H1N1 COUNTERMEASURES STRATEGY AND ... - PHE Home

NBSB Pandemic Influenza Working Group
Detailed Report
(BRFSS) to get population data, and we have ILINet. The systems we had in place
turned out to be pretty good, more robust than we anticipated.
Dr. Meltzer: The model that tried to estimate how many samples could be delivered to
public health labs in the middle of an epidemic, also tried to estimate the capacity of labs
to deal with the epidemic, (one was a influenza lab) and the lab capacity for response to
bioterrorism events through the LRN network. The results showed labs had limited surge
capacity, which is no surprise. Having more machines helps, but the biggest limitation is
personnel and sometimes just the physical space. With limited capacity, you need to
triage, plan up front, and stick to it. Analyzing 600 specimens per day is not enough to
meet the need, and that’s optimistic, because it pays no attention to the degradation of
capacity during the pandemic; like school closings, workers going home, staff exhausted.
You have to assume all the labs will be working at full capacity, and there will be no one
to borrow from.
Here are some of the things we’ve learned: First, you should determine your total
capacity and divide that by the number of tests per day per shift. Patient management is
not a priority - that’s separate. Public health testing and clinical management are
separate. And you need to manage that strictly or the labs will be overwhelmed, and then
they can’t fulfill their essential public service.
Among the main goals for public health labs is to determine the burden of disease - the
attack rate. CDC wants labs to report illness per day, each week, but that’s not going to
happen. The best solution would be well-designed sampling that gives an accurate
reading, and expect that there will be large confidence intervals.
Hospitalization data are useless for planning, because the y-axis is missing data. With
antiviral testing, we want to know, as the pandemic progresses, is the treatment working?
That’s essential information - virologic surveillance and antigenic transformation. Those
are the four key issues. You can allow for flexibility, but those are the issues for both
pandemic influenza and bioterrorism. It requires a change in culture, and I think people
are starting to realize that with our first-wave outbreak.
In your communication to lab directors and to the people sending them samples,
prioritization must be clear. Any expectations of markedly increasing capacity are not
realistic. Then there’s the international side; CDC will be overwhelmed if international
sites need help.
Dr. Neuzil: I can think of at least one very good public health reason for individual
clinical testing: to guide the use of antivirals or other scarce resources. Was anything
learned about rapid tests from this outbreak? In regular seasonal influenza, I think the
tests are better in children and when used earlier. Is it different for H1N1?
Dr. Jernigan: My data come from lots of adults. I think you may see better
performance in kids, with higher viral loads, and when you test earlier. There are a
number of variables that determine performance. It’s hard to do any evaluation of
comparability. The value of a positive result is clear - you can use that to support
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