22 October 2002 8:14 GMT

by Julie Clayton

[caption and credit]

Malta - The chaos that surrounded the anthrax outbreak following the events of September 11 last year was minor compared with what could happen when a major flu pandemic occurs, says epidemiologist Kathleen Gensheimer. Taking note, US authorities are applying lessons learned from 9/11 to prepare for the potentially catastrophic consequences of the next flu pandemic.

Gensheimer, state epidemiologist at the main department of human services in Augusta, Maine, and member of the US National Influenza Pandemic Steering Committee, today reported a billion dollar injection of cash across the US to deal with public health issues. Public health is enjoying a renaissance in the States, Gensheimer told delegates at the First European Influenza Conference here, and is giving the real threat of a flu pandemic the attention it deserves.

"The worst bioterrorist may be nature itself," she told a symposium on Pandemic Planning and Preparedness. "We always have to be prepared for the unexpected."

Gensheimer emphasized that, in contrast to the uncertainty over whether or not bioterrorists may strike again, a major flu pandemic is a certainty - the only question is when.

The prospect of a bioengineered version of influenza as a new bioterrorist weapon was more debatable, she said, than the likelihood of a natural catastrophic influenza outbreak.

The worst pandemic last century was the "Spanish flu," which killed more than 50 million people around the world between 1917 and 1919. Then came the 1957 and 1968 epidemics, which between them accounted for another 40 million deaths. With a periodic repeat pattern of approximately 30 years, researchers predict that we are now due for another pandemic.

Influenza pandemics and bioterrorist attacks have much in common when it comes to the action required for protecting people against infection, and preventing deaths in those that become infected. But last year, many of these elements were missing, or inadequate, when anthrax was sent through the US postal system, killing five people, says Gensheimer.

She summarized the situation as "miscalculation, missteps, and misunderstanding." She highlighted, in particular, the absence of a central command control to decide how to assess and deal with the anthrax outbreak, as well as the lack of communication between different agencies involved. As a result, there was too much uncertainty over who was at risk, and therefore who should receive prophylactic antibiotics, as well as ignorance about the necessary duration of treatment. A decision to investigate vaccine availability was only made at a very late stage, she notes.

Many new developments are now taking place in the US as a result of the analysis of what went wrong last year. One is an increase in surge capacity at public health laboratories, so as to cope with a potentially massive rise in specimens. In addition, there are efforts to develop year-round detection and tracking of novel viral variants as they emerge during normal winter flu epidemics.

The authorities are also "trying hard" to expand vaccination coverage, on the grounds that, with a sufficiently large infrastructure in place, it will be easier to meet demand in the event of a pandemic.

Delegates at the symposium also heard that northern neighbor Ontario, Canada, is already leading the way, with regard to vaccination coverage. Ontario has the world's most advanced universal vaccination program, which offers free flu jabs to all 11 million inhabitants. The latest figure shows that around 44% of the population accepted the offer during the 2001/2002 season, according to Monali Varia, epidemiologist and program coordinator for the Universal Influenza Immunization Program, Ontario Ministry of Health and Long-Term Care.

Picture caption and credit:
Left, photomicrograph of Haemophilus influenzae, and right, Bacillus anthracis from agar culture, CDC.

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See also:
Bioterrorism: responding to an emerging threat
[Opinion]
Margaret A. Hamburg
Trends in Biotechnology, 2002, 20:7:296-298

New approaches and old problems in the shadow of bioterrorism
[Meeting report]
John M. Leong, Nikhat Parveen and Jon D. Goguen
Trends in Microbiology, 2002, 10:3:112-114

Molecular diagnostics in infectious diseases and public health microbiology: cottage industry...
[Review]
Gwendolyn L. Gilbert
Trends in Molecular Medicine, 2002, 8:6:280-287
 

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