Pandemic flu and the elderly: A cause for concern

In the event of a flu pandemic, health officials are predicting that older people will be among the hardest hit by the disease, both in terms of the number of cases and deaths. But just how much at risk are the elderly?

A new commentary by members of APHA's Gerontological Health Section tries to answer that question. According to the commentary author Pierrette J. Cazeau MBA/H.S.A, CCJ, CHRM, CNPR findings from the regular flu season show that there is cause for concern for the elderly during a pandemic, especially those who live in group settings. Health officials need to plan for rapid exposure in communal dwellings to prevent the potential impact of pandemic influenza on the elderly, according to the authors, and prepare to provide vaccinations, if they become available.

To read the full commentary, visit APHA's Get Ready for Flu Web site.

Companies to develop rapid tests for avian flu

Health professionals will someday be able to tell in a matter of minutes whether your case of sniffles is due to avian flu or seasonal flu, once plans announced by the Centers for Disease Control and Prevention come to fruition.

CDC awarded $11.4 million in contracts last week to four companies to develop tests to quickly and accurately test patients for the H5N1 virus.

The four companies –- MesoScale, Gaithersburg, Md.; Iquum, Marlborough, Mass.; Cepheid, Sunnyvale, Calif.; and Nanogen, San Diego -- will work during the next year to create tests that will differentiate avian flu from seasonal flu within 30 minutes.

CDC officials said they hope to have the tests approved and put on the market by the Food and Drug Administration within two to three years.

The tests could give public health experts around the world critical information on existing flu viruses and help monitor viruses that could cause a global flu pandemic, according to CDC. Currently, rapid diagnostic tests can only determine if a patient is infected with the seasonal A or B flu viruses, but not H5N1, the avian fu virus that has killed 154 people in 11 countries.

"These contracts will support development of promising technology that could help doctors treat their patients faster and help public health authorities track influenza viruses that could spur a pandemic," said Dr. Julie Gerberding, CDC's director.

For more information on pandemic preparedness, visit www.pandemicflu.gov or www.getreadyforflu.org.

'Tis the Season: Holiday Traveler's Advice for Preventing the Spread of Infectious Disease

Traveling home for the holidays? If you aren't careful, you could end up bringing home an uninvited guest to meet the family: infectious disease.

In addition to monitoring the weather for possible delays, squeezing everyone's gifts into your suitcase and bagging your carry-on liquids for the plane trip, travelers should take a few extra steps to protect themselves from germs and viruses while traveling:

* Get vaccinated. Immunization can drastically reduce your chances of contracting many infectious diseases. Before you travel, make sure you, your family members and loved ones have gotten their seasonal flu shot.

* Keep hydrated. Drink lots of water before and during your flight.

* Try to catch some sleep on the way. Most of us get sick when we are stressed or tired. If you can catch some ZZZs on the plane, train or bus, you might be able to stave off a little of that exhaustion.

* Bring a scarf or a small blanket. Packing a small blanket, scarf or sweatshirt in your carry-on bag will allow you to bundle up when you get cold without using blankets that have been who knows where.

* Keep your hands clean. You've heard it before and you'll hear it again: The best thing you can do to prevent the spread of germs and protect your heath is to wash your hands with warm water and soap.

* If you are flying, turn up the air. While there has been speculation that the forced-air systems in planes actually spread germs, recently experts have said that the air vents above your seat on planes can help push away the germs that might float into your space.

* Keep to your schedule. As best you can, try not to change your daily habits. Eat the same breakfast, work out the same amount and avoid over- or under-sleeping.

* Watch for symptoms. After your return home, monitor your health. If you become ill with a fever, cough, sore throat, shortness in breath or any other of the regular signs and symptoms of the flu, call your doctor. If you get sick, limit contact with others and stay home from work to prevent the spread of flu and other infectious illnesses.

photo credit: iStockphoto

Bird flu and flu pandemic: What role will vaccines play?

As anyone who has ever rolled up their sleeve for a shot at the doctor knows, vaccines are just about the best way to stop the spread of infectious disease. Which is exactly why creating a vaccine that protects us from bird flu is of such high importance to researchers.

Right now, scientists are testing experimental vaccines against H5N1, the type of avian flu virus that is making birds and some people sick. Some early results have been promising, and researchers are hoping to come up with a vaccine that will work soon.

In the meantime, global health officials are crossing their fingers that the H5N1 virus doesn't mutate into a form that people can easily catch from one another. Because once that happens, a pandemic — which is basically a worldwide infectious disease outbreak — will likely occur.

So if there is a pandemic, all we need to do is start handing out that vaccine researchers have been working on, right? Not necessarily. Chances are, the experimental bird flu vaccines now in development will offer limited protection in the event of a pandemic. The change in the mutated virus' "ingredients" will be too great, and it won't look like the H5N1 currently being tested, so another vaccine would have to be developed.

Here is some more food for thought: Even if researchers do come up with the right type of vaccine, it will probably be in short supply, since it takes so long to produce it.

The bottom line is that in the first months of a pandemic, we are going to have to use other measures to lessen our risk of getting sick, including washing our hands often, covering our noses and mouths when we cough or sneeze, and avoiding close contact with people who are sick. In the end, the same things that keep us well every day may be the very things that keep us healthy during a flu pandemic.

Take our flu shot poll!

Flu season is here, and that means it is time to get your your flu shot. Have you gotten yours yet? Take our poll, at right, and let us know!

Seasonal flu shots no protection for bird flu

With all the talk about the importance of getting your seasonal flu shot, you may be wondering whether there is a vaccination that you can get that will protect you from bird flu or a flu pandemic.

Unfortunately, the answer is no. Right now, there is no vaccine to protect us from H5N1, the bird flu virus that is proving deadly to birds and some humans around the world, or from a future flu pandemic.

The seasonal flu shot we receive every year is made to protect us from the common types of flu that are being passed around in the United States and around the globe. But because H5N1 is a new type of flu, the seasonal flu shot does not contain the ingredients necessary to protect us from it.

That doesn't mean of course, that you should forgo your seasonal flu shot. With 36,000 people each year dying of seasonal flu in the United States, and more than 200,000 hospitalized for flu complications, it is important that you get vaccinated, especially if you are elderly or in a high-risk group. Ditto if you are a health worker. Still haven't gotten your seasonal flu shot? Now is the perfect time, as it's National Influenza Vaccination Week. So what are you waiting for?

Community measures key in the event of a flu pandemic, experts say

Communities can play an important role in keeping their residents safe in the event of a flu pandemic, according to a panel of experts who spoke at APHA’s 134th Annual Meeting in November.

While many people are counting on vaccines or drug treatments to help protect their health in the event of a flu pandemic, such supplies may not be readily available, panel presenters said. During a flu pandemic, it could take up to six months for enough vaccines and medications to be available for every person, according to David Heyman, director and senior fellow of the Center for Strategic and International Studies’ Homeland Security Program, which means it is important to know about other ways to work to protect communities.

Protecting community residents requires cooperation, preparation and communication, according to panel presenter Donna L. Richter, EdD, FAAHB, dean of the Arnold School of Public Health at the University of South Carolina. In the end, all emergencies are local, so it is the local response that matters the most, she said. For pandemic planning to truly work, leaders must involve everyone, including individuals, families and communities.

Keeping the public up to date with information during an emergency can help reduce worry and encourage everyone to accept measures needed to control the flu, such as school closings or possible quarantines, said Robert J. Levine, MD, co-director of Interdisciplinary Bioethics Center at Yale University.

Education campaigns before and during an emergency are key, as they remind people to take simple measures, such as frequent handwashing or avoiding public places. Such measures will help people protect themselves and others, according to Heyman, who is the author of a 2005 report detailing ways to safeguard the public during disease outbreaks.

It is especially important to make sure that all people have equal access to services and help during a pandemic, Levine stressed. In addition to doctors and health workers, police, social workers and others can work together to help sick people stay at home so they don’t infect others. Helping people get the services they need, whether it be providing medical care or just going to get groceries, is also vital.

Communities must prepare now, as diseases that occur on the other side of the world can quickly make their way to the United States, Richter emphasized.

"For the flu, the world is one interconnected community that has no boundaries," Richter said.

Photo: Image of David Heyman speaking during a session at APHA's 134th Annual Meeting in Boston this November (photo credit: EZ Event Photography)

CDC: It's not too late to get your seasonal flu shot

As you spend your post-Thanksgiving days recovering from turkey over-indulgence and shopping for bargains, the Centers for Disease Control and Prevention is hoping you will take time to consider something more serious: your annual flu shot.

To increase the number of Americans who receive their seasonal flu shot, CDC officials have declared Nov. 27 to Dec. 3 as "National Influenza Vaccination Week." (http://www.cdc.gov/od/oc/media/pressrel/r061113.htm) The event will help spread the word that it's not too late to receive a seasonal flu shot and encourage health providers to schedule vaccine clinics, extend clinic hours and hold mass vaccinations at retail stores and other locations.

While most people think of October as the time to receive flu shots, people can receive their shots during November, December and early next year and still be protected from the flu, according to CDC.

"It is a good idea to check now with your provider or your health officials to determine where and when vaccine is expected in your community and get ready to step up to the plate and get vaccinated," said Dr. Julie Gerberding, CDC's director. "We want you to go to your holiday gatherings with your good food and your gifts and your good cheer and not with the flu virus."

Despite some early distribution problems, CDC officials report that 77 million flu vaccine doses have been distributed this year and vaccine supply is expected to reach an all-time high. For the first time, CDC is recommending that children ages 24 months to 59 months be vaccinated, as they are considered at risk for flu complications. Each year, about 36,000 Americans die of the flu.

More information on flu and flu vaccine is online at www.cdc.gov/flu. To find a flu shot clinic in your area, use the American Lung Association's Flu Clinic Locator, online at http://www.flucliniclocator.org/.

Advice on keeping kids safe from infections

The best way to keep kids safe from influenza or other infectious diseases is to make sure they are immunized, according to APHA member Jonathan Kotch, MD, MPH, FAAP, who discusses the issue in a new Q&A on APHA's Get Ready Web site.

Kids are at higher risk for infectious diseases both because of their young immune systems and their behaviors, such as their tendency to put things in their mouths, said Kotch, a professor of maternal and child health at the School of Public Health at the University of North Carolina at Chapel Hill.

"I don't think we appreciate how prevalent seasonal flu is in very young children," Kotch said. "They do get it frequently but it's not often as serious in young children as it is in older kids and adults, and it is frequently misdiagnosed as something else, such as an upper respiratory infection or viral syndrome. For that reason, kids are a risk factor for adults getting it, which is why we want kids to be immunized against seasonal flu."

For more advice on keeping your kids safe from infection, visit APHA's Get Ready Web site.

New Harvard Survey Finds One in Four Americans Say They May Lose Job or Business in Flu Pandemic

One in four Americans believe they or a household member would lose their job or business if they had to stay at home for seven to 10 days during a severe flu pandemic, according to a Harvard School of Public Health study released last week.

Although the survey found that more than three-fourths of Americans would cooperate if public health officials recommended that they stop some activities for one month, such as using public transportation and going to the mall, a substantial number of people surveyed also said they would have no one to care for them if they became ill. Many of the 1,697 adults surveyed also said they would face serious financial problems, such as loss of pay and health care, if they had to stay home from work for a week or more. More than four in 10 people living in one-adult households and about a third of low-income adults said they would not have anyone to take care of them if they were sick and had to remain at home for seven to 10 days.

When asked about their current employers plans for dealing with a flu pandemic, only 19 percent of respondents said they were aware of any preparedness plan at their workplace. Fifty percent of employed Americans believe that their workplace would stay open if public health officials recommended that some businesses in their community should shut down.
The full survey results may be found at http://www.cq.com/flatfiles/editorialFiles/healthBeat/reference/20061026-flusurvey.pdf.

Don't take flu home for the holidays

It's autumn. Time to put together the perfect Halloween costume, buy those plane tickets for Thanksgiving and start saving your pennies for the holiday shopping spree. So make room for candy corn, mashed potatoes... and oh, the flu.

Sounds like a pretty unwelcome house guest, right? Well, the flu doesn't usually make reservations. Much of the time, the nasty bug simply takes advantage of our forgetfulness and, yes, laziness. In other words, Mr. Forgets-to-Wash-His-Hands meets Ms. Influenza, and BAM!, here comes runny noses, sweaty fevers and sleepless nights.

The best was to avoid seasonal flu is by getting a flu shot, which is highly recommended. However, there's a number of other things you can do to protect yourself. Here's a few tips:

1. Call in sick: Your co-workers will thank you
Most of us have been guilty of going to work or school when we've been sick because of an upcoming important deadline or a big test. However, we are not setting the best example and, in fact, we could be causing more harm than good by giving the flu to a co-worker. Staying home when you are sick will be especially important if and when a flu pandemic or an outbreak of another infectious disease occurs, so we should all take this opportunity to practice.

How long do you need to stay at home? According to our top health officials, most healthy adults may be able to get others sick a day before they even start showing symptoms and up to five days after becoming sick. So, if you are not feeling well, be a thoughtful co-workers and stay home. Curling up in front of your TV or with a good book isn't the worst way to spend a day or two, right?

2. Rub a dub dub . . . wash your hands!
Wash your hands often, long enough and with warm water and soap. Wash your hands for as long as it takes to sing the "Happy Birthday" song all the way through twice (about 20 seconds). If it helps, don't be afraid to sing aloud in the bathroom or kitchen! For more tips on handwashing, visit http://getreadyforflu.blogspot.com/2006/08/for-pandemic-flu-prevention-best.html.

3. Say it, don't spray it
Why is covering your cough or sneeze so important? Because people with the flu can easily pass it along to others. Also, people can catch the flu by touching something with flu viruses on it and then touching their mouths or noses. It's best to protect yourself and others, so cover your mouth when you cough or sneeze, and avoid touching your eyes, nose and mouth.

By getting a flu shot and following these tips, there's a much better chance that you will be sharing your holidays with pumpkins and eggnog instead of tissues and cold medicine.

WHO Releases Report Calling for Increased Commitment to Global Influenza Resources

The World Health Organization (WHO) called today for "immediate and sustained action and funding" to increase the world's influenza vaccine resources in its newly released Global Pandemic Influenza Action Plan to Increase Vaccine Supply. More than 120 scientific experts from national immunization programs, regulatory agencies, scientists and vaccine manufacturers developed the plan. The Action Plan identifies and prioritizes solutions for reducing potential gaps in the world's pandemic flu vaccine supply, including:

*An increase in seasonal flu vaccine use to protect individuals against seasonal flu and at the same use the increased demand to stimulate manufacturers to produce more vaccine;

*An increase in vaccine production capacity through measures such as improving vaccine production yields and building new manufacturing plants; and

*Further research and development to design more effective vaccines and to produce vaccines more efficiently and quickly.

Experts estimate that by 2008-2009, the production of pandemic flu vaccine will not exceed 2.34 billion doses a year. The production capacity currently for seasonal flu vaccine now stands at 350 million doses, far short of the manufacturing capacity needed to vaccinate the world's 6 billion people.

U.S. Health and Human Services Secretary Mike Leavitt called WHO's plan a "significant step forward" in the global effort to prepare for a flu pandemic. The number of avian flu cases in humans has more than doubled to over 250 cases in 10 countries, and more than half of those individuals infected have died, Leavitt said.

The flu shot: The best thing you can do to head off the flu

It's that time of year again: the start of the flu season. The annual flu season begins in October and can continue until May. Every year, between 5 percent and 20 percent of the U.S. population gets the flu. That means at least 15 million Americans (and as many as 60 million) get sick from the flu every year. Seasonal flu results in more than 200,000 hospitalizations and about 36,000 deaths annually.

So, what can you do to protect yourself and your family from seasonal flu? The most important thing, by far, is to get a flu shot. October and November are the best months to get a flu shot, but getting vaccinated later in the flu season still helps. The flu is still circulating in January and February, and sometimes even as late as May. The seasonal flu shot won't protect you from H5N1, the type of avian influenza that has killed birds and people in countries such as Indonesia and Thailand, but it can protect you from regular flu.

We've encountered some problems in recent years with vaccine supplies that have made it difficult for everyone who wanted a flu shot to get one. This year, however, the Centers for Disease Control and Prevention has reported that more than 100 million doese of the flu caccine will be available, which is more then ever before. There may be a few bumps in the year ahead, but don't let this keep you from getting vaccinated. There should be enough doses of vaccine available for all of those who want one, even if it takes a few extra weeks.

CDC also recommends that certain people, such as very young children, the elderly and people living with illnesses that affect the immune system get vaccinated against the flu. For a complete list of those who are most at risk, visit www.cdc.gov/flu/protect/keyfacts.htm.

Sometimes people are afraid to get a flu shot because they're afraid it will make them sick with the flu, but that's not true. The flu shot that many of us get every year contains dead influenza virus, which experts call "inactive virus." You can't get sick from it because the virus is no longer alive. This vaccine, given with a needle, is approved for people older than 6 months of age. If you are allergic to eggs, contact your health care provider, as the flu vaccine will have to be administered differently, if at all.

Beyond the shot, there is a newer flu vaccine introduced in recent years that is given via a nasal spray. However, it is not recommended for everyone since it contains live (but weakened) flu virus. Only healthy people between 5 and 49 years of age who are not pregnant are approved to use it. The nasal spray flu vaccine is a great alternative for those of us who are afraid of needles, especially healthy, school-aged children.

Whichever type of flu vaccination you choose, it's the best thing you can do to head off the flu.

APHA Launches Get Ready Campaign to Help Americans Prepare Themselves for Flu Pandemic

APHA has officially launched its Get Ready campaign to help the public prepare for a potential influenza pandemic and outbreaks of other emerging infectious diseases. APHA's campaign speaks directly to individuals, families and communities and helps fill gaps by telling people what they need to prepare themselves.

Currently, the campaign includes the Get Ready For Flu blog, a Web site and podcasts featuring expert commentary and conversations with APHA members and other public health authorities. Fact sheets and other materials are available through the Get Ready Web site at www.getreadyforflu.org.

Future plans for the campaign include grassroots activities, toolkits, community partnerships, preparedness surveys and a calculator to help people determine what supplies they will need to prepare for pandemic flu or other emerging infectious diseases. For more information, e-mail pandemicflu@apha.org.

APHA Launches Flu Podcast Series

Adding to the tools to help you prepare for a flu pandemic or for infectious disease, the American Public Health Association has launched a new podcast series.

The podcasts, available online (at http://aphagb.podshowcreator.com/podcasts.aspx) , will help educate the public about protecting themselves, their families and their communities against a potential pandemic and also advise people on other issues such as news on the seasonal flu or infectious diseases.

The expert commentary and conversations in these podcasts will be direct, clear and straightforward. APHA members and other public health authorities will cover topics such as "flu 101," vaccine availability, safe cooking procedures and preparing for seasonal flu. The debut podcast, which features APHA Executive Director Georges Benjamin, MD, FACP, discusses the threat of pandemic flu and APHA's Get Ready campaign.

Give a listen, and send us your ideas on what topics you'd like to see covered.

How safe is my cat? Keeping Fluffy free from the flu

With all the talk about flu in birds, cat owners may be wondering: How safe is my cat? Along with hairballs and distemper, do I have to worry about my kitty getting an avian flu infection? Recent reports and studies suggest the answer is "yes," but there is no need to panic. As a pet lover, you can take steps to make sure Fluffy and Snowball stay healthy and safe.

Besides birds and people, a multitude of animals - such as pigs, ferrets, rats, rabbits - can become infected with the H5N1 avian flu virus, and that list includes felines. Internationally, both domestic kitties and big zoo cats have gotten the flu after eating H5N1-infected chickens, and sick cats can spread infection to other cats through their waste.

Raw meat from infected birds can be a risk for cats, and the World Health Organization reported this year that pet cats in Germany died from the H5N1 virus after eating infected birds. Other reports of infected cats have come from Austria, France and Bangkok. Sick cats are said to have the same symptoms as infected humans - fever, sore throat and muscle aches.

Luckily, there are no reported cases of infected cats in the United States and experts emphasize that the avian flu risk to felines in North America is very low. As a pet owner, you can take special care to protect your cat. Just follow these steps:
*Don't let your cat roam outdoors, because cats may be exposed to a virus after coming into contact with infected birds or eating fowl and other wildlife.
*Keep your cat away from birds and their droppings.
*Do not allow your cat to eat raw chicken, eggs or other poultry.

The same advice applies to dogs. While canines are not usually susceptible to avian flu, a 2005 unpublished study conducted in Thailand showed that dogs could be infected with the virus, according to the American Veterinary Medical Association. Given the limited information, the jury is still out on the risk for Fido. But dog owners can play it safe by following the same rules that are recommended for cats.

By using caution and watching out for your furry family members, you can ensure that both Fido and Fluffy remain happily curled up at the foot of your bed for years to come.

APHA Fact Sheet Provides Advice on Pandemic Flu

Are you concerned about pandemic flu? Wondering what to do or how to prepare? A new fact sheet from the American Public Health Association can help.

The fact sheet addresses ways you can prepare for and protect yourself against pandemic flu. It also covers signs and symptoms of pandemic flu and reviews key facts.

The next time you are meeting with friends or heading to your church, YMCA, community center or kid's school, bring copies of the fact sheet along. By sharing information and educating others, we can all be more ready.

Deadliness of 1918-1919 flu linked to immune response in victims

The pandemic flu outbreak that swept the world in 1918 to 1919 was so deadly because of the severe immune response it caused in its victims, new research shows.

Scientists report in the Oct. 5 online edition of Nature that certain genes related to immune response and infection fighting were activated in victims, leading to what researcher John Kash called an "overblown inflammatory response."

"What we think is happening is that the host's inflammatory response is being highly activated by the virus, and that response is making the virus much more damaging to the host," said Kash, research assistant professor of microbiology at the University of Washington and lead author of the study. "The host's immune system may be overreacting and killing off too many cells, and that may be a key contributor to what makes this virus more pathogenic."

The 1918 to 1919 pandemic flu outbreak, which involved an H1N1 strain of avian influenza, is estimated to have killed 50 million people globally. Unlike the seasonal flu, which typically hits children and the elderly, the pandemic flu outbreak took a heavy toll on young adults with strong immune systems, leading researchers to wonder why it caused so many deaths in that population group.

Chicken about eating poultry? Properly cooking and handling your food is the answer.

With all the talk of avian flu, are you afraid to eat chicken? Thinking of passing up omelettes or scrambled eggs because they might make you sick? The U.S. Department of Agriculture says you can put those worries aside: As long as poultry and eggs are properly handled and cooked, they're still safe to eat. We just need to take a common-sense approach to preparing food.

While the deadly type of avian flu that is a potential threat to humans has never been detected in U.S. poultry, properly cooking and handling your chicken, turkey or duck would kill the virus before it reaches your table, according to USDA.

The best way to be sure your food is safe is by using a meat thermometer to make sure your chicken is cooked all the way through. The inside of your chicken should be at a temperature of at least 165 degrees throughout to kill foodborne germs that might be present, including salmonella, E. coli and influenza.

It's never a good idea to eat raw eggs, or food with raw egg ingredients such as cookie dough or cake batter (as tempting as it may be!). Play it safe by thoroughly cooking all dishes with raw eggs.

Here are some other helpful tips from USDA:
* Wash your hands with warm water and soap for at least 20 seconds (equal to singing the "Happy Birthday" song all the way through twice) before and after handling food.
* Prevent the cross-contamination of foods by keeping raw meat, poultry, fish and their juices away from other items.
* After cutting raw meats, wash your cutting board, knife and counter tops with hot, soapy water.
* Sanitize cutting boards by using a solution of 1 teaspoon chlorine bleach in 1 quart of water.

For more tips, read the USDA's helpful brochure on avian flu or ask questions online via the USDA Web site. Bon appetit!

Leavitt pledges U.S. support of global pandemic flu preparedness

Global efforts to prepare for and respond to a potential human influenza pandemic have "gained momentum and strength," during the past year, according to U.S. Health and Human Services Secretary Mike Leavitt.

Addressing representatives of the United Nations General Assembly in New York City Sept. 20, Leavitt detailed progress made on the International Partnership on Avian and Pandemic Influenza, which was announced by President Bush in 2005. The partnership focuses on enhancing preparedness, prevention, response and containment activities for pandemic influenza.

"Responding to a pandemic will demand the cooperation of the world community," Leavitt said. "No nation can go it alone. If a country is to protect its own people, it must work together with other nations to protect the people of the world."

The United States is playing a role in fighting pandemic flu by funding research on cell-based vaccines, developing mitigation strategies and creating rapid diagnostic testing, among other efforts, according to Leavitt. He pledged that the United States will continue to support the international partnership, highlighting the country's role in funding a specimen transport fund, which helps flu samples from affected countries travel quickly and securely. The United States has also helped reinforce antiviral stocks internationally by sending supplies of Tamiflu, an antiviral flu drug, to "a secure location in Asia," Leavitt said.

"It is our collective global resources and cooperation that will make our pandemic preparedness efforts a success and that will position us as a global community to (be) better prepared tomorrow than we are today," Leavitt said.

Take action! Tell your members of Congress that we need their help to be ready for pandemic flu

By now, you've probably heard that there is a pandemic flu plan out there from the federal government. The latest version, which came out in May, is billed as a "strategic, government-wide pandemic flu preparedness and response plan" meaning that the government has inked out (in 233 wordy pages, no less) what it is going to do if a highly infectious type of bird flu makes it to the United States.

But how good is this plan, really? It has its strong points, such as the fact that it recognizes that every person in the United States and all kinds of businesses would be affected (if a pandemic strain of bird flu sickens the nation, schools and workplaces will be closed, and people will be panicked and looking for advice). It also recognizes that we need to get ready now, long before the virus wings its way here via a migrating bird or international airplane.

One area where the federal flu plan is weak, though, is in how it expects us to get ready: The plan relies on people, families and communities to have their own flu plans in place, and assumes everyone will be able to have a closet full of canned goods, bottled water and batteries in case we have to hide out in our homes for a few weeks or months.

Unfortunately, the plan doesn't help communities and people become prepared, it just tells them to be so. Families will need to know what and how many supplies to buy. Hospitals will need more staff. Public safety and emergency services personnel in our communities will need a way to communicate during a crisis.

The reality is that if we are all going to get ready for pandemic bird flu, local and state health departments, community governments and leaders are going to need money to do it. If our communities are left to prepare on their own, using already-stretched resources, will we really be ready for bird flu, or any other infectious disease threats that come our way? Or will we be forced to cross our fingers and hope for the best?

(Think about it: If you turned on your TV news tomorrow and the overly coiffed talking news heads said that people in your city or town were sick from bird flu, would you be ready? Would you know what to do?)

In the end, it all comes down to money. It is up to us now to make sure that Congress provides enough funding so that we can prepare, and it's going to take a lot of dough. The federal plan says we will need $7.1 billion over several years to get ready for bird flu. That's a whopping figure, even to Congress, but we need to get started. To begin, APHA is urging Congress to provide at least $2.3 billion in funding for fiscal year 2007. You can help us get there.

Call, e-mail or write your senators or representatives and tell them we need this funding now to be prepared for pandemic influenza. (Enter your ZIP code and our advocacy tool will provide you with talking points as well as contact information so that you can connect to your members of Congress. CLICK HERE TO SEND A LETTER)

We need to act now, so that we can get people, families and communities involved in preparing for pandemic flu. We need to give our health workers and hospitals the tools and money they need to be ready, and we need to do it sooner, rather than later. This is your chance to make a difference.

When bird flu hits the United States (and at this point, it is not a matter of IF, but WHEN), we will all be a lot better off if we have real, well-funded community-based plans and systems in place, not just a hefty document on some desk in D.C.

School closings could negatively affect businesses

Holiday. Vacation day. Personal leave. No matter what you call it, having an occasional day off from work is a nice treat. But imagine having to take leave for several days, weeks or even months because of forced school or day care closings. If schools were closed during a flu pandemic or other outbreak of infectious disease, could you skip work and stay home to care for your kids?

While it may be a nice change of pace for you for a day or two, your employer may think otherwise. Some employers aren't flexible. They may not grant sick or vacation leave, and they may not offer the option of working from home. For many parents or guardians, an unexcused absence could lead to job or wage loss.

School closings will have an impact far beyond the school yard. Any closings, even for a relatively short period of time, will result in high rates of workplace absenteeism, causing both social and economic disruptions. Staff absences may interrupt the daily operations of a workplace and how it functions during an emergency. They may even impair the delivery of essential public services such as power, transportation and communications.

Communities and businesses need to investigate options for child care if schools must close and establish a "plan B" to minimize work place absenteeism. Telecommuting is one alternative. No matter what the circumstances, both communication and planning is key for ensuring that everyone is prepared.

Mute swan update

The U.S. Department of Agriculture confirmed Aug. 28 that two mute swans that were suspected to have contracted avian flu in August did have the disease, but were not infected with the type of H5N1 bird flu that is causing sickness and death among humans and birds in Asia.

Although the swans tested positive for an H5N1 bird flu, the type they were carrying is low-pathogenic, meaning that it is a weaker kind, and "poses no threat to human health," according to USDA. News reports have described it as "mostly harmless."

Since the Michigan swans were identified, birds in at least two other states have been found to be carrying low-pathogenic types of avian flu.

School preparedness for pandemic flu is a must

Preparing for a pandemic is like studying for a test. If you want to do well, you've got to be ready. Nowhere is this more true than in our schools, which are the center of community life. While schools work to educate our kids, they also provide social services and extracurricular programs. And since schools are so important to our communities, it is essential that they are involved in pandemic flu planning, both for their schools and with their communities.

How will schools operate if people get sick? When a flu pandemic or other infectious disease outbreak strikes, schools will need to have policies in place to accommodate sick students, teachers and staff who are absent for long periods. During the pandemic flu outbreak that swept through the United States from 1918 to 1919, schools around the country were closed to prevent spread of disease. And even in schools that were open, parents kept their kids home out of fear.

What will it mean for schools if this happens again, whether from pandemic flu or some other disease? For students, this may include posting schoolwork online, at least for those who have Internet access at home. For teachers, this may require more paid sick leave. The school year may need to be extended to make up for lost classes.

If a pandemic or outbreak is widespread in a community, and hospitals are overwhelmed, it is possible that schools will be closed and used for other purposes. Think of what happens when there are community disasters such as hurricanes or flood: Schools become much more than places for reading, writing and arithmetic. Oftentimes school cafeterias, gymnasiums and auditoriums become shelters to care for residents. Schools need to consult with their local health departments now to determine whether their buildings will be used as medical facilities, shelters or food distribution sites for residents in the event of a pandemic. Beyond infrastructure, schools could also lose some of their staff, as school nurses, counselors and other personnel are put into service to help out in the larger community. If so, who will be there to care for our schoolchildren?

Governments, school organizations and others have started thinking through these questions, and resources for schools to create plans are available online. If you are a parent, caretaker or just a community resident, it's up to you to find out how ready your schools are. If they're not, talk to your principal, school board or local elected leaders and offer to help. The time to get ready is now.

What if your child's school closed because of pandemic flu?

It's everyone's favorite time of year - time for kids to go back to school! As summer creeps to a close, families are preparing their children for the beginning of a new school year. But what if an influenza pandemic or other infectious disease outbreak closed our schools?

While we've heard from the federal government that officials are "not ruling out" the option of closing schools for a period of time if a flu pandemic occurs, there are no real details about what this would mean, and there are far more questions than answers for parents and communities.

What would you do if your child was unable to attend school or daycare? Where would kids go if such services suddenly closed and no one knew when they would reopen? Many of us depend on schools or daycare to care for our children on a daily basis, but we probably have not truly thought about the impact that pandemic influenza or an infectious disease outbreak would have on our families.

By preparing now, we can have plans in place when a flu pandemic or other emergency occurs. Here are some questions to ask yourself: Where will my children go if their school or daycare closes and I have to work? Does my work place grant paid leave time that will allow me to miss work? How would a flu pandemic or infectious disease outbreak affect my children's diet and their access to regular, healthy foods?

Beyond your own family, there are also issues for kids in your larger community. Many low-income children rely on school breakfast and lunch programs for their daily meals. How will these children eat if schools and daycare are closed? Are there services such as food pantries or shelters that will be prepared to feed them? How will those families know where to go? Every community should have a preparedness plan in place that will allow kids to eat healthily during an emergency, whether it is an outbreak of pandemic influenza, infectious disease or another disaster.

All of these questions may leave you feeling overwhelmed and anxious. But by thinking ahead now and deciding what your family and community can do to prepare, we'll all be ready if our school doors are closed.

Photo courtesy University of Toronto in Mississauga.

For pandemic flu prevention, the best advice may be "rub-a-dub-dub."

With all the talk of a possible flu pandemic coming our way, it is good to know that the simplest of acts can help keep you safe.

And anyone can do it. You do not need health insurance or a prescription (or the sometimes dreaded referral note from your doctor). You do not need seven years at a prestigious medical school or a letter from the school nurse. It is as easy for a 50-year-old to do as it is for a 10-year-old, and best of all, it is free. In fact, it is really quite universal and can help fight more than just the flu.
Here is how you do it: Find a sink, pick up some soap, wash your hands. Seems too simple to be true, right? But as it turns out, Mom was right: Washing your hands is good for your health. Viruses can survive on your hands for hours and washing your hands regularly is a proven way to decrease your chances of getting sick - even if a deadly pandemic flu hits.

You are probably thinking "Please! Of course, I wash my hands!" Well, not to burst your (soapy) bubble, but many of us are guilty of skipping out at the sink. According to an August 2005 survey sponsored by the American Society for Microbiology, 91 percent of adults say they always wash their hands after using a public bathroom, but in reality, only 83 percent were observed doing so. Even grosser, only 32 percent of those surveyed say they always wash their hands after coughing or sneezing, which means it may be time to replace the commonly heard "Gesundheit" with "Wash your hands!"

To illustrate just how big a small thing like washing your hands can be, check this out: In 2005, health workers in a poor community in Karachi, Pakistan, educated residents about washing their hands and gave out free soap. The results were quite impressive. Soap and handwashing education decreased impetigo, a contagious skin infection, by 34 percent, diarrhea by 53 percent and pneumonia by 50 percent. A researcher who studied the Pakistan experiment put it best, noting that "the time has come to shout from the roof tops that hand-hygiene promotion should be a worldwide priority."

So, even though washing your hands is the simplest of tasks, here is a few tips from our nation's top health officials: use warm water, wash with soap for at least 20 seconds (imagine singing the "Happy Birthday" song twice), and if possible use your paper towel to turn off the faucet. If you are not near soap and water, an alcohol-based gel will do.

And if not getting sick is not enough to make you wash your hands, just think how proud your Mom would be.

Photo by Julie Deshaies, courtesy iStockphoto.

Michigan mute swans test positive for bird flu

As reported in The Seattle Times, the U.S. Departments of Agriculture and Interior announced Aug. 14 that two wild mute swans in Michigan may have been infected with H5N1 bird flu. Over the next two weeks, tests will be conducted to confirm if they were in fact carrying H5N1, and if so, how severe it was. However, tests have confirmed that the cases are NOT the same H5N1 virus that has caused severe illness and death in poultry and humans around the world, primarily in Asia. Initial testing suggests this is a weaker form of the H5N1 virus, what experts call "low pathogenic." Scientists are not sure yet whether the swans were infected with one H5N1 virus or with two separate bird flu viruses - one containing the H5 protein, the other N1.

The good news is that the U.S. system for tracking and testing birds for bird flu appears to be working. The two swans were tested on Aug. 8 in Monroe County, Mich., on the coast of Lake Erie. Another piece of positive news is that Americans can keep eating chicken and other poultry. As mute swans are not migratory birds, there is no evidence linking these swans to any poultry on commercial farms.

We are not out of the woods, though. Just because this appears to be a weaker form of the H5N1 virus doesn't mean it can't mutate into something much more serious. And, in reality, this is just a preview of what is yet to come, as experts predict that we are rather likely to see the more serious and deadly form of H5N1 in the United States before the end of the year.

What does H5N1 mean?

With the alphabet soup of acronyms that are being talked about in reference to the flu (H5N1, CDC, WHO) it can be hard to understand exactly what is going on.

One of the most important acronyms you may have heard is H5N1, which is the name of the bird flu strain that is causing so much concern around the world right now. H5N1 has already caused a flu pandemic in birds and infected about 230 people.

So why is it called H5N1? Every time a new flu virus is identified, it is named for two proteins, hemagglutinin and neuraminidase, that are on the surface of the virus. Hence the H and the N abbreviation.

The numbers that are included in the virus name signal a genetic change in the virus. Some combinations of H and N cause serious illness and death, while others only cause mild symptoms. Flu viruses that begin with H5 or H7 are highly likely to make birds and people sick.

And as for those other acronyms you may hear? CDC stands for the Centers for Disease Control and Prevention, which is the principal federal health agency that works to protect the health and safety of Americans. WHO is the World Health Organization, the health arm of the United Nations. Both organizations are serving as watchdogs for pandemic flu and sharing information as the threat develops.

Photo: Colorized transmission electron micrograph of avian influenza H5N1 viruses (seen in gold) grown in MDCK cells (seen in green). From the CDC, courtesy of Cynthia Goldsmith, Jacqueline Katz, and Sherif R. Zaki.

APHA Releases List of Questions and Answers on Pandemic Flu for the Public

There is now a one-stop shop for people who need their basic questions answered on pandemic flu. The American Public Health Association has posted answers to frequently asked questions on pandemic flu on its influenza Web site. We hope it helps you understand seasonal, bird and pandemic flu a bit better. However, as the list does not answer every question on this complicated topic, keep your questions and comments coming!

Indonesia Reports Additional H5N1 Human Cases

According to press reports, Indonesian officials today announced that several people from a village in northern Sumatra are being treated for avian flu-like symptoms. The patients include at least three children. Family members have been admitted to a hospital in Medan. Doctors suspect the cases could be new clusters of the H5N1 virus.

The new cases are from the same area of Indonesia where seven members of another family became sick from the H5N1 virus in May and died. A connection has yet to be established between the cases that occured in May and new cases.

According to the World Health Organization, Indonesia has reported 41 human deaths from the H5N1 strain.

Vaccine against avian flu is just the beginning

A major drug company reported today that a new vaccine against the H5N1 type of avian flu is showing a lot of promise. According to manufacturer GlaxoSmithKline, the vaccine created a protective response in 80 percent of people it was tested on, which is an impressive result. News reports say the vaccine could be for sale in the United States as soon as the end of the year.

The reported success of the vaccine seems like good news. However, the vaccine is most effective against the H5N1 strain used to make the vaccine. Flu strains mutate as they pass from bird-to-bird or bird-to-human. If the strain mutates to one that easily passes from human-to-human, this vaccine may not be as effective. And even if we end up with a vaccine for this strain, a completely independent strain could crop up. So it's important that we not declare this the "be-all, end-all" cure for pandemic flu.

If this new vaccine works as well as the drug company says, there may be calls to start vaccinating people, especially if the bird threat increases. (Whether or not we're going to need mass vaccinations against H5N1 is another story.) If we decide to start vaccinations here in the United States, there a few things that would need to be done first: The Food and Drug Administration would need to confirm that the vaccine works and is safe. And health insurers will need to agree to cover the cost of the vaccination, which sometimes will not happen unless the government recommends the vaccine in its immunization guidelines.

Once an avian flu vaccine becomes available, the U.S. government plans to stockpile it, to the tune of 20 million courses, to protect health care workers, emergency personnel, government officials and other "first responders." That means that our parents, children, friends and families may not be the first ones to receive the vaccine. (Unless of course, they are health care workers, first responders, etc.)

We also need to remember that it's not just the United States that needs the vaccine, and that it's not just for the rich. Most of the human cases of H5N1 avian flu we've seen so far have been in countries where individuals may not be able to afford the cost of the vaccine, and where there may not be strong health systems in place.

If this vaccine holds true on its promise, we need to make sure that those who most need it are the ones who are able to get it, both here in the United States and around the world.

Pandemic flu: Why should you care?

To many people, the possibility of a flu pandemic seems like just another one of those far-off, scary "what-ifs" that we hear about every so often. But at the beginning of the last century, it was a reality. From 1918 to 1919, avian flu swept across the globe, killing 20 million people, including 675,000 in the United States.

The disease was fast-spreading and frighteningly lethal, 25 times more deadly than the regular flu. Across the country, schools and churches were closed. Young victims lay gasping for air in their hospital beds as their lungs filled up with fluid. In many cases, doctors were unable to do much except helplessly watch their patients die. On a single day in Philadelphia in 1918, almost 800 people died. Cities had trouble keeping up with the burials of the dead.

Because of that pandemic, history has taught us to be wary of avian flu. Right now, a strain of avian flu called H5N1 has health officials around the globe worried. Since December, 2003, about 230 cases of H5N1 have been reported in humans, with 131 deaths. Right now, the disease is mostly infecting chickens and other poultry. Scientists are concerned, however, that the strain could soon turn into one that could quickly spread from person to person, much the way the common cold is passed along. If that happens, more than 1.9 million Americans could die, according to estimates.

Almost 2 million deaths, that's a lot of people. It's equivalent to more than 13,000 plane crashes, half of all the babies born in the United States in 2004 or the entire population of Houston, Texas. The chances are good that at least a few of those people would be someone you know or love. It could be your co-worker, your teacher, your child.

The reality is that if a pandemic hits the United States, all of us will be affected. And unfortunately, we are not ready yet. If a pandemic occurred tomorrow, our government, hospitals and health departments would be overwhelmed. And most people just aren't prepared.

That's why it's important that you should get ready now, and why we need to work to prepare our communities. The question we are faced with now is not "why should I care?" It's "how can I get ready?"

Photo: Demonstration at the Red Cross Emergency Ambulance Station in Washington, D.C., during the influenza pandemic of 1918. From the National Photo Company Collection (Library of Congress).

So what is a flu pandemic, anyway?

It is getting pretty confusing. On TV, in newspapers and online, we keep hearing about how a flu pandemic is likely. Then, the conversation turns to bird flu. The other day, one of our staff members talked to her mom, who asked "What is the difference between a flu pandemic and the flu that I get a shot for every year?" Even though her mother was pretty up on the news, she was confused and wanted to know more. So what is the difference between regular flu and avian flu, and why are people making a flu pandemic seem so scary?

An influenza pandemic occurs when a new type of flu virus that our bodies are not protected against spreads around the world, causing serious illness and possibly even death.

The flu shot that people are encouraged to get every year for seasonal flu will offer little or no protection against pandemic flu, as this new virus won't be included in the shot ingredients.

Because our bodies have not come across the flu virus that causes a pandemic before, people can easily catch it from one another. Anyone who gets the new virus can become much sicker than they would for seasonal flu, and can possibly die as a result.

So, what is the link to birds? The flu that is causing concern around the world right now is a strain that occurs primarily in poultry, such as chickens. It's also sickened other animals, including cats that have eaten birds. More troubling, though, is that this new type of bird flu has sickened people that are in close contact with birds, such as those that work and live on farms.
Right now, people can not easily catch this bird flu from another person. But that could change if the virus mutates. If it does, it could cause the next flu pandemic.

Although people are used to flu season occurring at a certain time of year, a flu pandemic can happen anytime. It does not have to be winter or the normal flu season. The scary fact is that a flu pandemic will occur sometime in the future; we just do not know when.

Every year, more than 200,000 people in the United States are hospitalized because of seasonal flu, and 36,000 people die from it. In the event of a flu pandemic, we are talking about something that can be hundreds of times worse than that. Past flu pandemics have sent millions to the hospital and killed hundreds of thousands in this country. It is definitely something that everybody needs to get ready for. The first step though is for everyone, including our friends, families, and our mothers, to learn more about pandemic flu.

Welcome to the APHA "Get Ready For Flu" blog

You may have noticed the increase in Web sites, government plans and information in recent months responding to the threat of pandemic influenza. The threat is a real one, and it's great that the U.S. government has made the issue a priority. But most of the federal information out there is too wordy and not written for average Americans.

To test the influenza planning materials that are available now, we asked our friends and families to check out some of the government sites. The findings weren't surprising: our testers couldn't understand most of it, nor figure out how to apply it to themselves. For example, materials on the government sites contain checklists and lists of items to stockpile in case of a flu pandemic, but no specifics. How much bottled water and canned food should a family of four stockpile? Should diabetics and those with heart conditions hesitate to eat stockpiled food if they have high salt content? Should they take nutritional supplements instead? None of these answers are available.

Additionally, government sites are so over-packed with information that it can become overwhelming. Web users have to download large PDF files and wade through miles of documents. And what about those who don't have access to the Web?

Government plans for pandemic flu preparedness also have a flaw in that they rely on individuals, families and communities to have their own flu plans in place, and expect them to have a full stockpile of goods for the foreseeable future. Good idea, but the major question is: HOW?

To help address some of those questions, APHA is launching the "Get Ready For Flu" blog. The blog will be a discussion forum on pandemic influenza, where the public can come and learn about pandemic flu and share their comments on the issue. Most importantly, we want this to be a venue for people who are looking for real advice on how to prepare for flu.

In coming posts, the APHA "Get Ready For Flu" blog will feature discussions on how to prepare your home, business and community for a flu pandemic or other emerging infectious disease threat. We will also include discussions on how to understand and apply recommendations from global, federal, state and local government sources. Upcoming topics will include egg and chicken safety, cats and avian flu and the availability of vaccines.

The APHA "Get Ready For Flu" blog is being written by APHA in consultation with experts and using the best science available. (Click here and here for more information on the APHA Flu Team.) It is being published in conjunction with APHA's new "Get Ready" campaign that will help Americans prepare for a pandemic of influenza or other emerging infectious diseases.

We will be posting information and commentary on the blog as things develop on influenza, so check back weekly. We look forward to hearing your thoughts and concerns and starting a public discussion on preparing for pandemic flu. This is your chance to get involved and make a difference on this emerging public health issue. Let's get ready!

About this blog

About this blog: The "Get Ready For Flu" blog is published by the American Public Health Association as a resource for the public on pandemic influenza. The blog was created in conjunction with APHA's new "Get Ready" campaign that will help Americans prepare for a pandemic of flu or other emerging infectious diseases.

About APHA: The American Public Health Association is the oldest, largest and most diverse organization of public health professionals in the world, dedicated to protecting all Americans and their communities from preventable, serious health threats and assuring community-based health promotion and disease prevention activities and preventive health services are universally accessible in the United States. Since 1872, APHA has led national movements for all Americans to be able to protect themselves, their families, and their communities from preventable, serious health threats. APHA accomplishes this by serving as the only association for public health professionals from every sector of society and health-related discipline.

About the authors of this blog: APHA staff, who include policy analysts, public health workers, global health advocates, journalists and grassroots advocacy staff, are the authors of the entries posted on the blog. Collectively, we are the "APHA Flu Team." The blog is being written in consultation with experts who include APHA members and using the best science available.

Comment Policy: Comments on this blog are screened, so there may be a delay before your comment is posted. Comments that include profanity, personal attacks, spam, inappropriate text or are irrelevant to the discussion topic will not be posted. By posting a comment, you are agreeing to abide by these rules. APHA reserves the right to block users who violate these posting standards and/or remove their comments.

Have a question about something discussed? Or a news item? Or a suggestion for us? Please contact us at pandemicflu@apha.org.