And President Bush has met with vaccine makers to urge increases in flu vaccine production.
Further, the Bush administration and Congress are considering spending billions to stockpile the antiviral drug Tamiflu (oseltamivir); legislation has been introduced that would further ramp up vaccine production and pandemic preparedness; and the National Institute of Allergy and Infectious Diseases has teamed with MedImmune Inc. to develop and manufacture new influenza vaccines, including vaccines against high-priority strains such as H5N1.
But some experts have suggested H5N1 does not confer a pandemic threat, saying that if it was going to develop the ability to efficiently transmit between people, it would have done so by now, and that because the current avian influenza strain is distantly related to earlier flu viruses, much of the population already has some level of immunity.
Whether or not H5N1 becomes pandemic, preparing for a potential pandemic is warranted and worthwhile, experts agree.
“Even if it does not materialize, the planning and development of effective interventions will provide the necessary preparations in the event that another avian strain jumps the species barrier or a known human pathogen like H2N2, to which large segments of the population lack immunity, reemerges,” John G. Bartlett, M.D., of Johns Hopkins University, Baltimore, and Frederick G. Hayden, M.D., University of Virginia Health Sciences Center, Charlottesville, Va., wrote in a recent editorial (Ann. Intern. Med. 2005;143:460–2).
Preparations would also enhance the nation's ability to cope with annual epidemics and their substantial toll.
Widespread vaccination and use of antiviral drugs could provide the foundation for responding to the next pandemic, thus warranting the stockpiling of antiviral agents, they wrote.
Physician groups are taking heed.
Emergency medicine in general has been planning for years for events such as an influenza pandemic. Severe acute respiratory syndrome (SARS), bioterrorism threats, and pandemic influenza have been on the radar screen for a while.
Planning at the national and local levels has been focused on how emergency departments should and will respond to such a crisis, Richard Rothman, M.D., Ph.D., of Johns Hopkins University and a member of the public health committeee for the American College of Emergency Physicians, said in an interview with FAMILY PRACTICE NEWS.
“It's there, people are aware of it, and they're trying to plan as best as possible,” Dr. Rothman, noting that both ACEP and the Society for Academic Emergency Medicine are actively addressing matters such as policy, clinical issues, and risk of hospital overcrowding.
Likewise, the American Academy of Family Physicians is participating in discussions regarding national and state preparedness, and the AAFP is encouraging and facilitating communications among local chapters.
The academy will be conducting educational activities to help physicians understand what their role will be in the event of a pandemic, Dr. Campos-Outcalt said.
What Can YOU Do?
The most effective thing individual physicians can do is in preparation for a potential avian influenza pandemic is to vaccinate patients against the currently circulating influenza strains, Dr. Poretz said.
Such vaccination will address the immediate concern of influenza outbreaks in the United States, and, according to WHO guidelines, could be useful for preventing co-infection with H5N1 and a human influenza strain.
According to the WHO, doing so will decrease the opportunity for genetic reassortment of the avian H5N1 strain with genes from a human (H1 or H3) strain and thereby reduce the likelihood that a novel pandemic strain will emerge from the current situation in Asia.
If an avian influenza pandemic does occur, diagnosis could prove quite difficult, because the symptoms of H5N1 are similar to those of “regular flu,” Dr. Campos-Outcalt said.
Communication and surveillance will be the cornerstones of effective management, he added. This is where education for and by physicians becomes important.
Physicians need to stay up to date, because so much is unknown about how patients would present in the event of a pandemic. And physicians need to educate patients about the preventive measures that will become imperative should available vaccines and antivirals prove ineffective for the pandemic strain.
When it comes to potential patient requests for antiviral medications such as oseltamivir, “I would encourage physicians to prescribe as recommended by the CDC and the manufacturer,” said Dr. Campos-Outcalt.
The CDC's influenza page is located at