The September issue of the Emerging Infectious Diseases includes a policy review that assesses variability in state plans to contain pandemic influenza. The report reviewed 49 of 50 states’ pandemic influenza plans (Lousiana was the only state without one on the web), and focused on three key areas: vaccination, surveillance & detection, and containment measures. Although the report describes variability in the first two areas, containment strategies–such as legal and practical plans for quarantine–showed the most marked heterogeneity:
…confusion and lack of specificity exist in these posted state plans in proposing practical containment measures in the community.
The authors, all from the Research Triangle Institute International (RTII), make helpful recommendations to fill this gap:
Several practical nonpharmaceutical containment steps need to be considered. For example, only approximately one third of the state plans are explicitly considering recommending self-isolation of adults with influenzalike symptoms and keeping children with such symptoms home from school and daycare. Even in this increasingly computer-based economy, in which a considerable percentage of persons can work from home most of the time, this simple stratagem is not addressed in most state plans. Other simple recommendations for use in the community, such as avoiding mass gatherings; shopping on off hours; and household and workplace strategies such as frequent hand washing, avoiding handshaking, and keeping towels separate, are often neglected in state plans.
We should remember that health officials who fought against the spread of SARS in 2003 used extensive exposure control measures, including restrictions on mass gatherings and voluntary home quarantines. Many officials credited such measures as important to slowing disease spread, including CDC director Julie Gerberding. And a Harvard survey of Toronto citizens impacted by SARS demonstrates that the public is not as allergic to the idea as many think. Creative solutions, such as Singapore attention to workforce issues and Hong Kong’s guidance for business and special needs groups, should be thoughtfully considered.
The RTII researchers suggest lack of federal guidance and gaps in epidemiological knowledge as primary reasons for variable state plans, and recommend a revision of the national pandemic influenza plan. Such a revised plan should pay close attention to exposure controls like isolation, quarantine, community restrictions, and other practical containment measures.