Inter-Pandemic Period and Pandemic Alert Period 117

Personal stockpiling of oseltamivir is strongly discouraged (Brett 2005, Moscona 2005) as this would likely lead to the use of insufficient doses or inadequate courses of therapy, and thus facilitate the emergence of oseltamivir-resistant variants. Moreover, personal stockpiling of oseltamivir further depletes the current supply that is already inadequate to meet the demand.

Antibiotics should be stockpiled for the treatment of Staphylococcus aureus and other secondary infections by each hospital.

General Measures

Non-medical interventions have been shown to be relevant for controlling emergent infectious diseases. In Thailand, community participation at different levels was considered in the national program against H5N1 avian influenza. Public health workers, veterinary health workers, village health volunteers, and others participated in an ongoing national surveillance campaign beginning in October 2004 with written guidance from national authorities (Barnett 2005). The fact that 17 patients were infected with H5N1 during 2004, while only 5 were infected during 2005 in Thailand, might be reflecting an initial success in this nation’s national program against H5N1 avian influenza (WHO 2005c). Intersectoral co-ordination involving non-health sectors (especially agriculture, economic, social and internal affairs) is needed. Professional networks outside the health sector (i.e. law, education, tourism) should also be engaged in the planning process.

Effective pre-event risk communication can reduce event-phase risk communication barriers (USDHHS 2005). Pre-event risk communication to at-risk populations and to the general population is of outstanding importance for easing social tension. By means of mass communication media (TV, radio), the general population should obtain essential information about relevant measures of hygiene, preventive measures, non-recommended actions, risk practices and other relevant issues. Mass communication media should contribute to the general knowledge of the influenza pandemic threat to create social awareness.

Training activities for healthcare professionals directed specifically at pandemic preparedness are useful in increasing healthcare workers’ compliance with personal protective equipment and infection control procedures.

Finally, pandemic simulation exercises are useful for learning what to do in case a pandemic occurs. Around 1,000 health workers and civilians took part in an emergency drill in the Vietnamese capital Hanoi to practise the official response to a bird flu pandemic there. The rehearsal, organised by the city’s authorities, involved people from the local quarter, hospitals, security and army units from Hanoi's Long Bien district where the event took place (Thanhnien 2005).

Seasonal Influenza Vaccination

Routine influenza vaccine should be administered to risk groups to decrease the chances of dual infection with the seasonal circulating influenza strain and the potential pandemic strain, facilitating reassortment. Vaccination with inactivated influenza vaccine is recommended for the following persons who are at increased risk of complications from influenza (ACIP 2005):

118Pandemic Preparedness

•persons aged > 65 years;

•residents of nursing homes and other chronic-care facilities that house persons of any age who have chronic medical conditions;

•adults and children who have chronic disorders of the pulmonary or cardiovascular system, including asthma (hypertension is not considered a high-risk condition);

•adults and children who required regular medical follow-up or hospitalisation during the preceding year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, haemoglobinopathies, or immunosuppression (including immunosuppression caused by medications or by human immunodeficiency virus [HIV]);

•adults and children who have any condition (e.g., cognitive dysfunction, spinal cord injuries, seizure disorders, or other neuromuscular disorders) that can compromise respiratory function or the handling of respiratory secretions or that can increase the risk of aspiration;

•children and adolescents (aged 6 months – 18 years) who are receiving long-term aspirin therapy and, therefore, might be at risk of developing Reye’s syndrome after influenza infection;

•women who will be pregnant during the influenza season; and

•children aged 6-23 months.

Political Commitment

One of the most significant factors is political and social willingness to acknowledge and report disease dissemination. Without this key factor, no further national action to prevent pandemics can take place. High-level political support and commitment are necessary to develop a preparedness plan. Increased regional collaboration and networking may not only lead to the mutual support of people involved in the planning, but can also be used as an instrument for increasing international pressure and thus political commitment (WHO 2004). Records of past pandemics, especially that of 1918, show that a pandemic event may have disastrous consequences for any country due to its impact on the national socio-economic and political structures (PPHSN 2004).

Legal and Ethical Issues

Appropriate legislation must be in place before the pandemic event arrives. In a national disaster situation such as that of a pandemic, there are public health measures that need the support of the national legal system to be efficiently implemented. For example, a quarantine act usually authorises designated services and persons to take necessary measures to eradicate or control the spread of infectious