Pandemic Flu Plans Need More Federal Guidance, Coordination

States require additional direction and guidance from federal health officials as well as answers to epidemiological questions to adequately develop their pandemic flu plans, according to a report conducted by researchers at RTI International.

The report, which was published in the September issue of Emerging Infectious Diseases, evaluated 49 state pandemic plans as they existed in March 2006. Louisiana's plan had not yet been released at the time.

Although the report found widespread disparities among the state plans, all states did agree to prioritize flu vaccine distribution during a pandemic to health care workers, people with chronic high-risk medical conditions and the elderly. In about one-third of states, young children were also included as a priority to receive the vaccine.

"The control of future pandemic or interpandemic influenza will necessarily rely on each individual state's plan to vaccinate persons and detect and contain this disease," said Scott Holmberg, MD, RTI's lead author on the report. "Still, the current national pandemic influenza plan presents only a categorization and listing of steps, rather than explicit direction for the states. This lack of central coordination can result in a patchwork of plans that will not adequately detect and control this or other respiratory disease pandemics."

The United States Department of Health and Human Services (HHS) has recently issued guidelines to prepare for a flu pandemic, but much of the specific planning, problem solving and funding has been left to individual states.

According to the report, few state plans included guidelines for personal avoidance steps during a pandemic, such as staying home from work, keeping sick children at home and avoiding mass gatherings.

The state plans also displayed confusion and lacked specificity in proposing practical containment measures in the community. Eight states were developing procedures for screening international travelers, but international airport hubs such as Chicago and Atlanta did not yet include plans for international traveler quarantine and testing. State plans also lacked an agreed-upon definition of geographic clustering of cases or the number of people infected that would trigger the declaration of a pandemic.

"We believe some of the problems result from weak central direction from federal officials, which has been a criticism of national bioterrorism preparedness," Holmberg said. "Fortunately, state and federal plans are still in flux, and many are still in draft form. Getting a clearer delineation of a basic plan that all states can follow is still possible."

The authors also point out that some of the confusion among state plans stems from a lack of information. Key epidemiologic questions needed for pandemic planning remain unanswered, such as the typical ways the disease spreads within households and institutions under different conditions and whether early detection would lead to behavior changes that could slow the spread of the disease.

"There is no single, best solution for all states," said Diane Wagener, PhD, RTI's co-author on the report. "But there is need for active communication and collaboration between federal, state, and local health departments to advance these plans and come up with an effective, coordinated multi-layered approach to pandemic influenza."

The report was funded as part of the Modeling Infectious Disease Agent Study (MIDAS) network, funded by the National Institute of General Medical Sciences, a division of the National Institutes of Health.

Source: RTI International