Planning for possible pandemic under way

The threat of an influenza pandemic has health and safety officials worldwide on alert as they monitor and map cases of the newest virus (H5N1) in Southeast Asia and Europe.

Ironically, WSU Pullman is experiencing a fairy-tale-like year in which (as of Jan 17) “not one case of common influenza” has been reported to Health & Wellness Services.

But that doesn’t mean the bubble won’t break or that WSU leaders are sitting idly by. On the contrary, health and safety officials are using this lull to prepare locally and regionally for a possible battle against a future pandemic or epidemic.

Influenza pandemics are “rare but reoccurring events” that, according to the World Health Organization, erupt about every 10 to 50 years. Historically, recent flu pandemics were seen in 1918, causing 40 million deaths; 1957, causing two million deaths; and 1968, causing one million deaths.

In comparison, common influenza epidemics occur nearly every year, infecting 5-15 percent of the population of the earth, causing three to five million cases worldwide and 250,000-500,000 deaths.

WSU usually is a good example of that trend, experiencing annual outbreaks of common influenza usually beginning in October and running through March, said Dr. Bruce Wright, medical director of Health and Wellness Services. The number of cases often mushrooms in January, after students, faculty and staff return from Christmas break — so don’t let down your guard.

This fall, as in the past, Health & Wellness Services provided seasonal flu vaccinations (about 1,350) to students, faculty and staff at WSU Pullman. To make vaccines more accessible, Wright said, HWS offered inoculations at numerous campus locations, including residence halls, the CUB, French Administration Building, etc.

“In general, we’d like as many people as possible to get the flu vaccine,” said Wright. “The seasonal flu is usually not life threatening but can take a bite out of the semester, especially for students. Last year and this year, however, there have been vaccine shortages because of production and distribution problems.”

When asked why more people at WSU don’t get the annual vaccine, Wright said “people often don’t think about it until they have it. Some people see themselves as somewhat invincible, with the idea that they’ve gone many years without getting the vaccine and haven’t got the flu or have survived it, so they don’t get the vaccine.

“We’re trying to increase the number of people who are vaccinated through increased communications and advertising, to make people more aware of it’s availability,” Wright said.

This pattern may become important in that, if a pandemic were to begin spreading, health officials are hoping scientists could develop an effective vaccine that could be reproduced and distributed quickly enough to limit its spread.

From birds to humans
The first cases of H5N1 in birds were recorded in December 2003 in six countries in Southeastern Asia. As of Jan. 9, 2006, cases in birds have been found in Cambodia, China, Croatia, Indonesia, Kazakhstan, Malaysia, Mongolia, Romania, Russia, Thailand, Turkey, Ukraine and Vietnam.

So far, human outbreaks of the virus have been found in Cambodia, China, Indonesia, Thailand, Turkey and Vietnam. And — here is the key preventing factor — the virus does not infect humans easily.

In order to become a pandemic, H5N1 would need to mutate during human infections and become progressively easier to transmit on a human-to-human basis.

Not an easy or common feat, but mutating is one of the things that influenza viruses specialize in. That’s why every year there are new influenza vaccines.

“Currently, it (human outbreaks) seems to require extensive contact with poultry,” said Wright. “But the more often it infects humans, the greater the chance that a strain could pop out for which we have no immunity. Right now, the H5N1 strain doesn’t seem to have the capability to infect human cells easily — this seems to take exposure to very large quantities of the virus.”

If the mutation(s) were to occur, the World Health Organization says, bird flu could — given today’s levels of international travel — spread worldwide within three months, about one-half to one-third the time seen in the past. And because this influenza would be a mutation, existing vaccines would not be effective. (Hence, this is one of the great fears of terrorist germ warfare.)

Health organizations already are working on a vaccine for the current virus, so they will be as near to ready as possible should mutation(s) occur.

WSU pandemic workgroup
WSU’s Environmental Health & Safety department, WSU Emergency Management and WSU Health and Wellness Services, in following the university’s Emergency Response Plan (http://www.ehs.wsu.edu/esrp490/emergencyresponse.htm), recently formed a Pandemic Illness Workgroup, including Wright and Chris Tapfer, WSU’s emergency management coordinator, and a variety of other universitywide representatives.

The goal of this workgroup is to put in place a plan and mechanism to prepare WSU in the event that a pandemic should erupt. One of its initial steps has been the production of two brochures: “Handwashing and Disinfection: Reducing the Spread of Infection” and “Respiratory Protection: Its Role in Seasonal Influenza.”

“Rather than focus now on the potential outbreak of avian flu — since it currently is not being transmitted from human to human and since we don’t know if or when it will get here — we have decided that it is best to begin by focusing on the cold and flu outbreak which moves through our campuses every year,” said Tapfer.

Like other respiratory infections, common flu and a pandemic strain of flu are both usually transmitted by the same methods — coughing, sneezing and direct contact — and are usually transmitted prior to the onset of symptoms.

“We felt the best way to prevent colds and flu is to train our community in respiratory etiquette and protection and in handwashing and sanitation,” Tapfer said. “In doing that, we are preparing our community with the best methods of preventing a pandemic.”

“We’re developing a plan with several levels of strategic responses that will be driven by the circumstances surrounding a pandemic,” said Wright. “Currently we are in a prepandemic alert phase, which occurs whenever a new influenza strain (normally in birds) is identified as having the capability to infect humans somewhere in the world.”

WSU’s plan goes on to identify the three following phases:
• Phase 1: When cases involving sustained human-to-human transmission of that virus are identified.
• Phase 2: When a case(s) is confirmed within a 400-mile radius of Pullman
• Phase 3: When case(s) are confirmed within a 50-mile radius of Pullman.

City, state coordination
In addition to focusing on university efforts, Wright said WSU is working to integrate and coordinate its plans with city, county and state agencies. In March, these groups are planning to launch a countywide tabletop exercise. Once these plans are solidified, WSU Pullman will try to integrate across state lines with Moscow, Latah County and the University of Idaho.

For now, Tapfer said, the Environmental Health and Safety department and the Pandemic Workgroup want to launch the first step of their plan by distributing, as widely as possible, the new brochures. To save money and ensure that they are easily accessible, the brochures available for viewing, downloading, sharing and printing at http://www.hws.wsu.edu. This site also offers tips on avoiding colds and flu; see http://www.hws.wsu.edu/News-Events/fluinfo.htm.

Department chairs and deans are encouraged to alert faculty and staff about the brochures and to post them or make them available in high-traffic areas.

Other sites where you can obtain information on H5N1 and other types of disease of national and world concern include the U.S. Center for Disease Control at www.cdc.gov; and the World Health Organization at http://www.who.int. Furthermore, two fact sheets regarding handwashing and respirators for preventing the spread of infection can be found on the EHS Web

Two fact sheets regarding handwashing and respirators for preventing the spread of infection are now on the EHS website at http://www.ehs.wsu.edu/Factsheets/FAQHandwashing.asp and http://www.ehs.wsu.edu/Factsheets/FAQFluRespirators.asp.