Pandemic Influenza Preparedness Research Articles

Informing influenza pandemic preparedness using commercial poultry farmer knowledge, attitudes, and practices (KAP) surrounding biosecurity and self-reported avian influenza outbreaks in Nepal

Avian influenza (AI) is a global health obstacle of critical concern as novel viruses are capable of initiating a pandemic. Recent spillover events of AI into human populations have occurred at human-poultry food system interfaces. As Nepal's poultry sector transitions to more intensified commercial production systems, it is important to examine the epidemiology of AI and the knowledge, attitudes and practices (KAP) of poultry sector workers. We conducted a cross-sectional KAP study utilizing a structured survey to interview 150 commercial poultry farmers in Chitwan District, Nepal. All commercial poultry farmers had knowledge of AI previous to the study and the majority farmers were able to identify farm-farm and poultry-human transmission mechanisms of AI. Farmers had more knowledge surrounding poultry AI symptoms as compared to human AI symptoms. Most farmers believe that AI is serious, contagious and a threat to everyone, yet only half believe it can be prevented. Individual-level personal protective equipment (PPE) uptake, such as facemask, glove and boot usage, on the enrolled farms was low and farm-level biosecurity practices varied greatly. Nine commercial poultry farms (6%) self-reported having an HPAI outbreak and 60 farms (40%) self-reported having an LPAI outbreak in the past 5 years. Layer farms had higher odds (OR: 5.4, 95% CI: 2.3–12.8) of self-reported LPAI as compared broiler farms. Poultry sector farmers face multiple obstacles when attempting to report AI to government authorities such as the fear of flock culling and the perceived lack of monetary compensation for culling. Our study provides updated KAP surrounding AI of farmers and self-reported AI farm-level epidemiology in Nepal's highest density commercial poultry production district. Commercial poultry farmers are fairly knowledgeable on AI, but do not take further protective practice efforts to implement their knowledge and prevent AI. Due to the potential role that human-poultry interfaces may play in AI emergence, it is critical to collaborate with the commercial poultry industry when planning and conducting AI pandemic preparedness mechanisms.

세계보건기구(WHO)의 대유행 인플루엔자 대비체계(PIPF)와 나고야의정서의 관계

코로나19와 같은 공중보건 위기상황에서는 병원체 표본 및 그 유전자염기서열정보에 대한 제공이 신속히 이루어져야 한다. 그런데 국가가 자국의 국경 내에 있는 병원체 자원도 국가의 주권적 자산이라고 주장하면서 생물다양성협약과 그 부속조약인 나고야의정서에 따라 접근 및 이익 공유를 요구한다면 추가적 거래비용이 발생할 뿐만 아니라 백신과 치료제 개발도 지연될 수 있다.BR 물론 나고야의정서 제8(b)조는 인간, 동물 또는 식물 건강에 위해를 줄 수 있는 긴급 상황이 발생할 경우 상당한 주의를 기울여야 하고, 관련 유전자원의 접근 및 이익 공유 절차의 간소화를 고려하도록 규정하고 있다. 즉 동 조항은 당사국들에게 신종 인플루엔자 등과 같은 전염병이 발생할 경우, 백신 및 치료제 개발 등에 필요한 병원체 등 유전자원에 대한 접근 절차를 간소화 할 수 있는 재량권을 부여하고 있다.BR 한편 세계보건기구는 보건의료 위기상황에 대비하여 2011년 대유행 인플루엔자 대비체계(PIPF)를 채택하였다. 2006년 12월 인도네시아 정부가 생물다양성협약을 근거로 자국의 국경 내에 있는 바이러스에 대한 주권을 주장하며 세계보건기구와의 바이러스 표본 공유를 거절하자 세계보건기구가 채택한 결의안이다. 즉 PIPF는 세계보건기구 회원국들이 대유행 잠재력을 지닌 인간 인플루엔자 바이러스에 대한 접근과 진단, 백신, 항바이러스 등 사용과 관련된 이익 공유를 규율하는 다자간 문서이다.BR 이처럼 병원체의 접근 및 이익 공유라는 동일한 사안을 두고 이를 규율하는 국제협약과 국제문서가 중복적으로 존재하는 상황에서 양자의 모호한 관계는 향후 전염병 대유행이 재발할 경우 국제적으로 신속한 협력과 대응을 가로막고, 과학기술의 발전도 저해할 수 있다. 즉 양 문서간의 관계를 명확히 정립하지 않으면, 급박한 보건의료 위기상황에서 나고야의정서의 이행으로 인한 세계보건기구의 대응과 일치하지 않는 상황이 발생할 수 있다. 따라서 나고야의정서와 세계보건기구가 채택한 문서인 PIPF 간의 관계를 정립할 필요가 있다.BR 이에 본고는 먼저 나고야의정서가 이행되고 있는 상황에서 세계보건기구가 병원체 대상 별도의 접근 및 이익 공유 체계를 마련할 수 있는지 양자 간의 관계부터 살펴보고자 한다. 나고야의 정서 제3조는 동 의정서의 적용범위에 병원체를 제외한다고 명시하지 않고 있고, PIPF이 나고야의정서 제4.4조상의 특별국제문서에 해당하는지를 두고 해석의 여지가 있다. 다음으로 PIPF의 적용대상 및 범위를 살펴보고, 나고야의정서가 적용될 수 없는 요건, 다시 말해서 PIPF가 적용되는 요건들을 알아보고자 한다.

On Pandemic Preparedness: How Well is the Modeling Community Prepared for COVID-19?

On Pandemic Preparedness: How Well is the Modeling Community Prepared for COVID-19?

Legal agreements: barriers and enablers to global equitable COVID-19 vaccine access

Law can serve as both an enabler and a barrier to global health, equity, and justice.1 The impact of legal determinants of health on the COVID-19 pandemic is evident where law is being used as a mechanism to enable or prevent global equitable access to COVID-19 vaccines. Barriers to equitable access are partly driven by vaccine nationalism2 with governments seeking to use law to secure priority access to future vaccines through Advance Purchase Agreements (APAs) with vaccine manufacturers. These bilateral legal agreements can be in a nation's interest, but given the uncertain success of individual COVID-19 vaccine candidates and the global spread of SARS-CoV-2, APAs are a gamble and erode collaboration between countries. Importantly, such bilateral legal agreements are likely to contribute to inequities and potentially extend the pandemic's time frame. By contrast, multilateral legal agreements could be the path back to global health security and justice by re-establishing norms of international solidarity, committing to global equitable vaccine access initiatives, and laying a foundation for a post-pandemic era built on multilateralism and cooperation.

Albania’s Plan: Response to COVID-19

The current novel coronavirus (COVID-19) outbreak, which began in December 2019, represents a significant challenge for Albania, as well as for the entire world. This study considers that Albania has prepared several action plans over the years related to pandemic influenza preparedness, health security, and health emergencies. The result shows that sharing information about the preparedness of Albania’s plan has a significant positive impact on the response adequately and in a timely manner, offering protection to the population. This paper first investigates the novel nature of the virus during a pandemic situation in Albania and proposes public protection plans to respond to the coronavirus. In brief, the current main objectives in Albania are to create a protected environment, update information and create response measures for the Albanian population. The results show that the measures taken are helping the health indicators to stay constant and decrease the curve of the pandemic.Keyword: coronavirus, measures, indicators, response, Albanian population

Global health and data-driven policies for emergency responses to infectious disease outbreaks

In 2011, WHO reached a global health milestone when the organisation achieved international agreement on a framework for pandemic influenza preparedness that would facilitate the sharing of influenza virus samples and data, allow vaccine access, and address aspects relevant to low-income and middle-income countries (LMICs).1 Similarly, in 2015, a WHO consultation during the Ebola virus outbreak in west Africa emphasised the need for global norms and for the public availability of data during public health emergencies.

Opportunities and challenges for telehealth within, and beyond, a pandemic

Opportunities and challenges for telehealth within, and beyond, a pandemic

Editorial introductions

Editorial introductions

Country level analysis of COVID-19 policies.

Country level analysis of COVID-19 policies.

Tropism and neutralisation studies on bat influenza H17N10

The diversity of subtypes within Influenza A recently expanded with identification of H17N10 and H18N11 from bats. To study the tropism and zoonotic potential of these viruses, we successfully produced lentiviral pseudotypes bearing haemagglutinin H17 and neuraminidase N10. We investigated a range of cell lines from different species for their susceptibility to infection by these pseudotypes and show that a number of human haematopoietic cancer cell lines and the canine kidney MDCK II (but not MDCK I) cells are susceptible. Using microarrays and qRT-PCR we show that the dog leukocyte antigen DLA-DRA mRNA is over expressed in late passaged parental MDCK and commercial MDCK II cells, compared to early passaged parental MDCK and MDCK I cells, respectively. The human orthologue HLA-DRA encodes the alpha subunit of the MHC class II HLA-DR antigen-binding heterodimer. Small interfering RNA- or neutralizing antibody-targeting HLA-DRA, drastically reduced the susceptibility of Raji B cells to H17-PV. Conversely, over expression of HLA-DRA and its paralogue HLA-DRB1 on the surface of unsusceptible HEK293T/17 cells conferred susceptibility to H17-PV. The identification of HLA-DR as an H17N10 entry mediator will contribute to understanding the tropism of the virus and help to elucidate its zoonotic transmission. We also show that H17 pseudotypes can be efficiently neutralised by the broadly-neutralizing HA2 stalk monoclonal antibodies CR9114 and FI6. The lentiviral pseudotype system is a useful research tool, amenable for investigation of bat influenza tropism, restriction and pandemic preparedness, without safety issues of producing a replication-competent virus, to which the human population is naïve.

Exploring the role of mass immunisation in influenza pandemic preparedness: A modelling study for the UK context

The nature and timing of the next influenza pandemic is unknown. This makes it difficult for policy makers to assess whether spending money now to prepare for mass immunisation in the event of a pandemic is worthwhile. We used simple epidemiological modelling and health economic analysis to identify the range of pandemic and policy scenarios under which plans to immunise the general UK population would have net benefit if a stockpiled vaccine or, alternatively, a responsively purchased vaccine were used.Each scenario we studied comprised a combination of pandemic, vaccine and immunisation programme characteristics in presence or absence of access to effective antivirals, with the chance of there being a pandemic each year fixed. Monetarised health benefits and cost savings from any influenza cases averted were set against the option, purchase, storage, distribution, administration, and disposal costs relevant for each scenario to give a discounted net present value over 10 years for planning to immunise, accounting for the possibility that there may be no pandemic over the period considered. To support understanding and exploration of model output, an interactive visualisation tool was devised and made available online.We evaluated over 29 million combinations of pandemic and policy characteristics. Preparedness plans incorporating mass immunisation show positive net present value for a wide range of scenarios, predominantly in the absence of effective antivirals. Plans based on the responsive purchase of vaccine have wider benefit than plans reliant on the purchase and maintenance of a stockpile if immunisation can start without extensive delays. This finding is not dependent on responsively purchased vaccine being more effective than stockpiled vaccine, but rather is driven by avoiding the costs of storing and replenishing a stockpile.

Expanding the pandemic influenza preparedness framework to the epidemic of COVID-19

On March 11, 2020, WHO officially declared that COVID-19 had become Pandemic. As of March 31, the epidemic had affected more than 178 countries and regions, with more than 780 000 confirmed cases. The Pandemic Influenza Preparedness Framework for the sharing of influenza viruses and access to vaccines and other benefits (the 'PIP Framework' or 'Framework') is an international arrangement adopted by the World Health Organization in May 2011 to improve global pandemic influenza preparedness and response. Since the transmission route and transmission capacity of COVID-19 are similar to that of influenza A (H1N1) in 2009, which conforms to the basic elements of "human pandemic", and the epidemic scale has exceeded that of influenza A (H1N1)， it is probable to incorporate COVID-19 epidemic response into PIPF, and at the same time to verify and improve PIPF in practice. It is recommended that WHO, other international organizations and relevant countries make full use of the PIPF system to respond to the epidemic and better coordinate national actions at the global level. At the same time, China should also make the planning and deploy of domestic epidemic prevention and control and international epidemic cooperation under the framework.

Applicazione e potenziamento del PIP (Pandemic Influenza Preparedness Framework) in ambito OMS: un'arma in più per affrontare le fasi successive al picco da Covid-19

Pandemic Influenza Preparedness (PIP) Framework, developed by the World Health Organization, is the only existing framework to face a global pandemic crisis It is aimed to define a line of intervention which overcomes characteristics of health systems and allows the Member States at accessing to vaccines and other benefits Besides reviewing its evolution, this article attempts to explore whether – and how – PIP could support future political and economic challenges engendered by Covid-19 In the absence of a new global agreement, PIP may represent the first outline of a framework for reacting to the present pandemic crisis Moreover, a revised and more robust version of PIP may increase preparedness to future health crises Copyright © FrancoAngeli

Mexico: Lessons learned from the 2009 pandemic that help us fight COVID-19.

In April 2009, Mexican, American, and Canadian authorities announced a novel influenza that became the first pandemic of the century. We report on lessons learned in Mexico. The Mexican Pandemic Influenza Preparedness and Response Plan, developed and implemented since 2005, was a decisive element for the early response. Major lessons-learned were the need for flexible plans that consider different scenarios; the need to continuously strengthen routine surveillance programs and laboratory capacity and strengthen coordination between epidemiological departments, clinicians, and laboratories; maintain strategic stockpiles; establish a fund for public health emergencies; and collaboration among neighboring countries. Mexico responded with immediate reporting and transparency, implemented aggressive control measures and generous sharing of data and samples. Lessons learned induced changes leading to a better response to public health critical events.

Operational stresses on New York City Health+Hospitals Health System frontline hospitals during the 2017-18 influenza season.

Identify operational lessons to support hospital and health system preparedness and response for sea-sonal and pandemic influenza based on firsthand experiences from the 2017-2018 influenza season. We conducted semistructured, retrospective interviews with New York City Health+Hospitals (NYCH+H) personnel to gather firsthand experiences from the 2017-2018 influenza season and evaluated stress data across four operational domains reported by NYCH+H hospitals during the 2017-2018 influenza season. Frontline hospitals in the NYCH+H health system during and after the 2017-2018 influenza season. Interviews conducted with personnel from 5 NYCH+H frontline hospitals. Operational stress data reported by 11 NYCH+H hospitals during the 2017-2018 influenza season. Operational challenges and lessons from frontline hospitals responding to severe seasonal influenza. Operational stresses during the 2017-2018 influenza season varied over the influenza season, between facilities, and across operational domains. Patient surge and staff absenteeism pushed some facilities to their limits, and supply shortages highlighted shortcomings in existing procurement systems. Resources tied to pandemic influ-enza were unavailable without a pandemic declaration. Seasonal influenza poses dynamic operational stresses across health systems and cities, poten-tially causing major impacts outside of declared pandemics. Lessons from NYCH+H can help other hospitals and health systems anticipate operational challenges, but novel solutions are needed to mitigate effects of patient surge and personnel and supply shortages during severe influenza seasons and pandemics. Improved data collection can help health systems better understand operational stresses and challenges across their facilities.

Fifty Years of Influenza A(H3N2) Following the Pandemic of 1968.

In 2018, the world commemorated the centennial of the 1918 influenza A(H1N1) pandemic, the deadliest pandemic in recorded history; however, little mention was made of the 50th anniversary of the 1968 A(H3N2) pandemic. Although pandemic morbidity and mortality were much lower in 1968 than in 1918, influenza A(H3N2) virus infections have become the leading cause of seasonal influenza illness and death over the last 50 years, with more than twice the number of hospitalizations from A(H3N2) as from A(H1N1) during the past six seasons. We review the emergence, progression, clinical course, etiology, epidemiology, and treatment of the 1968 pandemic and highlight the short- and long-term impact associated with A(H3N2) viruses. The 1968 H3N2 pandemic and its ongoing sequelae underscore the need for improved seasonal and pandemic influenza prevention, control, preparedness, and response efforts.

Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings-International Travel-Related Measures.

International travel–related nonpharmaceutical interventions (NPIs), which can include traveler screening, travel restrictions, and border closures, often are included in national influenza pandemic preparedness plans. We performed systematic reviews to identify evidence for their effectiveness. We found 15 studies in total. Some studies reported that NPIs could delay the introduction of influenza virus. However, no available evidence indicated that screening of inbound travelers would have a substantial effect on preventing spread of pandemic influenza, and no studies examining exit screening were found. Some studies reported that travel restrictions could delay the start of local transmission and slow international spread, and 1 study indicated that small Pacific islands were able to prevent importation of pandemic influenza during 1918–19 through complete border closure. This limited evidence base indicates that international travel-related NPIs would have limited effectiveness in controlling pandemic influenza and that these measures require considerable resources to implement.

Operational stresses on New York City Health+Hospitals Health System frontline hospitals during the 2017-18 influenza season.

Identify operational lessons to support hospital and health system preparedness and response for sea-sonal and pandemic influenza based on firsthand experiences from the 2017-2018 influenza season. We conducted semistructured, retrospective interviews with New York City Health+Hospitals (NYCH+H) personnel to gather firsthand experiences from the 2017-2018 influenza season and evaluated stress data across four operational domains reported by NYCH+H hospitals during the 2017-2018 influenza season. Frontline hospitals in the NYCH+H health system during and after the 2017-2018 influenza season. Interviews conducted with personnel from 5 NYCH+H frontline hospitals. Operational stress data re-ported by 11 NYCH+H hospitals during the 2017-2018 influenza season. Operational challenges and lessons from frontline hospitals responding to severe sea-sonal influenza. Operational stresses during the 2017-2018 influenza season varied over the influenza season, between facilities, and across operational domains. Patient surge and staff absenteeism pushed some facilities to their limits, and supply shortages highlighted shortcomings in existing procurement systems. Resources tied to pandemic influ-enza were unavailable without a pandemic declaration. Seasonal influenza poses dynamic operational stresses across health systems and cities, potentially causing major impacts outside of declared pandemics. Lessons from NYCH+H can help other hospitals and health systems anticipate operational challenges, but novel solutions are needed to mitigate effects of patient surge and per-sonnel and supply shortages during severe influenza seasons and pandemics. Improved data collection can help health systems better understand operational stresses and challenges across their facilities.

The spread of the COVID ‐19 coronavirus

While it is too late to confine the COVID-19 coronovirus outbreak to China, a wealth of data spurs epidemiological and vaccine research.

Prisons and custodial settings are part of a comprehensive response to COVID-19

Comment: Prisons are epicentres for infectious diseases because of the higher background prevalence of infection, the higher levels of risk factors for infection, the unavoidable close contact in often overcrowded, poorly ventilated, and unsanitary facilities, and the poor access to health-care services relative to that in community settings. Infections can be transmitted between prisoners, staff and visitors, between prisons through transfers and staff cross-deployment, and to and from the community. As such, prisons and other custodial settings are an integral part of the public health response to coronavirus disease 2019 (COVID-19).