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Influenza pandemic intervention planning using InfluSim: pharmaceutical and non- pharmaceutical interventions
Hans P Duerr, Stefan O Brockmann, Isolde Piechotowski, Markus Schwehm, Martin Eichner
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-76
Abstract: We use the freely available planning tool InfluSim to investigate how pharmaceutical and non-pharmaceutical interventions can mitigate an influenza pandemic. In particular, we examine how intervention schedules, restricted stockpiles and contact reduction (social distancing measures and isolation of cases) determine the course of a pandemic wave and the success of interventions.A timely application of antiviral drugs combined with a quick implementation of contact reduction measures is required to substantially protract the peak of the epidemic and reduce its height. Delays in the initiation of antiviral treatment (e.g. because of parsimonious use of a limited stockpile) result in much more pessimistic outcomes and can even lead to the paradoxical effect that the stockpile is depleted earlier compared to early distribution of antiviral drugs.Pharmaceutical and non-pharmaceutical measures should not be used exclusively. The protraction of the pandemic wave is essential to win time while waiting for vaccine development and production. However, it is the height of the peak of an epidemic which can easily overtax general practitioners, hospitals or even whole public health systems, causing bottlenecks in basic and emergency medical care.The recent spread of highly pathogenic avian influenza from Asia to Europe and the transmission to humans has intensified concerns over the emergence of a novel strain of influenza with pandemic potential. While still being in an inter-pandemic stage, nations plan for pandemic contingency following recommendations of the WHO [1,2]. National influenza preparedness plans are constantly being refined, aiming to mitigate the effects of pandemic influenza on a national, regional and local level. Even in the absence of a pandemic strain, seasonal influenza causes substantial morbidity and mortality [3]. Seasonal outbreaks put pressure on general practitioners and strain hospital resources, leading to bottlenecks in outpatient treatment and hos
Preparedness planning for pandemic influenza among large US maternity hospitals
RH Beigi,G Davis,J Hodges,A Akers
Emerging Health Threats Journal , 2009, DOI: 10.3134/ehtj.09.002
Abstract: The objective of this investigation was to determine the state of pandemic influenza preparedness and to delineate commonly reported challenges among a sample of larger US national maternity hospitals. This was done given the recent emphasis on hospital disaster planning and the disproportionate morbidity and mortality that pregnant women have suffered in previous influenza pandemics. An internet-based survey was sent to all 12 members of the Council of Women's and Infants' Specialty Hospitals. Questions addressed hospital demographics and overall pandemic preparedness planning, including presence of a pandemic planning committee and the existence of written plans addressing communications, surge capacity, degradation of services, and advance supply planning. Nine of 12 (75%) hospitals responded. All had active pandemic planning committees with identified leadership. The majority (78%) had written formal plans regarding back-up communications, surge/overflow capacity, and degradation of services. However, fewer (44%) reported having written plans in place regarding supply-line/stockpiling of resources. The most common challenges noted were staff and supply coordination, ethical distribution of limited medical resources, and coordination with government agencies. In conclusion, the majority of the Council of Women's and Infants' Specialty Hospitals maternity hospitals have preliminary infrastructure for pandemic influenza planning, but many challenges exist to optimize maternal and fetal outcomes during the next influenza pandemic.
The first influenza pandemic in the new millennium: lessons learned hitherto for current control efforts and overall pandemic preparedness  [cached]
Franco-Paredes Carlos,Carrasco Peter,Preciado Jose
Journal of Immune Based Therapies and Vaccines , 2009, DOI: 10.1186/1476-8518-7-2
Abstract: Influenza viruses pose a permanent threat to human populations due to their ability to constantly adapt to impact immunologically susceptible individuals in the forms of epidemic and pandemics through antigenic drifts and antigenic shifts, respectively. Pandemic influenza preparedness is a critical step in responding to future influenza outbreaks. In this regard, responding to the current pandemic and preparing for future ones requires critical planning for the early phases where there is no availability of pandemic vaccine with rapid deployment of medical supplies for personal protection, antivirals, antibiotics and social distancing measures. In addition, it has become clear that responding to the current pandemic or preparing for future ones, nation states need to develop or strengthen their laboratory capability for influenza diagnosis as well as begin preparing their vaccine/antiviral deployment plans. Vaccine deployment plans are the critical missing link in pandemic preparedness and response. Rapid containment efforts are not effective and instead mitigation efforts should lead pandemic control efforts. We suggest that development of vaccine/antiviral deployment plans is a key preparedness step that allows nations identify logistic gaps in their response capacity.
Pandemic influenza preparedness: Africa at the crossroads  [cached]
Oluyemisi C. Ijamakinwa,Niamh Stephenson
Journal of Public Health in Africa , 2012, DOI: 10.4081/jphia.2012.e28
Abstract: At least two distinct approaches to pandemic preparedness have arisen in response to the threats posed by pandemic influenza: a traditional public health approach and an increasingly securitised one. Traditional public health focuses on the population and their living conditions. In contrast, public health strategies informed by concerns with security focus on the resilience of critical infrastructure, such as electricity and communication, and on the ensuring good connections between different layers of government and any private bodies likely to be central to the response. Pandemic plans can be informed by one or a mix of both approaches. The securitised approach is more prevalent in the World Health Organization (WHO)’s plans and Western countries’ plans. In contrast, the WHO-AFRO Regional Pandemic Influenza Preparedness Plan 2009 utilises the existing Integrated Diseases Surveillance and Response framework as its starting point. It is informed by both rationales. Will African preparedness efforts develop in the direction of those already more informed by concerns about security? This paper examines how a securitised approach glosses over the differences between existing and threatened diseases. This is a particular problem in the African context with a high burden of infectious disease and underfunded health systems. Rather than a diversion of resources into a securitised approach, we suggest that the preparedness needs of the African continent are best served by focussing political will, international aid, financial and technical resources on the development of the health sector, including the integrated diseases surveillance and response framework. By tracing the distinct rationales at work in preparedness plans, it becomes apparent that an emphasis on the population will better position the continent for the future pandemics.
Farida Soetiarto
Bulletin of Health Research , 2012,
Influenza pandemic preparedness: motivation for protection among small and medium businesses in Australia
Rochelle E Watkins, Feonagh C Cooke, Robert J Donovan, C Raina MacIntyre, Ralf Itzwerth, Aileen J Plant
BMC Public Health , 2007, DOI: 10.1186/1471-2458-7-157
Abstract: Semi-structured face-to-face interviews were conducted with 201 small and medium business owners or managers in New South Wales and Western Australia. Eligible small or medium businesses were defined as those that had less than 200 employees. Binomial logistic regression analysis was used to identify the predictors of having considered the impact of, having a plan for, and needing help to prepare for pandemic influenza.Approximately 6 per cent of participants reported that their business had a plan for pandemic influenza, 39 per cent reported that they had not thought at all about the impact of pandemic influenza on their business, and over 60 per cent stated that they required help to prepare for a pandemic. Beliefs about the severity of pandemic influenza and the ability to respond were significant independent predictors of having a plan for pandemic influenza, and the perception of the risk of pandemic influenza was the most important predictor of both having considered the impact of, and needing help to prepare for a pandemic.Our findings suggest that small and medium businesses in Australia are not currently well prepared for pandemic influenza. We found that beliefs about the risk, severity, and the ability to respond effectively to the threat of pandemic influenza are important predictors of preparedness. Campaigns targeting small and medium businesses should emphasise the severity of the consequences to their businesses if a pandemic were to occur, and, at the same time, reassure them that there are effective strategies capable of being implemented by small and medium businesses to deal with a pandemic.Since late 2005 the risk of pandemic influenza and the need for preparedness have featured reasonably frequently in the news media in Australia, often associated with overseas reports of large outbreaks of infection among birds or small clusters of infection among humans. Strategic plans have been prepared for an outbreak of pandemic influenza associated with
Pandemic influenza preparedness: an ethical framework to guide decision-making
Alison K Thompson, Karen Faith, Jennifer L Gibson, Ross EG Upshur
BMC Medical Ethics , 2006, DOI: 10.1186/1472-6939-7-12
Abstract: In this paper, we present an ethical framework for pandemic influenza planning. The ethical framework was developed with expertise from clinical, organisational and public health ethics and validated through a stakeholder engagement process. The ethical framework includes both substantive and procedural elements for ethical pandemic influenza planning. The incorporation of ethics into pandemic planning can be helped by senior hospital administrators sponsoring its use, by having stakeholders vet the framework, and by designing or identifying decision review processes. We discuss the merits and limits of an applied ethical framework for hospital decision-making, as well as the robustness of the framework.The need for reflection on the ethical issues raised by the spectre of a pandemic influenza outbreak is great. Our efforts to address the normative aspects of pandemic planning in hospitals have generated interest from other hospitals and from the governmental sector. The framework will require re-evaluation and refinement and we hope that this paper will generate feedback on how to make it even more robust.As the world prepares for the emergence of a pandemic strain of influenza, trans-national, national and local organisations and agencies are designing plans to manage community outbreaks. In addition, the medical community is identifying scientific research priorities and needs related to the anticipated pandemic [1-5]. There is also a need to examine the ethical issues that arise from planning for a public health crisis of this magnitude. Who should get the limited supply of antivirals? Are health care workers duty-bound to care for the ill in a pandemic when they may have competing familial obligations? Who will be prioritized for scarce ventilated hospital beds? When should hospitals cancel elective surgeries or restrict hospital visitation? To date, the bioethics community has been slow to respond to public health issues in general [6,7], and pandemic influenz
A Systematic Analytic Approach to Pandemic Influenza Preparedness Planning  [PDF]
Daniel J Barnett ,Ran D Balicer,Daniel R Lucey,George S Everly Jr,Saad B Omer,Mark C Steinhoff,Itamar Grotto
PLOS Medicine , 2005, DOI: 10.1371/journal.pmed.0020359
A systematic analytic approach to pandemic influenza preparedness planning.  [cached]
Barnett Daniel J,Balicer Ran D,Lucey Daniel R,Everly George S
PLOS Medicine , 2005,
Pandemic influenza preparedness and health systems challenges in Asia: results from rapid analyses in 6 Asian countries
Piya Hanvoravongchai, Wiku Adisasmito, Pham Chau, Alexandra Conseil, Joia de Sa, Ralf Krumkamp, Sandra Mounier-Jack, Bounlay Phommasack, Weerasak Putthasri, Chin-Shui Shih, Sok Touch, Richard Coker, for the AsiaFluCap project
BMC Public Health , 2010, DOI: 10.1186/1471-2458-10-322
Abstract: The study relied on the Systemic Rapid Assessment (SYSRA) toolkit, which evaluates priority disease programmes by taking into account the programmes, the general health system, and the wider socio-cultural and political context. The components under review were: external context; stewardship and organisational arrangements; financing, resource generation and allocation; healthcare provision; and information systems. Qualitative and quantitative data were collected in the second half of 2008 based on a review of published data and interviews with key informants, exploring past and current patterns of health programme and pandemic response.The study shows that health systems in the six countries varied in regard to the epidemiological context, health care financing, and health service provision patterns. For pandemic preparation, all six countries have developed national governance on pandemic preparedness as well as national pandemic influenza preparedness plans and Avian and Human Influenza (AHI) response plans. However, the governance arrangements and the nature of the plans differed. In the five developing countries, the focus was on surveillance and rapid containment of poultry related transmission while preparation for later pandemic stages was limited. The interfaces and linkages between health system contexts and pandemic preparedness programmes in these countries were explored.Health system context influences how the six countries have been preparing themselves for a pandemic. At the same time, investment in pandemic preparation in the six Asian countries has contributed to improvement in health system surveillance, laboratory capacity, monitoring and evaluation and public communications. A number of suggestions for improvement were presented to strengthen the pandemic preparation and mitigation as well as to overcome some of the underlying health system constraints."World 'well prepared' for virus" is the title of a news article from the BBC on 27 April 2009
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