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      Pandemic Influenza Planning in the United States from a Health Disparities Perspective

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          Abstract

          Preparedness plans must account for the fact that illness and death rates may differ for members of some socioeconomic and racial/ethnic groups during a pandemic.

          Abstract

          We explored how different socioeconomic and racial/ethnic groups in the United States might fare in an influenza pandemic on the basis of social factors that shape exposure, vulnerability to influenza virus, and timeliness and adequacy of treatment. We discuss policies that might differentially affect social groups’ risk for illness or death. Our purpose is not to establish the precise magnitude of disparities likely to occur; rather, it is to call attention to avoidable disparities that can be expected in the absence of systematic attention to differential social risks in pandemic preparedness plans. Policy makers at the federal, state, and local levels should consider potential sources of socioeconomic and racial/ethnic disparities during a pandemic and formulate specific plans to minimize these disparities.

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          Pandemic versus epidemic influenza mortality: a pattern of changing age distribution.

          L Simonsen, M J Clarke, L B Schonberger … (1998)
          Almost all deaths related to current influenza epidemics occur among the elderly. However, mortality was greatest among the young during the 1918-1919 pandemic. This study compared the age distribution of influenza-related deaths in the United States during this century's three influenza A pandemics with that of the following epidemics. Half of influenza-related deaths during the 1968-1969 influenza A (H3N2) pandemic and large proportions of influenza-related deaths during the 1957-1958 influenza A (H2N2) and the 1918-1919 influenza A (H1N1) pandemics occurred among persons <65 years old. However, this group accounted for decrementally smaller proportions of deaths during the first decade following each pandemic. A model suggested that this mortality pattern may be explained by selective acquisition of protection against fatal illness among younger persons. The large proportion of influenza-related deaths during each pandemic and the following decade among persons <65 years old should be considered in planning for pandemics.
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            Early administration of oral oseltamivir increases the benefits of influenza treatment.

            D MacLeod, E Waalberg, C. Ward … (2002)
            Our objective was to evaluate the benefit of early treatment of influenza illness using oral oseltamivir. This open-label, multicentre international study investigated the relationship between the interval from illness onset to first dose (time-to-treatment) and illness duration in the intent-to-treat infected population using accelerated failure time (AFT) modelling. A total of 1426 patients (12-70 years) presenting within 48 h of the onset of influenza symptoms were treated with oseltamivir 75 mg twice a day for 5 days during the 1999-2000 influenza season; 958 (67%) had laboratory-confirmed influenza virus infection. Earlier intervention was associated with shorter illness duration (P < 0.0001). Initiation of therapy within the first 12 h after fever onset reduced the total median illness duration by 74.6 h (3.1 days; 41%) more than intervention at 48 h. Intermediate interventions reduced the illness proportionately compared with 48 h. In addition, the earlier administration of oseltamivir further reduced the duration of fever, severity of symptoms and the times to return to baseline activity and health scores. Oseltamivir was well tolerated. The most common adverse events were nausea and vomiting, which were transient and generally occurred only with first dosing. When oseltamivir was taken with food, the tolerability was enhanced. The overall discontinuation rate was low (1.8%). In conclusion, the IMPACT study demonstrated that earlier initiation of oral oseltamivir therapy increased its therapeutic effects, which were seen at every time point of intervention and were progressive. Thus, early presentation, diagnosis and treatment of patients with influenza maximized the benefits of oseltamivir therapy.
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              Use of the selective oral neuraminidase inhibitor oseltamivir to prevent influenza.

              F Hayden, L Huson, R Poretz … (1999)
              Safe and effective antiviral agents are needed to prevent infection with influenza A and B virus. Oseltamivir (GS4104), which can be administered orally, is the prodrug of GS4071, a potent and selective inhibitor of influenzavirus neuraminidases. We studied the use of oseltamivir for long-term prophylaxis against influenza in two placebo-controlled, double-blind trials at different U.S. sites during the winter of 1997-1998. We randomly assigned 1559 healthy, nonimmunized adults 18 to 65 years old to receive either oral oseltamivir (75 mg given once or twice daily, for a total daily dose of 75 or 150 mg) or placebo for six weeks during a peak period of local influenzavirus activity. The primary end point with respect to efficacy was laboratory-confirmed influenza-like illness (defined as a temperature of at least 37.2 degrees C accompanied by at least one respiratory and at least one systemic symptom). In the two studies combined, the risk of influenza among subjects assigned to either once-daily or twice-daily oseltamivir (1.2 percent and 1.3 percent, respectively) was lower than that among subjects assigned to placebo (4.8 percent; P<0.001 and P=0.001 for the comparison with once-daily and twice-daily oseltamivir, respectively). The protective efficacy of oseltamivir in the two active-treatment groups combined was 74 percent (95 percent confidence interval, 53 to 88 percent) at all the sites combined and 82 percent (95 percent confidence interval, 60 to 93 percent) at sites in Virginia, where the rate of influenza infection was higher than the overall rate. For culture-proved influenza, the rate of protective efficacy in the two oseltamivir groups combined was 87 percent (95 percent confidence interval, 65 to 96 percent). The rate of laboratory-confirmed influenza infection was lower with oseltamivir than with placebo (5.3 percent vs. 10.6 percent, P<0.001). Oseltamivir was well tolerated but was associated with a greater frequency of nausea (12.1 percent and 14.6 percent in the once-daily and twice-daily groups, respectively) and vomiting (2.5 percent and 2.7 percent, respectively) than was placebo (nausea, 7.1 percent; vomiting, 0.8 percent). However, the frequency of premature discontinuation of drug or placebo was similar among the three groups (3.1 to 4.0 percent). Oseltamivir administered daily for six weeks by the oral route is safe and effective for the prevention of influenza.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Emerg Infect Dis
                Journal ID (publisher-id): EID
                Title: Emerging Infectious Diseases
                Publisher: Centers for Disease Control and Prevention
                ISSN (Print): 1080-6040
                ISSN (Electronic): 1080-6059
                Publication date (Print): May 2008
                Volume: 14
                Issue: 5
                Pages: 709-715
                Affiliations
                [* ]Weill/Cornell Medical College, Ithaca, New York, USA
                [† ]University of California, Berkeley, California, USA
                [‡ ]University of California, San Francisco, California, USA
                [§ ]Robert Wood Johnson Foundation, Princeton, New Jersey, USA
                [1 ]Current affiliation: University of California, San Francisco, California, USA
                Author notes
                Address for correspondence: Susan Egerter, Senior Epidemiologist, Department of Family and Community Medicine, University of California San Francisco, 3333 California St, Suite 365, UCSF Box 0943, San Francisco, CA 94118, USA; email: egerters@ 123456fcm.ucsf.edu
                Article
                Publisher ID: 07-1301
                DOI: 10.3201/eid1405.071301
                PMC ID: 2600245
                PubMed ID: 18439350
                SO-VID: 88afc9f8-715a-48ff-ae7a-ccd6f1fc8a5d
                History
                Categories
                Subject: Perspective

                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: disease outbreaks,ethnic groups,perspective,influenza a virus,socioeconomic factors,health services accessibility,influenza,human epidemiology,disaster planning
                Data availability:
                ScienceOpen disciplines: Infectious disease & Microbiology
                Keywords: disease outbreaks, ethnic groups, perspective, influenza a virus, socioeconomic factors, health services accessibility, influenza, human epidemiology, disaster planning

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