Not IF, but WHEN: The Threat of Pandemic Influenza

Speaker:                     Michael Olesen

Manager, Infection Control & Epidemiology

Abbott Northwestern Hospital (Minneapolis, MN)

Level of Knowledge: Multi

Short Abstract:

This presentation links the 1918 pandemic, Avian influenza, and how this could become a pandemic today.  In addition to the history of the 1918 pandemic, the presentation discusses the biology of influenza viruses, including their naming and pathophysiology.  The ecology of these viruses explored, explaining why pigs, people, and birds interact in the development of new strains and why vaccines and antiviral agents may be ineffective.

Social impacts are reviewed, including the impact at the end of World War I and the potential impact on our current society.  Ethical decisions will be discussed in light of the lack of healthcare resources for an event of this scale

Examples of poor communication are provided with some risk communication strategies and prevention messages that will be helpful for the public.  Finally, there is a discussion on the management of a pandemic and resources to help in this planning.

Long Abstract:

This presentation looks at the very real threat of a pandemic influenza arising from the H5N1 Avian Influenza virus. The first part of the presentation gives a historical account of the pandemic to provide the audience a better grasp of the sheer volume of the impact when extrapolating up to the present world population.

The biology of the virus is then reviewed, including the criteria for a pandemic virus, the nomenclature of influenza viruses, their pathophysiology and the resulting cause of death in most patients.  The ecology of the virus is discussed, including the relationship that exists between humans, pigs, and birds which leads to the hybridization of viruses into a very communicable and pathogenic form. Maps are used to show the relationships between disease in humans, pig and bird density, and bird migration patterns.

The social impact of the virus is then discussed, with a brief review of the history between WWI and WWII which may have been impacted by the virus. Population pyramids are used to show some of the areas potential impact of a similar pandemic today, including the Social Security system and the housing market.

There is a discussion around ethics, including the imperative of mandatory vaccination/declination forms in healthcare and schools, the concept of herd immunity, the likely failure of the availability of vaccines and antiviral medications, the lack of surge infrastructure to provide medical care, and the higher mortality rates on certain subpopulations.

Examples of the need to improve communications/education with the public are reviewed. Risk communication strategies and key messages for the public are provided.  Finally, management strategies for both pre- and mid-pandemic planning are given to help with prevention and mitigation activities. A number of resources are provided to aid in these efforts.

Learning Objectives:

  1. Explain the causes for the differences in the epidemic curves for a normal influenza season and that which occurred during the Spanish Flu of 1918.
  2. List the characteristics required for an influenza virus to trigger a pandemic and which of these have been met by the H5N1 avian flu virus.
  3. Identify problems that will arise in healthcare facilities during a pandemic and resources to assist in planning a response.