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Avian influenza: A bit of perspective needed
By Richard Mandsager, M.D.


October 27, 2005

It is impossible to watch the news or to pick up a newspaper without hearing or reading about H5N1 avian influenza ("bird flu"), antiviral drug shortages, vaccine stockpiling and, in the case of a pandemic, military-enforced quarantines. Talking heads describe past pandemics, such as the "Spanish flu" of 1918, which killed up to 50 million people worldwide. We see pictures of countless dead chickens. We learn about migratory Asian birds that might bring H5N1 to Alaska and the rest of North America.
jpg Richard Mandsager

Amidst all the increased media attention, a bit of perspective is important. A global influenza epidemic ("influenza pandemic") occurs only when a new virus appears and is transmitted efficiently from person to person. There were three pandemics during the last century, all involving strains of virus that evolved from avian influenza.

H5N1 primarily infects birds and rarely infects humans. However, the H5N1 strain is unusual in its severity. Over 100 persons in Asia have been infected with H5N1, and roughly half have died. Almost all had exposure to infected domestic poultry. In only a few instances has person-to-person spread of H5N1 infection been suspected. Although the recent spread of avian influenza to Europe is a major agricultural and economic threat, it is not a pandemic.

Scientists and public health experts agree that we cannot stop an influenza pandemic, but we can control and limit disease and death through early detection and a well-planned response. In Alaska, disease-monitoring systems are in place for detection of influenza. All laboratories in Alaska report positive influenza tests to the Alaska Department of Health and Social Services, Division of Public Health. The State Public Health Virology Laboratory cultures and identifies influenza viruses and is a member laboratory of the World Health Organization influenza surveillance network.

In addition to detection, response planning is underway. Several communities have hosted mass vaccination clinics - using regular flu shots - to test our ability to rapidly get drugs and vaccines into the mouths and arms of the people. The Alaska State Hospital and Nursing Home Association is working with hospitals to improve planning for medical care during a pandemic. House Bill 95, a new public health emergencies and disasters bill passed by the Alaska Legislature, was signed into law by Governor Frank Murkowski in June. This statute gives the State authority to contain the spread of contagious diseases using appropriate isolation and quarantine measures, but only if absolutely necessary. These preparedness measures yield double dividends in that they also improve readiness for natural disasters or terrorist attacks.

We are better prepared for a pandemic than ever before, but we are not ready yet. We must expand and improve disaster response plans. We must be sure that we can get critical information to the medical community and to the public rapidly. We must assure that rural Alaskans have access to medications, vaccine and health care, despite the challenges of distance and weather. Communication systems between federal, state, tribal, and local agencies must work during an emergency.

Tough decisions will need to be made quickly, often based on limited scientific data. How do we use limited drugs or vaccine when there isn't enough for everyone? In addition to the federal pharmaceutical stockpile, should we have a supply of antiviral drugs ready in Alaska? If so, how much should we purchase and who will pay for it? Are we willing to limit travel and public gatherings to reduce spread until protective vaccines are available, which often takes months after a new flu strain is identified? When will our federal public health partners publish a much-needed national pandemic plan?

One thing seems certain - there will be another influenza pandemic. It may not be the H5N1 avian strain that is so prominent in the news right now, but no matter which virus is the culprit or when it happens, our work is cut out for us.

Dr. Richard Mandsager
Alaska Department of Health & Social Services Public Health Division Director


On the Web:

The latest on influenza and the Alaska pandemic influenza plan can be found at




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