U.S. flu pandemic plan highlights local response.(Clinical Rounds)

The United States should prepare now for the next influenza pandemic, which may be caused by a mutation of the avian flu viruses that now appear endemic in some parts of Asia and Europe, federal officials have said.

Before the next pandemic occurs, the country should generate plans for fast-tracking vaccine development, rationing vaccine and antiviral drugs, and limiting disease spread by restrictions on travel, schools, and public gatherings, according to the federal Pandemic Influenza Preparedness and Response Plan.

The Department of Health and Human Services, which released the plan in draft format, is seeking comment on the proposed strategy through the end of this month.

Although HHS Secretary Tommy G. Thompson called the plan a "roadmap on how we as a nation ... respond to the next pandemic influenza outbreak," it offers few solutions for the problems it lists. Instead, it calls upon localities and individual health care systems to develop strategies to mount an effective response to a pandemic.

The plan predicts that an influenza pandemic could kill more than 200,000 Americans, and cause illness in many times that number. The most likely agent for a future pandemic would be a mutation of an existing Asian avian flu strain. "If these strains reassort with human influenza viruses such that they can be effectively transmitted between people, a pandemic can occur," the plan said.

Modern influenza vaccines are vital in controlling mortality and morbidity with each seasonal flu outbreak, but they are based on previous years' strains and take 6-8 months to develop.

A pandemic arising from a newly mutated strain could move so quickly that no effective vaccine would be available for at least the first wave of infection, according to the plan. Therefore, significant effort should be invested now in developing viral seed "libraries" of existing and novel flu strains and in stockpiling antiviral drugs to help stave off infection until the new vaccine would be available.