A recent survey of American adults found that 76% worried about becoming ill if they had to stay home and take care of the sick during a severe flu pandemic.1
  Learn infection control measures. 


Setting up a Sick Room

Wash hands for 15 seconds with soap and water

infection prevention

Cover a cough or sneeze with tissue

prevent infection
What is a Pandemic?

A pandemic is an illness that affects very large numbers of people. It has been described as “an epidemic that is widespread across a country, continent, or a large populace, possibly worldwide.”1 Three recorded influenza pandemics have occurred worldwide (1918, 1957, and 1968). Each was caused by a different influenza virus and transmitted from infected sick people to others, primarily through the air, by coughing and sneezing.2  

Historical Influenza Pandemics

The 1918 influenza pandemic is an example of a severe pandemic because of the very high death rate among young adults (ages 24-35) who became sick.3 Almost half of all deaths during the 1918 pandemic were in the young adult age groups.4 This is unusual because most often the very young and the very old have the highest influenza death rates. Worldwide estimates of deaths from the 1918 influenza pandemic ranged from 20 million to more than 50 million deaths5.  

In the United States, although approximately 97% of people with “clinically reported illness” eventually recovered from pandemic influenza, more than 600,000 people died. High death rates also occurred among young adults ages 25-35, and especially among pregnant women6.These groups may have been more vulnerable to developing complications from illness caused by a new influenza virus. 

If an influenza pandemic occurred today, approximately 30% of the United States population (about 100 million people) could become ill.7  It is estimated that some 42 million people might seek medical care, and between 300,000 and 750,000 might need hospitalization. If the pandemic was severe (similar to the 1918 pandemic), almost 2 million people could be expected to die8.

How an Influenza Virus Becomes a Pandemic

Three conditions are necessary for an influenza virus to produce disease and result in a pandemic. They include:
  • “Transmission of a new virus subtype to humans (from a bird or animal sources)
  • Viral replication causing disease in humans (humans become infected, the virus multiplies, and the virus produces disease)
  • Human-to-human transmission of the virus"9(sick humans can infect others with the virus, becoming airborne, by coughing and sneezing)  

The Example of Avian Influenza (Bird Flu)

Recently, many countries all over the world have been concerned about an infectious disease called avian influenza or bird flu. Avian influenza is caused by the H5N1 virus. The virus has produced illness in wild birds and farm flocks of chickens, ducks, and turkeys on many continents, including Eurasia and Africa. The H5N1 virus that causes bird flu has been transmitted to humans from infected birds in certain situations. Humans have become ill when they were exposed to large amounts of infected bird droppings, bird blood and fluids during butchering, or when they ate raw infected meat or blood products from infected birds.10

The World Health Organization (WHO) has tracked numbers of human cases of avian influenza. The WHO has reported that between 2003 and the end of December 2007, more than 337 people have become extremely sick from bird flu. More than 207 people have died, primarily in Indonesia and Vietnam.11 As of June 19, 2008, 385 cases of avian influenza had occurred in humans, and 243 people have died.12 The WHO is concerned that the H5N1 virus that causes avian influenza could become the next worldwide influenza pandemic. 

Pandemic Plans, and Resources

The avian flu outbreak forced governments and organizations around the world into action, stockpiling medicines, researching vaccine development, drafting pandemic plans, and gathering information in order to be better prepared for a health emergency. Below are samples of resources available:  

  World Health Organization (WHO)
The WHO plan for dealing with avian influenza includes 5 major objectives. They are:
reducing the opportunity for human infection by controlling disease in birds
·        strengthening the early-warning system to notify countries around the world (now being implemented)
·        “contain or delay the spread of the virus at its source
·        reduce morbidity, mortality, and social disruption
·        conduct research to guide response measures" 13

The WHO Epidemic and Pandemic Alert and Response Program website home page can be accessed by going to  Click on “Diseases” on the left-hand side, then click on the link for “Avian Influenza,” at  Daily updates are added to the WHO website.

   Centers for Disease Control and Prevention (CDC)
The CDC information about avian influenza can be viewed online at The website features various sections including key facts, prevention information, resources for health professionals and references and links to other helpful resources. The website is updated as information about bird flu changes.       
   U.S. Department of Health and Human Services (HHS)

The HHS national pandemic plan for the United States can be obtained at This website is also updated as information changes. You can sign up for e-mail notification of website updates. 

   U.S. state plans and  resources
The HHS also has a link to each of the 50 state pandemic plans. You can obtain your individual state plan by going to: and clicking on the “Where You Live” link, then clicking on the map for your state. Most state plans have similar sections that include:
  • community preparedness and networking
  • surveillance
  • public health and clinical laboratories
  • health care and public health partners
  • infection control and clinical guidelines
  • vaccine distribution and use
  • antiviral drug distribution and use
  • community disease control and prevention
  • public health communications
  • workforce support
We urge you to find the report for your state, read it, and discuss it with family, friends, co-workers, and your developing community of care. (See page 36, Creating Communities of Care.

1 Timmreck, T. C. An Introduction to Epidemiology, 3rd ed. Sudbury, Massachusetts: Jones & Bartlett, 2002. p. 4.

2 World Health Organization. “Ten things you need to know about pandemic influenza.” 14 Oct. 2005. <> accessed 6 Apr. 2008.

3 Knobler, S. L., A. Mack, A. Mahmoud, and S. Lemon, eds. The Threat of Pandemic Influenza: Are We Ready, Institute of Medicine Workshop Summary, 2005. Washington, DC: National Academies Press, 2005. p. 8.

4 Taubenberger, J. and D. Morens. “1918 Influenza: The Mother of All Pandemics.” Emerging Infectious Disease. Vol. 12, No. 1, Jan. 2006, pp. 15-22. pp. 17, 19.

5 Barry, J. M. The Great Influenza: The Epic Story of the Deadliest Plague in History. New York: Viking Penguin, 2004. p. 4.

6 Knobler, et. al. p. 8.

7 Ibid. p. 22.

8 Health and Human Services. Pandemic Influenza Plan- Part 1: Strategic Plan. <> accessed 13 Mar. 2008.

9 Knobler, et. al. p. xii.

10 World Health Organization. “Avian Influenza (“bird flu”) fact sheet”. Feb. 2006 <> accessed 3 Mar. 2008.

World Health Organization. Avian Influenza. 2008. <> accessed 3 Mar. 2008

11 World Health Organization. “Cumulative number of confirmed human cases of Avian Influenza A/(H5N1) reported to WHO, Dec. 9, 2007.” <>

 accessed 3 Mar. 2008

12 World Health Organization. “Cumulative numbers of confirmed cases of Avian Influenza A/(H5N1) reported to WHO June 19, 2008.” <> accessed 04 Jul 2008

13 World Health Organization. Responding to the avian influenza pandemic threat: Recommended strategic actions. 2005. <> accessed 4 Mar. 2008.




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