WHO’s Project on Addressing Ethical Issues in Pandemic Influenza document points out that “many infections can be prevented by appropriate use of hygienic techniques. Pandemic planners have an obligation to ensure that all pandemic responders are provided with education and training on appropriate hygiene. To the greatest extent possible, personal protective equipment and other infection control modalities should be provided to health care workers. Although high-technology responses such as vaccines and antivirals may not be globally available, hand hygiene agents and education likely can be provided globally. Although there is no direct evidence of their value in an influenza pandemic, the evidence does suggest a likely protective effect if used correctly in other viral respiratory outbreaks.”

Lt. Gen. Russel Honoré, commanding general of the First Army who led the Defense Department’s response to Hurricane Katrina, perhaps put it best at the Synergy ’07 intelligence conference in New Orleans in August, telling the audience: “Prepare, America!” 

A close call

“The world really may have dodged a bullet with that one, and the next time we might not be so lucky,” warned Dr. Ira Longini Jr. of the Seattle, Wash.-based Fred Hutchinson Cancer Research Center.

Longini was referring to a study of which he was senior author, published in the September issue of the Centers for Disease Control and Prevention’s (CDC) journal, Emerging Infectious Diseases).

That study statistically analyzed the deaths in families in northern Sumatra, Indonesia, and eastern Turkey from the dreaded H5N1 avian flu virus and, statistically at least, confirmed for the first time that the H5N1 virus was transmitted from human to human.

Longini and many other experts believe the study indicates a global pandemic was narrowly averted.

Indeed, Longini told reporters a pandemic may have been dodged because of the quick action by health authorities or, more disturbingly, statistical good luck. Either way, scientists say the statistically relevant data confirm their private fears that some strains of H5N1 have been able to mutate into human transmissible form.

Dr. Alan Hampson of the World Health Organization’s (WHO) Pandemic Taskforce and an adviser to the Australian government on influenza, told reporters, “This study has looked at the dynamics of the spread of the virus in the family environment … and has come down with the conclusion that it clearly does show person-to-person transmission.”

Hampson said the Sumatra family infection had the potential to ignite a pandemic.

If that is the case, then it truly is only a matter of time before another human-to-human transmission occurs—this time possibly escaping containment efforts and exploding into a planetary pandemic of potentially frightening consequences.

Elements of training

The Department of Health and Human Services’ (HHS) Pandemic Influenza Plan education and training guidelines state that “each hospital should develop an education and training plan that addresses the needs of staff, patients, family members and visitors. Hospitals should assign responsibility for coordination of the pandemic influenza education and training program and identify training materials—in different languages and at different reading levels, as needed—from HHS agencies, state and local health departments and professional associations.”

That plan should consist of the following:

Staff education

Identify educational resources for clinicians, including federally sponsored teleconferences, state and local health department programs, web-based training materials and locally prepared presentations.

General topics for staff education should include: