WHO Declares Pandemic, But Little Else Changes

The World Health Organization, or WHO, raised its influenza pandemic alert to its highest level -- phase six -- on June 11, but the distinction is not expected to have much immediate impact on how public health officials, physicians and others deal with the novel H1N1 influenza virus in the United States. Still, says one Academy leader, it offers FPs an opportunity to examine their practices' current pandemic readiness levels.

"This just reminds us that practices need to review their pandemic flu plans," said Herbert Young, M.D., director of the AAFP Scientific Activities Division. "Members may wish to access the documents in the AAFP Resources section of the H1N1 Flu page."

The WHO's move comes as no surprise to federal health officials.

"We've been reacting as though we're in a pandemic already in terms of the intensity of our efforts to prepare as individuals and respond as a nation," said Anne Schuchat, M.D., interim deputy director for the CDC's Science and Public Health Program, in a June 11 news conference.

Schuchat said there are more than 13,000 probable and confirmed cases of infection attributed to the H1N1 virus in the United States, with more than 1,000 hospitalizations and 27 deaths.

During the news conference, CDC Director Thomas Frieden, M.D., M.P.H, stressed that the change in the WHO's pandemic level does not reflect any change in the illness itself.

"This doesn't mean there's any difference in the level of severity of the flu," Frieden said. "This is not, at this point, a flu that's anywhere near as severe as the 1918 pandemic, for example."

It also doesn't mean that the virus has mutated, he added, and the CDC has not changed any of its physician guidance on identifying and treating H1N1-infected patients based on the WHO's announcement.

Frieden said the WHO changed the pandemic level because this H1N1 strain is a new virus that people have little or no immunity to that has demonstrated sustained person-to-person transmission on multiple continents.

On June 10, WHO officials reported that there were 27,737 laboratory-confirmed cases, including 141 deaths, in 74 countries.

More than 21,000 of the confirmed cases were in North America, while Chile (1,694), Australia (1,224) and the United Kingdom (666) had the highest concentrations of confirmed cases elsewhere.

WHO Director-General Margaret Chan, M.D., said in a June 11 WHO news conference (8-page PDF; About PDFs) that the numbers don't tell the whole story.

"This is only part of the picture," she said. "With few exceptions, countries with large numbers of cases are those with good surveillance and testing procedures in place."

Chan also said in a June 11 statement that the H1N1 pandemic currently is considered moderate according to the WHO's three-tiered system of ranking pandemics as mild, moderate or severe, but she noted that situation could change.

The CDC uses a five-level pandemic severity index based on case-to-fatality ratio. The agency says the current situation ranks as a category two, with a 0.1 to <0.5 case-fatality ratio.

Schuchat said in the June 11 CDC news conference that most states are reporting a decrease in flu-like illness, with only two regions -- New England and New York-New Jersey -- above baseline for this time of year. She also reiterated that the CDC is monitoring how the virus is behaving in the Southern Hemisphere, which is at the beginning of its flu season, in preparation for the fall flu season in the Northern Hemisphere.