TABLE 1: PANDEMIC INFLUENZA and BIOTERRORISM

ISSUE

A Summary of Similarities and Differences
BIOTERRORISM
PANDEMIC INFLUENZA

Likelihood

HighHigh

Warning

None to days

Days to months

Occurrence

Focal or multifocal

Nationwide

Transmission / Duration of exposure

Point source / limited

Person-to-person / 6-8 weeks

Casualties

Hundreds to thousands

Hundreds of thousands to millions

First responders susceptible?

Yes

Yes

Disaster Med Team support/response Yes

No ( too widespread )Main site for preparedness, response, State and Local Areas
recovery and mitigation

State and Local areas

Essential Preparedness components:
Surveillance
Law enforcement intelligence
Investigation
Research
Liability programs
Communication systems
Medical triage and treatment plans

Yes
Yes
Yes
Yes
NoYes
Yes

Yes
NoYes
Yes
Yes
Yes
Yes

Vaccine supply issues

Yes ( for most likely threats )YesDrug supply issues

Yes

Yes

Training / tabletop exercises
Yes
Maintenance of essential community Yes
services

Yes
Yes

Essential response components
Rapid deployment teams
Effective communications / media
relations strategy

Yes
Yes

No
Yes

Vaccine delivery
Drug delivery
Hospital / Public health coordination

Yes ( for most )Yes ( for some )
Yes

Yes
Yes
Yes

Global assistance
Medical care
Mental health support
Mortuary services
Supplies and equipment

PossiblyYes
Yes
Yes
Yes

Yes
Yes
Yes
Yes
Yes

Essential mitigation components
Enhanced surveillance
Enhanced law enforcement
intelligence
Vaccine stockpile
Drug stockpile
Pre-event vaccination

Yes
Yes

Yes
No

Yes ( selected agents )Prototype vaccines only
Yes
Yes
Vaccination of selected groups Vaccination of medically high-risk
only*groups with8) pneumococcal
vaccine**

NOTE: *current vaccines for selected bioterrorism threats are in short supply and havemarginal safety profiles.
NOTE: **It may eventually be possible to vaccinate high priority target groups and/or thegeneral population with a yet-to-be-developed "common epitope" vaccine which may provide
for a broader spectrum of protection against a variety of influenza A subtypes. It has also
beensuggested[antigenicallythatrelated]pre-eventvaccination

hemagglutinins

withand/or

vaccines

containing

neuraminidases"prototype"correspondingto

antigenically novel subtypes might provide partial protection against the actual pandemicstrain and reduce the severity of illness.

TABLE 2: ESTIMATES OF THE HEALTH IMPACT OF PANDEMIC INFLUENZALOWER LIMIT16)UPPER LIMIT16)OUTPATIENT VISITS
High-risk patients
0-19 years
20-64 years
65+ years

289
70
79

403
149
130

165
4045

230
85
74

Other ( "standard-risk" ) patients
0-19 years
20-64 years
65+ years

HOSPITALIZATIONS ( note: average length-of-stay=4,6, and 7 daysin the 0-19, 20-64, and 65+ year age groups, respectively )High-risk patients
0-19 years
20-64 years
65+ years

2.1
0.9
49
5.1
13

0.13
0.1
2.8

2.9
2.8
3

0.13
0.1
2.8

7.7
5.7
5.6

0.014
0.025
0.028

0.13
0.09
0.54

Other ( "standard-risk" ) patients
0-19 years
20-64 years
65+ years

DEATHS
High-risk patients
0-19 years
20-64 years
65+ years

Other ( "standard-risk" ) patients
0-19 years
20-64 years
65+ years

NOTES: (1) Estimates provided by M. Meltzer, N. Cox, and K, Fukuda, CDC[unpublished17] data]. (2) Estimates of the percentage of high-risk persons in each age groupare as follows: 0-19 years [6-11%]; 20-64 years [14-25%]; 65+ years [40-55%].
(3) Length-of-stay for hospitalizations noted above are based on data for inter-pandemic
years; these may be shorter (due to high demand) or longer (due to increased increased
illness severity) during a pandemic.