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									                               Pandemic Influenza
                               Get Informed…Be Prepared
                             A newsletter for Minnesota organizations preparing for a possible influenza pandemic.



                       1918 pandemic flu virus
March 2007             gene completely                                CDC issues ‘Ethical Guidelines in
Vol. 2. No. 3          sequenced, but                                 Pandemic Influenza’ for comment
                       mysteries about its                      The U.S. Centers for Disease Control and Prevention
                       origins, ferocity remain                 (CDC) frames the ethical considerations decision-
                       In this issue of Pandemic                makers confront in planning for a potential pandemic in
  Subscribe to be                                               “Ethical Guidelines in Pandemic Influenza,” a paper
                       Influenza, we feature a
 notified by e-mail                                             released in mid-March. Distribution of antivirals and
                       thoughtful analysis of the 1918
 when a new issue                                               vaccines has historically been organized around the
                       “Spanish flu” pandemic and its
   of Pandemic                                                  principle of minimizing serious influenza-associated
                       lessons for today. The Journal
    Influenza is                                                complications. “However, in pandemic influenza
                       of Infectious Diseases recently
     available!                                                 management a second principle – that of preserving the
                       published “The 1918 Influenza
                       Pandemic: Insights for the 21st          functioning of society – should receive greater priority in
   Visit the MDH                                                decision-making than preventing serious complications,”
                       Century,” a long look backward
 Web site to sign up                                            according to the CDC.
                       at an outbreak responsible for
 or access previous
                       50-100 million deaths
       issues at                                                So how do pandemic planners deal with the issues raised
                       worldwide. Authors David M.
http://www.health.s                                             by limited resources in their processes? The guidelines
                       Morens and Anthony S. Fauci
tate.mn.us/divs/idep                                            suggest:
                       explain how much more we
c/newsletters/panflu                                            • Committing to transparency in the pandemic flu
                       know – the entire 1918 virus has
     /index.html.                                                   planning and response process.
                       been genetically sequenced,
                       giving researchers new hope of           • Engaging and involving the public.
                       discovering how to stop a                • Recognizing that public officials are responsible to
                       similar catastrophic subtype.                maximize preparedness.
Pandemic               Still, answers about the virus           • Basing decisions on best available scientific
Flu Planning           origin, virulence and patterns of            evidence.
Team
                       fatality remain a mystery. See           • Learning from global preparedness efforts.
Emily Litt,
                       http://www.journals.uchicago.ed          • Balancing individual liberty and community
(651) 201-5556         u/JID/journal/issues/v195n7/375              interests.
                       99/37599.html.                           • Ensuring diversity in ethical decision making.
Cheryl Petersen-                                                • Outlining and following a fair process, involving
Kroeber,                Also in this issue:                         consistent applications of standards, neutral
(651) 201-5722         • Governor’s budget proposal                 decision-makers, advance agreement on the process,
                           for pandemic flu                         respectful treatment, transparent communication,
Katherine Carlson,         preparedness, page 2.
(651) 201-5560                                                      accurate information, and methods to revise or
                       • Public information campaign                appeal decisions.
                           on track, page 3.
                       • Pandemic Influenza Annual              View the final guidelines, issued March 12, at
                          Update released, page 4.              http://www.cdc.gov/od/science/phec/guidelinesPanFlu.ht
                                                                m. Learn more about what Minnesota’s ethics
                                                                contractors are beginning to work on, page 3.



March 2007                                                                                         Volume 2, Number 3
Pandemic Influenza Newsletter                                                                               Page 2 of 4


                                                              The funding would:
       Demographic trends will influence
     pandemic influenza planning priorities                   •    Build healthcare supply stockpiles of personal
                                                                   protective equipment, ventilators, medical supplies
 We’re getting older, we’re multilingual, and we’re                and medications.
 moving to the suburbs. This is a snapshot of Minnesota       •    Purchase antivirals reserved by the federal
 mid-decade, taken from Halftime Highlights:                       government for treatment of up to 25 percent of the
 Minnesota at Mid-Decade, a 2005 publication                       state’s population.
 prepared by the State Demographic Center.
                                                              •    Maintain MDH laboratory testing, epidemiology
 Demographers analyze population data and project
                                                                   investigations of potential cases, planning,
 trends. Understanding these trends may help planners
                                                                   exercising plans, developing workforce and
 spare their communities the worst shock waves of a
                                                                   volunteer readiness.
 pandemic influenza event.
                                                              •    Support local public health preparedness efforts.
 •    Population disparities among rural and
                                                              Read more about the Governor’s proposal at
      urban/suburban counties are widening, with the
                                                              http://www.health.state.mn.us/divs/opa/budgetfacts0107.
      southwestern, northeastern and northwestern
                                                              html.
      counties losing the most people. Sharing pandemic
      flu resources and implementing multi-county
      planning make sense, if the trend continues.                APHA releases blueprint to strengthen
 •    The first of the “Baby Boom” (post World War II)                pandemic flu preparedness
      generation will retire this year – and dominate the     The American Public Health Association issued a
      population statistics for many years. Many older        blueprint on February 22 for strengthening the nation’s
      Minnesotans will be in multi-unit senior housing,       pandemic preparedness. The APHA recommends
      assisted-living and long-term care facilities, and      changes to the nation’s strategy, emphasizing the lack of
      using home care services to stay in single-family       resources for “an already overburdened public health
      housing. The focus of pandemic flu planning and         work force” to fully respond to a pandemic flu outbreak.
      resources may have to shift to ensure that these        The APHA also calls for clear federal guidance on
      facilities/services are prepared.                       school closures, quarantine and occupational health.
 •    Immigrants and refugees continue to make                http://www.apha.org/about/news/pressreleases/2007/AP
      Minnesota their home and make up much of the            HA+Releases+Prescription+for+Pandemic+Flu.htm.
      population gains in the state. Preparing
      communities for a possible pandemic becomes
      more challenging when people have limited                   MPCA developing guidelines on bird
      English proficiency, reduced economic                         disposal in avian flu outbreak
      circumstances, and diverse cultures. Planners may       If a high-pathogenic avian flu outbreak occurred in
      struggle to find translated tools and partners with     domestic flocks in Minnesota, hundreds or thousands of
      which to accommodate this more diverse world.           bird carcasses would require disposal. However, the
                                                              ground water upon which many rural areas depend for
 Read more about the state’s population trends at             drinking could be affected by on-site burial, and
 http://www.demography.state.mn.us/documents/Halfti           transportation of carcasses to landfills or incinerators
 meHighlights2006.pdf.                                        increases the risk of spreading the avian flu to new areas.

                                                              The Minnesota Pollution Control Agency (MPCA) is
        Governor’s budget proposal for
                                                              developing guidelines for disposal of birds during an
     pandemic flu is $19 million in biennium                  avian flu outbreak. One option: on-site composting, a
The 2007 Minnesota Legislative Session is in full swing,      process that avoids the transportation problems and
and the biennial budget discussions for FY 2008-2009          ground water impacts. The MPCA is looking at possible
are underway. Governor Tim Pawlenty has proposed a            risks to poultry workers in managing compost piles as a
budget requesting $12.4 million in FY2008 and $7.4            potential drawback. For more information about the
million in FY 2009 for pandemic flu preparedness.             MPCA’s discussion, contact Jim Chiles, (651) 296-7273
                                                              or jim.chiles@state.mn.us.
www.mdhflu.com                                www.birdflu.state.mn.us                          www.pandemicflu.gov
Pandemic Influenza Newsletter                                                                               Page 3 of 4



     Public Information Campaign                               Phase I of the campaign is funded through the end of
                                                               June. Possible funding sources are being sought for
   On track for a May launch of codeReady                      Phase II, so the codeReady partners can extend and build
     statewide preparedness campaign
                                                               on the work done during Phase I. For more information,
                                                               contact Emily Litt at the MDH, 651-201-5556 or
State officials, along with local and private sector
                                                               emily.litt@health.state.mn.us.
partners, are on track for a May launch of the state of
Minnesota’s new emergency preparedness public
information campaign, codeReady.                                                   Exercises

In addition to providing a unifying framework for the               K-12 school closing exercise CD-ROM
work now being done by StoneArch, the codeReady                            distributed to partners
brand is intended to serve as a unifying umbrella for          They didn’t last long! MDH distributed materials used in
future local, region, and state efforts to educate             the January 29, 2007, exercise on K-12 school closing as
Minnesotans about individual and family preparedness.          a disease containment measure to local public health and
A logo and graphic identity will not be unveiled until the     other partners, but all the copies are gone. The materials
May launch, in order to maximize their impact on public        are online, however, so you can access them at:
awareness.                                                     http://www.health.state.mn.us/divs/idepc/diseases/flu/pa
                                                               ndemic/scexercise/index.html.
Other elements of the campaign will include a highly
interactive codeReady Web site, with a wealth of                         Operationalizing the Plan
emergency preparedness information and materials, as
well as links to Web resources maintained by federal,              Process to recommend procedures for
state and local partners of the codeReady campaign.                allocating scarce resources underway
                                                               Work begins now for the Minnesota Center for Health
The codeReady Web site will be divided into three              Care Ethics and the University of Minnesota Center for
sections – Get Informed, Get Prepared, and Get                 Bioethics to produce a set of ethical procedures for
Connected. Local public health agencies and other              allocating medications, vaccines, protective equipment,
partner organizations may be invited to provide some           and other health care and medical items that may be in
resources for the content of the Get Connected page            short supply during a pandemic. The MDH has
(city, county, or tribal emergency preparedness resources      contracted with the two groups to:
or contacts, for example).
                                                               •   Review professional literature, plans and policies to
The May launch will include a media campaign                       develop background knowledge and materials.
promoting the codeReady brand. Although details are            •   Recruit a broad-based panel of experts and
still being finalized, the campaign is expected to include         stakeholders to complete key project activities,
statewide radio and print ads, outdoor billboards,                 including development of the actual
television sponsorships and unpaid television public               recommendations for allocating resources.
service announcements.                                         •   Providing leadership for the panel in developing the
                                                                   framework for resource allocation and
In addition to these traditional vehicles, the campaign            recommendations for implementing it.
will make use of non-traditional marketing, including a        •   Developing recommendations for ensuring
statewide tour of community events and gatherings.                 transparency and broad public participation in
                                                                   reviewing the initial draft of the allocation
One of the campaign deliverables is a well-stocked                 framework and conducting a public information
“partner tool kit,” which can be used by public agencies           campaign to build public awareness, understanding
at all levels of government as well as private sector              and acceptance of the framework.
partners to apply the codeReady brand to their own
materials and efforts. The kit will include a CD-ROM;          Read more about the process at
standardized, reproducible artwork; and guidelines for         http://www.health.state.mn.us/news/pressrel/ethics03120
effective use of the codeReady materials.                      7.html.

www.mdhflu.com                                 www.birdflu.state.mn.us                         www.pandemicflu.gov
Pandemic Influenza Newsletter                                                                                  Page 4 of 4

             Communication Planning                                    Rats! Could Rodents Transmit
                                                                      H5N1 from Wild to Farm Flocks?
    MDH Pandemic Influenza Annual Progress
                                                                     High pathogenicity H5N1 avian flu outbreaks on
          Update is available online                                 four farms in Japan likely began with migratory
See how MDH is preparing for a possible pandemic in a                birds from China. But rodents are suspected of
new report, Pandemic Influenza: Annual Progress                      carrying the virus into chicken coops, where
Update. It provides an overview of how MDH fits into a               domestic birds developed the disease.
pandemic influenza response, gives updates on each                   Nets and coverings preventing wild bird incursion
technical section of the MDH Pandemic Influenza Plan,                into coops suggested to Japanese scientists that
and outlines future goals and challenges. Look for this at           some other mechanism of transport took place. If
                                                                     testing shows the rats are the vector between wild
the end of the month.
                                                                     and domestic flocks, similar outbreaks are
                                                                     inevitable. “While it is necessary to prevent
             Pandemic Flu Digest                                     intrusion,” says Hiroshi Kida, professor of
                                                                     veterinary microbiology at Hokkaido University, “it
It’s technically spring, so stop and smell the resources!            is also important to strengthen the resistance of
                                                                     poultry by reducing stress on the birds and
•    Contra Costa (California) Health Services has                   improving ventilation to diffuse and inactivate the
     prepared a school action kit to assist educational              virus.”
     organizations facing decisions about school closings
     during a pandemic. It has checklists for school
     administration, sample letters for parents (in English    •    If you’d like to reach people through electronic,
     and Spanish), a set of actions for schools and flow            multimedia and Web strategies, the WGBH (Boston)
     charts outlining the process. Look at the site at              National Center for Accessible Media has a
     http://www.cchealth.org/topics/pandemic_flu/school             publication for you: Accessible Digital Media:
     _action_kit/.                                                  Design Guidelines for Electronic Publications,
•    The Wall Street Journal reported February 17 that a            Multimedia and the Web. The resource explains
     vaccine for H5N1 virus infections has been                     how to make electronic media accessible to those
     developed by major pharmaceutical manufacturers –              with sensory disabilities and is available at
     but not approved for use by any regulatory agency.             http://ncam.wgbh.org/publications/adm/.
     A “generic” vaccine against H5N1 is of debatable
     use, depending upon what variant of the flu is                The Last Word…
     circulating. Read a brief on the story at
     http://online.wsj.com/article/SB1171584359242104                                   If you’re interested in the futures
     61-search.html?KEYWORDS=bird-                                                      market, forget about soybeans or
     flu+vaccine+is+a+fact&COLLECTION=wsjie/6mo                                         pork bellies. Predicting an
     nth (subscription required).                                                       influenza pandemic is the next
•    The Center for Law and the Public's Health                                         wave in prognostication.
     presented its findings from a CDC-funded project,
     "Assessing Legal Preparedness for School Closure                                   According to National Public
     in Response to Pandemic Flu or other Emergencies,"                                 Radio, the University of Iowa
     at the 2007 Public Health Preparedness Summit. For                                 launched a new project to select
     more information, including a link to the Center's                                 100 flu experts around the world
     Power Point presentation, visit                                                    and provide them $100 trading
     http://www.publichealthlaw.net/Research/Affproject                                 accounts. These seers can place
     s.htm#SC.                                                 their bets on when and where a human case of H5N1
•    The New York State Department of Health has               will first occur in North America, for example. Their
     general public brochures in both English and              hunches will drive a “flu prediction market,” and the
     Spanish on respiratory hygiene and personal               Iowa researchers hope “to provide a keener expert
     protection during a pandemic. Get a list of the           consensus on pandemic probabilities to guide pandemic
     offerings at                                              planners.” Don’t believe us? Check for yourself, at
     http://www.health.state.ny.us/diseases/communicabl        http://fluprediction.uiowa.edu/fluhome/index.html.
     e/influenza/pandemic/docs/order_form.pdf.

www.mdhflu.com                                 www.birdflu.state.mn.us                           www.pandemicflu.gov

								
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