The production of the Influenza vaccine involves three stages. First, an influenza virus that has a different genome from the circulating influenza virus is identified (Rappuoli and Giudice, 2010, p.63). After identification, it is adapted for use in vaccines by growing it together with another virus strain to form a hybrid.
The hybrid contains the outer components of the influenza virus and inner components of the other virus strain. Secondly, the influenza virus is grown in hen’s eggs (Rappuoli and Giudice, 2010, p.63). Eggs are preferred because of their availability and nutritive value. Thirdly, the virus is purified to make it safe. Fourthly, the virus is killed completely using toxic chemicals such as formaldehyde.
The vaccine can include either live or killed influenza viruses. For example, FluMist is an influenza vaccine that contains weakened influenza viruses, and is administered as a nasal spray (Rappuoli and Giudice, 2010, p.65).
The vaccine protects vaccinated people against influenza infection, and is recommended for people between the ages of 2 and 49. Most influenza vaccines that are administered through injections contain killed influenza viruses. Other vaccines are administered into the skin instead of the muscles, and contain live viruses.
New vaccines are produced every year because the influenza virus is always mutating, thus forming new strains (Rappuoli and Giudice, 2010, p.66). The eight RNA strands that make up the genetic material of the virus undergo continuous mutations through the processes of antigenic drift and antigenic shift (Rappuoli and Giudice, 2010, p.67). These processes cause gradual evolution of the virus.
Another reason for production of vaccines every year is due to the steady weakening of antibodies. Antibodies produced against the virus by the host’s body weaken over time and become unable to eliminate the virus.
New vaccines have to be produced to eradicate the viruses that are continually changing their genomes through mutations. If new vaccines were not produced, disease control would be difficult because of the evolving nature of viruses.
Vaccines play an important role in disease prevention. First, they augment the body’s immune system, thus helping it resist diseases effectively (Naff, 2004, p.34). When a vaccine is injected into the body, the body responds by producing antibodies against the antigens contained in the vaccine.
If the actual disease appears after a person has been vaccinated, the antibodies produced when that person got vaccinated eradicate the disease. Secondly, vaccines prevent the prevalence of diseases in the population (Naff, 2004, p.34). Some diseases have been eradicated completely using vaccines.
These diseases include Measles and Polio. Vaccines help keep these diseases away from people, and help protect non-vaccinated people from contracting them because many diseases are contracted through person-to-person infection.
The possible effects of not being vaccinated for influenza and other diseases include poor health, reduced productivity and a high mortality rate. When people fail to get vaccinated, they contract diseases that were eradicated by the use of vaccines (Cockey, 2010, par5).
For example, a drop in immunization rates in the United Kingdom against whooping cough led to more than 100,000 people contracting the disease and 36 deaths (Cockey, 2010, par6).
There is a high risk of suffering permanent disabilities if people contract diseases that have been eliminated by vaccines. For example, if Polio and Measles emerge because of failure to vaccinate, they could have devastating consequences on victims.
References
Cockey, C. (2010). Consequences of Not Vaccinating. Web.
Naff, C. (2004). Vaccines. New York: Greenhaven Press.
Rappuoli, R., and Giudice, G. (2010). Influenza Vaccines for the Future. New York: Springer.
A flu pandemic can be controlled through four steps that would be aimed at reducing the rate of spread of the disease and reducing its impact on the community. The steps are useful if an outbreak is detected early before it could have explosive growth (Interim Pre-pandemic Planning Guidance, 2007). If it is severe, then the steps should be maintained and applied consistently in the community to deal with the pandemic.
First, individuals confirmed or suspected to be affected by the avian flu virus should be isolated and treated with tested antiviral drugs. Isolation of the avian virus infected persons could be done at home or within healthcare settings, depending on how severe the disease manifests.
If it is severe, isolation should be done within healthcare settings, but mild severe cases can be isolated at home (Interim Pre-pandemic Planning Guidance, 2007). Second, influenza infected individuals should be quarantined at home on a voluntary basis as they undergo prophylaxis using antiviral medications.
However, this could only be done if sufficient amounts of effective drugs are available (Interim Pre-pandemic Planning Guidance, 2007). Third, students should be sent away from all learning institutions. Also, all activities that promote children coming together for social activities should be discouraged because the virus could be spread through the air quite easily.
Thus, close contact to infected persons could lead to virus transmission and infection. Fourth, measures should be adopted to reduce contact between adults in the workplace and social gatherings like meetings and church services (Interim Pre-pandemic Planning Guidance, 2007).
Legal authorities
When isolating and quarantining cases in flu outbreaks the following legal authorities are invoked: CDC, state, local and tribal authorities, and Commerce Clause of the US Constitution. The legal authorities are used to prevent patients from harm when they are being isolated and quarantined (CDC, 2012).
Factors to determine or deter the success of the plan
Several factors would impact the plan aimed at controlling a flu pandemic (H5N1 Avian Flu, n.d., para. 1). First, finances would have a great impact on the success of the plan. Adequate funding of the plan would result in the success of the plan while inadequate funds would make the plan fail along implementation.
Availability of healthcare providers would also determine the pace at which the pandemic control plan is implemented (H5N1 Avian Flu, n.d., para. 2). Enough personnel would ensure that the plan is successful within a short period of time. Third, collaboration with various stakeholders in the community would impact the plan.
For example, school managers would help in identifying flu cases and facilitating closure of learning institutions. Fourth, sufficient amounts of effective medications would go a long way in ensuring that isolated cases are treated (Community planning, n.d., para. 1).
Controlling the outbreak
Yes, I would control the outbreak. It would be crucial to control the outbreak to prevent it from reaching the pandemic phase 6. The outbreak could be controlled by gathering all the required resources like healthcare providers and antiviral medications. If the resources are utilized, then the outbreak could be handled and prevented from proceeding to pandemic phase 6 (Community planning, n.d., para. 1).
Improving the government’s plan
The government’s plan is a laudable approach to handling H5N1 outbreak in the society. However, I would suggest that it adopts a step that would ensure that there are strict travelling requirements in areas confirmed to have flu outbreaks. In fact, public means of transport should be discouraged because it could contribute to fast spread of the communicable disease.
Interim Pre-pandemic Planning Guidance: Community Strategy for Pandemic Influenza Mitigation in the United States- Early, Targeted, Layered Use of Nonpharmaceutical Interventions (2007). Web.
Common cold and influenza are both illnesses of the respiratory tract but are caused due to the attack of different viruses. The symptoms of the two illnesses are similar, which is the reason why it is difficult to differentiate a common cold from flu. However, with a slightly deep observation, the two illnesses can be differentiated from one another.
By and large, flu causes more trouble than common cold, making it a more serious illness, which sometimes can even result in death. The virus which causes the flu is a virus which belongs to a single family of influenza viruses. People, who have flu, generally develop a fever between the ranges of about 102 to 106 degrees, unexpectedly. The face of the patient is flushed and there is a terrible body ache accompanied by absolute energy loss and extreme body pain. Some people may also display symptoms of nausea and dizziness. The fever generally lasts from about two days to five days following which the other symptoms also begin to subside. However, the virus may settle in any part of the respiratory tract affecting that part severely and may cause sore throat, bronchitis, ear infections and in some cases even pneumonia.
On the other hand, the common cold can be caused by more than two-hundred types of viruses, and the attack of the virus is more concentrated in the nose. The most common symptoms of common cols are a running nose, incessant sneezing and stuffiness of the nose which results in difficulty in breathing. Persons affected by the common cold virus may develop fever a minimal fever in the ranges of 100 to 102 degrees. In some cases the virus may also produce headaches and cough with burning sensations in the eyes. In most cases there is a decrease in the appetite. Common cold usually subsides within seven days and may have certain lingering problems like coughing in some cases.
The major difference between flu and common cols is that flu is preventable where as common cold is not. Vaccines are present in the market for the prevention of influenza and the Centers for Disease Control recommend that children between the age group of six months and five years must be given the flu vaccination.
In both the cases, antibiotics do not render much help in the treatment of the illness as the viruses which attack the body have an ability to fight antibiotics. The most ideal treatment for influenza and common cold is to take enough rest and stay indoors and the room must be ventilated well. In order to prevent de-hydration, the patients must drink plenty of water and must increase the intake of fluids and juices. Alcoholic-fluids must be avoided. Since the affected persons are low on energy, the intake of energy rich foods and fruits must be increased. These include fruits rich in vitamin C such as oranges, and foods rich in carbohydrates such as potatoes and pastas. In case the fever is on the higher side, paracetamol may be taken to reduce it. The paracetamol also helps in reducing the body pain. Doctors usually recommend warm salt-water gargles two to three times a day to relieve the sore throat.
Thus, it must be noted that although flu and common cold display similar symptoms, the two are caused by different viruses. However, flu can be prevented by a vaccine, while a common cold cannot be prevented. Flu may cause complications such as pneumonia and other bacterial infections whereas common colds are less dangerous. The treatment for both the illnesses is not benefited by antibiotics, as both the illnesses are time-bound, and recover naturally within a week’s time.
References
Centers for Disease Control and Prevention. ‘Cold versus Flu’. Web.
Swine Flu has been a recent threat to humans all around the globe. The virus is severe in terms of effectiveness and can lead to fatal results. This paper is going to highlight all the points that may assist in increasing the awareness about H1N1 virus, its causes, preventions and post- disease curing techniques.
H1N1 Influenza
The published material by V. Racaniello (2009) states that the major groups of Islamic and Jewish background have at last, persuaded the WHO (World Health Organization) to replace the name Swine Flu virus to a more specific name as H1N1 virus. Like any other type of influenza, H1N1 also as an H protein, hem-agglutinin, which actually permits the germ to join to human host cell, and N proteins called neuraminidase, which demolishes mucous. Since there are various forms of H and N elements, the numbers following H and N depict the particular form of hem-agglutinin and neuraminidase present in the virus. Hem-agglutinin and neuraminidase are vital since they are critical proteins that let the virus contaminate people. For instance, a sore throat is a result of destroyed mucous layer due to neuraminidase in which the vulnerable cells are infected by hem-agglutinin causing the final destruction of cells. The virus has two types, H1N1 and H3N2. Both have been the major cause of respiratory contagions dating back to 1977. Earlier, it was widely understood that, there is a single form of virus that prevails each season. Although the latest research has proved that vital modification in the shell glycoprotein of this virus known as the antigenic shift, lead to global outbreak of flu identified as pandemics. Up till now six forms of antigenic shift has been recognized since 1889. Each of the pandemic carries HA and NA proteins that have been deficient in individuals thus reducing the immunity levels parallel to non-existence (Racaniello, 2009).
Symptoms of H1N1 virus
According to the article of Genevive Kieger (2009), the symptoms of the H1N1 virus are identical to the symptoms of normal flu. A regular fever of about 100 F, occurs in most of the cases. Other symptoms include dry cough, sore throat and nasal stuffness. Headaches, chills and fatigue also indicate flu and in some cases diarrhea and vomiting is observed also. These symptoms however do not require medical assistance unless they get severe. Drinking a lot of fluids and resting is suggested often as the main counterattack until the position gets serious and medical attention is required. Consulting to a doctor immediately, is necessary for people who are suffering from cancer, blood disorders, diabetes, chronic heart and lung diseases, kidney and liver disorders, people with diluted immune systems, pregnant women and children under the age of 5. According to CDC, the caution signs of that indicate serious swine flu attacks on adults include breathing problems, dizziness and confusion, vomiting and pains in the chest and abdominal regions.
Children to get infected tend to breath with a faster rate, the color of their skin changes to bluish or gray. Severe vomiting and lack of interaction and awakeness also indicates the same symptom. Flu like symptoms improve and come back with fever and bad cough (Kiger, 2009).
Causes of swine flu
The article published by L. Chang ( 2009) The Cold & Flu Health Center highlights the major causes that result in the presence and infection of the H1N1 virus having an effect on humans. Swine flu is contagious and communicable form of disease that disseminates almost just in the identical manner as the normal regular flu does. People, who are considered as infected with this virus, tend to sneeze and cough frequently, releasing micro globules in the ambient air. Engaging in contact passively with these particles or touching areas where the infected individual has touched lately (such as door knobs and washroom sinks, towels and drinking utensils) can cause an infection of H1N1 swine flu. The period of being infectious differ from children to adults. Children can remain transmittable for about 10 days. Adults can be the same up to 7 days after they get sick. Swine flu can be communicable even before the individual show indications of the disease. Although the name of the germ depicts severe criticism towards pigs, swine flu doesn’t transmit through eating pork products like bacon, ham and other forms of the meat. Although it is recommended by health related organizations to cook the pork until it rises to an internal temperature of 160 degrees Fahrenheit (Chang, 2009).
H1N1 virus and pregnant women
As written by Tom Watkins (2009) in the article, the study propose that pregnant women being contaminated with swine flu, the H1N1 virus, use antiviral drugs to save themselves as well as their unborn babies from the harmful effects. Dr. Denise J. Jamieson who is the leading creator of this study and an officer at the Center for Disease Control and Prevention, has believed that the patients that feel sick during pregnancy are required to seek assistance from their health care providers and their health care providers should prescribe the antiviral drugs very promptly. The doctor also advised to prescribe the drugs irrespective to the concerns regarding the potential consequences on the fetuses since some practitioners are hesitant and refrain from taking the risk of providing drugs on their own behalf. An obstetrician cum gynecologist stated that pregnant women are more severely attacked and infected by influenza in this situation and the risks do hereby are overshadowed by the benefits. Dr. Jamieson reported that all pregnant women were healthy before they got infected. Due to the infection they initiated to develop viral pneumonia which further led them to sensitive respiratory pains which was quite agonizing and required ventilators to assist them in breathing. The doctor also agreed that the number of deaths was however little yet significant enough to raise concern since it consisted of around 6 percent of pregnant women off the total 266 affected death caused by H1N1 as reported by the CDC up till now. The percentage is almost six times higher than the percentage of U.S. women who tend to be expecting birth at any time. Additionally, women who are pregnant and infect with swine flu were four times higher in the ratio of sick people in the whole populace to get hospitalized. The study concerned that as an increase due to the willing of doctors who preferred admitting a pregnant woman than a normal person with identical indications. Pregnancy is certainly impacts in duration of time involving pain and risk thus affecting the abilities of counterattacking illnesses and diseases.
It is not clear whether that immunological shift interprets a greater chance of constricting the germs, it is certain that the results can be more serious among pregnant women who are infected with H1N1 virus (Watkins, 2009).
Treatments for H1N1 virus (swine flu)
According to the Public Health Agency of Canada (2009) there are some treatments and precautions advised by medical boards and doctors who are aware of the fact. Covering the nose and mouth with a tissue when coughing or sneezing is essential in prevention from the virus. The tissue should be disposed off after single usage. Hands should we washed with soap and water constantly since hands are in frequent use and vulnerability to this virus is on a higher level. Alcohol based cleansers are an effective germicide that prevents from being infected by touch-based items. Interactions with individuals who are sick especially those who carry flu like indications should be kept distant. Touching one’s own eyes mouth and nose should be avoided since it is the most alleviated way of disseminating germs. One should stay at home for at least 7 days after the signs are revealed, as it will prevent others to attract the virus and spreading it further.
There are vaccines recommended by certain boards like PHAC (Public Health Agency of Canada that should be given only in serious conditions. Mild levels of the disease don’t require medical treatment except in the case of pregnant women. There are anti-viral drugs available on prescription only. Tami-flu (oseltamivir) and Relenza (zanamivir) are two vital antiviral drugs that can be given to prevent the fatal results of swine flu. These drugs are recommended to be taken under serious conditions, within 48 hours of sickness. They tend to reduce the ability of viruses to duplicate but they do not guarantee or are meant to supply resistance in opposition to the illness. The government aims to purchase 50.4 million doses of H1N1 flu vaccines in order to fulfill the capacity of provincial, territorial and federal populace (PHAC, 2009).
Global Spread of Swine Flu and people
According to World Health Organization (2009) there have been more than 414900 definite cases around the globe consisting of nearly 5000 deaths due to this H1N1 swine flu. The update fetched on 17th October 2009 demonstrates the recent movement of the virus in other parts of the world like Trinidad, Tobago, Iceland, Sudan, Mongolia, Rwanda and Sao Tome, and Principe. The cumulative table (see Figure 1) shows the complete range of affected patients and deaths region wise. Most of the cases are seen in the American region as well death toll is significantly higher than other areas. Many countries have closed the count of individual case that bear illness of a less risky level, the count has decreased than the exact number of patients that have occurred. On the other hand, the tropical areas of the world have shown relative decrease in the pandemic related activity and the rate of illness there is lowering down. Asia reports to have a decrease in the rates of H1N1 virus infections also. The temperate region has no impacts of the deadly virus in the past week also (WHO, 2009).
Conclusion
It can be concluded that any virus which is defined as deadly can be prevented if necessary precautions are taken and by chance if the virus hits the host human cells, then adequate medical assistance and prescribed antiviral drugs can reduce the effects as a consequence of securing the life of the affected.
References
Chang, L. (2009). H1N1 Flu Virus (Swine Flu): The Cold & Flu Health Center. Web.
Kiger, G. (2009). What are the symptoms of swine flu? Web.
Public Health Agency of Canada. (2009). H1N1 Flu Virus – Frequently Asked Questions. Web.
Racaniello, V. (2009). Origin of current influenza H1N1 virus. Web.
Watkins, T. (2009). Study: H1N1 virus more severely affects pregnant women. Web.
WHO. Global Alert and Response – Pandemic (H1N1) 2009 – update 71. Web.
Diseases can be caused by different viruses and organisms of non-human origin. Viruses are an integral part of our life. One of the viruses is the influenza virus which is not dangerous by itself, but the complications after the illness can cause different kinds of complications and even death. Infectious diseases have affected human beings since the beginning of time. The infectious disease happens in the case of the interactions of some biological factors and the host within a specific environment.
Introduction
There are a great number of different diseases; some of them are infectious, others are not very dangerous. It is necessary to mention that the most perilous diseases are those that cause different complications after the illness. Thus diseases can be caused by different viruses and organisms of non-human origin. Viruses are an integral part of our life. One of the viruses is the influenza virus which is not dangerous by itself, but the complications after the illness can cause different kinds of complications and even death. Infectious diseases have affected human beings since the beginning of time. The infectious disease happens in the case of the interactions of some biological factors and the host within a specific environment. “Infectious disease occurs whenever conditions are right for a viable pathogen to infect and affect a susceptible host” (Ryan 3).
Discussion
There are many viruses that cause a range of complications, suchlike influenza and AIDS. Besides the history of mankind saw horrible diseases which affected the entire continents; such viruses are known as pandemics. The book “Pandemic Influenza: Emergency Planning and Community Preparedness” written by Jeffrey R. Ryan represents the range of environmental factors of transmission of infectious diseases: biological (susceptible, immune status, vector and host/reservoir), physical (geography, climate, shelter), and socio-economic (demographic, cultural, economic) (Ryan 5). Thus the factors indicate auspicious conditions for the transmission of infectious diseases and the most vulnerable areas of the world systems. There exist three types of influenza viruses; the A-type is the most dangerous as it can cause epidemics and pandemics (Barry 101).
The Public Health Agency of Canada published a guidance document which represents the detailed information on the new virus which affected the population of the whole world; the epidemiology of pandemic H1N1 human influenza is described in order to avoid panic and to clear up the situation with the virus. This document contains all necessary data about the epidemiology, the vaccination and outcomes of the virus:
“In April 2009 a novel influenza A virus (pH1N1) was determined to be the cause of outbreaks of respiratory illness in Mexico and influenza illness in two children in the United States. Within weeks, the infection spread to other parts of North America and to many areas of the world. In response to the spread of the new virus, the World Health Organization (WHO) declared pandemic influenza Phase 6 on June 11, 2009” (Public Health Agency of Canada, 5).
The new virus is considered to have multiple origins. One of the most dangerous viruses of our days is the virus of the A-type which has a non-human origin and can be the reason for spreading it all over the world.
Conclusion
Thus the disease is the abnormality of the organism which is provoked by a virus or another organism of a non-human origin. It affects the human body and causes different malfunctions. The infectious disease is more dangerous than the non-transmitting disease, as it can be transmitted from one individual to another or from animal to people. There are three types of viruses, whereas only one can be the reason for the epidemics or pandemics. The A-type viruses are extremely dangerous for people because they can cause different complications after the illness. Thus the virus is not as dangerous as the complications which can lead to fatal outcomes. The world has recently witnessed the pandemic influenza of the A-type virus. The results of it happened to be deplorable for mankind.
Works Cited
Barry, M. John. The Great Influenza: The Epic Story of the Deadliest Plague in History. London: Penguin, 2005.
Public Health Agency of Canada. “Guidance Document on the Use of Pandemic Influenza A (H1N1) 2009 Inactivated Monovalent Vaccine 2009”. Public Health Agency of Canada. 2009. Web.
Ryan, R. Jeffrey. Pandemic Influenza: Emergency Planning and Community Preparedness. New York: CRC Press, 2008.
Throughout the history of its existence humanity has encountered endless disasters which are impossible to either predict or prevent: natural calamities, such as earthquakes, floods, and fires, wiped whole settlements off the face of the earth. One of the most vehement catastrophes befalling humankind consists in the outbreaks of pandemic diseases that may spread over the planet and take the lives of millions. Since antiquity, documentary sources have been reporting plague as the social evil killing whole cities; but due to achievements of medicine, this bacterial infection has been stopped from mass manifestations by the early twentieth century. The situation is much more complex and underdeveloped in respect of viral epidemics, with influenza being the most urgent issue of modern virology. During the twentieth century, the population of the Earth experienced several deadly influenza pandemics, with no solution being found and with new influenza pandemics threatening humankind nowadays. This situation makes the objective of efficient resistance to the disease a primary task for specialists to solve. In their search for the cure, medics are investigating the historical development of the virus and tracing its existence back to the tragic events of 1918, when humankind was struck with the deadliest pandemic ever seen, the Spanish flu.
The pandemic of Spanish flu
Exhausted by the stress of the First World War, the whole world was looking forward to peaceful existence when it was overcome by a catastrophe no less deadly than the war itself. At first, the illness was not recognized as anything more than a seasonal cold; moreover, the armies involved in military action acted as one of the most mass nidi of infection, since ambitions would not let the generals admit the cause of multiple casualties to be an epidemic disease of unprecedented force. Among the most serious symptoms, obstruction of lungs was observed, which caused coughing blood and often resulted in the patients rapid death occurring literally the next day after contagion. The specific feature of the pandemic was that it caused mortality in an untypical age group: while common flu mostly affects young children and elderly people, the epidemic that lasted from March 1918 to June 1920 killed a large number of adults from twenty to forty years old. Due to political reasons, the most open and informative coverage of the pandemic was carried out by the Spanish mass media, and consequently, the disease got a corresponding name. However, it did not affect solely the Iberian Peninsula, nor did it originate therefrom. Infecting nearly one-fifth of the world population, the Spanish flu killed more than fifty million people, with the death rate estimated as high as two and a half percent, by far exceeding that of the common flu. The origins of the Spanish flu were initially believed to lie in China and arrive at the rest of the world as a result of a rare mutation in a common flu virus; but later research has shown that it was transmitted from poultry, either directly or through swine. The possibility of direct transmission between poultry and human is the main cause of the panic terror of the avian flu nowadays. (Diacu 151–152)
The pandemic of swine flu
Despite all the efforts of medical science, influenza continues its triumphant and deadly procession all over the planet. Recently the world has been struck by another pandemic: the so-called ‘swine flu’ being a new strain ofH1N1 influenza virus. Registered in April 2009 in Mexico, swine flu is admitted to be a virus that has never before circulated among humans (World Health Organization, “Pandemic (H1N1) 2009”). Swine flu is especially difficult to detect immediately since its symptoms closely resemble those of common influenza: sore throat, cough, headache, fever, joint and muscle pains are the typical signs of a seasonal cold or flu. Therefore a complex of specialized tests is applied to patients allegedly suffering swine flu; however, specialists advise to start preventive treatment without waiting for test results, since any delays might turn out to be fatal. According to WHO information of 29 November 2009,
“… worldwide more than 207 countries and overseas territories or communities have reported laboratory-confirmed cases of pandemic influenza H1N1 2009, including at least 8768 deaths.” (“Pandemic (H1N1) 2009”)
The situation update is carried out on a regular basis and shows that have peaked in the United States and Canada, the disease activity is now declining, while in Europe it has reached or is reaching its peak, with over ninety-nine percent of influenza cases being diagnosed as H1N1/2009 (World Health Organization, “Pandemic (H1N1) 2009”). Western and Central Asia remain centers of the virus activity, while in East Asia a decline has been reported in diseases of this kind. In Central and South America, the virus activity is observed as declining; Africa has reported isolated occasions of H1N1/2009 scattered throughout the continent; and the temperate southern hemisphere reports low rates of pandemic activity (World Health Organization, “Pandemic (H1N1) 2009”).
Comparison and contrast of the two types of flu based on the type of treatment applicable to them
With such an alarming situation, it appears vital to find a way of taking the events under control, and one of the most efficient ways until now has been seen in that of research and analysis of the past identical situations. Already in 2007 studies were published dedicated to discussion of the 1918 Spanish flu pandemic in the context of the impending threat of a new pandemic disaster. Medical history has shown that vaccination is the most efficient way of treating influenza in patients. And yet the problem with vaccines is that the influenza virus mutates at an alarming rate and in a rather unpredictable way; developing an efficient and safe vaccine in short terms appears an impracticable task so far. Therefore solutions should be sought for in other strategies of action. In the case of pandemics, such strategies involve, along with vaccination, the so-called ‘non-pharmaceutical interventions’ that are possible to apply efficiently in order to at least prevent the mass spread of the infection among the population.
In this case, the epidemics of Spanish flu and swine flu appear to be identical, as the non-pharmaceutical interventions applied in both instances appear to be quite the same. According to Stephen S. Morse, in 1918 measures were introduces varying “from wearing surgical masks to ‘social distancing’ measures (as we call them today) that ranged from closing schools and prohibiting public gatherings to isolating sick people in hospitals or encouraging them to stay home” (7313). To a certain degree, those measures appeared efficient in their combination: as Morse claims, some interventions are more effective than the other, but none of them can be considered universally applicable (7313). This idea is supported nowadays by the World Health Organization that recognizes the low degree of significance born by vaccines and antivirals in the current pandemic situation; WHO remarks on the necessity to concentrate efforts in the sphere of public measures that would reduce the severity of the pandemic (“Mathematical Modelling of the Pandemic H1N1 2009” 344).
The most important aspect in the application of the non-pharmaceutical interventions in 1918 and nowadays is the correct timing and distribution of measures. Morse analyses the Spanish flu situation and arrives at the conclusion that lower peak death rates were observed in the cities where, firstly, several measures were introduced at once, and secondly, those measures were enacted for a longer time period (7313). Taking into account the nature of the influenza epidemic that is estimated to be coming in waves, it is vital to maintain the measures once taken for sufficient time, since in 1918 influenza returned to the cities when the interventions were canceled (Morse 7313). In the current situation, specialists voice a consideration in support of precise timing necessary for the interventions: cases may occur when those interventions are “too effective”, and not enough population is infected with the virus to achieve “herd immunity” (World Health Organization, “Mathematical Modelling of the Pandemic H1N1 2009” 344).
Conclusion
In the situation of the modern pandemic of influenza, it becomes of vital importance to estimate the necessary balance of non-pharmaceutical interventions in terms of their effect on the health of the world population, as well as on the global economy. The present pandemic of swine flu appears similar to the Spanish flu pandemic of 1918, as scientists observe the same rapidness of contagion, high death rate, the animal origin of the virus, and limitedness of vaccination that makes non-pharmaceutical interventions the main efficient way to meet the challenge of the pandemic. Therefore, it is indisputably significant to study the lessons of the past epidemics and apply them wisely to the modern situation, assisting the world population at least by social if not by medical means before the medical cure is discovered.
Works Cited
Diacu, Florin. Megadisasters: The Science of Predicting the Next Catastrophe. Princeton, NJ: Princeton University Press, 2009. Print.
Morse, Stephen S. “Pandemic Influenza: Studying the Lessons of History.” PNAS 104.18 (2007): 7313–7314. Print.
World Health Organization. “Mathematical Modelling of the Pandemic H1N1 2009.” Weekly Epidemiological Record 84.34 (2009): 341–352. Print.
Making a problem statement feasible is one of the challenges facing healthcare policy analysis (Teitelbaum & Wilensky, 2017). For the current project, a possible broad problem statement might be the outbreak of flu in the state of Illinois in 2029. The narrow problem statement would be the ways of managing the risk of an outbreak of flu in Illinois in 2019. The question to be answered is: “In what ways can the Illinois State Public Health Department decrease the risk of a flu outbreak in Illinois in 2029?” This value-driven statement provides information on the direction that the policy analysis may take.
Background
Outbreaks of influenza hurt a large number of countries and populations every year. Adverse outcomes of this infectious disease include the loss of the ability to work and lead a normal life due to several symptoms, ranging from mild to severe ones. Seasonal outbreaks of flu result in many people experiencing fatigue, sore throat, and fever, respiratory failure, or even death (Nguyen, 2018). The seriousness of the problem is proved by statistics from all over the world in general, and for the state of Illinois, in particular. During this recent winter season, there have been 1229 flu-associated ICU admissions and 319 outbreaks in the state (Illinois Department of Public Health, 2018). While the baseline for outpatient visits for “influenza-like illness” is 1.8%, there have been 4.78% of such visits recorded for this specific season. The percentage of flu-positive tests was 19.3% (3070 of 15872) (Illinois Department of Public Health, 2018). The most tragic statistics are represented by the number of pediatric deaths – two have been recorded during this season (Illinois Department of Public Health, 2018). The seriousness of the problem is obvious, and it is necessary to work on the prevention of such statistics in the future.
Landscape
There are three major categories of stakeholders related to the problem of flu outbreaks: the government, citizens, and healthcare workers. State officials must arrange the most favorable conditions for healthcare workers to be able to disseminate information about influenza among citizens and to provide people with the necessary prevention and treatment procedures. Each year, the number of types of influenza increases, affecting many people (Jonges et al., 2013). The task of healthcare professionals is to be prepared for an epidemic but, simultaneously, do everything possible to prevent it. This can be done through educational materials and the spreading of data on flu via social media. The third category of stakeholders related to the problem is citizens. They constitute the biggest and most vulnerable group of stakeholders. To ensure effective cooperation between all stakeholders, it is necessary to provide relevant financial and informational support. Citizens should be informed about the severe outcomes that may be caused by influenza, while healthcare workers should do everything possible to minimize the negative impact. The role of state officials is to provide the necessary funding to minimize the losses caused by an epidemic.
Options
Two of the most effective options available to address the problem are surveillance and antiviral medicines and vaccination (Rubinstein, Marcu, Yardley, & Michie, 2015; Suwantarat & Apisarnthanarak, 2015; Woolhouse, Rambaut, & Kellam, 2015). Each of these options has advantages and disadvantages that impact on their overall effectiveness. Vaccination is the most effective method of minimizing the risk of catching flu and spreading it to others (“Key facts about,” 2017). Another benefit of flu vaccines is that they can be adapted to suit the specific patient, depending on a person’s age and health condition, such as for children, elderly people, and pregnant women (“Key facts about,” 2017). Vaccination is a good preventive measure and can save money on the treatment of the disease. There are many places where people can be vaccinated: hospitals, clinics, health departments, or even offices and schools. Another benefit of vaccination is that it can prevent more serious chronic health conditions, such as heart disease and diabetes (“Key facts about,” 2017). However, this method has one serious disadvantage: it is quite costly (Semuels, 2013). According to Semuels (2013), the reasons for vaccines being so expensive are associated with the price of materials involved and the inability to predict the quantities that will be needed which leads to destroying vaccines in large numbers every year.
A second option for managing the outbreak of flu is surveillance. This method is manifested through collecting data on the spread of the virus and making assumptions about the possible outbreaks of infections. The advantage of this option is its moderate cost. Surveillance may be based on the data gathered at healthcare institutions without resorting to any additional techniques. However, Woolhouse et al. (2015) remark that there is a serious limitation to surveillance. It has frequently been noted that healthcare workers’ observations have not been able to predict a flu outbreak and, therefore, the situation may still lead to an epidemic.
Recommendations
Taking into consideration the benefits and limitations of both options, it seems more relevant to choose vaccination as the one that best addresses the problem. Outcomes of selecting vaccination include; fewer numbers of people being infected, a decreased rate of influenza-related hospital admissions, and a smaller number of deaths caused by flu. The reasons as to this option being the best one are concerned with its effectiveness. Although it may be more expensive than surveillance, in the long run, vaccination proves to be cost-effective.
References
Illinois Department of Public Health. (2018). Influenza surveillance update. Web.
Jonges, M., Meijer, A., Fouchier, R. A., Koch, G., Li, J., Pan, J. C., … Koopmans, M. P. (2013). Guiding outbreak management by the use of influenza A(HzNx) virus sequence analysis. Euro Surveillance, 18(16), 1-8.
Rubinstein, H., Marcu, A., Yardley, L., & Michie, S. (2015). Public preferences for vaccination and antiviral medicines under different pandemic flu outbreak scenarios. BMJ Public Health, 15(1), 1-13.
Suwantarat, N., & Apisarnthanarak, A. (2015). Risks to healthcare workers with emerging diseases: Lessons from MERS-CoV, Ebola, SARS, and avian flu. Current Opinion in Infectious Diseases, 28(4), 349-361.
Teitelbaum, J. B., & Wilensky, S. E. (2017). Essentials of health policy and law. (3rd ed.). Burlington, MA: Jones & Bartlett Learning.
Woolhouse, M. E. J., Rambaut, A., & Kellam, P. (2015). Lessons from Ebola: Improving infectious disease surveillance to inform outbreak management. Science Translational Medicine, 7(307), 307rv5-307rv5.
Influenza is a contagious but preventable disease, which can have severe complications. If the virus is not treated in time, it can cause hospitalization or even death. To stop the infection from spreading among people, doctors use the preventive way, and that is called vaccination. However, the lack of understanding of vaccines and how exactly they work is interfering with the proper implementation of precautionary measures (Srivastav et al., 2019).
People are not educated enough on the subject and are anxious about what a vaccine can do to the immune system. However, several Hong Kong researchers like Leung et al. (2017) are confident that educated patients are more likely to increase the vaccination rate. This paper will focus on analyzing their article “Impact of Patient Education on Influenza Vaccine Uptake Among Community-Dwelling Elderly: A Randomized Controlled Trial”. The analysis will be conducted according to Rapid Critical Appraisal Checklist for a Randomized Clinical Trial (Melnyk & Fineout-Overholt, 2005, p. 51).
Review of the study
The main purpose of this study is to determine the performance of a short face-to-face educational session between the doctor and the patient. The authors believe that the information may motivate the patients to make a well-informed and balanced decision, thus increasing the influenza vaccination rate among people up to 75 years old (Thomas & Lorenzetti, 2018). The search was conducted with the help of medical students who approached patients in General Out-patient Clinics. They invited them to participate in the study, which means that random assignment was not concealed from the individuals.
After giving written consent, patients were divided according to their gender and if they received the influenza vaccination in the previous 2 years. Out of 529 patients, 265 were placed into the experimental group, and 243 were put in the control group (Leung et al., 2017).
Subjects and providers were not blind to the study group. Then investigators gave each patient in the intervention group a personal 3-minute verbal session about the outcomes of the influenza vaccine. Patients in the control group have not received an educational session but could access information from other sources like the Internet or nurses. From this information it can be concluded that the researchers selected an appropriate control group of adults similar on variables, the subjects were not assigned randomly into groups. However, subjects in the group were not analyzed individually.
Results
The essential goal was to figure out the number of patients who decided to get an influenza vaccination within three days after their educational session. To record the results of the experiment, nursing stations provided lists of people who got vaccinated. The study does not elaborate on instruments used to measure the outcomes. The trial indicated that in three days, a pamphlet and a short educational session increased the vaccination rate from 25.0% in the control group to 33.6% in the intervention group (Leung et al, 2017), thus making the NNT of 11.6.
Such results are also compatible with previous randomized experiments, where doctors and nurses used personal interventions, which created moderate advances in influenza vaccination rates (Chan et al., 2015). The results from other randomized trials seem to show even less productivity (Wong et al., 2016). Nevertheless, even with the help of educational materials, the vaccination uptake was still low, revealing the discrepancy between what was planned and the results.
Conclusion
While the research and report seem to be thoughtfully done, and the results demonstrated the importance of spreading awareness about vaccines, the study does not fully solve the problem. The results of the intervention were not up to what was expected. The researchers consider that the main reasons were such limitations as social biases and the 3-day follow-up period. They suggest that because of such limitations, some people may have been feeling pressured to make a deliberate decision to get an influenza vaccine. Nevertheless, such a method of education is feasible in a clinical setting because of its affordability and can help in caring for patients. Therefore, it can be suspected that patients may benefit from the information given by their medical staff and increase the vaccination rate.
References
Chan, S. S., Leung, D. Y., Leung, A. Y., Lam, C., Hung, I., Chu, D & Lam, T. H. (2015). A Nurse-delivered brief health education intervention to improve pneumococcal vaccination rate among older patients with chronic diseases: a cluster randomized controlled trial. International Journal of Nursing Studies, 52(1), 317-324.
Leung, K. C., Mui, C., Chiu, W. Y., Ng, Y. Y., Chen, M. H., Ho, P. H., Pang, H. H. (2017). Impact of patient education on influenza vaccine uptake among community-dwelling elderly: A randomized controlled trial. Health Education Research, 32(5), 455-464.
Melnyk, B. M., & Fineout-Overholt, E. (2005). Rapid critical appraisal of randomized controlled trials (RCTs): An essential skill for evidence-based practice (EBP). Pediatric Nursing, 31(1), 50-2.
Srivastav, A., Lu, P. J., Santibanez, T., Amaya, A., Dever, J., Stanley, M., Williams, W. (2019). Influenza vaccination hesitancy among adults. Proceedings of APHA’s 2019 Annual Meeting and Expo, Philadelphia, PA: American Public Health Association.
Thomas R. E., Lorenzetti D. L. (2018). Interventions to increase influenza vaccination rates of those 60 years and older in the community. Web.
Wong, V. W. Y., Fong, D. Y. T., Lok, K. Y. W., Wong, J. Y. H., Sing, C., Choi, A. Y. Y., Tarrant, M. (2016). Brief education to promote maternal influenza vaccine uptake: A randomized controlled trial. Vaccine, 34(44), 5243-5250.
The number of people infected with influenza increases every year. The state of Illinois has reported over a thousand cases this winter season alone (Illinois Department of Public Health, 2018). The seriousness of the issue is aggravated by the fact that not only adults but also children suffer severely from flu outbreaks. Therefore, it is necessary to take serious measures to initiate policies to decrease the flu outbreak in Illinois for 2029.
Position of Novelty
The best of the available options for addressing the problem of influenza outbreaks is vaccination (Rubinstein, Marcu, Yardley, & Michie, 2015; Suwantarat & Apisarnthanarak, 2015). By choosing this approach, the state will decrease the number of infected people, reduce the levels of hospital admissions, and lower death rates. Vaccination requires significant preparation and may seem like a large financial burden but in the long run, it is more cost-effective. Therefore, the article by Jit, Newall, and Beutels (2013) in which the authors analyze vaccination strategies and their cost-effectiveness is a significant contribution to the development of the policy aimed at decreasing flu outbreak.
Critique the Merits
Jit et al. (2013) suggest a thorough analysis of the challenges that appear in the process of assessing the cost-effectiveness of vaccination. Not only do they estimate the epidemiological burden of the illness but they also analyze the economic burden of vaccination, as well as the impact of the vaccine on the population. The authors support their arguments with an extensive review of the literature and detailed analysis. Jit et al. (2013) outline as many as seven challenges to the cost-effectiveness of vaccination. Another merit of the article is that its authors define the possible limitations of their suggestions and provide a list of potential further recommendations to be analyzed. The authors’ support of vaccination as an effective method of eliminating the spread of influenza is supported by other credible sources such as the article by Rainwater-Lovett, Chun, and Lessler (2014) in which pharmaceutical interventions are discussed.
Recommendations
Taking into consideration the severity of influenza outbreaks and the need to manage them with an effective policy, the study by Jit et al. (2013) may be regarded as a significant contribution to this management process. However, even though vaccination is a highly productive method of preventing influenza, it is necessary to check its cost-effectiveness (Jackson & Nelson, 2013). Also, policymakers should perform regular surveillance of the disease to predict epidemics.
References
Illinois Department of Public Health. (2018). Influenza surveillance update. Web.
Jackson, M. J., & Nelson, J. C. (2013). The test-negative design for estimating influenza vaccine effectiveness. Vaccine, 31(17), 2165-2168.
Jit, M., Newall, A. T., & Beutels, P. (2013). Key issues for estimating the impact and cost-effectiveness of seasonal influenza vaccination strategies. Human Vaccines and Immunotherapeutics, 9(4), 834-840.
Rainwater-Lovett, K., Chun, K., & Lessler, J. (2014). Influenza outbreak control practices and the effectiveness of interventions in long-term care facilities: A systematic review. Influenza and Other Respiratory Viruses 8(1), 74-82.
Rubinstein, H., Marcu, A., Yardley, L., & Michie, S. (2015). Public preferences for vaccination and antiviral medicines under different pandemic flu outbreak scenarios. BMJ Public Health, 15(1), 1-13.
Suwantarat, N., & Apisarnthanarak, A. (2015). Risks to healthcare workers with emerging diseases: Lessons from MERS-CoV, Ebola, SARS, and avian flu. Current Opinion in Infectious Diseases, 28(4), 349-361.
The 2009 Novel Influenza A (H1N1) pandemic brought to the forefront the critical issues of disaster preparedness and planning. Influenza pandemics often portend a political, humanitarian, social, and economic crisis if managed poorly. The essence of this assertion is that an influenza outbreak is an unpredictable and recurrent event (Jhung et al., 2013). As such, Nelson et al. (2007) have argued that advanced preparedness and adequate planning are essential to mitigate the impacts of influenza pandemics. Nonetheless, these efforts require the input of everyone in the community. Both national and international guidelines have provided the framework for addressing these issues adequately (McCormick et al., 2009). The state of Tennessee’s response to the H1N1 pandemic has provided valuable lessons for future practice.
The health and disaster management agencies should form collaborative linkages to respond to pandemics efficiently (Barrios et al., 2012). No single organization can respond to a pandemic independently considering the practical issues involved in disaster management. In addition, an effective reaction to emergencies requires the mobilization of massive resources (Nelson et al., 2007). Interagency collaboration is essential to build sufficient capacity. Emergency response mechanisms achieve their intended goals when agencies utilize their resources and knowledge base collectively (Barrios et al., 2012). The health administrators in Tennessee understood the value of cooperation by deploying the services of the Tennessee Emergency Management Agency (TEMA).
Each of the agencies involved in the multidisciplinary team should have explicit roles to avoid a conflict of interest. The best strategy to achieve this goal entails the delegation of duties depending on the resources and specialty of each organization (McCormick et al., 2009). For instance, the Department of Health (DOH) and TEMA assumed the leading role during the H1N1 pandemic in Tennessee. On the one hand, DOH had the resources, expertise, and contacts to address public health issues because of its background in health matters. On the other hand, TEMA would have addressed the security and logistic concerns since it had developed expertise in these areas over the years.
The agencies involved in emergency response should ramp-up resources in a progressive manner depending on the magnitude of the situation (McCormick et al., 2009). According to Barrios et al. (2012), the deployment of resources should follow a rational plan to prevent the incidences of overutilization. An influenza pandemic often expands in scope and magnitude as the virus spreads. It is illogical to deploy all the resources at once during the initial stages of outbreak. Such an action may constrain the capacity to respond to a fully blown situation in the future (McCormick et al., 2009). The authorities at Tennessee abdicated TEMA’s lead role to DOH after realizing that the pandemic would not increase in severity based on the initial assessment.
The development of efficient communication channels is essential to coordinate interagency efforts during a pandemic (Nelson et al., 2007). Interagency collaboration mechanisms are often complicated because the organizations involved have conflicting interests. These agencies may move in different directions without a clear chain of command (McCormick et al., 2009). The state of Tennessee ensured efficient communication by within the team through the establishment of the State Health Operations Center (SHOC). The principal function of SHOC was to act as a conduit for coordinating and disseminating information between the state authorities and their partners. This was an integral task because Tennessee has a hybrid public health system.
A two-way communication and collaboration between authorities and the public is an elemental strategy to dispel fear. The deleterious social and health effects of pandemics usually cause anxiety among community members (McCormick et al., 2009). The residents look to their local leaders to provide timely and accurate information. In the same vein, the contagious nature of pandemics requires the delivery of risk planning and reduction information (Nelson et al., 2007). Nelson and his colleagues have identified risk communication as one of the essential aspects that keep the local communities apprised of the risks and prevention measures. The Tennessee health authorities worked closely community leaders to prevent an explosive spread of the virus. For instance, these authorities engaged with school administrators on the issue of school closures.
Health authorities and their partners should work closely with the media during a pandemic. Media channels play a significant role in reducing the risk of cross-transmission. The media serves as the primary source of information for the masses (Nelson et al., 2007). Conversely, speculative and sensationalized reporting can increase anxiety and fear. As such, the disaster management team should keep the media informed to avoid these challenges (McCormick et al., 2009). The senior public health officials in Tennessee held conferences and briefs with representatives of media organizations. The authorities also participated in talk shows on both the radio and television to respond to the concerns of the public. These correspondences facilitated the dissemination of crucial information.
The emergency response team should use the established guidelines and protocols to minimize the spread of pandemics. National and international protocols provide best practices based on scientific evidence (Barrios et al., 2012). According to McCormick et al. (2009), these standards should inform the development of strategies that are necessary to counter the emergency. For example, Tennessee relied on policy updates from the CDC to determine the closure of schools. Conversely, some of these provisions may not address unique circumstances considering the unpredictability of emergencies. Health authorities should instead revise these guidelines based on the situation on the ground (Barrios et al., 2012). Tennessee adopted this strategy when one school reported a positive diagnosis after the CDC had relaxed its school closure policy.
The implementation of the pandemic response should consider legal and ethical issues relating to the distribution of scarce resources. Health agencies face the challenge of prioritizing the distribution of the vaccines, medications, and beds in intensive care units (Thomas, Dasgupta, & Martinot, 2007). Tennessee experienced a shortage of vaccines because of delays in production and distribution. In addition, the state recorded a surge of patients at the Le Bonheur Children’s Hospital due a severe outbreak among children. These challenges require the emergency response team to develop both implicit and explicit measures to rationalize the distribution of vaccines and antiviral drugs (Coleman, 2009).
First, Influenza pandemic has the potential to overwhelm the medical system. Jhung et al. (2013) have asserted that the overutilization of the emergency department imposes an immense stress on hospital resources. Consequently, Barrios et al. (2012) have demonstrated that patients who need urgent care desperately may leave the hospital without receiving any medical attention. Health facilities and departments should develop rational patient care pathways to ensure that only deserving patients utilize the emergency services. Le Bonheur Children’s Hospital addressed the surge at the surge at the facility by redirecting patients to hospitals with low capacity. This plan would not have succeeded without efficient triaging and communication.
The development and implementation of public health education and promotion is essential to minimize the spread of pathogens. Although vaccines and antiviral offer protection, they do not provide a cure (Thomas, Dasgupta, & Martinot, 2007). The execution of public health countermeasures reduces the risk of exacerbation significantly. The emergency response team should work with the local authorities, the media, and other partners to educate the public about the modes of influenza transmission (Coleman, 2009). For example, the interdisciplinary team should distribute information fliers and pamphlets, as well as establish a call centre where people can get accurate information (Nelson et al., 2007). One of the major challenges of vaccinations is the low rates of compliance because of religious or philosophical reasons. Health education can benefit defaulters and minimize the risk of exposure (Thomas, Dasgupta, & Martinot, 2007).
Secondly, the contagious nature of pandemics may necessitate the use of restrictive measures (quarantine, travel restrictions, and social distancing). Nonetheless, these strategies raise fundamental questions regarding human rights and liberties (Barrios et al., 2012). Health authorities should communicate effectively to justify the use of quarantine and other containment strategies instead of making unilateral decisions. Thomas, Dasgupta, and Martinot (2007) have indicated that health authorities carry the legal mandate of ensuring that disease containment measures do not stigmatize or harm the affected individuals. The health authorities should ensure that the affected individuals have full access to essential goods and services to prevent human suffering (Barrios et al., 2012).
References
Barrios, L. C., Koonin, L. M., Kohl, K. S., & Cetron, M. (2012). Selecting nonpharmaceutical strategies to minimize influenza spread: The 2009 influenza A (H1N1) pandemic and beyond. Public Health Reports, 127, 565–571.
Coleman, C. H. (2009). Allocating vaccines and antiviral medications during an influenza pandemic. Seton Hall Law Review, 39(4), 1111-1123.
Jhung, M. A., Epperson, S., Biggerstaff, M., Allen, D., Balish, A., Barnes, N., … Finelli, L. (2013). Outbreak of variant influenza A (H3N2v) virus in the United States. Clinical Infectious Diseases, 57, 1703–1712.
McCormick, L. C, Yeager, V. A., Rucks, A. C., Ginter, P. M., Hansen, S., Kazzi, Z. N., & Menachemi, N. (2009). Pandemic influenza preparedness: Bridging public health academic and practice. Public Health Representative, 124, 344–349.
Nelson, C., Lurie, N., Wasserman, J., & Zakowski, S. (2007). Conceptualizing and defining public health emergency preparedness. American Journal of Public Health, 97(1), S9-S11.
Thomas, J. C., Dasgupta, N., & Martinot, A. (2007). Ethics in a pandemic: A survey of the state pandemic influenza plans. American Journal of Public Health, 97(1), S26-S31.