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Abkhazia: Responsibilities in influenza prevention

Georgia Government’s responsibilities

The Georgian government is responsible for nationwide coordination of the pandemic influenza response. Specific areas of responsibility include the following:
• Surveillance in the Georgia
• Epidemiological investigation in the Georgia
• Development and use of diagnostic laboratory tests and reagents
• Development of reference strains and reagents for vaccines
• Vaccine evaluation and licensure
• Determination of populations at highest risk and strategies for vaccination and antiviral use
• Assessment of measures to decrease transmission (such as travel restrictions, isolation, and quarantine)
• Deployment of purchased vaccine
• Deployment of antiviral agents
• Evaluation of the efficacy of response measures
• Evaluation of vaccine safety
• Deployment of the Epidemic Intelligence Service officers
• Medical and public health communications

Proposed Center for Disease Control and Prevention (PCDCP) Responsibilities

PCDCP is responsible for coordination of the pandemic influenza response within and between their jurisdictions. Specific areas of responsibility include the following:
• Identification of public and private sector partners needed for effective planning and response.
• Development of key components of pandemic influenza preparedness plan (surveillance, vaccine and antiviral distribution, disease control, and communications) following guidance provided by the WHO in the national Pandemic Influenza Preparedness and Response Plan.
• Integration of pandemic influenza planning with other planning activities conducted under Georgian Government, cooperative agreements with Abkhazia, South Ossetia and countries who will participate in our program.
• Coordination with local areas to ensure development of local plans as called for by the AISER plan and provide resources, such as templates to assist in planning process.
• Development of data management systems needed to implement components of the plan.
• Assistance to local areas in exercising plans.
• Coordination with adjoining jurisdictions and separatist Government.

Assumption

• An influenza virus strain will likely emerge in a country other than the Georgia, but a novel strain could emerge first in the Abkhazia region of Georgia.
• The pandemic may occur during time periods not normally associated with the usual influenza season, and the pandemic strain may attack categories of people at different rates than that which normally occurs during the influenza season.
• There may be as little as one to six months warning before outbreaks begin in the Georgia, if the pandemic emerges outside this country.
• Although there may be isolated pockets, the pandemic could affect all areas of the state.
• When the pandemic occurs, vaccines and antiviral medicines will be in short supply and will have to be allocated on a priority basis.
• It will take six to eight months after the novel virus is identified before the vaccine is available for distribution, unless a DNA vaccine is developed and deemed safe and necessary.
• A second dose of vaccine (two to four weeks after the first) may be required to develop immunity to the novel virus.
• In a pandemic, vaccine purchase and distribution options include:
•    public sector purchase and distribution of all pandemic influenza vaccine
•    a mixed public-private system where public sector supply may be targeted to specific priority groups (e.g., health care workers and those providing essential public safety services) and those who may be underserved by the current system
•    maintenance of the current, largely private, system
• The federal government has assumed responsibility for devising a liability program for vaccine manufacturers and persons administering the vaccine.
• Secondary bacterial infections following influenza illness may stress antibiotic supplies.
• Response to the demand for services may require non-standard approaches, including:
•    Discharge of all but critically ill hospital patients
•    Expansion of hospital capacity by using all available space and less than code beds
•    Increase of patient ratio to hospital staff
•    Recruitment of volunteers who can provide custodial services under the general supervision of health and medical workers
•    Relaxation of practitioner licensure requirements as deemed appropriate, and
•    Utilization of general purpose and special needs shelters as temporary health facilities.
• Educating the public about the rationale for priority groups for antivirals and vaccine will be an important aspect of public education.
• There will be widespread circulation of conflicting information, misinformation, and rumors. Communication must be coordinated among all relevant agencies to ensure consistent messages to the general public.

Ramaz Mitaishvili, MD 

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