US Readiness for Flu Outbreak "Spotty"
Putting aside for a moment whether an outbreak of Pandemic avian flu (H5N1) is on the horizon or not, the recent outbreaks in China (where no concrete connections have yet been proven) and in Pakistan (where a small chain of human to human transmission has occurred according to the World Health Organization) raise the concern level.
Keiji Fukuda, coordinator of the WHO's global influenza program, told Reuters this week that the Pakistan cases probably represent a mix of poultry-to-human infections and human-to-human transmission resulting from close contact when people cared for infected relatives. "We don't have any indication of a broader health threat, other than poultry outbreaks" in the area, WHO spokesman John Rainford told CIDRAP (Center for Infectious Disease Research & Policy - University of Minnesota) news today. "Our risk assessment suggests no evidence of sustained transmission. All the close contacts and involved healthcare workers remain asymptomatic and have been released from close medical observation."
At the same time, CIDRAP is also reporting that the origins of the more recent outbreak in Indonesia in which five members of one family have been infected are unknown (see also from CIDRAP: CIDRAP News story "Possible H5N1 family cluster probed in Pakistan” and CIDRAP News story "Reports suggest common source in family H5N1 cases"
Therefore, despite explanations, there is a possibility that in both Pakistan and China (and maybe Indonesia), we are seeing both human-to-human and bird-to-human transmission. The question of human-to-human transmission, and whether that jump can or will turn into a pandemic has to be considered. In fact, the World Health Organization, in its latest reports said that there is a possibility that the reported Bird Flu in Pakistan might be spreading both from person to person and from poultry to humans. Additionally, the U.S. State Department this week began a series of articles on the bird flu preparations in Vietnam
Vietnam's Vaccination Effort Helps in Fight Against Avian Flu Vaccinating its highest-risk populations of chickens and ducks has been an expensive and logistically complex effort for Vietnam’s central government, but animal health officials say it has slowed deadly outbreaks of highly pathogenic H5N1 avian influenza among birds in the Southeast Asian nation and, critically, among people. Also see: The State Department’s Bird Flu website is found here, Bird Flu (Avian Influenza) and National Strategy for Pandemic Influenza
Why make this point (over and over again)? It’s all about preparedness. Based on a report from Trust for America’s Health (tagged as a “watchdog” group by some local media), "Ready or Not? Protecting the Public's Health from Disease, Disasters, and Bioterrorism," we remain unprepared. The report indicates that a “number of critical areas of the nation's emergency health preparedness effort still require attention.” More on point:
Thirteen states don't have adequate plans to distribute vaccines and antidotes in the event of a flu pandemic or a bioterrorism attack. Among the findings outlined in the report:
● Flu vaccination rates decreased among the elderly in 11 states during the past year."There is little doubt that emergency health preparedness is on the national radar," Levi added. "But until all states are equally well prepared, our country is not as safe as it can and should be."
● Six states cut their public health budgets between fiscal 2005 and fiscal 2006.
● Thirteen states do not have adequate plans to distribute emergency vaccines, antidotes, and medical supplies from the Strategic National Stockpile
● Twenty-one states do not have statutes that allow for adequate liability protection for healthcare volunteers during emergencies
● Twelve states do not have a disease surveillance system compatible with the Centers for Disease Control and Prevention's (CDC) National Electronic Disease Surveillance System
● Seven states have not purchased any portion of their federally-subsidized or unsubsidized antivirals to use during a pandemic flu
● Seven states and D.C. lack sufficient capabilities to test for biological threats
All fifty U.S. states and the District of Columbia (D.C.) were graded based on publicly available data. The results? Thirty-five states and D.C. scored eight or higher on the scale of ten indicators. Illinois, Kentucky, Nebraska, New Jersey, Pennsylvania, Tennessee, and Virginia scored the highest with 10 out of 10. Arkansas, Iowa, Mississippi, Nevada, Wisconsin, and Wyoming scored the lowest with six out of 10.
We are dealing with the potential onset of a naturally borne medical disaster. I believe that it is important to recognize that the question of the “jump” to human-to-human transmission is one that could be “only one mutation” (of the virus) away. This was discussed back in October in The “Next” Step in Bird Flu Mutations. While "some" people may argue that "human-to-human" transmission is not occuring (or at least not yet on a large scale), or even that if an outbreak of H5N1 occurs in the United States, it might not become a pandemic, I blieve that the saying that "a chain is only as strong as its weakest link" holds true here.