Pandemic Influenza, National and Community Measures, Appendix 1

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Vol. 12, No. 1
January 2006

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Policy Review

Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures

World Health Organization Writing Group*¹

Appendix 1. Examples of Nonpharmaceutical Public Health Interventions

Examples of nonpharmaceutical interventions that may be considered during influenza pandemic phases 4, 5, and 6 (1, derived from [2], which contains additional information and the complete World Health Organization recommendations).

Phases 4 and 5 (Virus is Becoming More Transmissible among Humans)

Rapid detection and isolation of persons infected with the novel subtype.

Tracing of close contacts during the patient's first two weeks of illness and voluntary quarantine of symptomatic persons for one week.

Use of antiviral drugs for treatment of cases and prophylaxis of others in the affected area.

Restriction on the movement of persons in and out of the affected area.

Screening of travelers departing from areas where clusters of human cases are occurring.

Phase 6 (Pandemic Declared)

Patient isolation and tracing and quarantine of contacts should cease, as such measures will no longer be feasible or useful.

Persons with fever and respiratory symptoms and their contacts should be asked to undergo voluntary home confinement.

Populations in countries with cases should be asked to defer nonessential domestic travel to affected parts of the country.

Countries should provide incoming travelers with health alert notices describing symptoms and where to report should these symptoms develop.

Countries with cases may introduce exit screening measures for departing travelers. However, such measures are disruptive and costly and will not be fully efficient, as influenza viruses can be carried by asymptomatic persons, who will escape detection during screening.

For persons known to have been exposed in an aircraft or aboard a large cruise ship, consideration can be given to recommended daily fever checks among passengers and crew and prophylactic treatment with antiviral drugs, when available.

"Social distancing" measures, such as the closing of schools or cancellation of large gatherings, may be recommended if evidence indicates an association of certain settings or events with amplified transmission or dispersion into the wider community.

Populations should be repeatedly informed of the need for frequent handwashing with soap and water.

Populations should be repeatedly informed of the need for "respiratory hygiene" (covering mouth when coughing or sneezing, careful disposal of soiled tissues or other materials).

Mask wearing by the general population is not expected to have an appreciable impact on transmission, but should be permitted, as this is likely to occur spontaneously.

Appendix 1 References

World Health Organization. Non-pharmaceutical interventions: their role in reducing transmission and spread. 2005 [cited 2005 Nov]. Available from http://www.who.int/csr/disease/avian_influenza/pharmaintervention2005_11_3/en/index.html
World Health Organization. WHO global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics. Annex 1. 2005 [cited 2005 Apr]. Available from http://www.who.int/csr/resources/publications/influenza/WHO_CDS_CSR_GIP_2005_5/en/

¹The writing group was established by request of the WHO Global Influenza Programme. It consisted of the following persons: David Bell, Centers for Disease Control and Prevention, Atlanta, Georgia, USA (coordinator); Angus Nicoll, European Centre for Disease Prevention and Control, Stockholm, Sweden, and Health Protection Agency, London, United Kingdom (working group chair); Keiji Fukuda, WHO, Geneva, Switzerland; Peter Horby, WHO, Hanoi, Vietnam; and Arnold Monto, University of Michigan, Ann Arbor, Michigan, USA. In addition, the following persons made substantial contributions: Frederick Hayden, University of Virginia, Charlottesville, Virginia, USA; Clare Wylks and Lance Sanders, Australian Government Department of Health and Ageing, Canberra, Australian Capital Territory, Australia; and Jonathan Van Tam, Health Protection Agency, London, United Kingdom.

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David M. Bell, Office of Strategy and Innovation, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Mailstop D28, Atlanta, GA 30333, USA; fax: 404-639-5172; email: dbell@cdc.gov

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