Transcript Influenza Surveillance in the United States:

Antivirals in the Draft
CDC Pandemic Plan
David K. Shay
Influenza Branch
National Center for Infectious Diseases
Centers for Disease Control and Prevention
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CDC’s Pandemic Plan
• Public Health Guidance for Community-Level
Pandemic Influenza Planning
• Goal is to help the public health and medical
communities across the nation respond to a
pandemic
• Augments information for state and local
partners described in the DHHS Pandemic
Influenza Preparedness and Response Plan,
which provides the framework for coordinated
federal and state-level planning
• Due to DHHS by August 1
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Purpose and aims I
• Provide guidance to public health
agencies for the development of
state-level pandemic influenza
response plans, as recommended in
Cross-Cutting Critical Benchmark #6
of the CDC and HRSA cooperative
agreements for Public Health and
Hospital Bioterrorism
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Purpose and aims II
• Help healthcare partners address
the medical challenges of pandemic
influenza (e.g., large patient volume,
occupational health risks, and
targeting limited supplies of antiviral
medications and vaccines)
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Purpose and aims III
• Define the public health role in healthcare
planning and preparedness for pandemic
influenza
• Strengthen linkages between public health
agencies and private sector partners -including healthcare facilities, communitybased organizations, clinical laboratories, and
first responders -- to protect health and
preserve essential services during a pandemic
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CDC’s Federal Role in Pandemic
Influenza Preparedness and Response
• CDC is lead agency in these areas:
– Disease surveillance and laboratory diagnostics
– Disease control and prevention strategies, including
community containment measures, mitigation of
travel-related transmission risk, and effective use of
antiviral drugs and vaccines
– Public health communication with the states,
healthcare and public health organizations,
ministries of health, and the World Health
Organization
– Public health investigations and research
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11 Supplements in Plan
1. Disease Surveillance
2. Laboratory Diagnostics
3. Healthcare
4. Infection Control
5. Vaccine Use
6. Antiviral Drug Use –
draft reviewed with
APHL, ASTHO,
NACCHO, CSTE on
5/27
7. Community Disease
Control and Prevention
8. Mitigation of TravelRelated Transmission
Risk
9. Public Health
Communications
10. Psychosocial Issues
11. Clinical Guidelines
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Recommendations for the InterPandemic and Pandemic Alert Periods
A. Use of Antivirals in Management of
Cases and Clusters of Novel Influenza
Use of Antivirals for Treatment
Use of Antivirals for Prophylaxis of
Contacts
Use of Antivirals for Containment of
Disease Clusters
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Recommendations for the InterPandemic and Pandemic Alert Periods
B. Preparedness and Planning for Use of Antivirals During a Pandemic
National Recommendations on Use of Antivirals during a Pandemic
State Level Planning
Procurement
Distribution to Priority Groups
Monitoring and Data Collection
Supply and Distribution
Antiviral Effectiveness
Adverse Events
Antiviral Drug Resistance
Coordination with Bordering Jurisdictions
Legal Preparedness
Training
Public Health Information
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Recommendations for the Pandemic
Period
A. When Pandemic Influenza Is Reported
Abroad
B. When There is Limited Transmission of
Pandemic Influenza in the United
States
C. When There is Widespread
Transmission of Pandemic Influenza in
the United States
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Appendix
Antiviral Drugs with Activity Against
Influenza: Pharmacology, Side
Effects, Prophylaxis, Treatment,
Resistance
• M2 Ion Channel Inhibitors:
Amantadine and Rimantadine
• Neuriminidase Inhibitors: Oseltamivir
and Zanamivir
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Antiviral Drugs in the Strategic
National Stockpile
As of May 2005, the Strategic National
Stockpile contains 2.26 million
treatment regimens of oseltamivir
(capsules and suspension), and 5
million treatment regimens of
rimantadine (tablets and syrup), with
additional purchases of antivirals
pending
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National Recommendations on
Use of Antivirals
…recommendations for optimal use of limited supplies
of antivirals during a pandemic are under
consideration by DHHS, in consultation with the
National Vaccine Advisory Committee (NVAC),
bioethicists, and other expert partners. During an
actual pandemic these recommendations may be
modified, based on the characteristics of the
causative virus (e.g., drug susceptibilities, initial
geographic distribution, fatality rate, age-specific
morbidity and mortality rates)
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Recommendations will
include:
•
•
•
Priority groups for treatment, based on predicted
medical risk, and the goal to reduce morbidity and
mortality
Priority groups for short- and long-term prophylaxis,
based on predicted medical and occupational risk,
and the goal to preserve healthcare and other
essential services
Effective antiviral use by healthcare providers,
including:
Strategies for administration to individual patients
Strategies for retarding the development of drug resistance
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Size of SNS stockpile
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Distribution to Priority Groups:
recommendations for states
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•
•
Estimating the size and needs of priority groups in local
jurisdictions
Making arrangements for transport, receipt, storage, security,
tracking, and delivery of:
-- SNS antiviral stocks for use in treatment to hospitals,
clinics, nursing homes, alternative care facilities, and other
healthcare institutions
-- SNS antiviral stocks for use in short-term prophylaxis (e.g.,
for direct contacts of infected patients)
-- SNS antiviral stocks for use in long-term prophylaxis (e.g.,
for healthcare workers, public safety workers, and essential
service providers).
Developing a communication plan to explain the rationale for
establishing these target groups
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Questions about Distribution
•
•
Will states request antivirals from SNS, or will they be
distributed to states after a federal decision?
What are the criteria for release of antivirals in SNS?
-- What’s the process for requesting antivirals from SNS?
-- How will requests be approved?
-- Will there be a ‘reserve’? How large?
•
•
•
How will SNS assets be divided amongst the states? A pro
rata scheme based on population?
How will states receive SNS assets? Will assets be delivered
to SNS receipt, storage, staging (RSS) sites, to state health
departments, or to local health departments and large
integrated healthcare delivery systems?
How can states best prepare to:
-- Deliver antivirals to institutions/health care facilities during a
pandemic?
-- Use data management systems to track distribution?
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