Pandemic Influenza: Still a Threat

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Symposium on Pandemic Influenza - October 2007

By John T. Carlo, MD, MSE, Guest Editor  

Global health disparities, continued destabilization of impoverished nations, and the unprecedented human population create our current environment, in which a potential new strain of influenza virus may emerge. Further, global travel, as evidenced in the  severe acute respiratory syndrome (SARS) epidemic, can heavily increase the spread of disease, with a new pathogen from a remote region of the world here within hours. 1 Past patterns of influenza pandemics have demonstrated its potential. The deadly Spanish flu in 1918 serves as the current possibility for which governmental officials have been asked to plan. 2

For local health officials in the United States, the task of preparing local communities is daunting. Years of underfunded local, state, and federal agencies have only recently been reversed with grant funds from both the Department of Health and Human Services (HHS) and the Department of Homeland Security. 3  Further, health disparities and underserviced populations, as well as the high incidence of chronic diseases in our communities, make the stakes extremely high. 4

Much has been done in Texas communities to prepare. Large funding blocks 5 have enabled us to acquire new technologies, develop more in-depth preparedness plans, and create more sensitive surveillance systems. Many area businesses now have pandemic preparedness plans. Faith-based organizations and school districts are actively planning for a pandemic.

On the federal level, vaccine manufacturers, encouraged by a $1 billion HHS investment, continue to research new technologies and adjuvants that could enable the capacity to deliver a vaccine for every man, woman, and child in the United States. 6  On April 17, 2007, the Food and Drug Administration approved the first influenza virus vaccine against H5N1; currently, this vaccine is being stockpiled in the Strategic National Stockpile. 7

Thankfully, a novel strain of influenza virus has not emerged as a global pandemic in the past two decades. The H5N1 avian influenza strain has been circulating since 1996, yet it has not been able to make the jump into an efficient transmitter of human disease. Certainly the opportunity for this avian strain to infect human hosts has existed. 8

The influenza virus remains a continued threat, and many other subtypes in the avian population could emerge. Unfortunately, the lack of significant change with the current H5N1 virus recently may result in "pandemic fatigue," where the priority for planning and preparing is lowered in the public's mind. This is currently evidenced by the reduced media attention directed toward the current threat and planning efforts. 9

This special issue on pandemic influenza demonstrates the continued need for pandemic planning in local communities. Through their work, the authors recognize specific challenges. Hospital planning and physician office preparedness are particularly important areas that deserve continued attention. Our children, if a pandemic behaves like typical influenza, could be the major transmitters of disease, and health care resources available for pediatric care are significantly lacking. Local health officials, through the guidance of their medical community, must begin to develop triage protocols to lesson the inevitable burden on hospitals' urgent care centers. Private industry must understand its continued role as the educator and supporter of its employees by instituting pandemic planning and creating solid continuity of operations plans. Citizens need to be ready through education and stockpiling of the necessary goods at home.




I sincerely thank all of the contributors for this edition. All of the authors have succeeded in their careers of medicine and public health in Texas. I also wish to thank my staff at Dallas County Health and Human Services and, particularly, Mary-Katherine Sanchez, DrPH, our pandemic preparedness coordinator, for her assistance in assembling these articles. I also take this opportunity to thank my community's medical leaders in the Dallas County Medical Society as well as the assistance from the editors of Texas Medicine for their continued support in both this project and others over the past several years.

Dr. Carlo is the medical director/health authority of the Dallas County Health and Human Services Department.  




  1. Hufnagel L, Brockmann D, Geisel T. Forecast and control of epidemics in a globalized world. Proc Natl Acad Sci . 2004;101(42):15124-15129.
  2. HHS Pandemic Influenza Implementation Plan. U.S. Department of Health and Human Services. . Accessed Aug. 1, 2007.
  3. Lurie N. Five years after 9/11: Public health preparedness, an opportunity and a challenge. RAND Review . 2006/30(2):26-29. . Accessed Aug. 1, 2007.
  4. Ai A, Carrigan L. Social-strata-related cardiovascular health disparity and comorbidity in an aging society: implications for professional care. Health and Social Work . 2007;32(2):97-105.
  5. HHS announces $896 million in funding to states for public health preparedness and emergency response [news release]. Washington, D.C.: U.S. Department of Health and Human Services; 2007. . Accessed Aug. 1, 2007.
  6. Department of Health and Human Services Pandemic Planning Update IV: A Report for Secretary Michael O. Leavitt; July 18, 2007. . Accessed Aug. 1, 2007.
  7. FDA approves first U.S. vaccine for humans against the avian influenza virus H5N1 [press release]. FDA News . April 17, 2007. . Accessed Aug. 1, 2007.
  8. Liem NT, Lim W; World Health Organization International Avian Influenza Investigation Team, Vietnam. Lack of H5N1 avian influenza transmission to hospital employees, Hanoi, 2004. Emerg Infect Dis . 2005;11(2):210-215.
  9. National Strategy for Pandemic Influenza: Implementation Plan One Year Summary. Homeland Security Council; July 2007. . Accessed Aug. 1, 2007.



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