JEFFERSON CITY - In a room of state government normally reserved for coordinating responses to geological disasters, government officials met to plan for a biological one - a potential influenza pandemic.
Emergency response and public health officials from federal, state and local governments convened Wednesday at the State Emergency Operations Center for a two-day seminar and mock exercise on how best to coordinate efforts between agencies should a flu pandemic occur.
Such an event could prove crippling to the medical system and other societal institutions, according to Mahree Skala of the Missouri Health Department.
Missouri was selected by the federal Centers for Disease Control and Prevention to test its national plan.
Exercise participants will meet today (Thursday) to address specific issues such as delivering vaccines, communicating with the public, and keeping essential community services functioning during an emergency.
The most recent pandemics hit briefly in 1977 and caused thousands of deaths in 1968 and 1957, but none matched the destruction of the 1918 "Spanish flu," which consumed 20 million lives.
Most health officials argue the question is not whether another pandemic will strike - but when.
"The influenza clock is ticking, we just don't know what time it is," Raymond Strikas of the CDC quoted a former chairman of the National Vaccine Advisory Commission as saying.
Since 1993, Strikas has been designing a national plan to implement once a pandemic is declared. Strikas of the CDC's National Immunization Program concentrates his efforts on reinforcing worldwide surveillance of ever-changing viral strains and the development and subsequent distribution of vaccines.
New strains of viruses constantly appear, making development of vaccines an ongoing battle. Health officials refer to minor changes to the genetic code of viruses as "drifts." Major changes are known as "shifts" and represent strains that have leaped from other animals and that have not yet been experienced by humans.
"Sooner or later there will be a shift," said Denny Donnell, an epidemiologist at the state Health Department. "We keep adjusting the vaccine slightly during years of drift."
In the wake of recent school closings in Fayette and depleted vaccine supplies in Boone County, the flu is on the minds of many. Missouri could experience its own episode of "drift." "Sydney," a variant of the strains used in the 1997 flu vaccinations, has appeared in other states, though no cases have been reported in Missouri, according to Eric Blank of the Health Department.
Blank said seven flu cases have been isolated that Missouri labs couldn't identify. Samples have been sent to CDC. "We're awaiting answers. There's something out there we don't know about."
Donnell said Missouri is currently experiencing a regional flu outbreak, as opposed to scattered episodes. Regional outbreaks occur in counties representing less than 50 percent of the state's population.
"We're constantly trying to find a moving target - that's what surveillance is all about," Blank said. Surveillance determines whether viral changes constitute shifts or drifts, how rapidly they are affecting the population, and when a virus can be expected, Blank said.
For Blank, the issue is "constructing a better early warning system."
Worldwide surveillance and lab collaboration begins at the local level, with physicians reporting to local health departments, who in turn report to state health departments. The CDC gathers and analyzes information from state health departments and reports to the World Health Organization. Information and strategy can then flow back to the local level.
Upon identification of new, destructive viral strains, time becomes the greatest opponent of health agencies. "The time between the recognition that a pandemic is occurring and the time it reaches Missouri is pretty short," Skala said, noting the greater ease and frequency of national and international travel.
Efficient distribution of vaccines, if they can be developed, is another issue for the planners. "Current manufacturing capacity couldn't produce enough for everyone all at once," Skala said. "There's a short time between the delivery of the first vaccines and the arrival of the pandemic itself." Health agencies must then establish distribution priorities, considering those most likely at risk of the flu and those most likely to benefit from the vaccine.
The CDC is monitoring closely the "bird virus" situation in Hong Kong. More than a million chickens were slaughtered after 18 episodes of human illness were reported stemming from a viral strain previously restricted to birds. Six of the 18 died.
So far, however, there has been no evidence of the virus being transmitted between humans, according to the CDC.
"It has the potential to be very strong in its effect on people," Donnell said. "But it's not moving like wildfire. To do that it would have to undergo recombination."
"This virus in its current configuration is not likely to cause a pandemic," Strikas said. "We're worried about the mixing, about that virus and a human virus getting together, whether in a human or a pig or somewhere else, and sharing genes. That virus becoming transmissible and causing widespread disease--that's the big worry. Hong Kong is having its regular flu season now...so stay tuned."