Minn:State officials prepare for super-flu outbreak

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Published: Monday, September 18, 2000

State officials prepare for super-flu outbreak A 43-page plan spells out strategy

-------------------------------------------------------------------------------- TOM MAJESKI STAFF WRITER

No one knows when -- or if -- a super-flu epidemic will invade Minnesota, but state health and emergency officials will be ready. After a year of meetings and strategy sessions, a group of the state's most knowledgeable experts have developed a comprehensive 43-page plan that spells out how health and safety officials will deal with a crippling epidemic triggered by a rare and potent strain of the deadly flu virus.

``One thing to make clear is that this planning is for a future event,'' cautioned Kris Ehresmann, an epidemiologist with the Minnesota Health Department and the flu project's coordinator. ``We're not expecting one this season.''

It may not happen this year or in 10 years. But a growing number of international experts believe conditions are ripe for the type of flu outbreak that killed an estimated 20 million people in 1918.

To prepare for what the experts call a pandemic, Ehresmann and her colleagues applied for and landed a $7,500 planning grant from the Council of State and Territorial Epidemiologists.

``We affectionately call it a kick in the pants, but that's just what we needed,'' Ehresmann said of the grant. ``As soon as we found out, we formed a core team of Health Department experts.''

But the task they faced was daunting. Tornadoes, floods and fires affect relatively small areas and often involve property more than people. What's more, devastated areas usually can count on help from neighboring areas, which were untouched by the disaster. But a flu pandemic strikes large numbers of people around the world, so little if any outside help is available.

``I was not sleeping at first when we started working on this because it's overwhelming,'' Ehresmann said. ``It's going to be happening everywhere in the state, country and world, so you won't have the ability to shift resources.''

But Ehresmann's spirits soared after she contacted the Minnesota Public Safety Department's Emergency Management Division, which develops and implements plans to deal with natural disasters.

``When we teamed up with Emergency Management and learned the extent of their planning and preparedness, I was relieved as a citizen and impressed as a colleague,'' she said. ``We were able to leverage the skills of their department and our department and that makes sense.''

The flu planners developed a draft plan and then invited experts from across the state to participate in a series of strategy sessions that eventually led to a revision of the plan in June 1999.

By November, the group had devised a disaster scenario and was ready to conduct a tabletop exercise to test how well the plan worked.

``It involved a lot of creative writing,'' Ehresmann said the scenario. ``We called it the Cold Zone and we even threw in a blizzard.''

Participants were divided into groups, which were asked to explain how they would handle the growing crisis. Feedback from the exercise was then used to refine the plan into what has become the final draft.

``But it's never final,'' Ehresmann said of the report. ``We're going to continue to have to change it as technology changes. It's a living document.''

Because it takes months to develop a vaccine, Ehresmann said there will be delays and shortages, so it's important to prepare the vaccine delivery system so that it can quickly spring into action and vaccinate the most crucial people first.

``Because this is a virus we haven't seen before, we don't know who it is going to affect,'' Ehresmann said. ``In 1918, it was the younger, healthier people. We will need to look at the epidemiology of the virus. The plan is fluid enough so that we will be able to make some changes as to who is going to be at highest risk.''

A feature unique to Minnesota's plan is its clear division of responsibilities. Because of their experience and expertise, public health workers have been assigned to vaccine distribution, while doctors and nurses in the private sector have been assigned to patient treatment.

``It's fascinating,'' Ehresmann said of the plan. ``There are a lot of ethical issues and logistics. It's got it all: civic responsibility, intrigue, social responsibility and science. We know that when it happens it's going to be challenging. This is the kind of situation that will have a huge impact and, even with planning, it won't always go as we want.''

-------------------------------------------------------------------------------- Tom Majeski, who covers medical news, can be reached at tmajeski@pioneerpress.com or (651) 228-5583.

Progression of a pandemic Minnesota's battle plan for fighting a potentially devastating flu pandemic has been divided into the following stages:

Pre-pandemic: The current period, which involves planning, watching and waiting.

Novel virus alert: New virus jumps from a pig or bird to a human. There have been several novel virus alerts in recent years, but the viruses never spread from one human to another. A novel virus alert doesn't mean that there's going to be a pandemic.

Pandemic alert: There's evidence that there has been person-to-person transmission.

Pandemic eminent: The virus has been identified in one area, say Asia, and now there is transmission in another area, say China.

Pandemic: Virus has spread to other countries in multiple hemispheres. Six to nine months after the first wave dies down, a second wave sweeps around the globe.

Pandemic over. The world breathes a sigh of relief.

Fighting a flu pandemic: the plan

Surveillance: Epidemiologists and doctors around the state closely monitor the flu virus and quickly report any changes.

Vaccine delivery: Public health experts stand ready to deliver available vaccine to those who need it the most. Those high on the list include public safety and health care workers.

Command/control/communication: They are responsible for getting information to the emergency management team and to the public.

Emergency management: Their duties include ensuring that health care is available, electrical power continues to flow and the streets are plowed. Each local area knows how many hospital beds are available and what gymnasiums can be used to handle the overflow


-- Martin Thompson (mthom1927@aol.com), September 19, 2000


Flu vaccine shortages may delay area immunization campaigns By FINN BULLERS - The Kansas City Star Date: 09/17/00 22:15

Manufacturers of influenza vaccine say production will be down 10 percent this year, and delays are expected for immunization campaigns aimed at high-risk individuals.

The Centers for Disease Control and Prevention in Atlanta had warned earlier of potential shortages, and federal officials still say vaccine may be in short supply.

Area health officials now say the situation most likely will mean delays.

This year's version of the vaccine, which is adjusted annually, has proved unusually difficult to produce. In addition, two of the world's four suppliers have struggled to meet federally required plant renovations.

"The majority of the public health departments report their suppliers are saying it will be mid-November at the earliest until they receive their vaccines," said Rhonda Luther of the Missouri Department of Health.

In Kansas, however, the Johnson County Health Department has received its influenza vaccine and will offer flu shots to the elderly and chronically ill at two sites beginning Oct. 9.

Private clinics that buy directly from manufacturers are more likely to have supplies on hand. Public health departments that must negotiate low-bid contracts are likely to face delays.

Some public health officials say delays aren't necessarily a bad thing.

"What people don't understand is that here in the Midwest the true influenza bug doesn't even strike until February. So if you get your shot too early then the main efficacy of the vaccine is starting to wane when you need it most," said Teresa Tunstill, nurse manager of the Jackson County Health Department, which expects its first shipment by the end of October.

"But the first time we have a chilly night -- which might be tonight - - people start thinking about their flu shots and want to be the first to get it."

One of the first places to offer flu shots this season will be area Price Chopper stores beginning Oct. 4.

Healthy Solutions Inc., which handles the Price Chopper campaign, will launch its $10-a-shot immunization effort in high-traffic areas aimed at inoculating up to 80,000 people this flu season.

Healthy Solutions has received enough vaccine to inoculate 60,000 people and expects to receive additional shipments. The effort will culminate Oct. 15 in a public campaign at Arrowhead Stadium when the Chiefs play the Oakland Raiders.

At the University of Kansas Medical Center, health officials expect to receive their first vaccine shipment Oct. 6 in an overall effort to provide some 6,000 free flu shots.

The center's "Drive Thru Flu" event will be from 8 a.m. to 1 p.m. Oct. 14 at 39th Street and Rainbow Boulevard. At KU MedWest, Interstate 435 and Midland Drive, residents can schedule an appointment by calling (913) 588-1227.

"We're not going to turn anyone away," said wellness coordinator Amy Metcalf. "But we want to target the at-risk population first."

At the American Red Cross, health officials aren't sure when they will receive the vaccine, but they hope to begin immunizations by the first week in November.

Last year the Red Cross gave 10,000 shots, doubling the previous year's total. This year the organization expects to give 11,000 shots.

Once the vaccine arrives, immunization clinics will be set up at dozens of clinic sites, including library branch offices. Details can be found on the Internet at www.kcredcross.org or by calling (816) 931-8400.

In Johnson County, 1,600 doses of this year's flu vaccine will be available to the public at the county health department's two offices in Mission and Olathe. Last year, supplies ran out after 1,596 shots were given.

No appointments are necessary to receive the $10 shots, and no one will be turned away if they can't afford the cost. The clinics will be open from 8:30 a.m. to noon.

Becky Tonkens, coordinator of The Medicine Shoppe immunization campaign, says the 15 locations in the Kansas City area have not received the vaccine and expect delays.

In response, their immunization effort has been delayed by a week. They will begin giving $8 flu shots to their high-risk customers on Oct. 13.

"I just hope people don't make a mad dash to get a shot, and when they can't, just forget about it," said Tonkens, a retired nurse.

How big the problem is and how severe the winter flu bug will be are still wild-card factors.

Vaccine concerns come at a time when national health officials fear an influenza pandemic.

Will there be a mad scramble for flu vaccine?

"I hope not," said Victoria Hanley, director of health education for Johnson County. "But this exercise prepares us for a potential pandemic if we have to come up with flu vaccine in a hurry."


-- Martin Thompson (mthom1927@aol.com), September 19, 2000.

Published Friday, September 15, 2000, in the Miami Herald

Stage set for outbreak of flu New strains may hit world with a `big one,' experts warn BY SETH BORENSTEIN Herald Washington Bureau

WASHINGTON -- Public health officials are so concerned about a possible super-epidemic of deadly influenza that they are preparing for the worst -- counting hospital beds and fretting about drug shortages much as disaster officials do before hurricanes and earthquakes.

Not one person has come down with the kind of flu that worries them.

But the stage is set for a nasty outbreak that could kill at least 88,000 Americans in one fast season.

Here's why:

The world is long due, if not overdue, for a super epidemic, six leading experts told The Herald's Washington Bureau. New flu strains strike humans every 30 to 40 years on average and when they do they are far more deadly than ordinary flu -- and this hasn't happened since 1968.

And then there are new flu strains now brewing among animals, ready to spread to unprotected humans.


While officials at the Centers for Disease Control and Prevention in Atlanta stress that is no reason for people to worry, health experts are preparing to handle what may be inevitable.

``We really can't say if there will be a pandemic in our lifetime, but there could be one tomorrow,'' said Nancy Cox, chief of the CDC influenza branch, which has been working the problem since 1996. ``We're preparing for an unpredictable event.''

State epidemiologists gathered in Atlanta on Tuesday and Wednesday to figure out how they would cope with a worldwide outbreak. They worry most about a strain of flu new to humans, who would have no natural defenses against it.

That's called a global pandemic.

``The appearance of a pandemic is sort of like an earthquake,'' said W. Paul Glezen, an epidemiologist at the Influenza Research Center at Baylor University in Houston. ``You know the conditions are right for it to happen. You just don't know when it's going to happen.''

Florida health officials, who have been working on an action plan for the next flu pandemic, attended this week's Atlanta meeting, said Dr. Richard Hopkins, chief of the Bureau of Epidemiology at the state Department of Health.

``It's a hard thing to get people to prepare for because an event that happens every 10 or 20 years or even every 30 years people don't have any experience with,'' Hopkins said. ``There is hardly anybody alive who remembers 1918.''

Three times in the 20th Century new flu strains surfaced in humans. Each of those times, in 1918, 1957 and 1968, the new flu strain first hit as a pandemic. The most severe, in 1918, killed 620,000 Americans and at least 20 million people worldwide.

Not everyone who gets these new flu strains die, but a higher percentage of those infected die than with normal influenza, maybe as high as one out of 20.

Those three strains of human influenza have now become so common in the human population that people have developed a basic resistance to them. Each year slightly altered versions of those three strains hits. Victims get sick, but not too sick because their immune systems recognize the basic strain and fight it. That's the story in the annual flu epidemics that still kill about 20,000 Americans yearly, mostly the elderly and chronically ill.

In 1977 a minor pandemic occurred with a strain known as Russian flu, Hopkins said. Only young people were severely affected because most people over age 25 had been exposed to the strain in the early 1950s.

The scenario that has health officials preparing for the worst is an altogether new strain that human immune systems are unequipped to fight off. This happens when a virus from another species, typically a bird, passes to a human. Once in a person, the virus mutates -- or combines with an already existing human flu -- in a way that allows the new hybrid disease to spread easily and quickly from human to human.

Virologists are especially concerned because a dozen flu strains now exist in birds but not in humans. Not only would they catch human immune systems completely off guard, but no vaccines have been made for those strains. Two of those new bird flu strains have come perilously close to making a pandemic-scale jump in the past few years, said Robert Webster, chairman of virology and molecular biology at St. Jude Hospital in Memphis.


Scientists don't know how or why flu moves from birds to people, but it most often begins in Asia where chickens and people live close together, Webster said, and transmission from chicken waste is likely.

Just how quickly flu jumps from birds to people varies. Once there, it could mutate into something that can spread from human to human in less than a day, Webster said. And after that, such a flu virus can spread to epidemic levels around the world, with modern air transport, in a matter of several weeks.

The CDC has produced a 20-page guide to help local officials deal with a flu pandemic and figure out how big a problem they would face. One big concern: Since it takes six to eight months to develop a custom-targeted flu vaccine, supplies would be very short. Who should get them?


Cox estimates that up to 200 million Americans will be infected with the flu in a pandemic. They will require up to 45 million visits to the doctor and up to 800,000 hospitalizations. Cox estimates that between 88,000 and 300,000 Americans will die. No world fatality figure was computed. Cox estimates that the pandemic would cost the U.S. economy up to $166.5 billion.

Flu traditionally hurts the old and ailing most. But the 1918 flu killed high percentages of young adults. Their elders may have been protected by a lingering immunity from earlier flu outbreaks.

Herald staff writer Christine Morris contributed to this report.


-- Martin Thompson (mthom1927@aol.com), September 19, 2000.

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