The potential to cause faster increase in illness and deaths than almost any other natural health threat exists in an influenza pandemic. Preparedness and planning at the interpandemic period (before the strike) is essential for operational response efficiency (Brown, 2000). This article describes a planned strategy to respond and prepare for a possible influenza pandemic attack. It also offers direction to local, federal, state, tribal, and international health departments and agencies as the primary target to enhance preparation and planning, at the level where the main response activities start. The plan offers for coordination of activities among the federal government, health care provider facilities, private businesses, charitable organizations among other agencies of states government.

Intent of the plan

The purpose of the preparations and response plan is to provide for the State, federal, private sector, local, and non-government entities a framework to work together to reduce the mortality, influenza-morbidity and social disruption which would result from a disease outbreak (Uhernik  & Husson, 2009).  The plan describes the incident management concepts, activities, and structure that the State will operate during an influenza outbreak and the activities, responsibilities and roles that apply to control and command staff. Other objectives of the project include:

• To define and recommend activities that are necessary before a pandemic occurs to increase its effectiveness.
• To define the intended interventions as components of an effective influenza response
• To guide health care systems, health departments and first respondents on the preparedness and response plans as designed by the State.
• To offer expertise advice on which response for recommendations and preparedness are centered.

Goals and Objectives the Plan

The Pandemic Influenza Preparedness and Response Plan main goal is to limit mortality and morbidity of influenza and its complications during a decrease social disruption, pandemic and economic loss (Bynner, 2000).

• Guarantee optimal decision-making, coordination, and communication between local, state, and federal levels.
• Identify novel influenza strains through virological and clinical monitoring of animal and human influenza disease.
• Initiate vaccination implementation program that rapidly administer vaccine to monitor vaccine safety and effectiveness to priority groups.
• Deliver prophylaxis and antiviral drug therapy and avoid inappropriate use of these agents that can encourage drug resistance (Uhernik & Husson, 2009).
• Initiate measures to decrease the disease spread guided by the pandemic epidemiology.
• Maintain and provide optimal medical care through essential community services.
• Communicate effectively with the health care providers, public, media, and community leaders.

Planning assumptions

• In response and preparedness, the main characteristics of an influenza epidemic that have to be considered include:
• Concurrent effects on different areas across the country, restraining the capacity of the jurisdictions to offer assistance and support to other affected regions.
• Increase of sick people that need outpatient medical care or hospitalization
• Delay and shortage of availability of vaccine and antiviral drugs
• Interruption of community and national infrastructure, including commerce, transportation, public safety, and utilities
• International spread of infection with outbursts globally (Brown, 2000).

Prevention and Preparedness

In planning the main aim of prevention and preparedness are to:

• Ensure there is adequate monitoring to assess the public health risk, identify any emerging threats, and support containment activities from the beginning.
• Plan, identify and prepare, including protective and pharmaceutical equipment stockpile, for the full range of health and non-health related impacts.
• Define key national initiatives for preparedness, prevention, recovery, and response in the event of an influenza outbreak.
• Put in place the essential administrative and legislative framework to support effective response.
• Support and encourage business continuity planning across all levels and sectors of governance.

Response

While the response actions continue to be implemented, recovery operations may start. The goals of response actions are to

• Offer a flexible variety of response options adequate to the pandemic characteristics such as the geographical spread and virulence, of the virus.
• Limit mortality and morbidity are arising with the pandemic virus
• Maintain essential services and infrastructure
• Support the maintenance of civil society and normal
• Provide business, household, community, and media with practical and updated authoritative information.

Recovery

The operations of recovery may function concurrently with the response action. The main operational goals include:

• Analyzing the impact of an influenza pandemic
• Helping the citizens recover quickly
• Offering strategies of restoring psychological and emotional health
• Assisting the countries economic and social recovery from these effects
• Restoring community and essential infrastructure to standard services
• Assisting national recovery from the pandemic effects through multilateral and bilateral relationships

Plan Development and Maintenance

The entire preparedness and response plan is reviewed and revised yearly by the (DPH) department of health office of preparedness and response. The DPH office will collaborate with other divisions, offices, and programs to ensure continued applicability of the organizations and agencies listed in the plan to review their responsibilities and roles and change as necessary (Kok, et al., 2010).

Planning and Coordination

The EMA (Emergency management agencies) and DPH department directors will jointly establish a multi-agency, multijurisdictional committee responsible for developing recommendations for improving pandemic influenza response and preparedness within the State. The members at a minimum will include representatives from the Governors office, EMA, DPH, hospitals, local health departments and infection control practitioners, appropriate non-governmental and private sector organizations and local emergency management agencies (Silver & Fischhoff, 2011).

Preparedness

Different stakeholders have important roles in pandemic influenza response and preparedness. Stakeholders include agencies, federal departments, state and local health departments, public health organizations, laboratories, influenza vaccine and antiviral manufacturers, private health care organizations, vaccinators and vaccine distributors.

Not all parts of the plan will be relevant immediately to each of the stakeholders. The purpose of the organizing committee is to compile into a single program the guidelines with the aim of enhancing improvement and understanding between private and public sectors and at different levels of the health care system. This guideline also stresses that an effective response requires infrastructure, planning, and action at many levels and by different groups.

Precautions, travel advisories and screen shots of people arriving from affected areas, restricting public gathering, closing schools, and quarantine of exposed people may be necessary steps for mitigating transmission, and different authority departments can get entrusted with handling this aspect. These interventions applications are based on the evolving patterns of the epidemic epidemiology (Kok et al., 2010).

Inter-pandemic phase of the pandemic

This inter-pandemic phase of the pandemic is subdivided into 4 main levels. The first category is level zero that has no identification of an influenza-causing strand in human anatomy, therefore, poses no threat. Level one has a case alert of possible human infection by the virus strain. Level two has no documented person transition and unclear cause of outbreaks, but has two or more speculated cases of infection outbreaks. Level three is the pandemic alert level with an outbreak in one country and people spread in the community for more than two weeks (World Health Organization, 2006).

Transition from a virus alert to an epidemic level is followed by response activities that involve heightened global and local surveillance. These responses include virology and epidemiology investigation of a novel influenza strain, including international cooperation with global stakeholders on vaccine development, containment, and clinical testing.  That leads towards licensing of pandemic vaccine, activation of local plans and coordination, and communication strategy implementation that educate the public and health care providers (Silver & Fischhoff, 2011).

CONCEPT OF OPERATIONS

The response of the pandemic influence will use similar guidelines as that needed for response to any public health response. However, many areas are specific to pandemic influenza and thus need specific considerations. Following are six operational considerations of the plan;

• Surveillance
• Command and management
• Communication
• Emergency health medical services
• Non-pharmaceutical control

Epidemiologic Investigation

The health care departments and DPH during the epidemiology phase tries to:

• Implement and develop protocol and criteria for epidemiology investigation of the influenza case and outbreak with unusual clinical presentation, and the unexpected pneumonia cluster.
• Expand and enhance the capacity at the state and local level to conduct case investigations and epidemiological investigations during the WHO phases these activities will include determining current skill levels, conducting an inventory of current capacity, develop forecast of the future, identify gaps in capacity and conduct epidemiological investigations during WHO phase one and two.
• In collaboration with the local health departments, implement and evaluate an outbreak management system to assist with case ascertainment, case management, case reporting, data analysis, and surveillance.
• Identify training and funding strategies to ensure that epidemiology capacity at the local and state level is consistent wit current and future needs.

Relevance of the Pandemic Influenza Response and Preparedness Plan

The plan mainly aims to limit and maintain the spread of an influenza pandemic and cushion the impact it has on the economy, sustain infrastructure and reduce social disruptions. It offers the state government’s executive branch with a set of response functions, preparedness activities and provides health care provider systems, local health departments, and first-responder organizations with response and preparedness expectations (Bynner, 2000).

The reaction and mitigation plan is supposed to be implemented within the framework of a unified command emergency operating structure involving representations from federal, state, and local governments. The process will work under the leadership and monitoring of the office of the Governor, with the collaboration from different emergency management agencies (Brown, 2000). The structure allocates roles to state agencies. The maintenance of the project involves a yearly analysis by the responsible stakeholders and agencies, managed by the Department of Health.

Effective Pandemic Response Coordination

In an influenza attack, a national crisis is present, and it will need State governments role in the event of the epidemic that is to monitor the spread of the infection closely. Rapidly gather and deploy material to assist the efforts of the local government in dealing with the expected increase demands and widespread of the illness on most essential government services. Due to the expected characteristics associated with epidemics, the federal and state government is likely to become involved with providing guidance, assistance, and leadership almost immediately following such developments.

Overall control and direction of authority resides with the Office of the Governor, with management and coordination expertise supplied by (EMA) Emergency management agencies. The department of health will also assume a central response role during an influenza outbreak, based on the statutory and expertise authorities over many medical and health issues. The plan involves lines of succession for both the department of health director and governor.

Emergency Response Notification and Activation Procedures

Public and medical health authorities may detect the first human case of the virus spread through the laboratory and clinical evaluation of persons presenting with the upper respiratory disease or illness.  The EMA receives updated national surveillance from CDC (center for disease control) through the health care units. The CDC analyses these monitoring recommendations, offers any necessary revisions and technical clarification for application to State, and distributes recommendations to medical providers, local health departments, and hospital. based infection control practitioners through email and other Health Alert networks. Local health departments distribute recommendations to health alert networks and individual physicians or their own emergency communication mechanisms.

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