HHS provides planning guidance for pandemic-flu preparedness.

The Department of Health and Human Services (HHS) and its Centers for Disease Control and Prevention (CDC), in cooperation with departments and agencies across the federal government, have launched two new efforts designed to improve state, local, and community preparedness for an influenza pandemic.

CDC has released new guidance on community-planning strategies that state and local community decision makers, as well as individuals, need to consider, taking into account the severity of an influenza pandemic. These strategies are important, because the best protection against pandemic influenza--a vaccine--is not likely to be available at the outset of a pandemic.

The new guidelines focus primarily on community-level measures that could be used during an influenza pandemic to reduce the spread of infection. To help authorities determine the most appropriate actions to take, the guidelines incorporate a new pandemic-influenza planning tool for use by states, communities, businesses, schools, and others. The tool, called the Pandemic Severity Index (PSI), takes into account the fact that the amount of harm caused by pandemics can vary greatly, with that variability having an impact on recommended actions for public health departments, schools, and businesses.

The PSI, which is modeled after the approach used to characterize hurricanes, has five categories, with Category 1 representing moderate severity and Category 5 representing the highest severity. The severity of a pandemic is primarily determined by its death rate, or the percentage of infected people who die. A Category 1 pandemic is as harmful as a severe seasonal-influenza season, while a pandemic with the intensity of the 1918 flu pandemic, or worse, would be classified in Category 5.

Government and health officials may recommend different actions communities can take depending on the projected severity of the pandemic. These actions, which are designed primarily to reduce contact between people, may include

1. asking ill people to remain at home or not go to work until they are no longer contagious (for seven to 10 days); ill people will be treated with antiviral medication if drugs are available and are effective against the pandemic strain at issue;

2. asking members of households in which someone is ill to stay at home for seven days;

3. dismissing students from schools and closing child care programs for up to three months (for the most severe pandemics) and reducing contact among children and teenagers in the community; and

4. recommending social distancing of adults in the community and at work, which may include closing large public gatherings, changing workplace environments, and shifting work schedules--without disrupting essential services.

These measures will be most effective if they are implemented early and uniformly across communities during a pandemic--and that objective can be met only through advance planning. The guidance illustrates the interventions that are likely to be recommended for each category of severity.

While the recommended actions could significantly reduce the number of people who become ill during a flu pandemic, they each carry potentially adverse consequences that community planners should anticipate and address in their planning efforts. The guidance describes many of these consequences, and it provides planners with initial recommendations on strategies for addressing them. These recommendations may be revised in the coming months on the basis of feedback that the government will seek from a variety of specific communities, including the private sector, the education community, religious organizations, community-based organizations, and the public health community.

Also as part of the continuing effort to raise awareness and educate the public about pandemic influenza and the need to prepare in advance, HHS has unveiled a number of new radio and television public service announcements (PSAs). The PSAs encourage people to learn more about pandemic influenza and to know more about the efforts their state and local communities are making to prepare for a pandemic.

The PSAs and the community-planning guidance, titled Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States--Early Targeted Layered Use of Non-Pharmaceutical Interventions, are available at www.pan-demicflu.gov.