California Health Department Lays Out State Plan for Pandemic Flu Response
By Jenny Lim
STANFORD, CA Feb. 23- For those who have read California's pandemic flu preparedness plan, tomorrow is the last day to give the 170-page document a written review.
Feb. 24 is the final day of a five-week period for public comment on the state's official Pandemic Influenza Preparedness and Response Plan. The California Department of Health Services released the document Jan. 18, posting it on the department's Web site, www.dhs.ca.gov.
CDHS invited the public to e-mail remarks on the plan. According to a Jan. 18 press release, the department will review all comments and release a summary of the feedback this spring. The final prevention plan, with any revisions prompted by the public's critiques, will also be published in the spring.
The heath department felt it was important to get public feedback on the document, said CDHS spokesperson Tacey Derenzy. She said 42 people had submitted comments about the plan as of Feb. 23.
The document outlines key assumptions for the state's planning and response to an avian flu outbreak, including a blueprint for California's emergency management structure at the time of a pandemic. The duration of a pandemic influenza is unknown.
According to the document, CDHS will be the lead state agency for the pandemic response. California's health department director and public health officer will be responsible for CDHS' pandemic operations. Sandra Shewry serves as the current director, while Dr. Mark Horton is the chief medical officer for California.
The plan lists 11 CDHS departments and committees that will collaborate during a pandemic. They include: a Disaster Policy Council of CDHS executive staff who will advise the health department director; a Risk Communication Team of public affairs and disease control division employees; and a Joint Advisory Committee to counsel CDHS on pandemic flu policies. The prevention plan does not specify who is appointed to any of these groups.
CDHS will not be the only organization heading the response effort. While the department is in charge of public health during a pandemic, the Governor's Office of Emergency Services, the Emergency Medical Services Authority and the California Health and Human Services Agency will play principal roles in coordinating the state response. The prevention plan states local health departments are the "lead entities for pandemic planning on a community level."
The preparedness plan lists 116 acronyms and abbreviations for medical lingo, agencies and titles of officials involved in the pandemic response.
According to the document, the state's public health priorities will differ with each change in the pandemic's phase. The World Health Organization utilizes a series of six phases of pandemic alert as a warning system of an infectious disease's threat to public health. According to WHO, the global pandemic phase is at stage 3: a virus is causing some human disease, but has not mutated into a form that can spread efficiently from person to person.
The federal Centers for Disease Control, in coordination with WHO, will designate the U.S. pandemic phase. California will operate under the U.S. phase alert, which is also at level 3, according to the CDC Web site.
At phase 3, the priorities of the federal and local government are: ensuring rapid and early detection of the mutated H5N1 strain, and facilitating the response to any new avian influenza cases.
The California preparedness plan includes nine appendices that outline state operations before and after an outbreak, from strategies for influenza surveillance to California laboratory capacity for monitoring the H5N1 virus. Two appendices describe the state's proposed pandemic vaccine and anti-viral programs.
"A vaccine is the first and foremost effective" measure to stop the pandemic, said Michael Earls of Trust for America's Health, a non-profit, non-partisan health advocacy organization in Washington, D.C. But Earls said it will take six to nine months to create a vaccine to combat the mutated H5N1 strain that triggers a pandemic. States must wrestle with deciding who gets the vaccine first, since it initially will be in scarce supply, he said.
The plan's Appendix 6A lists five categories of people who would receive priority for vaccination in this state. The target populations are divided into a total of 69 sub-categories. Target groups include: persons with high risk of developing flu complications, such as pregnant women or people with chronic medical conditions; healthcare professionals; public administration, justice and safety workers; professionals in non-health industries, like postal workers or social service agency employees; and healthy populations.
The U.S. Department of Health and Human Services listed national vaccine priority recommendations in the federal pandemic influenza plan, which was released in November 2005. But the national recommendations are comprised of broad categories, such as "healthcare workers" or "persons ages 2 to 64 at high risk of influenza complications." The H.H.S. plan directs state and local health departments to come up with more specific priority groups.
The state preparedness plan does not yet rank its vaccine priority groups. CDHS will finalize its prioritization after completing a survey that asks occupational, health and public representatives to rank the groups. The survey should be finished by August 2006.
Contacy Jenny Lim at jennylim@stanford.edu
