan issued by the U.S. Department of Health and Human Services, the following actions must be taken now, before a pandemic strain emerges:

Expand manufacturing capacity for influenza vaccine, develop surge capacity for pandemic vaccine production, and assess potential approaches to optimize vaccine dose and diversify manufacturing.

Strengthen global surveillance — human and veterinary — leading to earlier detection of novel influenza strains that infect humans, cause severe disease, and are capable of person-to-person transmission such that they have a high probability of international spread and assess the susceptibility of the pandemic virus to antiviral drugs.

Strengthen U.S. surveillance by expanding to year-round surveillance for influenza disease and the viral strains that cause it. Develop hospital-based surveillance for severe respiratory illness (e.g., influenza and other infectious agents) and identify methods to rapidly expand the current sentinel physician surveillance system during an influenza pandemic or other health emergency.

Conduct research to better understand the pathogenic and transmission potential of novel influenza viruses to improve predictions about the strains that could trigger an outbreak that could lead to a pandemic.

To shorten the timeline to vaccine availability in a pandemic, develop collections (libraries) of novel influenza strains that may cause a pandemic; prepare reagents to diagnose infection and evaluate candidate vaccines; and develop high-growth reference strains that can be used for vaccine production.

For selected novel influenza strains, develop investigational vaccine lots and perform clinical studies to evaluate immunogenicity, safety, and whether one or two doses are needed for protection. In the determination of the optimal vaccine dose, studies also should be performed to assess whether adding an adjuvant, a substance to enhance the immune response to vaccination, or alternative vaccine administration approaches will lead to improved protection and/or the ability to protect more people with the available amount of vaccine virus and effectively expand the vaccine supply.

Conduct research to develop new influenza vaccines that are highly efficacious, easier to administer, or directed against a constant portion of the influenza virus and thus potentially sidestep the need to develop a new vaccine every year to match the predominant viral strains that are most likely to cause disease. With this approach, it may be possible to create an influenza vaccine stockpile in the future.

Continue efforts to expand annual influenza vaccine use and provide appropriate incentives to strengthen the vaccine delivery system. Increase vaccine use and encourage manufacturers to increase overall capacity.

Improve capacity to monitor influenza vaccine effectiveness and track vaccine distribution and coverage.

Periodically assess the appropriateness of the types and quantities of antiviral drugs included in the Strategic National Stockpile.

Promote planning and provide guidance to groups that will have the lead role in a pandemic response such as state and local health departments, the public and private health care organizations, and emergency response groups; and review, test, and revise the plans, as needed.

Evaluate the potential impacts of interventions to decrease transmission of infection such as travel advisories, school closings, limiting public gatherings, and quarantine and isolation.

Develop materials for various audiences that will inform and educate them about influenza and pandemic influenza.1

Reference 

1. Department of Health and Human Services. Pandemic Influenza Response and Preparedness Plan. Web site: www.hhs.gov/nvpo/pandemicplan.