22 January 2007

3-Part CDC Plan to Deliver Antivirals, Masks and Respirators, and other Countermeasures after WHO Pandemic Flu Phase 4 is Declared

The US CDC recently posted their “Influenza Pandemic Operation Plan” (OPLAN) on their website (www.cdc.gov/flu/pandemic/cdcplan.htm). This 350-page plan, last updated 20 December 2006, provides insight into multiple aspects of pandemic flu preparedness. For example, Annex G (pages 245-258) details guidance on timely delivery of critical “Countermeasures” against a future pandemic influenza virus.

Appendix 1 (Strategic National Stockpile “SNS”) to Annex G provides the following background/assumptions (page 251):

1. “The World Health Organization (WHO) will declare Phase 4 of an influenza pandemic when there is a confirmed small cluster of limited human-to-human transmission of avian influenza, with spread being highly localized. The Federal government will engage Stage 2 of its response at this point.

2. The director CDC, in consultation with the Secretary HHS or his/her designee, will determine when to activate the Strategic National Stockpile (SNS) to begin the distribution of critical medical material based on the WHO Phase characterization and the severity of the disease.

3. All 62 CDC Public Health emergency Preparedness (PHEP) projects areas (all 50 states, the three large urban areas, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and the six Pacific Jurisdictions) have incorporated distribution of medical countermeasures into their pandemic plans.”

Delivery of countermeasures (p. 253) will occur in three (3) parts:

Part 1: Antiviral drugs: Estimated to take 7 days.

Part 2: Masks and respirators: to take the next 7-10 days after Part 1.

Part 3: More Personal Protective Equipment (PPE) including protective face shields, gowns, gowns, as well as intravenous antibiotics (for secondary bacterial pneumonias and other infections that will predictably occur to varying extents in patients who become infected with the pandemic influenza virus), mechanical ventilators and other equipment. To begin after Parts 1 and 2 are completed (i.e., after 14-17 days).

90% of this critical material deployed during Part 3 of the response will be shipped pro rata. 10% will be held back, however, and “allocated via a case-by-case approval process based on State needs and requests” and also to be available in the event of a second simultaneous emergency (either natural or human in origin).

Part 1 (antiviral influenza drugs) and Part 2 (masks and respirators) are to be distributed based on population (“pro rata”) “pushing product proactively to a single location in each of the CDC/SNS 62 project areas”.

Of note, these antiviral drugs are to be deployed “to the States prior to receipt of a request”, thereby ensuring “that States receive supplies before the need for assets becomes critical”. In addition, “Shipping product out at the first signs of a pandemic and before a State request will also ensure that the SNS staff and federal transportation partners are available in full capacity to aid in the federal response, and be ready to respond to other events” (e.g., a bioterrorist event or a second natural disaster).

One other notable difference between SNS policies already in place and this current pandemic flu plan is that the “Technical Advisory Response Unit (TARU) teams will not deploy. Once a project area accepts Federal assets, they will become the property of that project area (p.255).”

Detailed, successive, and complementary US and global plans for the next pandemic of human influenza should be welcomed because much as “waves” of pandemic influenza infections should be anticipated to occur, so should there be “Waves of Pandemic Preparedness” before the epidemic emergency begins.

Daniel R. Lucey, MD, MPH

Director, Center for Biologic Counterterrorism and Emerging Diseases

EROne Institutes, Emergency Medicine, Washington Hospital Center

Co-Director, M.S. Program in Biohazardous Threat Agents and Emerging Infectious Diseases, Georgetown University Medical Center

Washington, DC

Website: www.BePast.org

Email:Daniel.R.Lucey@Medstar.net

Or email: drl23@georgetown.edu