Influenza pandemic preparedness

Because influenza epidemics and pandemics can devastate large regions of the world very quickly, WHO constantly monitors influenza disease activity on a global scale. This monitoring is useful for gathering information that can be used to prepare vaccines and that can be disseminated to health centres in countries where seasonal influenza outbreaks are likely to occur. Monitoring by WHO also plays an important role in preventing and preparing for potential epidemics and pandemics.

In the event that a potentially pandemic influenza virus emerges, WHO adheres to its influenza pandemic preparedness plan. This plan consists of six phases of pandemic alert. Phases 1–3, which are the early stages in pandemic preparedness, are designed to prevent or contain small outbreaks. In these early phases, isolated incidences of animal-to-human transmission of an influenza virus are observed and provide warning that a virus has pandemic potential. Later, small outbreaks of disease may occur, generally resulting from multiple cases of animal-to-human transmission. Phase 3 signals to affected countries that the implementation of efforts to control the outbreak is needed to prevent a pandemic. Phases 4 and 5 are characterized by increasing urgency in mitigating the outbreak. Confirmed human-to-human viral transmission, with sustained disease in human communities which subsequently spread so that disease transmission between humans occurred in two countries, indicates that a pandemic is imminent. Phase 6, the highest level of pandemic alert, is characterized by widespread disease and sustained transmission of the virus between humans. Influenza pandemics sometimes occur in waves. Thus, a post-pandemic phase, when disease activity decreases, may be followed by another period of high prevalence of disease. As a result, influenza pandemics may last for a period of months (see pandemic).

Transmission and symptoms

The flu may affect individuals of all ages, though the highest incidence of the disease is among children and young adults. Influenza is generally more frequent during the colder months of the year. Infection is transmitted from person to person through the respiratory tract, by such means as inhalation of infected droplets resulting from coughing and sneezing. As the virus particles gain entrance to the body, they selectively attack and destroy the ciliated epithelial cells that line the upper respiratory tract, bronchial tubes, and trachea. The incubation period of the disease is one to two days, after which the onset of symptoms is abrupt, with sudden and distinct chills, fatigue, and muscle aches. The temperature rises rapidly to 38–40 °C (101–104 °F). A diffuse headache and severe muscular aches throughout the body are experienced, often accompanied by irritation or a sense of rawness in the throat. In three to four days the temperature begins to fall, and the person begins to recover. Symptoms associated with respiratory tract infection, such as coughing and nasal discharge, become more prominent and may be accompanied by lingering feelings of weakness. Death may occur, usually among older people already weakened by other debilitating disorders, and is caused in most of those cases by complications such as pneumonia or bronchitis.

Treatment and prevention

The antiviral drugs amantadine and rimantadine have beneficial effects on cases of influenza involving the type A virus. However, viral resistance to these agents has been observed, thereby reducing their effectiveness. A newer category of drugs, the neuraminidase inhibitors, which includes oseltamivir (Tamiflu) and zanamivir (Relenza), was introduced in the late 1990s; these drugs inhibit both the influenza A and B viruses. Other than this, the standard treatment remains bed rest, ingestion of fluids, and the use of analgesics to control fever. It is recommended that children and teenagers with the flu not be given aspirin, as treatment of viral infections with aspirin is associated with Reye syndrome, a very serious illness.

Individual protection against the flu may be bolstered by injection of a vaccine containing two or more circulating influenza viruses. These viruses are produced in chick embryos and rendered noninfective; standard commercial preparations ordinarily include the type B influenza virus and several of the A subtypes. Protection from one vaccination seldom lasts more than a year, and yearly vaccination may be recommended, particularly for those individuals who are unusually susceptible to influenza or whose weak condition could lead to serious complications in case of infection. However, routine immunization in healthy people is also recommended. Advances in scientific understanding of influenza and vaccine technologies enabled the development of a so-called universal influenza vaccine, capable of protecting individuals against a broad range of different influenza subtypes; the vaccine was scheduled for initial testing in clinical trials involving human subjects in 2019.

In order to prevent human-infecting bird flu viruses from mutating into more dangerous subtypes, public health authorities try to limit the viral “reservoir” where antigenic shift may take place by ordering the destruction of infected poultry flocks.