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Department of Health and Human Services
Centers for = Disease=20 Control and Prevention

Pandemic Influenza=20 Resources

FluAid 2.0

The Official U.S. Government Website for = Pandemic=20 Influenza

=20

One-stop access to U.S. Government avian and = pandemic flu=20 information. Managed by the Department of Health and Human = Services.

Tiẽng = Vi=EAt=20 (Vietnamese)
Provided by=20 the World Health Organization

FluAid is a test version of software created by programmers at the = Centers=20 for Disease Control and Prevention (CDC). It is designed to assist state = and=20 local level planners in preparing for the next influenza pandemic by = providing=20 estimates of potential impact specific to their locality. FluAid = provides only a=20 range of estimates of impact in terms of deaths, hospitalizations, and=20 outpatients visits due to pandemic influenza. The software cannot = describe when=20 or how people will become ill, nor how a pandemic may spread through a = society=20 over time.

Download = FluAid=20 Software now

On this page:

Introduction

Influenza pandemics have occurred three times in the 20th century: = 1918,=20 1957, and 1968. Experts predict that another influenza pandemic is = highly=20 likely, if not inevitable. The impact of an influenza pandemic can be=20 devastating. For example, it has been estimated that over 20 million = people died=20 during the pandemic of 1918. Prepandemic planning, therefore, is = essential if=20 influenza pandemic-related morbidity, mortality, and social disruption = are to be=20 minimized. Unfortunately, no one can predict when the next = pandemic will=20 occur, nor can they accurately forecast who will become ill and suffer = adverse=20 health outcomes such as death and hospitalization.

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National estimates of = economic=20 impact

To help overcome uncertainty about the effects of an influenza = pandemic, a=20 national plan is being prepared by the U.S. Department of Health and = Human=20 Services. As part of the plan, a paper has been published which provides = a range=20 of national estimates of the numbers of deaths, hospitalizations, = outpatient=20 visits, and those who will become ill but not seek medical care = (Meltzer, Cox,=20 and Fukuda, 1999a). The authors then use the estimates to evaluate = the=20 potential economic impact of the next pandemic, and discuss the = implications of=20 various options for intervention.

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State and local-level = influenza pandemic=20 plans

Part of the national influenza pandemic plan calls for each state to = develop=20 its own state-specific plan to deal with an influenza pandemic. To = develop such=20 plans, state and local level public health planners need to have = estimates of=20 the potential impact of a pandemic in their state or locality. National = level=20 estimates of impact may not be useful when creating state or local level = plans. FluAid was developed to provide state and local level = planners with=20 estimates of potential impact specific to their localities. A set of = guidelines=20 for state and local officials on pandemic influenza preparedness can be = accessed=20 at http://www.cdc.gov/od= /nvpo/pandemicflu.htm.

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Estimates of impact: = Methodology

FluAid is designed to provide a range of estimates of impact in terms = of=20 deaths, hospitalizations, and outpatient visits due to pandemic = influenza. =20 The methodology used to design the software is similar to that used to = calculate=20 national level estimates of impact (Meltzer, Cox and Fukuda, 1999a,=20 1999b). The one notable difference is that, unlike the model used = to=20 calculate national level estimates, the software does not use = Monte-Carlo=20 methodologies to provide ranges of estimates. Instead, the = software=20 requires that the user supply minimum, most likely, and maximum = estimates of=20 some inputs (e.g., rates of death per 1,000 population). These = data are=20 then used by the program to provide estimates of the minimum, most = likely, and=20 maximum impact of an influenza pandemic.

Another important = difference between=20 the state and local level model and the national level model is that the = latter=20 included a predefined age distribution of cases. For simplicity, = this=20 assumption was omitted from the state and local level model.

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What this model does not = estimate

This software model provides only estimates of the total impact = (i.e.,=20 after-the-event estimates). The model is not an epidemiologic model and = cannot=20 describe when or how persons will become ill. That is, FluAid = cannot=20 provide any description of how a pandemic may spread through a = geographic region=20 over time. This is due to the difficulty of mathematically = modeling the=20 epidemiology of influenza (for a discussion of these difficulties, see = Cliff and=20 Haggett, 1993).

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Age and risk groups

As in the model used to generate national level estimates of impact, = FluAid=20 also distributes the defined state or local population into three age = groups=20 (0-18 years, 19-64 years, and 65+ years), and two risk categories: high = risk and=20 non-high risk. Individuals categorized as high risk are those who = have a=20 preexisting medical condition (e.g., asthma, diabetes mellitus) that = makes them=20 more susceptible to developing medical complications due to = influenza. =20 High risk does not mean that those persons are more likely to contract a = case of=20 influenza. It means that if they do have a case of influenza, then = they=20 are more likely to have an adverse health outcome (e.g., outpatient = visit,=20 hospitalization) than those considered non-high risk. Note that age by = itself=20 was not used as a high risk condition. The software, however, allows the = health=20 care planner to input higher rates of adverse health outcomes for those = aged 65=20 years and older.

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Gross attack rates

As in the model used to estimate the potential national level impact, = the=20 state and local level model uses different levels of gross attack rates. = Gross=20 attack rate is the percentage of population that becomes clinically ill = due to=20 influenza. Clinical illness is defined as a case of influenza that = causes some=20 measurable economic impact, such as one-half day of work lost or a visit = to a=20 physician's office.

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Impact of pandemic influenza = on the=20 health care system

This software contains elements of estimated impact not included in = the=20 national level model. These elements are designed to help the = public=20 health planner begin to estimate the potential impact on pandemic = influenza on=20 the state and local health care systems. The results are intended to = answer=20 questions such as: Will there be sufficient hospital beds? Will there be = enough=20 health care providers to deal with the estimated number of = outpatients?

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Data sources

Not all of the information required to run this model is readily=20 available. You will need to conduct research to find the necessary = data=20 specific to the state or locality of interest, such as the number of = health care=20 providers, number of hospital beds available for influenza-related = illness, etc.=20 Please refer to the list of suggested data sources for help in this = process.

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Modeling philosophy: = Sensitivity analyses=20 and overall objectives

Much of what will define the impact of the next influenza pandemic is = unknown. For example, one can only guess, based on existing data, what = the rate=20 of outpatient visits will be among the non-high risk 19-64 year olds. = The=20 existing data often relate to non-pandemic situations. Even those data = obtained=20 from pandemics may not be reliable predictors of the impact of the next=20 pandemic. Therefore, planners are encouraged to be realistic when = interpreting=20 the results obtained from this software.

Given this uncertainty, it is advisable to run this model several=20 times. Once you have become adept at using FluAid, you may wish to = consider a plan wherein you systematically alter the values of input = variables.=20 You may alter one variable at a time (univariate sensitivity analysis), = or alter=20 the values of two or more variables simultaneously (multivariate = sensitivity=20 analysis). Different results due to different values for the input = variables=20 will help you obtain a sense of the relative importance of each variable = in=20 determining the size of the estimated impacts.

Given the inherent uncertainty associated with trying to estimate the = potential impact of the next influenza pandemic, it is recommended that = you=20 avoid the temptation of using the software to obtain a = single=20 set of estimates describing the potential impact. Rather, FluAid should = be used=20 to obtain a range of estimates of potential impact. = Although=20 decision makers, the media, and the public may expect a single estimate = of=20 impact, the interest of public health may be better served if the degree = of=20 uncertainty is at least partially explained.

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Disclaimer

Please keep in mind that this is a test version of the software and a = draft=20 version of the manual. The numbers generated through use of FluAid = should not be=20 considered predictions of what will actually occur = during a=20 pandemic. Rather, they should be treated as estimates of what = could=20 happen.

Additional information

Users are encouraged to download the FluAid 2.0 User's Manual to = obtain=20 additional information regarding the use and interpretation of results, = as well=20 as comments on the general modeling philosophy used in designing FluAid. = In=20 addition to the resources listed in the References section, two = scientific=20 papers that address the economic impact of an influenza pandemic can be = found at=20 the CDC's Web site, or by clicking on the links provided below:

1. Meltzer MI, Cox NJ, Fukuda K. The economic impact of = pandemic=20 influenza in the United States: Implications for setting priorities for=20 interventions. Emerg Infect Dis 1999:5(5); 659-671. http://www.cdc= .gov/ncidod/EID/vol5no5/meltzer.htm

2. Meltzer MI, Cox NJ, Fukuda K. Modeling the economic = impact of=20 pandemic influenza in the United States: Implications for setting = priorities for=20 intervention. Background paper. http://www.c= dc.gov/ncidod/EID/vol5no5/melt_back.htm

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References

1. CDC. Prevention and Control of Influenza: Recommendations of the = CDC=20 Advisory Committee on Immunization Practices (ACIP). MMWR=20 1999;48(RR-04):1-28.

2. Cliff AD, Haggett P. Statistical modeling of measles = and=20 influenza outbreaks. Statl Methods Med Res 1993;2:43-73.

3. Meltzer MI, Cox NJ, Fukuda K. 1999a. The = economic=20 impact of pandemic influenza in the United States: Implications for = setting=20 priorities for intervention. Emerg Infect Dis 1999:5(5). Available on = the Web=20 at: http://www.cdc= .gov/ncidod/eid/vol5no5/meltzer.htm

4. Meltzer MI, Cox NJ, Fukuda K. 1999b. = Modeling the=20 economic impact of pandemic influenza in the United States: = Implications=20 for setting priorities for intervention. Background paper: = available=20 on the Web at: http://www.c= dc.gov/ncidod/eid/vol5no5/melt_back.htm

5. Simonsen L, Clarke MJ, Williamson GD, et al. The = impact of=20 influenza epidemics on mortality: Introducing a severity index. Am J = Public=20 Health 1997;87:1944-1950.

6. U.S. Bureau of the Census. 1999a. International = database,=20 Table -094 Midyear population, by age and sex, 1997. [online = database] Feb=20 1999: Available from: http://www.census.gov/

7. U.S. Bureau of the Census. 1999b. = Estimates of the=20 population of the U.S., regions, and states, by selected age groups and = sex:=20 Annual time series, July 1, 1990 to July 1, 1997. [online = database] Feb=20 1999: Available from: http://www.census.gov/

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Page last updated = July 25,=20 2000

Navigation for the CDC Pandemic Influenza Resources = Website

=95 Influenza = (Flu)

Additional Navigation for the CDC Website

USA.Gov =97 = The U.S.=20 Government's Official Web Portal

Department of = Health and=20 Human Services

=93Safer Healthier People=94Centers for Disease = Control and=20 Prevention, 1600 Clifton Rd, Atlanta, GA 30333, = U.S.A.
800=96CDC=96INFO=20 (800-232-4636), 888=96232=966348 (TTY), cdcinfo@cdc.gov

" + "

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'iePlugins'),pn=3D0,ps;if(s_apv>=3D4)s=3Dscreen.width+'x'+screen.height;i= f( s_isns||s_isopera){if(s_apv>=3D3){j=3D'1.1';v=3Ds_n.javaEnabled()?'Y':'N'= if(s_apv>=3D4){j=3D'1.2';c=3Dscreen.pixelDepth;bw=3Ds_wd.innerWidth;bh=3D= s_wd.innerHeight;if(s_apv>=3D4.06)j=3D'1.3'}}s_pl=3Ds_n.plugins}else if( s_isie){if(s_apv>=3D4){v=3Ds_n.javaEnabled()?'Y':'N';j=3D'1.2';c=3D screen.colorDepth;if(s_apv>=3D5){bw=3Ds_d.documentElement.offsetWidth;bh=3D= s_d.documentElement.offsetHeight;j=3D'1.3';if(!s_ismac&&s_d.body){ s_d.body.addBehavior("#default#homePage");hp=3Ds_d.body.isHomePage(tl)? 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FluAid 2.0

Download = FluAid=20 Software now

Introduction

National estimates of = economic=20 impact

State and local-level = influenza pandemic=20 plans

Estimates of impact: = Methodology

What this model does not = estimate

Age and risk groups

Gross attack rates

Impact of pandemic influenza = on the=20 health care system

Data sources

Modeling philosophy: = Sensitivity analyses=20 and overall objectives

Disclaimer

Additional information

References

Navigation for the CDC Pandemic Influenza Resources = Website

Additional Navigation for the CDC Website