Pediatricians Must Prepare for Influenza Pandemic

LYNNWOOD, WASH. — An influenza pandemic may seem abstract right now, but it will happen, Dr. Kathryn Koelemay, M.P.H., said at a conference sponsored by the North Pacific Pediatric Society.

“The time that we spend preparing for it will be time well spent,” she said.

Pediatricians can start now to ready their office and staff for such an event.

There have been three influenza pandemics during the past century, with the most notable being the Spanish flu, which circled the globe in 1918–1919. Smaller pandemics occurred in 1957–1958 and 1968–1969.

The most pressing concern currently is the outbreak of avian flu, caused by the highly pathogenic H5N1 strain, which first appeared in birds in 1997. Influenza viruses are common in birds, explained Dr. Koelemay, a medical epidemiologist at the Department of Public Health of Seattle and King County, Wash. “They affect birds all of the time, but they are generally of low pathogenicity.”

Since 1997, the highly pathogenic strain of influenza type A H5N1 has infected birds in more than 50 countries, and to date, 12 nations have reported human cases.

The mortality is very high in human avian flu infections, Dr. Koelemay explained, but it is not easily spread among human populations.

All cases thus far have involved close contact with infected birds or family members, and no sustained human-to-human transmission has been reported. In fact, it remains very difficult for a person to be infected with avian flu, which continues to be largely a disease of birds.

Many experts warn that we are unprepared for a global influenza pandemic, which may be overdue, and the avian H5N1 is the most likely candidate. Even though human transmission remains limited, the potential for viral mutation persists. Evidence from 1918 suggests that the Spanish flu evolved from avian origin, so it is not inconceivable that it could happen again.

“One of the major differences between now and 1918 is the greater degree of human migration. We know that the flu will move around the world much more quickly,” said Dr. Koelemay.

Government agencies are making plans for this, but we also need to rely as much as possible on our own resources, she added.

Community strategies will involve measures that include isolation and treatment of known cases, and voluntary home quarantine of family members of patients with influenza. Other pandemic mitigation interventions call for the closure of child care programs and schools, and the use of social distancing measures to reduce contact between adults in the community and workplace.

Pediatricians need to prepare themselves and their office staff for a possible pandemic. A major problem during any type of emergency is the difficulty in getting health care workers to report to work. Dr. Koelemay explained that the most frequently cited reason for the unwillingness of employees to report to work during a disaster was fear and concern for their own safety and that of their family.

“You need to ask yourself what you can do now to make sure that you can report to work during a health emergency,” said Dr. Koelemay.

Pediatricians and their employees need to develop a personal family emergency and disaster plan.

Additionally, expectations of health care workers also must be clarified in advance of a pandemic. Job expectations during a pandemic need to be specified, along with alternative work assignments for employees with medical conditions that place them at an increased risk, and policies for absenteeism, leave, and compensation.

The severe acute respiratory syndrome (SARS) outbreak taught us valuable lessons, which may help protect health care workers in the event of an influenza pandemic. SARS was transmitted to health care workers because of a lack of infection-control precautions and training, an inconsistent use of personal protective equipment, and the use of aerosol-generating procedures without requiring fit-tested N-95 equivalent respirators.

“You have to train everyone in your facility—even down to the person who sits at the front desk,” Dr. Koelemay said.

Effective education and training of all workers, providing appropriate protective equipment with sufficient training on how to use it properly, and establishing clear policies and protocols will help to alleviate fear among employees.

Pediatrics practices will encounter some specific challenges in the event of a pandemic, Dr. Koelemay pointed out.

“In pediatrics, beds tend to be more centralized than the patients are,” she said.

Designated pediatric beds may not be available in all area hospitals, and there may be only minimal planning in the outpatient community.

Caring for children during a pandemic will require trained personnel, equipment, and supplies suitable for a pediatric population, she said.

LYNNWOOD, WASH. — An influenza pandemic may seem abstract right now, but it will happen, Dr. Kathryn Koelemay, M.P.H., said at a conference sponsored by the North Pacific Pediatric Society.

“The time that we spend preparing for it will be time well spent,” she said.

Pediatricians can start now to ready their office and staff for such an event.

There have been three influenza pandemics during the past century, with the most notable being the Spanish flu, which circled the globe in 1918–1919. Smaller pandemics occurred in 1957–1958 and 1968–1969.

The most pressing concern currently is the outbreak of avian flu, caused by the highly pathogenic H5N1 strain, which first appeared in birds in 1997. Influenza viruses are common in birds, explained Dr. Koelemay, a medical epidemiologist at the Department of Public Health of Seattle and King County, Wash. “They affect birds all of the time, but they are generally of low pathogenicity.”

Since 1997, the highly pathogenic strain of influenza type A H5N1 has infected birds in more than 50 countries, and to date, 12 nations have reported human cases.

The mortality is very high in human avian flu infections, Dr. Koelemay explained, but it is not easily spread among human populations.

All cases thus far have involved close contact with infected birds or family members, and no sustained human-to-human transmission has been reported. In fact, it remains very difficult for a person to be infected with avian flu, which continues to be largely a disease of birds.

Many experts warn that we are unprepared for a global influenza pandemic, which may be overdue, and the avian H5N1 is the most likely candidate. Even though human transmission remains limited, the potential for viral mutation persists. Evidence from 1918 suggests that the Spanish flu evolved from avian origin, so it is not inconceivable that it could happen again.

“One of the major differences between now and 1918 is the greater degree of human migration. We know that the flu will move around the world much more quickly,” said Dr. Koelemay.

Government agencies are making plans for this, but we also need to rely as much as possible on our own resources, she added.

Community strategies will involve measures that include isolation and treatment of known cases, and voluntary home quarantine of family members of patients with influenza. Other pandemic mitigation interventions call for the closure of child care programs and schools, and the use of social distancing measures to reduce contact between adults in the community and workplace.

Pediatricians need to prepare themselves and their office staff for a possible pandemic. A major problem during any type of emergency is the difficulty in getting health care workers to report to work. Dr. Koelemay explained that the most frequently cited reason for the unwillingness of employees to report to work during a disaster was fear and concern for their own safety and that of their family.

“You need to ask yourself what you can do now to make sure that you can report to work during a health emergency,” said Dr. Koelemay.

Pediatricians and their employees need to develop a personal family emergency and disaster plan.

Additionally, expectations of health care workers also must be clarified in advance of a pandemic. Job expectations during a pandemic need to be specified, along with alternative work assignments for employees with medical conditions that place them at an increased risk, and policies for absenteeism, leave, and compensation.

The severe acute respiratory syndrome (SARS) outbreak taught us valuable lessons, which may help protect health care workers in the event of an influenza pandemic. SARS was transmitted to health care workers because of a lack of infection-control precautions and training, an inconsistent use of personal protective equipment, and the use of aerosol-generating procedures without requiring fit-tested N-95 equivalent respirators.

“You have to train everyone in your facility—even down to the person who sits at the front desk,” Dr. Koelemay said.

Effective education and training of all workers, providing appropriate protective equipment with sufficient training on how to use it properly, and establishing clear policies and protocols will help to alleviate fear among employees.

Pediatrics practices will encounter some specific challenges in the event of a pandemic, Dr. Koelemay pointed out.

“In pediatrics, beds tend to be more centralized than the patients are,” she said.

Designated pediatric beds may not be available in all area hospitals, and there may be only minimal planning in the outpatient community.

Caring for children during a pandemic will require trained personnel, equipment, and supplies suitable for a pediatric population, she said.

LYNNWOOD, WASH. — An influenza pandemic may seem abstract right now, but it will happen, Dr. Kathryn Koelemay, M.P.H., said at a conference sponsored by the North Pacific Pediatric Society.

“The time that we spend preparing for it will be time well spent,” she said.

Pediatricians can start now to ready their office and staff for such an event.

There have been three influenza pandemics during the past century, with the most notable being the Spanish flu, which circled the globe in 1918–1919. Smaller pandemics occurred in 1957–1958 and 1968–1969.

The most pressing concern currently is the outbreak of avian flu, caused by the highly pathogenic H5N1 strain, which first appeared in birds in 1997. Influenza viruses are common in birds, explained Dr. Koelemay, a medical epidemiologist at the Department of Public Health of Seattle and King County, Wash. “They affect birds all of the time, but they are generally of low pathogenicity.”

Since 1997, the highly pathogenic strain of influenza type A H5N1 has infected birds in more than 50 countries, and to date, 12 nations have reported human cases.

The mortality is very high in human avian flu infections, Dr. Koelemay explained, but it is not easily spread among human populations.

All cases thus far have involved close contact with infected birds or family members, and no sustained human-to-human transmission has been reported. In fact, it remains very difficult for a person to be infected with avian flu, which continues to be largely a disease of birds.

Many experts warn that we are unprepared for a global influenza pandemic, which may be overdue, and the avian H5N1 is the most likely candidate. Even though human transmission remains limited, the potential for viral mutation persists. Evidence from 1918 suggests that the Spanish flu evolved from avian origin, so it is not inconceivable that it could happen again.

“One of the major differences between now and 1918 is the greater degree of human migration. We know that the flu will move around the world much more quickly,” said Dr. Koelemay.

Government agencies are making plans for this, but we also need to rely as much as possible on our own resources, she added.

Community strategies will involve measures that include isolation and treatment of known cases, and voluntary home quarantine of family members of patients with influenza. Other pandemic mitigation interventions call for the closure of child care programs and schools, and the use of social distancing measures to reduce contact between adults in the community and workplace.

Pediatricians need to prepare themselves and their office staff for a possible pandemic. A major problem during any type of emergency is the difficulty in getting health care workers to report to work. Dr. Koelemay explained that the most frequently cited reason for the unwillingness of employees to report to work during a disaster was fear and concern for their own safety and that of their family.

“You need to ask yourself what you can do now to make sure that you can report to work during a health emergency,” said Dr. Koelemay.

Pediatricians and their employees need to develop a personal family emergency and disaster plan.

Additionally, expectations of health care workers also must be clarified in advance of a pandemic. Job expectations during a pandemic need to be specified, along with alternative work assignments for employees with medical conditions that place them at an increased risk, and policies for absenteeism, leave, and compensation.

The severe acute respiratory syndrome (SARS) outbreak taught us valuable lessons, which may help protect health care workers in the event of an influenza pandemic. SARS was transmitted to health care workers because of a lack of infection-control precautions and training, an inconsistent use of personal protective equipment, and the use of aerosol-generating procedures without requiring fit-tested N-95 equivalent respirators.

“You have to train everyone in your facility—even down to the person who sits at the front desk,” Dr. Koelemay said.

Effective education and training of all workers, providing appropriate protective equipment with sufficient training on how to use it properly, and establishing clear policies and protocols will help to alleviate fear among employees.

Pediatrics practices will encounter some specific challenges in the event of a pandemic, Dr. Koelemay pointed out.

“In pediatrics, beds tend to be more centralized than the patients are,” she said.

Designated pediatric beds may not be available in all area hospitals, and there may be only minimal planning in the outpatient community.

Caring for children during a pandemic will require trained personnel, equipment, and supplies suitable for a pediatric population, she said.