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Dark Clouds on the Horizon: Preparing for the Next Influenza Pandemic, Part 1

Authors: David N. Fisman, MD, MPHFaculty and Disclosures



Infectious diseases have been a source of social disruption, misery, and death throughout human history, and reports of the effects of major epidemics appear early in recorded history. As medical and public health practitioners prepare for the next major influenza pandemic, it is interesting to review the writings of the Greek historian Thyucidides, who described what may have been the first recorded influenza pandemic: the Great Plague of Athens (ca. 430 BC). As Thyucidides (translated by Prof. Rex Warner) wrote:

At the beginning the doctors were quite incapable of treating the disease...[i]n fact mortality among the doctors was highest of all, since they came more frequently in contact with the sick...Words indeed fail when one tries to give a general picture of this disease; and as for the sufferings of individuals, they seemed almost beyond the capacity of human beings to endure...Some died in neglect, some in spite of every possible care being taken of [recognized method of treatment] existed...Those with strong constitutions were no better able than the weak to resist the disease, which carried away all alike...The most terrible thing of all was the despair into which people fell when they realized that they had caught the plague; for they would immediately adopt an attitude of utter hopelessness.[1]

More than 2 millennia later, the devastating 1918-1919 influenza pandemic appeared, again in the context of a massive military conflict. The linkage between influenza pandemic and the mass movement of populations associated with the First World War is unlikely to be a coincidence. It has been suggested that a massive British supply depot at Etaples, in northern France, was the birthplace of the 1919 pandemic strain, with food animals (eg, chickens, ducks, and pigs) and large populations of soldiers living in close proximity necessary to provide opportunities for selection of an avian influenza strain characterized by efficient person-to-person transmission.[2]

At the start of the new millennium, the threat of a potentially devastating pandemic is again on the horizon. In this column, I provide a necessarily brief review of the current issues related to pandemic influenza, including the relationship between pandemic and seasonal influenza epidemiology and control; recent developments in the spread and evolution of the highly pathogenic avian influenza H5N1 virus subtype (HPAI); key concepts in pandemic influenza planning for communities, healthcare institutions, and businesses; and the utilization of both pharmacologic and nonpharmacologic measures for pandemic control. Finally, I review some valuable lessons for pandemic influenza planning in North America that were learned during the 2003 SARS outbreak in Toronto, Ontario, Canada.[3]

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