July 2006
Literature Review
How prepared is Europe for pandemic influenza: Analysis of national plans
Go to full text in PubMed: Mounier-Jack S, Coker JR Lancet 2006;367;1405
The authors surveyed the National Pandemic Influenza plans for 25 European Union countries, Bulgaria, Romania, Norway and Switzerland using the WHO checklist for influenza epidemic preparedness (WHO). WHO/CDS/CSR/GIP/2005.4 Geneva.World Health Organization, 2005.
The results were based on 21 national plans that were eligible by inclusion criteria; these represented 93% of the population reviewed.
The highest scores were for: France, Germany, Ireland, Netherlands, Sweden, Switzerland and the UK. Review of the plans indicated that attack rates were estimated at 15-50%, anticipated mortality was usually estimated at 230-465/100,000, hospital admissions were projected at 40-2,770/100,000, the coordinating body was always the Ministry of Health and the most common legal issues included were: quarantine, compulsory vs. voluntary vaccination and liability for adverse reactions related to the vaccine.
Public health issues dealt with surveillance plans, availability of an in-country lab, restricted travel, public gatherings and school closures and quarantine. Most of the plans dealt with these issues including at least 15 for each of the designated categories among the 21 plans reviewed.
For medical management, antivirals were recommended by all plans for treatment and by 18/21 plans for prophylaxis. The highest priority for both antivirals and vaccine administration were health care workers for the majority of the plans. A summary of these plans is provided in the following tabulation:
| Predictions and administration | |
| Attack rates | 15-50% |
| Death rates (/100,000) | 14-1685 |
| Most (/100,000) | 230-465 |
| Hospital admissions (/100,000) | 40-2707 |
| Usual coordinating body | Ministry of Health |
| Most common legal issue | Quarantine, compulsory vaccine & vaccine ADR |
| Public health | |
| Lead role of public health agency for planning | 21/21 |
| Surveillance plan | 21/21 |
| WHO-approved in-country lab | 19/21 |
| Link to animal surveillance | 17/21 |
| School closures expected | 19/21 |
| Restricted public gatherings | 17/21 |
| Quarantine-voluntary | 9 |
| Possibly mandatory | 14 |
| Travel restrictions - international | 15 |
| Medical management | |
| Recommend antivirals for treatment | 21 |
| Recommend antivirals for prophylaxis | 18 |
| Priorities for antivirals-defined | 16 |
| Top priority-health care workers | 11/16 |
| High risk groups | 4/16 |
| Immunization-entire population | 14/20 |
| Top priority-health care workers | 15/20 |
| Second priority-essential workers | 12/20 |
| Third priority-person at risk for serious complications | 11/20 |
Conclusions: The authors conclude that there is “strong” governmental commitment in most European countries for pandemic influenza preparedness.
Comment: The data reviewed appear to show that Europe is substantially ahead of the US in virtually every category. In large part, this is related to the fact that in the US much of the planning reviewed is relegated to states and major metropolitan areas. Problems at this level are that response has been slow and poorly funded. Further, in Europe, the great majority of health care is managed by national plans that have ownership and control. By contrast, the US system of health care is largely private, independent, financially distressed and poorly coordinated for any integrated response to a health care crisis.
Literature Review by John G. Barlett, M.D. Professor, Division of Infectious Diseases