April 3, 2006

A Tale of Two Pandemics: One Is Coming, One Is Here

By Steven D. Helgerson, MD, MPH
State Medical Officer

This is National Public Health Week, an appropriate time to consider a tale of two pandemics: one that looms in the future and requires our preparation and a second that is already under way and requires our immediate action.

A pandemic is a worldwide outbreak of disease.  Some pandemics, like those caused by influenza viruses, strike within a few months, persist a few more months, may occur in waves, but then dissipate.  Others, like the current diabetes pandemic, can build insidiously over many years and persist for many more years. 

Influenza viruses have caused pandemics many times throughout history, including three times in the 20th century: 1918, 1957, and 1968. It is likely that influenza pandemics will continue to occur periodically in the future, although no one can predict exactly when. 

Strategies to control the spread of influenza do exist.  Although they are not perfect, public health workers need to be prepared to use them.  Because the flu occurs seasonally, we have an annual opportunity to practice these disease-control measures.  When an influenza pandemic arrives, we will need to apply them in the most intense ways we can devise.

The fundamental steps needed to control pandemic disease are detection, prevention, and treatment.  Increasingly, sophisticated laboratory techniques--along with intense surveillance efforts to monitor influenza infections in humans, birds, and other species--mean that recognition of disease caused by an unusual strain of the influenza virus is very likely to be communicated rapidly around the world.  Detection and careful monitoring of disease with pandemic potential will stimulate intense prevention efforts by local and state health departments.  Key prevention efforts for influenza will involve:

• Surveillance:  Public health workers will monitor the movement of a pandemic around the world and in individual states and communities.  Groups of people at greatest risk for illness will be identified, and the severity of illness will be characterized.
• Vaccine: As soon as a vaccine for a pandemic strain of influenza is available, public health workers will need to deliver it. To the extent the vaccine supply is limited, it will be necessary to deliver vaccine to selected (risk) groups initially.
• Antiviral medications: In all likelihood, these medications will have a limited role in preventing new cases but a substantial role in treating ill people to limit complications.
• Personal hygiene and respiratory etiquette: Public health workers and important community partners will need to educate and encourage everyone to play an active role in preventing the spread of infection by using good hygiene.
• Social distancing and quarantine:  Especially until an effective vaccine is available, public health workers will need to communicate ways to decrease the frequency of close personal contacts (social distancing). They likely will urge a variety of voluntary quarantine steps.

Extraordinary work is under way at local health departments all across Montana to prepare for an influenza pandemic.  This preparation must continue, and it must include an assessment of the capacity of our medical facilities and personnel to respond to widespread illness.

In contrast to influenza pandemics, which have occurred repeatedly in the past, the current pandemic of diabetes is the first ever. The worldwide epidemic involves type 2 diabetes, which is strongly related to overweight and obesity. These conditions in turn are strongly related to physical inactivity and poor diet choices.

Of the fundamental steps necessary to control pandemic diseases, detection and treatment of diabetes continue to receive much more attention than does prevention of this devastating disease. In Montana, the prevalence of obesity has doubled from 9 percent of adults in 1990 to 19 percent in 2003. The prevalence of diabetes has doubled as well from less than 3 percent of adults to nearly 6 percent.  In 2004, more than one in five Montana adults reported no leisure-time physical activity.

Key prevention efforts needed to stem the rising tide of diabetes include:

• Surveillance:  Public health workers need to identify the groups at high risk for developing diabetes, such as people with pre-diabetes and mothers with gestational diabetes. They must measure the effectiveness of interventions to prevent diabetes in these groups.
• Targeted physical activity and dietary interventions:  Public health workers must convince people at risk to increase regular physical activity and reduce caloric intake.
• Broad physical activity and diet interventions:  Policy changes to facilitate healthy lifestyles throughout our population are urgently needed.  These changes might include promotion of increased physical activity for youth and adults, improved food choices at schools and in homes, and innovative design of our built environment to stimulate physical activity.

Successful prevention of diabetes would decrease the number of people at high risk for death from influenza. In that way, diabetes prevention becomes an important part of preparing for an influenza pandemic.

We commend our hardworking, dedicated public health practitioners and community partners. Together, let us continue to prepare to respond to pandemics in the future and act aggressively to control a pandemic that is unfortunately well under way. This should be our resolve this 2006 National Public Health Week.

Page last updated: 06/13/2006