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Avian Influenza: The Threatening Pandemic

Published by: Trimark Publications

Published: Aug. 16, 2006 - 139 Pages



Table of Contents


1. Overview

1.1 Statement of Report

1.2 Objectives

1.3 Methodology




2. Introduction and Executive Summary

2.1 Human and Avian Influenza Basics

2.2 Epidemiology of Avian Influenza

2.3 Diagnostics

2.4 Treatment

2.5 Preparedness

2.6 Economics

2.7 Market Projections




3. The Basics of Human Influenza

3.1 Influenza, the Disease


3.1.1 Symptoms

3.1.2 Transmission

3.1.3 Public Health Factors

3.1.4 Influenza Diagnosis


3.2 Influenza Viruses


3.2.1 Types, Subtypes, and Strains


3.2.1.1 Influenza Type A and Its Subtypes

3.2.1.2 Highly Pathogenic versus Lowly Pathogenic Avian Influenza A Viruses

3.2.1.3 Human Influenza Viruses and Avian Influenza A Viruses


3.2.1.3.1 Influenza A H5

3.2.1.3.2 Influenza A H7

3.2.1.3.3 Influenza A H9


3.2.1.4 Influenza Type B

3.2.1.5 Influenza Type C


3.2.2 How Influenza Viruses Change: Drift and Shift

3.2.3 Seasons and Human Influenza

3.2.4 Risk Factors and Human Influenza

3.2.5 Human Influenza Complications, Comorbidities and Dangers


3.2.5.1 Flu complications in children and teenagers


3.2.6 Human Influenza Prognosis


3.3 Pandemic Influenza

3.4 How Influenza Viruses Change




4. The Basics of Avian Influenza

4.1 Avian Influenza versus Human Influenza

4.2 Avian Influenza in Birds


4.2.1 Avian Influenza Outbreaks in Poultry

4.2.2 More information about avian influenza viruses


4.3 Transmission of Influenza A Viruses between Animals and People

4.4 Avian Influenza Infection in Humans


4.4.1 Instances of Avian Influenza Infections in Humans

4.4.2 Symptoms of Avian Influenza in Humans

4.4.3 Antiviral Agents for Influenza


4.5 Avian Influenza (H5N1)

4.6 Avian Influenza (H5N1) Outbreaks

4.7 All Types of Avian Influenza (Not Just H5N1) Worldwide Outside of Asia


4.7.1 Canada

4.7.2 Netherlands

4.7.3 United States


4.7.3.1 Delaware

4.7.3.2 Texas

4.7.3.3 Maryland

4.7.3.4 International Response

4.7.3.5 Available options





5. Epidemiology of Avian Influenza

5.1 Worldwide Avian Influenza

5.2 H5N1 avian influenza: timeline

5.3 U.S. Avian Influenza




6. Influenza Diagnosis & Laboratory Issues

6.1 “Classic” Methods for Influenza Diagnosis

6.2 Example Lab: Yale New Haven Hospital (YNHH)

6.3 Conventional PCR Assay for Sub-typing Influenza Virus


6.3.1 Gel Analysis


6.4 Real Time TaqMan PCR


6.4.1 From PacMan to TaqMan - a computer game revisited

6.4.2 The advantages of real-time TaqMan PCR over conventional quantitative PCR


6.5 Example Strategy for Avian Influenza

6.6 Laboratory safety issues for H5N1 viruses


6.6.1 Biosafety Level 3

6.6.2 Biosafety Level 3 -Ag

6.6.3 CDC Criteria for testing

6.6.4 What samples are needed?




7. Preparedness

7.1 Education

7.2 Ethical and Legal Issues

7.3 Worldwide


7.3.1 Overarching goals, objectives and actions for WHO and national authorities, by phase


7.3.1.1 Interpandemic period, phase 1 - Overarching goal

7.3.1.2 Interpandemic period, phase 2 - Overarching goal

7.3.1.3 Pandemic alert period, phase 3 - Overarching goal

7.3.1.4 Pandemic alert period, phase 4 - Overarching goal

7.3.1.5 Pandemic alert period, phase 5 - Overarching goal

7.3.1.6 Pandemic period, phase 6 - Overarching goal


7.3.2 Recommendations for non-pharmaceutical public health interventions


7.4 U.S.


7.4.1 U.S. Nationally

7.4.2 U.S. Locally


7.4.2.1 Community Preparedness Leadership and Networking

7.4.2.2 Surveillance

7.4.2.3 Public Health and Clinical Laboratories

7.4.2.4 Healthcare and Public Health Partners

7.4.2.5 Infection Control and Clinical Guidelines

7.4.2.6 Vaccine Distribution and Use

7.4.2.7 Antiviral Drug Distribution and Use

7.4.2.8 Community Disease Control and Prevention

7.4.2.9 Public Health Communications

7.4.2.10 Workforce Support: Psychosocial Considerations and Information Needs

7.4.2.11 State Plans



7.5 The Hospital Response


7.5.1 Introduction

7.5.2 Key Assumptions

7.5.3 Arrival

7.5.4 Triage

7.5.5 Isolation

7.5.6 Patient Movement

7.5.7 Communication

7.5.8 Medical Evaluation

7.5.9 Diagnosis

7.5.10 Treatment

7.5.11 Potential for Surge


7.6 Business Preparedness

7.7 School Preparedness

7.8 Individual Preparedness




8. Economics of Avian Influenza

8.1 Impact on Governments


8.1.1 Worldwide Economic Impact of Avian Flu

8.1.2 U.S. Nationally


8.2 Impact of a Pandemic


8.2.1 Supply Side Effect

8.2.2 Demand Side Effect




9. Fighting the Flu

9.1 The Worldwide Pharmaceutical Industry


9.1.1 FDA Approved Vaccines: Tamiflu and Relenza

9.1.2 Stockpiling

9.1.3 Total Avian Influenza Drug Market Size and Growth


9.2 Funding

9.3 Antiviral Agents for Influenza: Background Information


9.3.1 Introduction


9.3.1.1 2005-06 Antiviral Usage Recommendation


9.3.2 Neuraminidase Inhibitors (Zanamivir, Oseltamivir) 147io

9.3.3 How do the neuraminidase inhibitor drugs work?

9.3.4 How effective are the neuraminidase inhibitor drugs?


9.3.4.1.1 Treatment

9.3.4.1.2 Chemoprophylaxis


9.3.4.2 Side effects of the neuraminidase inhibitor drugs:

9.3.4.3 Antiviral resistance to the neuraminidase inhibitor drugs:


9.3.5 Adamantane Derivatives (Amantadine, Rimantadine)


9.3.5.1 Antiviral activity: How do the adamantane drugs work?

9.3.5.2 How effective are the adamantane drugs?


9.3.5.2.1 Treatment

9.3.5.2.2 Chemoprophylaxis


9.3.5.3 Side effects of the adamantane drugs:

9.3.5.4 Antiviral resistance:


9.3.6 Adamantanes Compared with Neuraminidase Inhibitors

9.3.7 Anti-Avian Influenza Drugs, Generics and Patents


9.3.7.1 Taiwan

9.3.7.2 India

9.3.7.3 Other countries


9.3.8 Regulatory Issues

9.3.9 New Anti-Avian Influenza Therapy

9.3.10 Pharmaceutical Business Perspective


9.3.10.1 A market dominated by GSK and Roche

9.3.10.2 Generic presence

9.3.10.3 Challenging Tamiflu



9.4 Other Treatment Requirements

9.5 Business Opportunities




LIST OF TABLES

Table 1: Probability of Influenza Diagnosis Using Office-Based Testing

Table 2: Prescribing Guidelines for Treating Influenza

Table 3: Influenza Virus Types

Table 4: H5N1 Cases and Deaths, Dec. 26, 2003, to June 8, 2005

Table 5: Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO

Table 6: Early (pre Wave I) events in Asia

Table 7: Wave I

Table 8: Wave II

Table 9: Wave III

Table 10: Methods for Influenza Diagnosis

Table 11: Summary of Current Clinical Virology Laboratory Tests for Influenza

Table 12: Interpandemic period, phase 1 - Planning and coordination

Table 13: Interpandemic period, phase 1 - Prevention and containment

Table 14: Interpandemic period, phase 1 - Health system response

Table 15: Interpandemic period, phase 1 - Communications

Table 16: Interpandemic period, phase 2 - Planning and coordination

Table 17: Interpandemic period, phase 2 - Situation monitoring and assessment

Table 18: Interpandemic period, phase 2 -Prevention and containment

Table 19: Interpandemic period, phase 2 - Health system response

Table 20: Interpandemic period, phase 2 - Communications

Table 21: Pandemic alert period, phase 3 - Planning and coordination

Table 22: Pandemic alert period, phase 3 - Situation monitoring and assessment

Table 23: Pandemic alert period, phase 3 -Prevention and containment

Table 24: Pandemic alert period, phase 3 - Health system response

Table 25: Pandemic alert period, phase 3 - Communications

Table 26: Pandemic alert period, phase 4 - Planning and coordination

Table 27: Pandemic alert period, phase 4 - Situation monitoring and assessment

Table 28: Pandemic alert period, phase 4 -Prevention and containment

Table 29: Pandemic alert period, phase 4 - Health system response

Table 30: Pandemic alert period, phase 4 - Communications

Table 31: Pandemic alert period, phase 5 - Planning and coordination

Table 32: Pandemic alert period, phase 5 - Situation monitoring and assessment

Table 33: Pandemic alert period, phase 5 -Prevention and containment

Table 34: Pandemic alert period, phase 5 - Health system response

Table 35: Pandemic alert period, phase 5 - Communications

Table 36: Pandemic period, phase 6 - Planning and coordination

Table 37: Pandemic period, phase 6 - Situation monitoring and assessment

Table 38: Pandemic period, phase 6 -Prevention and containment

Table 39: Pandemic period, phase 6 - Health system response

Table 40: Pandemic period, phase 6 - Communications

Table 41: National Measures (living or traveling within an affected country)

Table 42: International Measures (for entering or exiting a country)

Table 43: State & Local Planning Checklist - Community Preparedness Leadership and Networking

Table 44: State & Local Planning Checklist - Surveillance

Table 45: State & Local Planning Checklist - Public Health and Clinical Laboratories

Table 46: State & Local Planning Checklist - Healthcare and Public Health Partners

Table 47: State & Local Planning Checklist - Healthcare and Public Health Partners

Table 48: State & Local Planning Checklist - Vaccine Distribution and Use

Table 49: State & Local Planning Checklist - Antiviral Drug Distribution and Use

Table 50: State & Local Planning Checklist - Community Disease Control and Prevention

Table 51: State & Local Planning Checklist - Public Health Communications

Table 52: State & Local Planning Checklist - Workforce Support: Psychosocial Considerations and Information Needs

Table 53: Arrival

Table 54: Triage

Table 55: Isolation

Table 56: Patient Movement

Table 57: Communication

Table 58: Medical Evaluation

Table 59: Diagnosis

Table 60: Treatment

Table 61: Surge

Table 62: Plan for the impact of a pandemic on your business

Table 63: Plan for the impact of a pandemic on your employees and customers:

Table 64: Establish policies to be implemented during a pandemic

Table 65: Allocate resources to protect your employees and customers during a pandemic

Table 66: Communicate to and educate your employees:

Table 67: Coordinate with external organizations and help your community

Table 68: Planning and Coordination:

Table 69: Continuity of Student Learning and Core Operations:

Table 70: Infection Control Policies and Procedures:

Table 71: Communications Planning:

Table 72: Items to have on hand for an extended stay at home

Table 73: Immunizations FAQ

Table 74: WHO Global Plan for Pandemic Preparedness:

Table 75: Assumptions Underlying Estimates of the Supply-Side Impact of an Avian Flu Pandemic

Table 76: Assumed Declines in Demand, by Industry, in the Event of an Avian Flu Pandemic

Table 77: Top 30 pharmaceutical and biotech companies ranked by healthcare revenue (“Big Pharma”)

Table 78: Recommended Daily Dosage of Influenza Antiviral Medications for Treatment and Prophylaxis

Table 79: Examples of Preparedness Supplies

Abstract

The purpose of this TriMark Publications report is to describe the threatening world pandemic caused by avian influenza, also known as bird flu. This report discusses the origins of the disease, the bird-to-human infection risks, the catastrophic health crisis avian flu poses, and the efforts by world governments and international health organizations to mitigate of the impact the threat to humans. The U.S., Asia and Europe are the focus of this study. Primary attention is paid to the clinical market segment and, separately, to the medical procedures and supplies for the influenza infection control market. An analysis of the technology trends and developing areas of influenza infection science is provided, along with a review of the market for pharmaceutical agents, vaccines and hospital supplies in clinical use. Activity in research—including the factors that influence infection control—are addressed in this review. Also discussed are changes that have stimulated this disease and patterns of information processing in assessing its spread. Several subjects related to the major elements of influenza treatment such as disposable plastic supplies, needles and lancets are discussed only briefly because they are considered entirely different fields or markets. The goal of this report is to review the potential threat of a human influenza pandemic resulting from the avian flu virus. It defines the responses that are now being undertaken worldwide by governmental authorities to contain the spreading bird flu.

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