Pandemic Survival

Pandemic Survival Tips

Two years ago in 2011, the film Contagion was released.  The story is about a deadly virus that spreads around the world and wreaks havoc with society.

 

A few years earlier, ABC-TV presented the movie Fatal Contact, Bird Flu in America, a fictional account of the devastating effects of a bird flu pandemic in the United States. It followed the virus as it traveled from a market in Hong Kong and mutated into a human-to-human strain that quickly spread across the globe. After it was broadcasted last year, nearly 2000 of you wrote I.P.N. asking questions about the program and our official position on it. Normally, we would have dismissed programs like these as entertainment designed to attract viewers and exploit their fears about the subject for ratings & ticket sales. In this case, it wasn’t. It dramatically illustrated just how bad things could become if the H5N1 strain of flu mutates into a human-to-human transmissible form.

Seven years ago in Sumatra, the H5N1 strain mutated into a highly virulent human-to-human strain that infected eight family members and killed seven.

Currently, humans have no immunity to H5N1. Fortunately for all of us, this form of avian flu hasn’t spread yet, however, as most virologists & epidemiologists already know, the odds are high that very soon a global pandemic will develop and due to modern transportation systems, spread internationally with unprecedented speed. In past pandemics, influenza viruses have needed more than six months to spread.  The recent 2009 H1N1 virus outbreak in Mexico spread in less than six weeks.

A short time after it was it was first detected in Mexico City in April 2009, H1N1 killed over 1,154 people worldwide.  Most of the deaths were in the Americas. Eventually, there were over 1 million Americans infected.

The most troubling aspect of this development is that a virus of this type could conceivably combine with the avian flu H5N1 or other viruses and trigger a global pandemic similar to the Spanish flu pandemic (another avian flu virus) of 1918 that killed 675,000 Americans and approx. 50-100 million people worldwide.

With the numbers adjusted for the increase in world population, a similar pandemic would kill upwards of 2-3 million Americans over a period of 9-15 months and quite possibly, 150-300 million worldwide. As frightening as it may seem, it could even be much worse than this. In poor countries like Africa, Southern Asia, Latin America and the Caribbean, there are no buffers to prevent the spread. It could sweep across these countries like a biological brush fire, leaving a trail of death and suffering in its wake on a scale not seen since the “Black Death” swept through Europe in the 14th century. See link: http://www.eyewitnesstohistory.com/plague.htm

The H5N1 Avian flu strain has a 50-100% mortality rate. See: http://www.medicinenet.com/bird_flu/article.htm this means that in a hypothetical situation where 100 people are infected, between 50% & 100% of them will die upon contracting the virus. Even a mild pandemic would increase the annual death for influenza by a factor of 10 from approximately 36,000 to about 360,000.

See link: http://www.cdc.gov/od/oc/media/pressrel/r030107.htm

The only question here is: Are you prepared if the worst happens?

(Or even the least?)

If you aren’t read on.  The following document will outline all of the major survival strategies needed to help you survive any type of pandemic.

The highest urban risk areas listed below are marked with the bio-hazard symbol one indicates low risk, two medium, three  high, and four very high:

The best way to avoid illness is to minimize your exposure to the contagion.

This is very difficult to manage in a crowded city, but it isn’t impossible. Continue reading to learn about how you must change your behavior during a pandemic to avoid contact with this potentially lethal contagion.

Tamiflu is not the answer!

Currently, the only medicine that has been somewhat effective in treating H1N1 is a drug called “Tamiflu” (oseltamivir). It has been shown to be useful in some cases when taken before serious illness develops, but the H5N1 strain is showing signs that it may be developing a resistance.  New types such as the A(H1N1) type, found in Brazil, have a nearly 10% lethality rate for people with low risk factors. This recent development is forcing many governments around the world to rethink their H1N1 fighting strategies. Clearly, having stockpiles of Tamiflu will not be enough to combat this powerful virus. It will take a combination of methods to help keep it under control. Isolation and hygiene are the two best methods.

The following is a list of some of the others:

You must make your body as inhospitable to flu viruses as possible. If a pandemic breaks out, modify your diet to include as many flu fighting foods and beverages as you can. If you contract it, this will slow down the replication of the virus (viral load) in your system enough to keep it from spiraling out of control.

  • A Korean fermented cabbage dish called Kimchi (pronounced Kimâchee) that has shown some promise after a study by scientists in Seoul, Korea who discovered that 11 of 13 chickens infected with the avian flu recovered after they were fed an extract of Kimchi.  It might have the same effects on H1N1 see links:

http://news.bbc.co.uk/2/hi/asia-pacific/4347443.stmhttp://times.hankooki.com/lpage/nation/200510/kt2005101217270011950.htm, also see link:

http://www.freerepublic.com/focus/f-news/1504289/posts http://seattletimes.nwsource.com/html/health/2002608490_flucure07.html

  • Dark grape juice may help to keep the viral load low if you contract it. It contains substances called tannins. This has been known to kill flu viruses in laboratories. Elderberries (known as the “Englishman’s grape) may also help to keep the viral load lower or under control if it is taken before the illness becomes severe.  It contains a number of compounds that are effective against flu viruses.   Never use Elderberry unless it is the commercially produced extract. The flowers, unripe berries, bark, roots and leaves contain enough cyanide to produce cyanide poisoning or even death. Look for elderberry capsules, juice or syrup in your local health food store.  The preferred product is called Sambucol, a black elderberry extract that may help to minimize flu symptoms.

A recent study conducted by Dr. Erling Thom & his team at the University of Oslo in Norway demonstrated that 93% of flu patients that were given Sambucol lost all symptoms in 48 hours. It included 60 patients that were struggling with severe flu symptoms from two different strains of the virus for approx. two days. 90% had a “type A,” the others had a type “B.” 1/2 of the group was given 15 milliliters of Sambucol & the other half were given placebos four times a day for a five day period.   The Sambucol patients’ conditions rapidly improved in 72 hours and 90% were completely cured during that period.  In addition, the patients treated with Sambucol had no pronounced side effects (drowsiness, dizziness etc) as other anti-virals such as Tamiflu produce.

See link: http://www.elderberries.com/elderberries.html

The placebo group did not fare as well.  They didn’t begin to normalize until six days later & they also took more symptom reduction medications.  Elderberry extract could be one of the most effective and safe treatments available. Sambucol is the only form of elderberry that has had proven results in laboratory studies.  It is important to note that some believe that elderberry can trigger a “cytokene storm.”

Simply stated, this is a hyper-reaction of your immune system. Essentially, Cytokines are molecules that function to signal your body’s immune system to respond to infections and invading microorganisms.  The body uses white cells called macrophages that are activated by bacteria, viruses & circulating white cells called CD8+T-lymphocytes that attack when they are exposed to flu viruses and the proteins that they produce.

These cells create cytokines such as Interferon (gamma, alpha & beta) Tumor Necrosis Factor, Monocyte Chemoattractant Protein and others that work to destroy the foreign invader.  Too many cytokines are like a heavy rainstorm that floods the body with these immune cells that can cause major problems (tissue inflammation), and lead toward death.  This particular strain of flu may provoke an abnormal immune system response that triggers a Some believe the elderberry can trigger a cytokine storm, but most reports are unproven clinically. Diabetics who use Sambucol should carefully monitor their blood sugar as it has the potential to increase the release of insulin.

At the heart of the stormy matter are macrophages (‘first responder’ white cells activated by damaged cells or foreign invaders such as bacteria or viruses) and CD8+T-lymphocytes (circulating white cells that leap into

So, the human lung with too many cytokines is way too much of a good thing, causing swelling, hemorrhage, and tissue death which are ironically, more a result of the body’s defense mode than a primary flu-generated injury. Scientists theorize that young people may have a more robust cytokine response and less H1N1 immunity from previous exposure compared with older populations.

  • As of today, 8 cases have been reported in the US from California and Mexico that have been identified as the swinish H1N1 flu but mild and self-limited illnesses in those affected. Remember, increasing evidence suggests that robust body levels of vitamin D are flu-protective, so this might be a good time to get your blood tested for vitamin D and step up your supplements under advisement with your physician.

One drug that does show some promise is an antiviral medicine called Relenza (zanamivir). It is inhaled through the nose and has been shown to produce fewer side effects.

  • Take vitamin C (ascorbic acid) every day- some recommend mega doses (20,000mg per day) against Avian Flu “there is no comprehensive study to confirm this but some use the 1949 case of Dr. Frederick Klenner, a clinical researcher from Reidsville, North Carolina, who infused 60 polio patients with massive intravenous doses of Vitamin C (20,000mg daily for three days — today’s recommended daily allowance is 60mg) After the treatment and a period of rest, all 60 were cured.

NOTE: There is no way to tell if Vitamin C can have this effect on Avian Flu until it is tested against it under laboratory conditions. If you are ever infected and your treatments are unsuccessful, it may be your physicians’ best “last resort” method to help you recover. See the following links:

http://www.orthomolecular.org/resources/omns/v01n12.shtml http://www.apfn.net/Messageboard/11-03-05/discussion.cgi.67.html http://www.newmediaexplorer.org/sepp/2005/10/28/avian_flu_is_specialization_killing_us.htmhttp://www.worldwidehealthcenter.net/articles-361.html

For flu viruses, the primary methods of transmission will be pneumonic (by air — virus loaded droplets of their saliva float in the air and, are inhaled by someone standing nearby) and, by direct contact, hand to nose, eye & mouth. Most colds and flu viruses are caught when people sneeze, cough, exhale or, shake the hand of someone who is infected and touch the inside of their nose, eye and in some cases mouth.

The virus (in aerosolized droplets) can also be (in some cases) transmitted over longer distances if the air currents in the room are strong enough to keep the droplets floating and high enough to be inhaled before they settle on the surrounding surfaces (current data suggests that flu viruses can survive up to four days outside of a host (body) see link:http://vetextension.psu.edu/Newsletters/vn/vn0404.pdf.

Wash your hands frequently; almost compulsively during a flu outbreak check this link and follow the advice religiously see link:

Wash Your Hands Holiday Jingle http://www.cdph.ca.gov/programs/immunize/Documents/WashYourHands_jingle.mp3

Keep a large supply of non-perishable food items and water stocked away in your home during winter months. Contrary to what you may hear from the federal government, two weeks is not enough. For a global pandemic, you would need from one (minimum) and for worse case scenarios, three months or even more. This will cut back on the need for traveling to supermarkets and grocery stores where you could encounter someone with the infection and acquire it. In addition, this will also allow you to stay inside of your home just in case your area became quarantined.

The only question here is: are you prepared if the worst happens?

Or even the least?

If you aren’t read on.  The following document will outline all of the major survival strategies needed to help you survive any type of pandemic.

The highest urban risk areas listed below are marked with the bio hazard symbol one indicates low risk, two medium, three  high, and four very high:

The best way to avoid illness is to minimize your exposure to the contagion. This is very difficult to manage in a crowded city but, it isn’t impossible. Continue reading to learn about how you must change your behavior during a pandemic to avoid contact with this potentially lethal contagion.

Tamiflu is not the answer!

Currently, the only medicine that has been somewhat effective in treating H1N1 is a drug called Tamiflu (oseltamivir). It has been shown to be useful in some cases when taken before serious illness develops but, the H5N1 strain is showing signs that it may be developing a resistance.  New types such as the A(H1N1) type found in Brazil have a nearly 10% lethality rate for people with low risk factors.

This recent development is forcing many governments around the world to rethink their H1N1 fighting strategies. Clearly, having stockpiles of Tamiflu will not be enough to combat this powerful virus. It will take a combination of methods to help keep it under control. Isolation and hygiene are the two best methods.

The following is a list of some of the others:

  • You must make your body as inhospitable to flu viruses as possible. If a pandemic breaks out, modify your diet to include as many flu fighting foods and beverages as you can. If you contract it, this will slow down the replication of the virus (viral load) in your system enough to keep it from spiraling out of control.
  • A Korean fermented cabbage dish called Kimchi (pronounced Kimâchee) that has shown some promise after a study by scientists in Seoul, Korea who discovered that 11 of 13 chickens infected with the avian flu recovered after they were fed an extract of Kimchi.  It might have the same effects on H1N1 see links:

http://news.bbc.co.uk/2/hi/asia-pacific/4347443.stmhttp://times.hankooki.com/lpage/nation/200510/kt2005101217270011950.htm, http://www.freerepublic.com/focus/f-news/1504289/posts http://seattletimes.nwsource.com/html/health/2002608490_flucure07.html

  • Dark grape juice may help to keep the viral load low if you contract it. It contains substances called tannins. This has been known to kill flu viruses in laboratories. Elderberries (known as the “Englishman’s grape) may also help to keep the viral load lower under control if it is taken before the illness becomes severe.  It contains a number of compounds that are effective against flu viruses.   Never use Elderberry unless it is the commercially produced extract. The flowers, unripe berries, bark, roots, leaves contain enough cyanide to produce cyanide poisoning or even death. Look for elderberry capsules, juice, syrup, in your local health food store.  The preferred product is called Sambucol, a black elderberry extract that may help to minimize flu symptoms.  A recent study conducted by Dr. Erling Thom & his team at the University of Oslo in Norway demonstrated that 93% of flu patients that were given Sambucol lost all symptoms in 48 hours.

It included 60 patients that were struggling with severe flu symptoms from two different strains of the virus for approx. two days. 90% had a “type A,” the others had a type “B.” 1/2 of the group was given 15 milliliters of Sambucol & the other half were given placebos four times a day for a five day period.   The Sambucol patients conditions rapidly improved in 72 hours and 90% were completely cured during that period.  In addition, the patients treated with Sambucol had no pronounced side effects (drowsiness, dizziness etc) as other anti-virals such as Tamiflu produce.

The placebo group did not fare as well.  They didn’t begin to normalize until six days later & they also took more symptom reduction medications.  Elderberry extract could be one of the most effective and safe treatments available. Sambucol is the only form of elderberry that has had proven results in laboratory studies.  It is important to note that some believe that elderberry can trigger a “cytokene storm.”

Simply stated, this is a hyper-reaction of your immune system. Essentially, Cytokines are molecules that function to signal your body’s immune system to respond to infections and invading microorganisms.  The body uses white cells called macrophages that are activated by bacteria, viruses & circulating white cells called CD8+T-lymphocytes that attack when they are exposed to flu viruses and the proteins that they produce.

These cells create cytokines such as Interferon (gamma, alpha & beta) Tumor Necrosis Factor, Monocyte Chemoattractant Protein and others that work to destroy the foreign invader.  Too many cytokines are like a heavy rainstorm that  flood the body with these immune cells can cause major problems (tissue inflammation, and lead toward death.  This particular strain of flu may provoke an abnormal immune system response that triggers a Some believe the elderberry can trigger a cytokine storm, but most reports are unproven clinically. Diabetics who use Sambucol should carefully monitor their blood sugar as it has the potential to increase the release of insulin.

At the heart of the stormy matter are macrophages (‘first responder’ white cells activated by damaged cells or foreign invaders such as bacteria or viruses) and CD8+T-lymphocytes (circulating white cells)

So the human lung and too many cytokines is way too much of a good thing, causing swelling, hemorrhage, and tissue death which are, ironically, more a result of the body’s defense mode than a primary flu-generated injury. Scientists theorize that young people may have a more robust cytokine response and less H1N1 immunity from previous exposure compared with older populations.

  • As of today, 8 cases have been reported in the US from California and Mexico that have been identified as the swinish H1N1 flu but mild and self-limited illnesses in those affected. Remember, increasing evidence suggests that robust body levels of vitamin D are flu-protective, so this might be a good time to get your blood tested for vitamin D and step up your supplements under advisement with your

See link: http://www.elderberries.com/elderberries.html

One drug that does show some promise is an antiviral medicine called Relenza (zanamivir) it is inhaled through the nose and has been shown to produce fewer side effects.

  • Take vitamin C (ascorbic acid) every day, some recommend mega doses (20,000mg per day) against Avian Flu “there is no comprehensive study to confirm this but some use the 1949 case of Dr. Frederick Klenner, a clinical researcher from Reidsville, North Carolina, who infused 60 polio patients with massive intravenous doses of Vitamin C “(20,000mg daily for three days — today’s recommended daily allowance is 60mg) After the treatment and a period of rest, all 60 were cured.

NOTE: There is no way to tell if Vitamin C can have this effect on Avian Flu until it is tested against it under laboratory conditions. If you are ever infected and your treatments are unsuccessful, it may be your physicians’ best “last resort” method to help you recover. See the following links:

http://www.orthomolecular.org/resources/omns/v01n12.shtml http://www.apfn.net/Messageboard/11-03-05/discussion.cgi.67.html http://www.newmediaexplorer.org/sepp/2005/10/28/avian_flu_is_specialization_killing_us.htmhttp://www.worldwidehealthcenter.net/articles-361.html

For flu viruses, the primary methods of transmission will be pneumonic (by air — virus loaded droplets of their saliva float in the air and, are inhaled by someone standing nearby) and, by direct contact, hand to nose, eye & mouth. Most colds and flu viruses are caught when people sneeze, cough, exhale or, shake the hand of someone who is infected and touch the inside of their nose, eye and in some cases mouth.

The virus (in aerosolized droplets) can also be (in some cases) transmitted over longer distances if the air currents in the room are strong enough to keep the droplets floating and high enough to be inhaled before they settle on the surrounding surfaces (current data suggests that flu viruses can survive up to four days outside of a host (body) see link:http://vetextension.psu.edu/Newsletters/vn/vn0404.pdf.

Wash your hands frequently; almost compulsively during a flu outbreak check this link and follow the advice religiously see link: Wash Your Hands Holiday Jingle http://www.cdph.ca.gov/programs/immunize/Documents/WashYourHands_jingle.mp3

Keep a large supply of non-perishable food items and water stocked away in your home during winter months. Contrary to what you may hear from the federal government, two weeks is not enough. For a global pandemic, you would need from one (minimum) and for worse case scenarios —  three months or even more. This will cut back on the need for traveling to supermarkets and grocery stores where you could encounter someone with the infection and acquire it. In addition, this will also allow you to stay inside of your home just in case your area became quarantined.

High Risk Areas

Crowded subway cars “ This is an extremely high risk area. The poor ventilation combined with the close proximity of the riders creates the perfect environment for transmission. One infected passenger that is sneezing or coughing can potentially infect a number of others standing or sitting nearby.

3M 8233 N-100 RESPIRATOR

Always wear an N-100 or N-95 masks and surgical gloves when riding. Do not be concerned about looking strange. You will look much worse if you contract avian flu.

If possible, wear eye protection to prevent touching eyes with contaminated hands. The spray from a sneeze can also deposit the virus onto the eye surface.  Eye protection reduces this risk.  The suggested eye-shields are military style or sports eyeglass goggles with protective barrier lining. They range in price from $20 to $100 dollars.

Military style | Sport style

 

Crowded subway platforms: Not as bad as a subway car, but still a high risk environment.  Mask, gloves & eyeshields should be warned to maximize protection.

Crowded buses: Another high risk area, potentially as bad as crowded subways. The risk can be significantly reduced by opening windows.

Passenger trains & aircraft: One infected passenger in a railroad train can potentially infect others up to five rows ahead. On an aircraft, this effect is magnified by the compressed air in a sealed environment.

Taxicabs, limousines, ambulances, police cars with closed windows: An infected driver will fill the air with virus loaded micro-droplets upon exhalation. The droplets will settle on the hard surfaces contaminating them. When traveling in a cab always keep your passenger window open, wear gloves.

Crowded theaters, airports, bus terminals, indoor sports events, crowded outdoor events, concerts and other public gatherings.

All public contact surfaces: Presents a high degree of risk during pandemics this includes — doorknobs and handles, handrails (escalators & stairways), elevator buttons, sinks, toilets and every surface in a public bathroom, computer keyboards (internet café’s etc.) public phones, subway & bus poles, turnstiles, cab doors and any other hard surface (and some softer, as in the case of seating) you encounter publicly.

Money: Coins are often overlooked, but this will also be another source of transmission. After handling money, make sure to wash you hands or use your hand cleaning solution.

Restaurants: Highly subjective! A restaurant’s safety depends on the diligence of the workers, precautionary measures taken during food preparations and ventilation.  As a rule, to be on the safe side, they should be avoided during pandemics. Fast food restaurants are also high risk. Food is served on trays that are rarely cleaned. Cleaning instruments (mops & rags) are not sterilized. Influenza viruses require up to 2 minutes of exposure (or more) to a disinfectant solution to kill them.

Elevators: High risk! One infected person who sneezes in a crowded elevator has the potential to infect nearly everyone riding with them.

Malls: A well-ventilated mall should be relatively safe during a pandemic if it is not crowded, the ventilation is good and caution is exercised while inside.

Offices: A crowded office is like an influenza superhighway. The dry air, poor ventilation and close proximity of the workers make another ideal transmission spot that is almost as dangerous as crowded subway cars & buses.  Office workers will need to take extra measures to prevent contraction and transmission.

Hospitals: There will be a large concentration of infected people cycling through the hospitals. This will obviously result in the transmission of the virus to many patients and workers. When entering a hospital, always make certain to follow every protective protocol to the letter!

Nursing homes: Many elderly people will contract influenza and spread it to some of the workers and health care professionals.

Public Laundromats: Influenza can be transmitted by handling contaminated clothing.

Supermarkets: Relatively safe if the ventilation system is working properly and crowds are low. NOTE: Special attention must be paid to contact surfaces (products). During a pandemic, surgical gloves should be worn

Cats: Birds are not the only animal source of the avian flu. Cats can contract the virus and transmit it. See:

http://news.nationalgeographic.com/news/2004/09/0902_040902_birdflu.html and

http://www.fao.org/ag/AGAinfo/subjects/en/health/diseases-cards/avian_cats.htmlhttp://www.telegraph.co.uk/news/main.jhtml?xml=/news/2006/06/13/nflu13.xml&sSheet=/news/2006/06/13/ixuknews.html

Since they live in such close proximity to humans, they pose a serious threat to public health during a pandemic. A cat that is suspect must be avoided, or must be captured by professionals to be tested by the medical authorities. If you own a cat, you must not let it venture outside during a pandemic where it can be exposed to a possible source of the virus. If it is infected, it will contaminate your environment and spread the infection to anyone who comes in contact with it.

If your cat is infected, you must carefully throw out the litter and litter box. Wear a mask and protective clothing while moving it. Place it inside of a sealed plastic bag and tape a label on it marked dangerous biological waste to warn sanitation crews.

You must then thoroughly clean your home or apartment, taking note of every area where your cat would sleep or play. Use a strong disinfectant that lists its effectiveness against influenza. If you have a carpet or rug in your home, it will have to be thrown out or steam cleaned by professionals with PPE. (personal protective equipment)

NOTE: As grim as it sounds — in a pandemic, there may be a need for the mass culling of cats & any other animal that can contract the virus and transmit it to humans.

Playgrounds: They are rarely cleaned and some of the contact surfaces that are not exposed to direct sunlight (the UV radiation in sunlight kills the H5N1 virus) can become contaminated. Children will contract influenza by touching the surfaces and scratching their eyes, mouth and noses.

1/2 Gymnasiums: Machines that are not disinfected after each use can become contaminated. In addition, crowded gymnasiums with poor ventilation systems can be a very dangerous point of transmission for the avian flu virus.

All Delivery Services: Delivery service workers will be exposed to a number of dangers that not only place them at a higher degree of risk, but also to become part of the problem by helping to actually spread the disease to others after becoming infected.

Website links for information

Centers for Disease Control and Prevention?www.cdc.gov/flu/avian/

OSHA’s Guidance for Protecting Workers Against Avian Flu?www.osha.gov/dsg/guidance/avian-flu.html

World Health Organization?www.who.int/csr/disease/avian_influenza/en/

References

1. World Health Organization. Avian influenza: assessing the pandemic threat. 2005 [cited 2005 Jan]. Available from http://www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/index.html

2. Virus Transmission study for airplanes http://www.fluent.com/solutions/aerospace/pdfs/ja195.pdf

3. Nonpharmaceutical Interventions for Pandemic Influenza, International Measureshttp://www.cdc.gov/ncidod/eid/vol12no01/05-1370.htm

4. 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

5. Pandemic Influenza, what it is and what you can do.http://home.san.rr.com/earlybird/BF_PSA.pdf

6. 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

7. World Health Organization Writing Group. Nonpharmaceutical public health interventions for pandemic influenza, national and community measures. Emerg Infect Dis. 2006;12:88 “94.”

8. Frank AL, Taber LH, Wells CR, Wells JM, Glezen WP, Paredes A. Patterns of shedding of myxoviruses and paramyxoviruses in children. J Infect Dis. 1981;144:433 “41.

9. Hall CB, Douglas RG Jr, Geiman JM, Meagher MP. Viral shedding patterns of children with influenza B infection. J Infect Dis. 1979;140:610 “3.”

10. Sheat K. An investigation into an explosive outbreak of influenzaâ ”New Plymouth. Communicable Disease New Zealand. 1992;92:18 “9.”

11. Bridges CB, Kuehnert MJ, Hall CB. Transmission of influenza: implications for control in health care settings. Clin Infect Dis. 2003;37:1094 “101.

12. Moser MR, Bender TR, Margolis HS, Noble GR, Kendal AP, Ritter DG. An outbreak of influenza aboard a commercial airliner. Am J Epidemiol. 1979;110:1“6.

13. Alford RH, Kasel JA, Gerone PJ, Knight V. Human influenza resulting from aerosol inhalation. Proc Soc Exp Biol Med. 1966;122:800 “4.

14. Morens DM, Rash VM. Lessons from a nursing home outbreak of influenza A. Infect Control Hosp Epidemiol. 1995;16:275 “80.

15. Bean B, Moore BM, Sterner B, Peterson LR, Gerding DN, Balfour HH Jr. Survival of influenza viruses on environmental surfaces. J Infect Dis. 1982;146:47 “51.

16. World Health Organization. Consensus document on the epidemiology of severe acute respiratory syndrome (SARS). 2003 [cited 2005 Oct 27]. p. 25“27. Available from http://www.who.int/csr/sars/en/WHOconsensus.pdf

17.  Mills CE, Robins JM, Lipsitch M. Transmissibility of 1918 pandemic influenza. Nature. 2004;432:904 “6.

18.  Ferguson NM, Cummings DA, Cauchemez S, Fraser C, Riley S, Meeyai A, et al. Strategies for containing an emerging influenza pandemic in Southeast Asia. Nature. 2005;437:209 “14.

19. Neuzil KM, Hohlbein C, Zhu Y. Illness among schoolchildren during influenza season: effect on school absenteeism, parental absenteeism from work, and secondary illness in families. Arch Pediatr Adolesc Med. 2002;156:986 “91.

20. Cumpston JHL. Influenza and maritime quarantine in Australia. Report no. 18. Melbourne: Commonwealth of Australia, Quarantine Service; 1919.

21. McQueen H. “Spanish ‘flu” 1919: political, medical and social aspects. Med J Aust. 1975;1:565 “70.

22. New South Wales Department of Public Health. Report on the influenza epidemic in New South Wales in 1919. Section V. Sydney: William Applegate Gullick; 1920. p 139 “272.”

23. Camail. In: Huot. L’ÃpidÃmie d’influenza de 1918 “1919 dans les colonies françaises. 3. Colonies de la côte orientale d’Afrique. Madagascar. Annales de MÃdecine et Pharmacie Coloniales. 1921;19:463“5.”

24.  Patterson KD, Pyle GF. The diffusion of influenza in sub-Saharan Africa during the 1918 “1919 pandemic. Soc Sci Med. 1983;17:1299 “307.

25.  Barry JM. The great epidemic: the epic story of the deadliest plague in history. New York: Viking Penguin; 2004.

26.  Peltier. L’ÃpidÃmie d’influenza qui a sÃvi en Nouvelle CalÃdonie en 1921. Bulletin de l’Office International d’Hygiène Publique. 1922;14:676“85.

27. Patterson KD. The influenza epidemic of 1918“1919 in the Gold Coast. J Afr Hist. 1983;24:485 “502.

28. World Health Organization. Expert committee on respiratory virus disease: first report. World Health Organ Tech Rep Ser. 1959;58:1 “59.”

29. Bell DM, World Health Organization Working Group on Prevention of International and Community Transmission of SARS. Public health interventions and SARS spread, 2003. Emerg Infect Dis. 2004;10:1900 “6.”

30. St John RK, King A, de Jong D, Bodie-Collins M, Squires SG, Tam TW. Border screening for SARS. Emerg Infect Dis. 2005;11:6 “10.

31. Pitman RJ, Cooper BS, Trotter CL, Gay NJ, Edmunds WJ. Entry screening for SARS or influenza, policy evaluation. BMJ. 2005;331:1242“3.

32. Centers for Disease Control and Prevention. Use of quarantine to prevent transmission of severe acute respiratory syndrome ”Taiwan, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:680“3.

33. Mangili A, Gendreau MA. Transmission of infectious diseases during commercial air travel. Lancet. 2005;365:989“96.

34. Miller JM, Tam TW, Maloney S, Fukuda K, Cox N, Hockin J, et al. Cruise ships: high-risk passengers and the global spread of new influenza viruses. Clin Infect Dis. 2000;31:433 “8.”

35. Marsden AG. Influenza outbreak related to air travel. Med J Aust. 2003;179:172“3.

36. Centers for Disease Control and Prevention. Preliminary guidelines for the prevention and control of influenza-like illness among passengers and crew members on cruise ships. 1999 [cited 2005 Sep]. Available fromhttp://www.cdc.gov/travel/CDCguideflufnl.pdf

37. Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP, et al. Transmission of the severe acute respiratory syndrome on aircraft. N Engl J Med. 2003;349:2416 “22.”