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Abkhazia: Pandemic Influenza Phases

Written by Ramaz Mitaishvili

Sunday, 25 November 2007

Ramaz Mitaishvili, MD

Glendale, CA

Pandemic influenza is considered to be a relatively high probability event, yet no one knows when the next pandemic will occur and there may be very little warning. Most experts believe that there will be between one to six months between the identification of a novel influenza virus and the time that widespread outbreaks begin to occur in the Abkhazia and Caucasus region as well as Bleak Sea countries. Outbreaks are expected to occur simultaneously throughout the all those areas, preventing relocation of human and material resources. The effect of influenza on individual communities will be relatively prolonged, an estimated six to eight weeks. Due to the prolonged nature of a pandemic influenza event, the World Health Organization (WHO) has defined phases to a pandemic in order to facilitate coordinated plans (Table 1). The Abkhazia Institute for Social and Economic Research has developed its own pandemic phases for planning purposes, convenient for proposed Center for Disease Control and Prevention (Table 2).

Table 1: WHO Pandemic Influenza Phases

Period	Phase	Description
Inter-pandemic	1	No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk (a) of human infection or disease is considered to be low.
Inter-pandemic	2	No new influenza virus subtypes have been detected in humans However, a circulating animal influenza virus subtype poses a substantial risk (a) of human disease.
Pandemic Alert	3	Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact (b).
	4	Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans (b).
	5	Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk).
Pandemic	6	Increased and sustained transmission in general population (b).

(a) The distinction between phase 1 and phase 2 is based on the risk of human infection or disease resulting from circulating strains in animals. The distinction is based on various factors and their relative importance according to current scientific knowledge. Factors may include pathogenicity in animals and humans, occurrence in domesticated animals and livestock or only in wildlife, whether the virus is enzootic or epizootic, geographically localized or widespread, and/or other scientific parameters.

(b) The distinction between phase 3, phase 4 and phase 5 is based on an assessment of the risk of a pandemic. Various factors and their relative importance according to current scientific knowledge may be considered. Factors may include rate of transmission, geographical location and spread, severity of illness, presence of genes from human strains (if derived from an animal strain), and/or other scientific parameters.

Table 2: AISER Pandemic Influenza Phases

Corresponding WHO Period	AISER Phase	Description
Inter-pandemic (1&2)	1	No new influenza virus subtypes have been detected in humans.
Pandemic Alert (3)	2	Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact.
Pandemic Alert (4&5) Pandemic (6)	3	Human to human transmission occurring Limited transmission in other countries (but not in Abkhazia) or widespread transmission in other countries.
Pandemic	4	Widespread transmission in Georgia (but not in Abkhazia) and/or limited transmission in Abkhazia
Pandemic	5	Increased and sustained transmission in Abkhazia population