One hundred years after the 1918 #pandemic: new concepts for #preparing for #influenza pandemics (Curr Opin Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Curr Opin Infect Dis. 2019 May 20. doi: 10.1097/QCO.0000000000000564. [Epub ahead of print]

One hundred years after the 1918 pandemic: new concepts for preparing for influenza pandemics.

Pavia A1.

Author information: 1 Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA.




In the 100 years since the influenza pandemic of 1918-1919, the most deadly event in human history, we have made substantial progress yet we remain vulnerable to influenza pandemics This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system.


We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conventional infection control tools will be critical in healthcare settings. New evidence suggests that influenza virus may be present in aerosols; the contribution of airborne transmission and role of N95 respirators remains unknown. Baloxavir and pimodivir are new antivirals that may improve treatment, especially for severely ill patients. Optimal use and the risk of resistance require further study.


Despite the progress in pandemic preparedness, gaps remain including important scientific questions, adequate resources and most importantly, the ability to rapidly deliver highly effective vaccines.

PMID: 31116135 DOI: 10.1097/QCO.0000000000000564

Keywords: Pandemic Influenza; Spanish flu; Pandemic Preparedness; Antivirals; Vaccines.



Unlocking #pandemic #potential: #prevalence and spatial #patterns of key substitutions in #avian #influenza #H5N1 in #Egyptian isolates (BMC Infect Dis., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

BMC Infect Dis. 2018 Jul 6;18(1):314. doi: 10.1186/s12879-018-3222-6.

Unlocking pandemic potential: prevalence and spatial patterns of key substitutions in avian influenza H5N1 in Egyptian isolates.

Young SG1, Kitchen A2, Kayali G3,4, Carrel M5,6.

Author information: 1 Department of Environmental and Occupational Health, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 2 Department of Anthropology, University of Iowa, Iowa City, IA, USA. 3 Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Sciences Center, Houston, TX, USA. 4 Department of Scientific Research, Human Link, Hazmieh, Lebanon. 5 Department of Geographical and Sustainability Sciences, University of Iowa, Iowa City, IA, USA. 6 Department of Epidemiology, University of Iowa, Iowa City, IA, USA.




Avian influenza H5N1 has a high human case fatality rate, but is not yet well-adapted to human hosts. Amino acid substitutions currently circulating in avian populations may enhance viral fitness in, and thus viral adaptation to, human hosts. Substitutions which could increase the risk of a human pandemic (through changes to host specificity, virulence, replication ability, transmissibility, or drug susceptibility) are termed key substitutions (KS). Egypt represents the epicenter of human H5N1 infections, with more confirmed cases than any other country. To date, however, there have not been any spatial analyses of KS in Egypt.


Using 925 viral samples of H5N1 from Egypt, we aligned protein sequences and scanned for KS. We geocoded isolates using dasymetric mapping, then carried out geospatial hot spot analyses to identify spatial clusters of high KS detection rates. KS prevalence and spatial clusters were evaluated for all detected KS, as well as when stratified by phenotypic consequence.


A total of 39 distinct KS were detected in the wild, including 17 not previously reported in Egypt. KS were detected in 874 samples (94.5%). Detection rates varied by viral protein with most KS observed in the surface hemagglutinin (HA) and neuraminidase (NA) proteins, as well as the interior non-structural 1 (NS1) protein. The most frequently detected KS were associated with increased viral binding to mammalian cells and virulence. Samples with high overall detection rates of KS exhibited statistically significant spatial clustering in two governorates in the northwestern Nile delta, Alexandria and Beheira.


KS provide a possible mechanism by which avian influenza H5N1 could evolve into a pandemic candidate. With numerous KS circulating in Egypt, and non-random spatial clustering of KS detection rates, these findings suggest the need for increased surveillance in these areas.

KEYWORDS: Avian influenza; Egypt; Landscape genetics; Poultry

PMID: 29980172 PMCID: PMC6035396 DOI: 10.1186/s12879-018-3222-6 [Indexed for MEDLINE]  Free PMC Article

Keywords: Avian Influenza; H5N1; Pandemic Preparedness; Egypt.


Are we prepared for the next #influenza #pandemic? #Lessons from modelling different #preparedness policies against four pandemic #scenarios (J Theor Biol., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

J Theor Biol. 2019 May 3. pii: S0022-5193(19)30187-0. doi: 10.1016/j.jtbi.2019.05.003. [Epub ahead of print]

Are we prepared for the next influenza pandemic? Lessons from modelling different preparedness policies against four pandemic scenarios.

Panovska-Griffiths J1, Grieco L2, van Leeuwen E3, Baguelin M4, Pebody R5, Utley M6.

Author information: 1 Clinical Operational Research Unit, University College London, London, United Kingdom; Department of Applied Health Research, University College London, London, United Kingdom; Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom. Electronic address: 2 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address: 3 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom. Electronic address: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom; Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: 5 Vaccines and Countermeasures Service, Public Health England, London, United Kingdom. Electronic address: 6 Clinical Operational Research Unit, University College London, London, United Kingdom. Electronic address:



In the event of a novel influenza strain that is markedly different to the current strains circulating in humans, the population have little/no immunity and infection spreads quickly causing a global pandemic. Over the past century, there have been four major influenza pandemics: the 1918 pandemic (“Spanish Flu”), the 1957-58 pandemic (the “Asian Flu”), the 1967-68 pandemic (the “Hong Kong Flu”) and the 2009 pandemic (the “Swine flu”). To inform planning against future pandemics, this paper investigates how different is the net-present value of employing pre-purchase and responsive- purchased vaccine programmes in presence and absence of anti-viral drugs to scenarios that resemble these historic influenza pandemics. Using the existing literature and in discussions with policy decision makers in the UK, we first characterised the four past influenza pandemics by their transmissibility and infection-severity. For these combinations of parameters, we then projected the net-present value of employing pre-purchase vaccine (PPV) and responsive-purchase vaccine (RPV) programmes in presence and absence of anti-viral drugs. To differentiate between PPV and RPV policies, we changed the vaccine effectiveness value and the time to when the vaccine is first available. Our results are “heat-map” graphs displaying the benefits of different strategies in pandemic scenarios that resemble historic influenza pandemics. Our results suggest that immunisation with either PPV or RPV in presence of a stockpile of effective antiviral drugs, does not have positive net-present value for all of the pandemic scenarios considered. In contrast, in the absence of effective antivirals, both PPV and RPV policies have positive net-present value across all the pandemic scenarios. Moreover, in all considered circumstances, vaccination was most beneficial if started sufficiently early and covered sufficiently large number of people. When comparing the two vaccine programmes, the RPV policy allowed a longer timeframe and lower coverage to attain the same benefit as the PPV policy. Our findings suggest that responsive-purchase vaccination policy has a bigger window of positive net-present value when employed against each of the historic influenza pandemic strains but needs to be rapidly available to maximise benefit. This is important for future planning as it suggests that future preparedness policies may wish to consider utilising timely (i.e. responsive-purchased) vaccines against emerging influenza pandemics.

Copyright © 2019. Published by Elsevier Ltd.

KEYWORDS: Epidemiological modelling; Net-present value of pandemic immunisation; Pandemic influenza; Pre-purchase pandemic vaccine; Responsive-purchase pandemic vaccine

PMID: 31059716 DOI: 10.1016/j.jtbi.2019.05.003

Keywords: Pandemic Influenza; Pandemic Preparedness; Vaccines; Antivirals; UK.


#Canadian #Pandemic #Influenza #Preparedness: #Antiviral strategy (Can Commun Dis Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Can Commun Dis Rep. 2019 Jan 3;45(1):38-43. doi: 10.14745/ccdr.v45i01a05. eCollection 2019 Jan 3.

Canadian Pandemic Influenza Preparedness: Antiviral strategy.

Henry B1,2.

Author information: 1 Canadian Pandemic Influenza Preparedness Task Group, Chair. 2 Office of the Provincial Health Officer, Victoria, BC.



Antiviral medications are the only influenza-specific pharmaceutical intervention that can be used to mitigate the impact of a pandemic until a vaccine becomes available. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) outlines how federal, provincial and territorial governments will work together to ensure a coordinated and consistent health sector approach to pandemic influenza preparedness and response. This article summarizes Canada’s pandemic influenza antiviral strategy as described in the recently updated CPIP Antiviral Annex. The antiviral strategy builds on lessons learned during the 2009 H1N1 pandemic. Key elements of the strategy include ensuring equitable, timely and coordinated access to antivirals through government stockpiles; having regulatory mechanisms in place that facilitate timely access to antivirals; providing timely and evidence-based clinical guidance; maintaining effective stockpile management practices; and monitoring antiviral utilization, effectiveness and safety. Since the CPIP is an evergreen document, this Annex will be updated as new information warrants.

KEYWORDS: antivirals; influenza; pandemic; public health

PMID: 31015817 PMCID: PMC6461127 DOI: 10.14745/ccdr.v45i01a05

Keywords: Pandemic Preparedness; Pandemic Influenza; Antivirals; Canada.


#Quality Assurance Sampling #Plans in #US #Stockpiles for #PPE (Health Secur., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Health Secur. 2019 Mar/Apr;17(2):140-151. doi: 10.1089/hs.2018.0133.

Quality Assurance Sampling Plans in US Stockpiles for Personal Protective Equipment.

Yorio PL1, Rottach DR1, Dubaniewicz M1.

Author information: 1 Patrick L. Yorio, PhD, is a Health Statistician, and Dana R. Rottach, PhD, is a Physical Scientist; both at the National Personal Protective Technology Laboratory, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Pittsburgh, PA. Mitchell Dubaniewicz is a student researcher, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, and was on assignment with CDC/NIOSH/NPPTL.



Personal protective equipment (PPE) stockpiles in the United States were established to facilitate rapid deployment of medical assets to sites affected by public health emergencies. Large quantities of PPE were introduced into US stockpiles because of the need to protect healthcare and other professionals during these events. Because most stockpiled PPE was acquired during, or immediately following, large-scale public health events, such as pandemic influenza planning (2005-2008 0), SARS (2003), H1N1 (2009-10), and Ebola (2014-15), aging PPE poses a significant problem. PPE such as N95 filtering face piece respirators were not designed to be stored for long periods, and much of the currently stored PPE has exceeded its manufacturer-assigned shelf life. Given the significant investment in the procurement and storage of PPE, along with projections of consumption during public health emergencies, discarding large quantities of potentially viable PPE is not an attractive option. Although shelf-life extension programs exist for other stockpiled medical assets, no such option is currently available for stockpiled PPE. This article posits stockpile quality assurance sampling plans as a mechanism through which shelf-life extension programs for stockpiled PPE may be achieved. We discuss some of the nuances that should be considered when developing a plan tailored to stockpiles and provide basic decision tools that may be used in the context of a quality assurance program tailored to stockpiled PPE. We also explore basic information by comparing and contrasting different sample size options.

PMID: 31009257 DOI: 10.1089/hs.2018.0133

Keywords: Pandemic Preparedness; PPE; USA.


The #UK’s #pandemic #influenza #research portfolio: a #model for future research on emerging #infections (Lancet Infect Dis., abstract)

[Source: The Lancet Infectious Diseases, full page: (LINK). Abstract, edited.]

The UK’s pandemic influenza research portfolio: a model for future research on emerging infections

Prof Colin R Simpson, PhD, Dan Beever, MPH, Kirsty Challen, PhD, Daniela De Angelis, PhD, Ellen Fragaszy, MSc, Prof Steve Goodacre, PhD, Prof Andrew Hayward, MD, Prof Wei Shen Lim, DM, G James Rubin, PhD, Prof Malcolm G Semple, PhD, Prof Marian Knight, DPhil, on behalf of theNIHR hibernated influenza studies collaborative group†

Published: April 18, 2019 / DOI:



The 2009 influenza A H1N1 pandemic was responsible for considerable global morbidity and mortality. In 2009, several research studies in the UK were rapidly funded and activated for clinical and public health actions. However, some studies were too late for their results to have an early and substantial effect on clinical care, because of the time required to call for research proposals, assess, fund, and set up the projects. In recognition of these inherent delays, a portfolio of projects was funded by the National Institute for Health Research in 2012. These studies have now been set up (ie, with relevant permissions and arrangements made for data collection) and pilot tested where relevant. All studies are now on standby awaiting activation in the event of a pandemic being declared. In this Personal View, we describe the projects that were set up, the challenges of putting these projects into a maintenance-only state, and ongoing activities to maintain readiness for activation, and discuss how to plan research for a range of major incidents.

Keywords: Pandemic Influenza; Pandemic Preparedness; UK.


#Clinical #research #networks and assessing #pandemic #severity (Lancet Glob Health, summary)

[Source: The Lancet Global Health, full page: (LINK). Summary, edited.]

Clinical research networks and assessing pandemic severity

Srinivas Murthy, Gail Carson, Peter Horby, Laura Merson, Steve Webb

Open Access / Published: January, 2019 / DOI:


We agree with the challenges identified and solutions suggested by Lone Simonsen and colleagues (September, 2018)1 regarding the importance of established clinical research networks in the rapid collection and dissemination of high-quality data for assessing outbreak severity. This is a timely Comment, considering the 2009 influenza pandemic, regional experiences with Middle East respiratory syndrome coronavirus and plague, and ongoing Ebola outbreaks. We strongly endorse the observations made regarding the nature and magnitude of the problems identified and the proposed solution of using existing networks with established research infrastructure and proven capabilities. We extend this discussion by identifying two additional challenges: the absence of existing networks in many low-resource settings and the unmet imperative to standardise data collection.


We declare no competing interests.

Keywords: Infectious Diseases; Pandemic Preparedness.