Some Selected Scenarios for Vaccine and Antiviral Use in a Pandemic or Threat Situation in .NET framework

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TABLE 13.5
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Some Selected Scenarios for Vaccine and Antiviral Use in a Pandemic or Threat Situation
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BEST CASE SCENARIO The new virus does not spread as much as in serious pandemics or the illness caused overall is not a very severe event in usually vulnerable groups.
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Options
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Option 1: No special vaccination or antiviral program against the new virus.
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Considerable expenses are avoided.
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Option 2: Vaccinate or protect with antivirals selected groups, considered most important for health care and overall infrastructure of the country. Perhaps 25 30% of the population.
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The high costs and social upheaval associated with a large-scale vaccination or antiviral program are avoided.
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Option 3: Also attempt to vaccinate or protect with antivirals groups considered at high medical risk. Perhaps 15% of the population would be targeted.
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The new vaccine will replace Program would be at least one component most consistent with of the traditional one. normal in uenza High-risk populations vaccination activities may remain susceptible in many to illness if the new industrialized virus does not displace countries. the old one.
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Overall, there should be a cost bene t ratio for the vaccination and antiviral program in terms of health care nances, and the impact on critical functions of society will be minimized.
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Option 4: Attempt to vaccinate or protect with antivirals all (>90% of the population).
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Should the new virus evolve into a more serious form, the population will have already been vaccinated.
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Such a complicated program The maximum reduction in impact of the pandemic draws many resources away virus would be obtained. from other needs. Major National leaders would be controversy probable. acclaimed for their efforts. Large-scale vaccination or antiviral use increases chances of adverse events that raise questions about vaccine or drug safety.
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The general populations, including preschool and school-age children and most working-age adults, will be seriously affected. Thus the national economy and many normal noncritical activities will be disrupted, with some of the other problems expected Option 1 still likely. There may be lack of understanding of the fact the vaccine or antiviral is not 100% effective, and there will be situations where persons will claim they have been harmed by the vaccine or antiviral.
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THE EMERGENCE OF PANDEMIC INFLUENZA A
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priming vaccine. The practical experience from 1918, 1957, and 1968 in uenza pandemics, and more recently the SARS outbreak, showed how vulnerable the health care sector is to infection. An initial vaccine even in small quantities to immunize the most vulnerable 5 10% of the population would ameliorate the otherwise devastating effects in hospitals. Recently, the isolation of a new in uenza A H5N1 in humans triggered phase preparedness (PP) at level 2 but no widespread human-to-human transmission was detected. At PP trigger level 3, vaccine manufacturing will start. Experience from the past has shown that phase 3 can last as long as 9 12 months. The objectives during the pandemic phase itself is to organize distribution of vaccines and antivirals (Tables 13.3 and 13.4).
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13.10 INCIDENCE OF ILLNESS IN A PANDEMIC OR DELIBERATELY CAUSED OUTBREAK Analysis of the three global outbreaks of the twentieth century can provide vital information to help plan for the next outbreak. The rst observation from the recent past is that pandemic or bioterrorist in uenza may appear at any time of the year, not necessarily during the normal in uenza season (November to March in the northern hemisphere or July to August in the southern hemisphere). In most pandemics, activity can be expected to last 6 8 weeks, although in the 1968 1969 pandemic lower levels of activity continued for 3 4 months. The relatively short period of the outbreak itself, say, 5 6 weeks as in epidemic years, allows prophylactic strategies with antivirals to be implemented. In 1918, about 23% of the U.K. population developed in uenza; in the 1957 Asian in uenza pandemic an estimated 17% of the population suffered from in uenza illness; and in 1969 the Hong Kong virus produced illness in 8% of the adult population. It could safely be predicted that each clinical case would be accompanied by four nonclinical cases of in uenza. In normal years, although most in uenza infection occurs in children, the serious morbidity and mortality occurs almost entirely among elderly people with underlying chronic disease. A different pattern may emerge in a pandemic, as it did in 1918. The 1918 1919 pandemic also affected healthy young adults, as well as those at the extremes of life. Similarly, in 1957 the brunt of the outbreak, although not mortality, was suffered by schoolchildren and young adults. Therefore, it is clear that clinical management of in uenza with antivirals or vaccines will differ in a pandemic or bioterrorist year compared to the interpandemic period.
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