Preparing intensive care for the next pandemic influenza

Taylor Kain, Robert Fowler, Taylor Kain, Robert Fowler

Abstract

Few viruses have shaped the course of human history more than influenza viruses. A century since the 1918-1919 Spanish influenza pandemic-the largest and deadliest influenza pandemic in recorded history-we have learned much about pandemic influenza and the origins of antigenic drift among influenza A viruses. Despite this knowledge, we remain largely underprepared for when the next major pandemic occurs.While emergency departments are likely to care for the first cases of pandemic influenza, intensive care units (ICUs) will certainly see the sickest and will likely have the most complex issues regarding resource allocation. Intensivists must therefore be prepared for the next pandemic influenza virus. Preparation requires multiple steps, including careful surveillance for new pandemics, a scalable response system to respond to surge capacity, vaccine production mechanisms, coordinated communication strategies, and stream-lined research plans for timely initiation during a pandemic. Conservative models of a large-scale influenza pandemic predict more than 170% utilization of ICU-level resources. When faced with pandemic influenza, ICUs must have a strategy for resource allocation as strain increases on the system.There are several current threats, including avian influenza A(H5N1) and A(H7N9) viruses. As humans continue to live in closer proximity to each other, travel more extensively, and interact with greater numbers of birds and livestock, the risk of emergence of the next pandemic influenza virus mounts. Now is the time to prepare and coordinate local, national, and global efforts.

Keywords: Health care worker safety; Highly pathogenic avian influenza; Human; Influenza; Intensive care; Pandemic; Preparation; Research; Resource allocation; Triage.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Timeline of recorded influenza outbreaks in the past century as well as selected avian influenza outbreaks in humans. In the main figure, globe size corresponds to the estimated number of fatalities relative to global population size at the time, with vertical bars representing the estimated absolute number of fatalities. Numbers are averages from various approximations. In inset, horizontal bars represent time frame that cases from the influenza A virus strain were recorded
Fig. 2
Fig. 2
a Stages of mass critical care, with various ICU response thresholds. As a pandemic progresses, resources become scarce and there is increasing strain placed on the health care system from more cases [24]. b A potential triage strategy for various patient groups as the capacity of the ICU is slowly overwhelmed to streamline admissions without the greatest opportunity for benefit from ICU level care. Transparency is paramount in this process

References

    1. Johnson NP, Mueller J. Updating the accounts: global mortality of the 1918-1920 “Spanish” influenza pandemic. Bull Hist Med. 2002;76:105–115. doi: 10.1353/bhm.2002.0022.
    1. CDC. 2010. CDC’s Advisory Committee on Immunization Practices (ACIP) Recommends Universal Annual Influenza Vaccination. [Press release]. Retrieved from
    1. Nesmith N, Williams JV, Johnson M, Zhu Y, Griffin M, Talbot HK, Nesmith N, Williams JV, Johnson M, Zhu Y, Griffin M, Talbot HK. Clin Infect Dis 2017;65(6):1037.
    1. Taubenberger JK, Reid AH, Lourens RM, Wang R, Jin G, Fanning TG. Characterization of the 1918 influenza virus polymerase genes. Nature. 2005;437:889–893. doi: 10.1038/nature04230.
    1. Gorman OT, Bean WJ, Kawaoka Y, Donatelli I, Guo YJ, Webster RG. Evolution of influenza A virus nucleoprotein genes: implications for the origins of H1N1 human and classical swine viruses. J Virol. 1991;65:3704–3714.
    1. Webster RG, Bean WJ, Gorman OT, Chambers TM, Kawaoka Y. Evolution and ecology of influenza A viruses. Microbiol Rev. 1992;56:152–179.
    1. Smith GJ, et al. Dating the emergence of pandemic influenza viruses. Proc Natl Acad Sci U S A. 2009;106:11709–11712. doi: 10.1073/pnas.0904991106.
    1. Aligne CA. Overcrowding and mortality during the influenza pandemic of 1918. AJPH History. 2016;106(4):642–644. doi: 10.2105/AJPH.2015.303018.
    1. Brewer IW. Report of epidemic of ‘Spanish influenza’ which occurred at camp A.A. Humphreys, VA., during September and October, 1918. J Lab Clin Med. 1918;4(3):87–111.
    1. Low B. The incidence of epidemic influenza during 1918–1919 in Europe and in the Western Hemisphere. In Ministry of Health Reports on Public Health and Medical Subjects, No. 4. Report on the Pandemic of Influenza 1918–1919. Part III: Influenza in Foreign Countries. 1920, London UK 215.
    1. Belshe R. The origins of pandemic influenza – lessons from the 1918 virus. N Engl J Med. 2005;353(21):2209–2211. doi: 10.1056/NEJMp058281.
    1. Guan Y, Vijaykrishna D, Bahl J, Zhu H, Wang J, Smith GJD. The emergence of pandemic influenza viruses. Prot and Cell. 2010;1(1):9–13. doi: 10.1007/s13238-010-0008-z.
    1. Viboud C, Simonsen L, Fuentes R, Flores J, Miller MA, Chowell G. Global mortality impact of the 1957-1959 influenza pandemic. J Infect Dis. 2016;213:738–745. doi: 10.1093/infdis/jiv534.
    1. Simonsen L, Clarke MJ, Schonberger LB, Arden NH, Cox NJ, Fukuda K. Pandemic versus epidemic influenza mortality: a pattern of changing age distribution. J Infect Dis. 1998;178(1):53–60. doi: 10.1086/515616.
    1. Garten RJ, Davis TC, Cox NJ, et al. Antigenic and genetic characteristics of the early isolates of swine-origin 2009 A(H1N1) influenza viruses circulating in humans. Science. 2009;325(5937):197–201. doi: 10.1126/science.1176225.
    1. CDC. Past Pandemics. Influenza (flu). . Accessed 10 Nov 2018.
    1. Implementation of the International Health Regulations (2005): report of the Review Committee on the Functioning of the International Health Regulations (2005) in relation to pandemic (H1N1) 2009. Geneva: World Health Organization; 2011. .
    1. Sambala EV. Lessons of pandemic influenza from sub-Saharan Africa: experiences of 1918. J Public Health Manag Pract. 2011;17(1):72–76. doi: 10.1097/PHH.0b013e3181f8796f.
    1. Garrett L. The next pandemic? .
    1. Duggal A, Pinto R, Rubenfeld G, Fowler RA. Global variability in reported mortality for critical illness during the 2009-10 influenza A(H1N1) pandemic: a systematic review and meta-regression to guide reporting of outcomes during disease outbreaks. PLoS One. 2016;11(5):e0155044. doi: 10.1371/journal.pone.0155044.
    1. WHO. Global Epidemiological Surveillance Standards for Influenza. . Accessed 21 Nov 2018.
    1. Bertolini G, et al. Is influenza A (H1N1) pneumonia more severe than other community-acquired pneumonias? Results of the GiViTI survey of 155 Italian ICUs. Intensive Care Med. 2011;37:1746–1755. doi: 10.1007/s00134-011-2339-5.
    1. Bertolini G. The role of the intensive care unit in real-time surveillance of emerging pandemics: the Italian GiViTI experience. Epidemiol Infect. 2016;144:408–412. doi: 10.1017/S0950268815001399.
    1. Sheikhbardsiri H, Raeisi AR, Nekoei-moghadam M, Rezaei F. Surge capacity of hospitals in emergencies and disasters with a preparedness approach: a systematic review. Disaster Med Public Health Prep. 2017;11(5):612–620. doi: 10.1017/dmp.2016.178.
    1. Daugherty Biddison EL, Faden R, Gwon HS, Mareiniss DP, Regenberg AC, Schoch-Spana M, Schwartz J, Toner ES. Too many patients … a framework to guide statewide allocation of scarce mechanical ventilation during disasters. CHEST. 2019;155(4):848–854. doi: 10.1016/j.chest.2018.09.025.
    1. Ontario Ministry of Health and Long-term Care. Emergency Planning and Preparedness. . Accessed 7 Jan 2019.
    1. Christian M, et al. Critical care during a pandemic. Final report of the Ontario Health Plan for an Influenza Pandemic (OHPIP). Working group on adult critical care admission, discharge and triage criteria. 2005.
    1. Fowler R, et al. Critical care capacity in Canada: results of a national cross-sectional study. Crit Care. 2015;19(1):133–140. doi: 10.1186/s13054-015-0852-6.
    1. Rubinson L, Hick JL, Geiling JA, et al. Definitive care for the critically ill during a disaster: a framework for optimizing critical care surge capacity. Task Force for Mass Critical Care Summit Meeting, January 26-27, 2007, Chicago, IL. CHEST. 2008;133(5):18S–31S. doi: 10.1378/chest.07-2690.
    1. Dichter JR, Kanter RK, Kissoon N, et al. System-level planning, coordination, and communication. Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. CHEST. 2014;146(4):e87S–e102S. doi: 10.1378/chest.14-0738.
    1. Fowler RA, Lapinsky SE, Hallett D, Detsky AS, Sibbald WJ, Slutsky AS, Stewart TE, for The Toronto SARS Critical Care Group Critically ill patients with severe acute respiratory syndrome (SARS) JAMA. 2003;290:367–373. doi: 10.1001/jama.290.3.367.
    1. WHO. Emergency preparedness, response: summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. . Accessed 19 Nov 2018.
    1. Low DE, et al. In: SARS: lessons from Toronto. Institute of Medicine (US) Forum on Microbial Threats. Knobler S, Mahmoud A, Lemon S, et al., editors. Washington (DC): National Academies Press (US); 2004.
    1. He F, Leyrer S, Kwang J. Strategies towards universal pandemic influenza vaccines. Expert Rev Vaccines. 2016;15(2):215–225. doi: 10.1586/14760584.2016.1115352.
    1. Maclean KA, Goldin S, Nannei C, Sparrow E, Torelli G. The 2015 global production capacity of seasonal and pandemic influenza vaccine. Vaccine. 2016;34(45):5410–5413. doi: 10.1016/j.vaccine.2016.08.019.
    1. Jin H, Chen Z. Production of live attenuated influenza vaccines against seasonal and potential pandemic influenza viruses. Curr Opin Virol. 2014;6:34–39. doi: 10.1016/j.coviro.2014.02.008.
    1. Asgar RH, Fowler RA, et al. Time required to initiate outbreak and pandemic observational research. J Crit Care. 2017;40:7–10. doi: 10.1016/j.jcrc.2017.02.009.
    1. WHO. WHO surveillance case definitions for ILI and SARI. . Accessed 2 Jan 2019.
    1. The Global Health Network. Short PeRiod IncideNce sTudy of Severe Acute Respiratory Illness (SPRINT-SARI). .
    1. Fowler RA, Marshall JC, et al. Early observational research and registries during the 2009-2010 influenza A pandemic. Crit Care Med. 2010;38(4):e120–e132. doi: 10.1097/CCM.0b013e3181d20c77.
    1. Government of Canada. Canadian Pandemic Influenza Plan. 2015. . Accessed 14 Dec 2018.
    1. Department of Homeland Security. Pandemic influenza: preparedness, response, and recovery. 2006. . Accessed 16 Jan 2019.
    1. US Department of Health and Human Services. 2017. .
    1. Geiling J, Burkle FM, Dichter JR, et al. Resource-poor settings: response, recovery, and research. Care of the critically ill and injured during pandemics and disasters: CHEST consensus statement. CHEST. 2014;146(4):e168s–e177s. doi: 10.1378/chest.14-0745.
    1. Winsor S, Bensimon CM, Sibbald R, Anstey K, Chidwick P, Coughlin K, Cox P, Fowler R, Godkin D, Greenberg RA, Shaul RZ. Identifying prioritization criteria to supplement critical care triage protocols for the allocation of ventilators during a pandemic influenza. Healthc Q. 2014;17(2):44–51. doi: 10.12927/hcq.2014.23833.
    1. Kanter R. Would triage predictors perform better than first-come, first-served in pandemic ventilator allocation? CHEST. 2015;147(1):102–108. doi: 10.1378/chest.14-0564.
    1. Davies A, Jones D, Wilson M, Ziegenfuss M, Australian and New Zealand (ANZ) ECMO Influenza Investigators, et al. Extracorporeal membrane oxygenation for 2009 influenza A(H1N1) acute respiratory distress syndrome. JAMA. 2009;302(17):1888–1895.
    1. Michaels AJ, Hill JG, Morgan LJ, et al. Pandemic flu and the sudden demand for ECMO resources: a mature trauma program can provide surge capacity in acute critical care crises. J Trauma Acte Care Surg. 2013;74(6):1493–1497. doi: 10.1097/TA.0b013e31828d636e.
    1. Peek GJ, Mugord M, Tiruvoipati R, Wilson A, Allen E, Thalanany MM, et al. Efficacy and economic assessment of conventional ventilatory support versus extracorporeal membrane oxygenation for severe adult respiratory failure (CESAR): a multicenter randomised controlled trial. Lancet. 2009;374:1351–1363. doi: 10.1016/S0140-6736(09)61069-2.
    1. Combes A, Hajage D, Cappelier G, Levy B, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome. N Engl J Med. 2018;378:1965–1975. doi: 10.1056/NEJMoa1800385.
    1. Goligher EC, Tomlinson G, Hajage D, et al. Extracorporeal membrane oxygenation for severe acute respiratory distress syndrome and posterior probability of mortality benefit in a post hoc Bayesian analysis of a randomized clinical trial. JAMA. 2018;320(21):2251–2259. doi: 10.1001/jama.2018.14276.
    1. Altevogt BM, Stroud C, Hanson SL, et al., Ed. Guidance for establishing crisis standards of care for use in disaster situations: a letter report. Institute of Medicine (US) Committee on Guidance for Establishing Standards of Care for Use in Disaster Situations. Washington DC: National Academies Press; 2009.
    1. WHO. SARS emergency preparedness, response. . Accessed 24 Aug 2019.
    1. Lowen AC, Mubareka S, Steel J, Palese P. Influenza virus transmission is dependent on relative humidity and temperature. PLoS Pathog. 2007;1(3):113–120.
    1. Lateef F. Hospital design for better infection control. J Emerg Trauma Shock. 2009;2(3):175–179. doi: 10.4103/0974-2700.55329.
    1. Barry JM. The great influenza: the epic story of the deadliest plague in history. New York: Penguin; 2004.
    1. Gupta S. The big one is coming, and it’s going to be a flu pandemic. CNN (US edition). 2018. Sect. Health.
    1. Taubenberger JK, Morens DM. Influenza: the once and future pandemic. Public Health Rep. 2010;125(Suppl 3):16–26.
    1. Kumar B, Asha K, Khanna M, Ronsard L, Meseko CA, Sanicas M. The emerging influenza virus threat: status and new prospects for its therapy and control. Arch Virol. 2018;163(4):831–44.
    1. WHO. Influenza (avian and zoonotic). . Accessed 6 Dec 2018.
    1. Iskander J, Strikas RA, Gensheimer KF, Cox NJ, Redd SC. Pandemic influenza planning, United States, 1978-2008. Emerg Infect Dis. 2013;19(6):879–885. doi: 10.3201/eid1906.121478.
    1. Escoria M, Attene-Ramos MS, Estrada MJ, Nava GM. Improving global influenza surveillance: trends of A(H5N1) virus in Africa and Asia. BMC Research Notes. 2012;5(62):1–7.
    1. Fidler DP, Gostin LO. The WHO pandemic influenza preparedness framework: a milestone in global governance for health. JAMA. 2011;306(2):200–201. doi: 10.1001/jama.2011.960.
    1. Peiris JSM, Poon LLM, Guan Y. Surveillance of animal influenza for pandemic preparedness. Science. 2012;335:1173–1174. doi: 10.1126/science.1219936.

Source: PubMed

스폰서 및 공동 작업자

건강 상태

약물 개입

3
구독하다