Influenza Pandemic Preparedness

In the list of potential bioterrorist agents, influenza would be classified as a category C agent (1). While previous influenza pandemics were naturally occurring events, an influenza pandemic could be started with an intentional release of a deliberately altered influenza strain. Even if a deliberately altered strain is not released, an influenza pandemic originating from natural origins will inevitably occur (2) and will likely cause substantial illness, death, social disruption, and widespread panic. Globally, the 1918 pandemic killed at least 20 million people (3). This figure is approximately double the number killed on the battlefields of Europe during World War I (4). In the United States alone, the next pandemic could cause an estimated 89,000–207,000 deaths, 314,000–734,000 hospitalizations, 18–42 million outpatient visits, and 20–47 million additional illnesses (5). These predictions equal or surpass many published casualty estimates for a bioterrorism event (6–8). In addition to the potential for a large number of casualties, a bioterrorism incident and an influenza pandemic have similarities that allow public health planners to simultaneously plan and prepare for both types of emergencies (Table). Table Planning for pandemic influenza and bioterrorism: similarities and differencesa,b Preparing for both the next influenza pandemic and the next bioterrorist attack requires support and collaboration from multiple partners at the state, local, and federal level. Potential partners include the medical community, law enforcement, emergency management, and public health agencies. To help foster these crucial cross-discipline relationships, the Centers for Disease Control and Prevention (CDC) and the Council of State and Territorial Epidemiologists (CSTE), in collaboration with the National Emergency Management Association, the Association of State and Territorial Health Officials, the Federal Emergency Management Agency, and the Association of Public Health Laboratories, hosted a 2-day meeting on state and local pandemic influenza planning in May 2002. Over 125 officials representing epidemiology, communicable disease, laboratory, immunization, and emergency management programs from 46 states registered for this meeting. The objectives of the meeting were to enhance collaboration between state and local public health and emergency management agencies, establish mechanisms for integrating bioterrorism and pandemic influenza preparedness and response planning, and develop policy and strategy options for influenza pandemic preparedness and response at the state and local level. We report the results of a questionnaire distributed to the attendees; it was designed to elicit their views on the most important issues that must be addressed by a plan to respond to a catastrophic disease event.