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On Chicken Little and the Avian Influenza
DMR
Editorial
On Chicken Little and the Avian Influenza Judith Stoner Halpern, MS, NP, APRN, BC Editor
T
he children’s story ‘‘Chicken Little’’ is about a youngster who overreacts, creates widespread fear, and almost leads an entire flock of birds into greater danger. The fable teaches youngsters to be wary of alarmists. When we rally the general public to get ready for a pandemic, which we coincidentally claim may involve birds and the avian influenza, it is no wonder they look at us with skepticism. Coaching the public to be prepared is a major aspect of disaster planning. While international public health agencies track the chameleon-like influenza virus moving between birds, humans, and other species, clinicians are asked to explain the scientists’ findings in laymen’s terms. The virus changes partially from year to year, and because a portion of the virus is recognized by the human immune system, it causes predictable levels of illness. However, over several decades, the virus is capable of totally changing its genetic configuration and producing an illness to which no one has immunity. There is no way to predict what it will look like, and the question is not ‘‘if’’ a new, lethal strain will emerge, but ‘‘when?’’ Health care providers will need to make a deeper commitment to influenza prevention if we expect to be able to handle a pandemic. For instance, currently there is a concentrated effort to get the general
Disaster Manage Response 2005;3:59. 1540-2487/$30.00 Copyright Ó 2005 by the Emergency Nurses Association. doi:10.1016/j.dmr.2005.05.004 July-September 2005
population vaccinated against influenza. Yet as recently as the 2003 influenza season, the National Health Interview Survey found that only 40.1% of health care workers and fewer than 35% of adults aged 18 to 64 years received the flu vaccine.1 An increased demand for vaccine helps producers invest in the ability to produce larger supplies. Immunizing more people helps generate greater herd immunity. The influenza vaccine shortage during the fall of 2004 gave us a glimpse of how suddenly people can be made into believers and what demands they will place on medical care. On October 5, 2004, the Chiron Corporation notified the Centers for Disease Control and Prevention (CDC) that none of its influenza vaccine could be used in the United States for the 2004-2005 influenza season.2 The loss of the Chiron vaccine represented half of the total vaccine supply for the United States, and the announcement started a ripple effect. The pendulum shifted from nurses and physicians openly encouraging the complacent to get their ‘‘flu shot’’ to actually denying vaccine to alarmed, low-priority patients. As vaccine distribution started, patients anxiously waited in long lines for hours, created traffic jams near dispensing sites, or gave up and sought care out of the country. This was the response to a shortage of vaccine for a disease that would have far less morbidity and mortality than a pandemic. While no plans will ever be perfect, they are always better than no plan. Clinicians need multiple approaches for dealing with a pandemic when even the vaccine prob-
ably will not be available or feasible to administer. This issue of Disaster Management & Response provides readers with information about an influenza pandemic, starting with an overview of the disease and medical strategies for treating it (see ‘‘Pandemic Influenza: Are We Ready?’’ by Dr Sandro Cinti). Educators and planners who need resources to predict, strategize, recognize, protect, and treat patients and enable clinicians can find help in the News and Insights section, page 91. In the midst of a major infectious disease outbreak, bedside providers and infectious disease specialists will need services and tools, some of which have already been developed and tested (see the article by Fishman et al in the Quick Clinical Notes section, page 86). An influenza pandemic is like other types of recurring disastersda long time between events can cause the public to relax, develop amnesia, and lower their guard. Unfortunately, we know that even if this season is not the pandemic, there will always be next year.
References 1. Centers for Disease Control and Prevention. Estimated influenza vaccination coverage among adults and childrendUnited States September 1, 2004-January 31, 2005. MMWR 2005;54:304-7. 2. Centers for Disease Control and Prevention. Interim influenza vaccination recommendations: 2004-05 (news release) [online] [accessed 2005 May 8]. Available from: URL: http:// www.hhs.gov/news/press/2004pres/ 20041005b.html Disaster Management & Response/Halpern 59
Editorial
On Chicken Little and the Avian Influenza Judith Stoner Halpern, MS, NP, APRN, BC Editor
T
he children’s story ‘‘Chicken Little’’ is about a youngster who overreacts, creates widespread fear, and almost leads an entire flock of birds into greater danger. The fable teaches youngsters to be wary of alarmists. When we rally the general public to get ready for a pandemic, which we coincidentally claim may involve birds and the avian influenza, it is no wonder they look at us with skepticism. Coaching the public to be prepared is a major aspect of disaster planning. While international public health agencies track the chameleon-like influenza virus moving between birds, humans, and other species, clinicians are asked to explain the scientists’ findings in laymen’s terms. The virus changes partially from year to year, and because a portion of the virus is recognized by the human immune system, it causes predictable levels of illness. However, over several decades, the virus is capable of totally changing its genetic configuration and producing an illness to which no one has immunity. There is no way to predict what it will look like, and the question is not ‘‘if’’ a new, lethal strain will emerge, but ‘‘when?’’ Health care providers will need to make a deeper commitment to influenza prevention if we expect to be able to handle a pandemic. For instance, currently there is a concentrated effort to get the general
Disaster Manage Response 2005;3:59. 1540-2487/$30.00 Copyright Ó 2005 by the Emergency Nurses Association. doi:10.1016/j.dmr.2005.05.004 July-September 2005
population vaccinated against influenza. Yet as recently as the 2003 influenza season, the National Health Interview Survey found that only 40.1% of health care workers and fewer than 35% of adults aged 18 to 64 years received the flu vaccine.1 An increased demand for vaccine helps producers invest in the ability to produce larger supplies. Immunizing more people helps generate greater herd immunity. The influenza vaccine shortage during the fall of 2004 gave us a glimpse of how suddenly people can be made into believers and what demands they will place on medical care. On October 5, 2004, the Chiron Corporation notified the Centers for Disease Control and Prevention (CDC) that none of its influenza vaccine could be used in the United States for the 2004-2005 influenza season.2 The loss of the Chiron vaccine represented half of the total vaccine supply for the United States, and the announcement started a ripple effect. The pendulum shifted from nurses and physicians openly encouraging the complacent to get their ‘‘flu shot’’ to actually denying vaccine to alarmed, low-priority patients. As vaccine distribution started, patients anxiously waited in long lines for hours, created traffic jams near dispensing sites, or gave up and sought care out of the country. This was the response to a shortage of vaccine for a disease that would have far less morbidity and mortality than a pandemic. While no plans will ever be perfect, they are always better than no plan. Clinicians need multiple approaches for dealing with a pandemic when even the vaccine prob-
ably will not be available or feasible to administer. This issue of Disaster Management & Response provides readers with information about an influenza pandemic, starting with an overview of the disease and medical strategies for treating it (see ‘‘Pandemic Influenza: Are We Ready?’’ by Dr Sandro Cinti). Educators and planners who need resources to predict, strategize, recognize, protect, and treat patients and enable clinicians can find help in the News and Insights section, page 91. In the midst of a major infectious disease outbreak, bedside providers and infectious disease specialists will need services and tools, some of which have already been developed and tested (see the article by Fishman et al in the Quick Clinical Notes section, page 86). An influenza pandemic is like other types of recurring disastersda long time between events can cause the public to relax, develop amnesia, and lower their guard. Unfortunately, we know that even if this season is not the pandemic, there will always be next year.
References 1. Centers for Disease Control and Prevention. Estimated influenza vaccination coverage among adults and childrendUnited States September 1, 2004-January 31, 2005. MMWR 2005;54:304-7. 2. Centers for Disease Control and Prevention. Interim influenza vaccination recommendations: 2004-05 (news release) [online] [accessed 2005 May 8]. Available from: URL: http:// www.hhs.gov/news/press/2004pres/ 20041005b.html Disaster Management & Response/Halpern 59