#NewYork State #Emergency #Preparedness and Response to #Influenza #Pandemics 1918-2018 (Trop Med Infect Dis., abstract)

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

Trop Med Infect Dis. 2019 Oct 30;4(4). pii: E132. doi: 10.3390/tropicalmed4040132.

New York State Emergency Preparedness and Response to Influenza Pandemics 1918-2018.

Escuyer KL1, E Fuschino M2, St George K3.

Author information: 1 Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA. Kay.Escuyer@health.ny.gov. 2 Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA. Meghan.Fuschino@health.ny.gov. 3 Laboratory of Viral Diseases, Wadsworth Center, New York State Department of Health, Albany, NY 12208, USA. Kirsten.St.George@health.ny.gov.



Emergency health preparedness and response efforts are a necessity in order to safeguard the public against major events, such as influenza pandemics. Since posting warnings of the epidemic influenza in 1918, to the mass media communications available a century later, state, national and global public health agencies have developed sophisticated networks, tools, detection methods, and preparedness plans. These progressive measures guide health departments and clinical providers, track patient specimens and test reports, monitor the spread of disease, and evaluate the most threatening influenza strains by means of risk assessment, to be able to respond readily to a pandemic. Surge drills and staff training were key aspects for New York State preparedness and response to the 2009 influenza pandemic, and the re-evaluation of preparedness plans is recommended to ensure readiness to address the emergence and spread of a future novel virulent influenza strain.

KEYWORDS: emergency preparedness; incident management system; influenza pandemic; just-in-time training; surge support

PMID: 31671539 DOI: 10.3390/tropicalmed4040132

Keywords: Pandemic preparedness; Pandemic Influenza; New York; USA.


Preparing intensive care for the next #pandemic #influenza (Crit Care, abstract)

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

Crit Care. 2019 Oct 30;23(1):337. doi: 10.1186/s13054-019-2616-1.

Preparing intensive care for the next pandemic influenza.

Kain T1, Fowler R2,3.

Author information: 1 Department of Critical Care, University of Toronto, Toronto, ON, Canada. 2 Department of Critical Care, University of Toronto, Toronto, ON, Canada. rob.fowler@sunnybrook.ca. 3 Sunnybrook Health Sciences Centre, Room D478, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada. rob.fowler@sunnybrook.ca.



Few viruses have shaped the course of human history more than influenza viruses. A century since the 1918-1919 Spanish influenza pandemic-the largest and deadliest influenza pandemic in recorded history-we have learned much about pandemic influenza and the origins of antigenic drift among influenza A viruses. Despite this knowledge, we remain largely underprepared for when the next major pandemic occurs.While emergency departments are likely to care for the first cases of pandemic influenza, intensive care units (ICUs) will certainly see the sickest and will likely have the most complex issues regarding resource allocation. Intensivists must therefore be prepared for the next pandemic influenza virus. Preparation requires multiple steps, including careful surveillance for new pandemics, a scalable response system to respond to surge capacity, vaccine production mechanisms, coordinated communication strategies, and stream-lined research plans for timely initiation during a pandemic. Conservative models of a large-scale influenza pandemic predict more than 170% utilization of ICU-level resources. When faced with pandemic influenza, ICUs must have a strategy for resource allocation as strain increases on the system.There are several current threats, including avian influenza A(H5N1) and A(H7N9) viruses. As humans continue to live in closer proximity to each other, travel more extensively, and interact with greater numbers of birds and livestock, the risk of emergence of the next pandemic influenza virus mounts. Now is the time to prepare and coordinate local, national, and global efforts.

KEYWORDS: Health care worker safety; Highly pathogenic avian influenza; Human; Influenza; Intensive care; Pandemic; Preparation; Research; Resource allocation; Triage

PMID: 31665057 DOI: 10.1186/s13054-019-2616-1

Keywords: Pandemic influenza; Pandemic preparedness; Intensive care.


#Biosafety #risk #assessment for #production of candidate #vaccine viruses to protect #humans from #zoonotic highly pathogenic #avian #influenza viruses (Influenza Other Respir Viruses, abstract)

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

Influenza Other Respir Viruses. 2019 Oct 28. doi: 10.1111/irv.12698. [Epub ahead of print]

Biosafety risk assessment for production of candidate vaccine viruses to protect humans from zoonotic highly pathogenic avian influenza viruses.

Chen LM1, Donis RO1, Suarez DL2, Wentworth DE1, Webby R3, Engelhardt OG4, Swayne DE2.

Author information: 1 Virology, Surveillance, and Diagnosis Branch, Influenza Division, National Center for Immunization and Respiratory Disease, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA. 2 Exotic and Emerging Avian Viral Diseases Research Unit, Agricultural Research Service, U.S. National Poultry Research Center, U.S. Department of Agriculture, Athens, GA, USA. 3 Department of Infectious Diseases, St Jude Children’s Research Hospital, Memphis, TN, USA. 4 Division of Virology, National Institute for Biological Standards and Control, Potters Bar, UK.



A major lesson learned from the public health response to the 2009 H1N1 pandemic was the need to shorten the vaccine delivery timeline to achieve the best pandemic mitigation results. A gap analysis of previous pre-pandemic vaccine development activities identified possible changes in the Select Agent exclusion process that would maintain safety and shorten the timeline to develop candidate vaccine viruses (CVVs) for use in pandemic vaccine manufacture. Here, we review the biosafety characteristics of CVVs developed in the past 15 years to support a shortened preparedness timeline for A(H5) and A(H7) subtype highly pathogenic avian influenza (HPAI) CVVs. Extensive biosafety experimental evidence supported recent changes in the implementation of Select Agent regulations that eliminated the mandatory chicken pathotype testing requirements and expedited distribution of CVVs to shorten pre-pandemic and pandemic vaccine manufacturing by up to 3 weeks.

Published 2019. This article is a U.S. Government work and is in the public domain in the USA. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.

KEYWORDS: avian influenza; biosafety; candidate vaccine viruses; influenza vaccine; pandemics; pre-pandemic

PMID: 31659871 DOI: 10.1111/irv.12698

Keywords: Avian Influenza; Pandemic preparedness; Biological hazards; Biosafety.


Recommended #hospital #preparations for future cases and #outbreaks of novel #influenza viruses (Expert Rev Respir Med., abstract)

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

Expert Rev Respir Med. 2019 Oct 25. doi: 10.1080/17476348.2020.1683448. [Epub ahead of print]

Recommended hospital preparations for future cases and outbreaks of novel influenza viruses.

Hui DS1,2, Ng SS1.

Author information: 1 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital , Shatin , New Territories , Hong Kong. 2 Stanley Ho Center for Emerging Infectious Diseases, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin , New Territories , Hong Kong.




Seasonal influenza epidemics and periodic pandemics are important causes of morbidity and mortality. Influenza transmits predominantly by respiratory droplets and fomites but opportunistic airborne transmission may occur in the hospital setting due to overcrowding, poor compliance with infection control measures, and performance of aerosol generating procedures.

Areas covered:

This article reviews the risk factors of nosocomial influenza outbreaks and discusses clinical, diagnostic, and treatment aspects of seasonal and avian influenza to facilitate hospital preparations for future influenza outbreaks. Literature search was conducted through PubMed of relevant peer-reviewed full papers in English journals with inclusion of relevant publications by the WHO and US CDC.

Expert opinion:

Accurate and rapid identification of an influenza outbreak is important to facilitate patient care and prevent nosocomial transmission. Timely treatment with a neuraminidase inhibitor (NAI) for adults hospitalized with severe influenza is associated with lower mortality and better clinical outcomes. Baloxavir, a polymerase endonuclease inhibitor, offers a new treatment alternative and its role in combination with NAI for treatment of severe influenza is being investigated. High-dose systemic corticosteroids are associated with worse outcomes in patients with severe influenza. It is important to develop more effective antiviral and immuno-modulating therapies for treatment of influenza infections.

KEYWORDS: avian influenza; nosocomial transmission; seasonal; treatment

PMID: 31648548 DOI: 10.1080/17476348.2020.1683448

Keywords: Influenza A; Pandemic Preparedness.


#ZikaPLAN: addressing the knowledge #gaps and working towards a #research #preparedness #network in the #Americas (Glob Health Action, abstract)

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

Glob Health Action. 2019;12(1):1666566. doi: 10.1080/16549716.2019.1666566.

ZikaPLAN: addressing the knowledge gaps and working towards a research preparedness network in the Americas.

Wilder-Smith A1, Preet R1, Brickley EB2, Ximenes RAA3,4, Miranda-Filho DB4, Turchi Martelli CM5, Araújo TVB6, Montarroyos UR7, Moreira ME8, Turchi MD9, Solomon T10, Jacobs BC11, Villamizar CP12,13, Osorio L13, de Filipps AMB14, Neyts J15, Kaptein S15, Huits R16, Ariën KK16, Willison HJ17, Edgar JM17, Barnett SC17, Peeling R2, Boeras D2, Guzman MG18, de Silva AM19, Falconar AK2,20, Romero-Vivas C20, Gaunt MW2, Sette A21,22, Weiskopf D21, Lambrechts L23, Dolk H24, Morris JK25, Orioli IM26, O’Reilly KM2, Yakob L2, Rocklöv J1, Soares C27, Ferreira MLB28, Franca RFO29, Precioso AR30,31, Logan J2, Lang T32, Jamieson N32, Massad E33,34.

Author information: 1 Department of Epidemiology and Global Health, Umeå University , Umeå , Sweden. 2 London School of Hygiene & Tropical Medicine , London , UK. 3 Departamento de Medicina Tropical, Universidade Federal de Pernambuco , Recife , Brasil. 4 Departamento de Medicina Interna, Universidade de Pernambuco , Recife , Brasil. 5 Instituto Aggeu Magalhães, Fundação Oswaldo Cruz , Recife , Brasil. 6 Departamento de Medicina Social, Universidade Federal de Pernambuco , Recife , Brasil. 7 Instituto de Ciências Biológicas, Universidade de Pernambuco , Recife , Brasil. 8 Instituto Fernandes Figueira – Fundação Oswaldo Cruz , Rio de Janeiro , Brasil. 9 Instituto de Patologia Tropical e Saúde Publica, Universidade Federal de Goiás , Goiânia , Brasil. 10 Institute of Infection and Global Health, The University of Liverpool , Liverpool , UK. 11 Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam , The Netherlands. 12 Johns Hopkins University , Baltimore , MD , USA. 13 Universidad del Valle , Colombia. 14 Laboratório de Flavivírus, Instituto Oswaldo Cruz , Brazil. 15 Department of Microbiology, Immunology and Transplantation, KU Leuven, Rega Institute of Medical Research , Leuven , Belgium. 16 Institute of Tropical Medicine , Antwerp , Belgium. 17 Institute of Infection, Immunity & Inflammation, University of Glasgow , Glasgow , UK. 18 Insitituto Medicina Tropical , Pedro Kouri , Cuba. 19 Department of Microbiology and Immunology, University of North Carolina at Chapel Hill , NC , USA. 20 Departmento del Medicina, Fundacion Universidad del Norte , Barranquilla , Colombia. 21 Division of Vaccine Discovery, La Jolla Institute for Allergy and Immunology , La Jolla , CA , USA. 22 Department of Medicine, University of California San Diego , La Jolla , CA , USA. 23 Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS , Paris , France. 24 Maternal Fetal and Infant Research Centre, Institute of Nursing and Health Research, Ulster University , Newtownabbey , UK. 25 Population Health Research Institute, St George’s, University of London , London , UK. 26 Associação Técnico-Científica Estudo Colaborativo Latino Americano de Malformações Congênitas (ECLAMC) no Departmento de Genética, Instituto de Biologia, Universidade Federal do Rio de Janeiro , Rio de Janeiro , Brazil. 27 Hospital Federal dos Servidores do Estado , Rio de Janeiro , Brazil. 28 Hospital da Restauração , Recife , Brazil. 29 Oswaldo Cruz Foundation , Recife , Brazil. 30 Instituto Butantan , Brazil. 31 Pediatrics Department, Medical School of University of Sao Paulo , Sao Paulo , Brazil. 32 The Global Health Network, Masters and Scholars of the University of Oxford , Oxford , UK. 33 Fundacao de Apoio a Universidade de Sao Paulo , Sao Paulo , Brazil. 34 School of Applied Mathematics, Fundacao Getulio Vargas , Rio de Janeiro , Brazil.



Zika Preparedness Latin American Network (ZikaPLAN) is a research consortium funded by the European Commission to address the research gaps in combating Zika and to establish a sustainable network with research capacity building in the Americas. Here we present a report on ZikaPLAN`s mid-term achievements since its initiation in October 2016 to June 2019, illustrating the research objectives of the 15 work packages ranging from virology, diagnostics, entomology and vector control, modelling to clinical cohort studies in pregnant women and neonates, as well as studies on the neurological complications of Zika infections in adolescents and adults. For example, the Neuroviruses Emerging in the Americas Study (NEAS) has set up more than 10 clinical sites in Colombia. Through the Butantan Phase 3 dengue vaccine trial, we have access to samples of 17,000 subjects in 14 different geographic locations in Brazil. To address the lack of access to clinical samples for diagnostic evaluation, ZikaPLAN set up a network of quality sites with access to well-characterized clinical specimens and capacity for independent evaluations. The International Committee for Congenital Anomaly Surveillance Tools was formed with global representation from regional networks conducting birth defects surveillance. We have collated a comprehensive inventory of resources and tools for birth defects surveillance, and developed an App for low resource regions facilitating the coding and description of all major externally visible congenital anomalies including congenital Zika syndrome. Research Capacity Network (REDe) is a shared and open resource centre where researchers and health workers can access tools, resources and support, enabling better and more research in the region. Addressing the gap in research capacity in LMICs is pivotal in ensuring broad-based systems to be prepared for the next outbreak. Our shared and open research space through REDe will be used to maximize the transfer of research into practice by summarizing the research output and by hosting the tools, resources, guidance and recommendations generated by these studies. Leveraging on the research from this consortium, we are working towards a research preparedness network.

KEYWORDS: European Commission; Guillain-Barré syndrome; Zika; birth defect; congenital Zika syndrome; encephalitis; epidemic preparedness; microcephaly; research capacity building; sustainability

PMID: 31640505 DOI: 10.1080/16549716.2019.1666566

Keywords: Zika Virus; Pandemic Preparedness; American Region.


A systematic #review and evaluation of #Zika virus #forecasting and #prediction research during a #PHEIC (PLoS Negl Trop Dis., abstract)

[Source: PLoS Neglected Tropical Diseases, full page: (LINK). Abstract, edited.]


A systematic review and evaluation of Zika virus forecasting and prediction research during a public health emergency of international concern

Pei-Ying Kobres, Jean-Paul Chretien, Michael A. Johansson, Jeffrey J. Morgan, Pai-Yei Whung, Harshini Mukundan, Sara Y. Del Valle, Brett M. Forshey, Talia M. Quandelacy, Matthew Biggerstaff, Cecile Viboud, Simon Pollett

Published: October 4, 2019 / DOI: https://doi.org/10.1371/journal.pntd.0007451 / This is an uncorrected proof.




Epidemic forecasting and prediction tools have the potential to provide actionable information in the midst of emerging epidemics. While numerous predictive studies were published during the 2016–2017 Zika Virus (ZIKV) pandemic, it remains unknown how timely, reproducible, and actionable the information produced by these studies was.


To improve the functional use of mathematical modeling in support of future infectious disease outbreaks, we conducted a systematic review of all ZIKV prediction studies published during the recent ZIKV pandemic using the PRISMA guidelines. Using MEDLINE, EMBASE, and grey literature review, we identified studies that forecasted, predicted, or simulated ecological or epidemiological phenomena related to the Zika pandemic that were published as of March 01, 2017. Eligible studies underwent evaluation of objectives, data sources, methods, timeliness, reproducibility, accessibility, and clarity by independent reviewers.


2034 studies were identified, of which n = 73 met the eligibility criteria. Spatial spread, R0 (basic reproductive number), and epidemic dynamics were most commonly predicted, with few studies predicting Guillain-Barré Syndrome burden (4%), sexual transmission risk (4%), and intervention impact (4%). Most studies specifically examined populations in the Americas (52%), with few African-specific studies (4%). Case count (67%), vector (41%), and demographic data (37%) were the most common data sources. Real-time internet data and pathogen genomic information were used in 7% and 0% of studies, respectively, and social science and behavioral data were typically absent in modeling efforts. Deterministic models were favored over stochastic approaches. Forty percent of studies made model data entirely available, 29% provided all relevant model code, 43% presented uncertainty in all predictions, and 54% provided sufficient methodological detail to allow complete reproducibility. Fifty-one percent of predictions were published after the epidemic peak in the Americas. While the use of preprints improved the accessibility of ZIKV predictions by a median of 119 days sooner than journal publication dates, they were used in only 30% of studies.


Many ZIKV predictions were published during the 2016–2017 pandemic. The accessibility, reproducibility, timeliness, and incorporation of uncertainty in these published predictions varied and indicates there is substantial room for improvement. To enhance the utility of analytical tools for outbreak response it is essential to improve the sharing of model data, code, and preprints for future outbreaks, epidemics, and pandemics.


Author summary

Researchers published many studies which sought to predict and forecast important features of Zika virus (ZIKV) infections and their spread during the 2016–2017 ZIKV pandemic. We conducted a comprehensive review of such ZIKV prediction studies and evaluated their aims, the data sources they used, which methods were used, how timely they were published, and whether they provided sufficient information to be used or reproduced by others. Of the 73 studies evaluated, we found the accessibility, reproducibility, timeliness, and incorporation of uncertainty in these published predictions varied; indicating there is substantial room for improvement. We identified that the release of study findings before formal journal publication (‘pre-prints’) increased the timeliness of Zika prediction studies, but note they were infrequently used during this public health emergency. Addressing these areas can improve our understanding of Zika and other outbreaks and ensure forecasts can inform preparedness and response to future outbreaks, epidemics, and pandemics.


Citation: Kobres P-Y, Chretien J-P, Johansson MA, Morgan JJ, Whung P-Y, Mukundan H, et al. (2019) A systematic review and evaluation of Zika virus forecasting and prediction research during a public health emergency of international concern. PLoS Negl Trop Dis 13(10): e0007451. https://doi.org/10.1371/journal.pntd.0007451

Editor: Paulo F. P. Pimenta, Fundaçao Oswaldo Cruz, BRAZIL

Received: May 8, 2019; Accepted: August 27, 2019; Published: October 4, 2019

This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.

Data Availability: All relevant data is available within the manuscript and supporting information files.

Funding: The authors received no specific funding for this work.

Competing interests: The authors have declared that no competing interests exist.

Keywords: Zika Virus; Pandemic Preparedness.


Better Prepare Than React: Reordering #PublicHealth #Priorities 100 Years After the #SpanishFlu #Epidemic (Am J Public Health, abstract)

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

Am J Public Health. 2018 Nov;108(11):1465-1468. doi: 10.2105/AJPH.2018.304682. Epub 2018 Sep 25.

Better Prepare Than React: Reordering Public Health Priorities 100 Years After the Spanish Flu Epidemic.

Greenberger M1.

Author information: 1 Michael Greenberger is with the Carey School of Law and the Center for Health and Homeland Security, University of Maryland, Baltimore. He is also the founder and director of the University of Maryland Center for Health and Homeland Security.



This commentary argues that 100 years after the deadly Spanish flu, the public health emergency community’s responses to much more limited pandemics and outbreaks demonstrate a critical shortage of personnel and resources. Rather than relying on nonpharmaceutical interventions, such as quarantine, the United States must reorder its health priorities to ensure adequate preparation for a large-scale pandemic.

PMID: 30252520 PMCID: PMC6187800 DOI: 10.2105/AJPH.2018.304682 [Indexed for MEDLINE] Free PMC Article

Keywords: Pandemic Influenza; Pandemic Preparedness; Spanish Flu; USA.