PANDEMIC FLU PREPARATION

Many tools are available

The practice of public health and the science of medicine provide organizations with an array of tools to help mitigate the spread of influenza. These tools or interventions have benefits and drawbacks, but should all be considered in a review of options.

Medical interventions

Medical interventions for pandemic flu consist of two major types: pharmaceutical (vaccines and antivirals) and non-pharmaceutical (medical devices/supplies such as masks and respirators).

The pharmaceutical interventions:

• Vaccines. The single best way to prevent the flu is a flu vaccination.[6] However, there are not adequate supplies of vaccine at the start of a flu pandemic [18] because a vaccine tailored to the pandemic strain of the virus must first be developed and produced.[19]
   
• Antivirals. Antiviral drugs might be useful for the treatment and prevention of pandemic flu. Antivirals could have a significant impact on the burden of disease, social disruption and economic upheaval of pandemic influenza.[28]

There are multiple antivirals approved by the US Food and Drug Administration (FDA) to treat and sometimes prevent flu, but RELENZA® (zanamivir for inhalation) and Tamiflu® (oseltamivir phosphate) are the most likely antivirals to be used in a pandemic.

Click here to learn more about RELENZA and pandemic flu.

In the US, government agencies have started stockpiling each of these drugs.[21]

Non-pharmaceutical interventions include:

• Facemasks. Surgical facemasks are designed to protect against blood and other body fluids but are not designed to prevent the inhalation of small airborne contaminants.[24] Because surgical masks do not have a sealing surface and only fit loosely, they provide only minimal protection from airborne particles.[30] However, surgical facemasks have a role in pandemic flu prevention if used in conjunction with other interventions such as handwashing.[24]
   
• Respirators. Designed to fit the face tightly, respirators reduce exposure to airborne contaminants. However, it is important to evaluate whether or not a person can perform their work tasks while wearing a respirator. Air-purifying respirators are likely the most useful to employees in the time of a pandemic because they filter particles out of the air that a person breathes.[24]

Community interventions

The most effective tool for mitigating a pandemic (a well-matched pandemic strain vaccine) will not be available when a pandemic begins.  This means the first wave of a pandemic requires community (social) solutions as well as medical solutions.

Pandemic community interventions include:

• Isolation (and treatment as appropriate with influenza antiviral medications of all persons with confirmed or probable influenza.) Isolation may occur in the home or healthcare setting.
   
• Voluntary home quarantine of members of households with confirmed or probable influenza case(s) and consideration of combining this intervention with the prophylactic use of antiviral medications.
   
• Dismissal of students from school and school-based activities and closure of childcare programs, coupled with protecting children and teenagers through social distancing in the community to achieve reductions of out-of-school social contacts and community mixing.
   
• Social distancing measures to reduce contact between adults in the community and workplace. For example, cancellation of large public gatherings and alteration of workplace environments and schedules to decrease social density. Effort should be made to preserve a healthy workplace to the greatest extent possible without disrupting essential services. 

All such social strategies should be used in combination with individual infection control measures, such as hand washing and cough etiquette.[31]

 
Important Safety Information About RELENZA

• Serious cases of bronchospasm, including fatalities, have been reported during treatment with RELENZA in patients with and without underlying airway disease. Many of these cases were reported during postmarketing, and causality was difficult to assess
  
• RELENZA SHOULD BE DISCONTINUED IN ANY PATIENT WHO DEVELOPS BRONCHOSPASM OR DECLINE IN RESPIRATORY FUNCTION; immediate treatment and hospitalization may be required
  
• Safety and efficacy have not been demonstrated in patients with high-risk underlying medical conditions
  
• Patients should be instructed in the use of the delivery system. Instructions should include a demonstration whenever possible
  
• If treatment with RELENZA is considered for a patient with underlying airway disease, the potential risks and benefits should be carefully weighed. If a decision is made to prescribe RELENZA for such a patient, this should be done only under conditions of careful monitoring of respiratory function, close observation, and appropriate supportive care including availability of fast-acting bronchodilators
  
• Common adverse events in treatment and prophylaxis studies with RELENZA were nausea, diarrhea, sinusitis, viral respiratory infections, headaches, nasal signs and symptoms. The incidence of these adverse events was similar in both groups for RELENZA and placebo-treated groups
  
• Please see complete Prescribing Information for RELENZA