Friday, September 26, 2014

MMWR: Updated Preparedness and Response Framework for Influenza Pandemics


Hypothetical Influenza Outbreak Curve


# 9016


Last year the World Health Organization Unveiled New Pandemic Guidance, replacing their old pandemic phase system (3 pre-pandemic phases+ 3 pandemic phases+2 post-pandemic phases) with a more streamlined 4-phase system.



As you’ll note, this system utilizes `soft’ transitions from one phase to the next, indicating that changes may happen slowly, or at different rates in different regions, rather than abruptly.  The interpandemic phase is a time for preparedness, while the response is ramped up once an alert is sounded.


Yesterday the CDC published a new pandemic preparedness and response framework that aligns the CDC’s pandemic phase system more closely with the WHO’s, although there are some differences.


According the the CDC, this update `provides greater detail and clarity regarding the potential timing of key decisions and actions aimed at slowing the spread and mitigating the impact of an emerging pandemic’.

This is a fairly lengthy update, and so I’ve only posted the summary.  Follow the link below to read it in its entirety.  When you return, I’ll have a bit more.


Updated Preparedness and Response Framework for Influenza Pandemics

Recommendations and Reports

September 26, 2014 / 63(RR06);1-9

Prepared by Rachel Holloway1, Sonja A. Rasmussen, MD1, Stephanie Zaza, MD2, Nancy J. Cox, PhD3, Daniel B. Jernigan, MD3, with the Influenza Pandemic Framework Workgroup

1Influenza Coordination Unit, Office of Infectious Diseases

2Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

3Influenza Division, National Center for Immunization and Respiratory Diseases

Corresponding preparer: Sonja A. Rasmussen, MD, CDC. Telephone: 404-639-2297; E-mail:


The complexities of planning for and responding to the emergence of novel influenza viruses emphasize the need for systematic frameworks to describe the progression of the event; weigh the risk of emergence and potential public health impact; evaluate transmissibility, antiviral resistance, and severity; and make decisions about interventions. On the basis of experience from recent influenza responses, CDC has updated its framework to describe influenza pandemic progression using six intervals (two prepandemic and four pandemic intervals) and eight domains.

his updated framework can be used for influenza pandemic planning and serves as recommendations for risk assessment, decision-making, and action in the United States. The updated framework replaces the U.S. federal government stages from the 2006 implementation plan for the National Strategy for Pandemic Influenza (US Homeland Security Council. National strategy for pandemic influenza: implementation plan. Washington, DC: US Homeland Security Council; 2006. Available at ).

The six intervals of the updated framework are as follows: 1) investigation of cases of novel influenza, 2) recognition of increased potential for ongoing transmission, 3) initiation of a pandemic wave, 4) acceleration of a pandemic wave, 5) deceleration of a pandemic wave, and 6) preparation for future pandemic waves. The following eight domains are used to organize response efforts within each interval: incident management, surveillance and epidemiology, laboratory, community mitigation, medical care and countermeasures, vaccine, risk communications, and state/local coordination.

Compared with the previous U.S. government stages, this updated framework provides greater detail and clarity regarding the potential timing of key decisions and actions aimed at slowing the spread and mitigating the impact of an emerging pandemic. Use of this updated framework is anticipated to improve pandemic preparedness and response in the United States. Activities and decisions during a response are event-specific. These intervals serve as a reference for public health decision-making by federal, state, and local health authorities in the United States during an influenza pandemic and are not meant to be prescriptive or comprehensive. This framework incorporates information from newly developed tools for pandemic planning and response, including the Influenza Risk Assessment Tool and the Pandemic Severity Assessment Framework, and has been aligned with the pandemic phases restructured in 2013 by the World Health Organization.

(Continue . . . )

Despite their (mostly cosmetic) differences, both the CDC and the WHO stress that the time before the next pandemic strikes is a time for preparedness.   While there’s a perception that pandemics only come around every few decades, and most are – if not mild, at least manageable -  there are no guarantees how long it will be before the next severe one arrives.

Earlier this month, in NPM14: Because Pandemics Happen I wrote about both the history of pandemics, and the concerns held by some of the highest offices in the land over the potential impact of the next pandemic.


Many agencies consider pandemics to be among the top threats to national and global security.

While most people think that their state or federal government are prepared to handle the next pandemic, the Feds continue to remind us that they can’t handle a major disaster – including a pandemic – without the help of everyone involved.


Which is why September of every year is declared National Preparedness Month, where  FEMA and encourage everyone to prepare for a variety of disaster situations.  


And it’s not just me saying it.  This from


Pandemic Flu

The federal government cannot prepare for or respond to the challenge of a flu pandemic alone. Your community can develop strategies that reduce the impact and spread of pandemic flu.

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist (PDF – 68.91 KB)

Lista de Preparacion para una Pandemia de Gripe Tanto para Organizaciones Comunitarias como Religiosas (PDF – 268 KB)

Community Strategy for Pandemic Influenza Mitigation (PDF – 10.3 MB)

Plan Now to Be Ready for the Next Flu Pandemic (PDF – 213.55 KB)

The Next Flu Pandemic: What to Expect (PDF – 226.83 KB) (excerpts below)



Their advice (and this is for before a pandemic threat becomes imminent).