Nonpharmaceutical Interventions for Pandemic Influenza, International Measures

World Health Organization (WHO) Writing Group


Emerging Infectious Diseases. 2006;12(1) 

In This Article

Abstract and Introduction


Since global availability of vaccine and antivirals against influenza caused by novel human subtypes is insufficient, the World Health Organization (WHO) recommends nonpharmaceutical public health interventions to contain infection, delay spread, and reduce the impact of pandemic disease. Virus transmission characteristics will not be completely known in advance, but difficulties in influenza control typically include peak infectivity early in illness, a short interval between cases, and to a lesser extent, transmission from persons with incubating or asymptomatic infection. Screening and quarantining entering travelers at international borders did not substantially delay virus introduction in past pandemics, except in some island countries, and will likely be even less effective in the modern era. Instead, WHO recommends providing information to international travelers and possibly screening travelers departing countries with transmissible human infection. The principal focus of interventions against pandemic influenza spread should be at national and community levels rather than international borders.


Pandemic preparedness ideally would include pharmaceutical countermeasures (vaccine and antiviral drugs), but for the foreseeable future, such measures will not be available for the global population of >6 billion.[1] Thus, in 2005, after consultations with experts, the World Health Organization (WHO) recommended nonpharmaceutical public health interventions in its updated global influenza preparedness plan.[2] The recommendations are intended as guidance, not as formal WHO advice.[3] Such interventions, designed to reduce exposure of susceptible persons to an infectious agent, were commonly used for infection control in previous centuries. This report (part 1) and a companion article (part 2[4])summarize the scientific data, historic experience, and contemporary observations that make up the limited evidence base for these interventions as applied to influenza. Part 1 summarizes the relevant transmission characteristics of influenza and the basis for interventions to prevent spread from 1 country to another; part 2 summarizes the basis for measures within countries at the national and community levels. Both parts are designed to be read in conjunction with WHO recommendations.[2,3]

Nonpharmaceutical interventions outside of healthcare settings focus on measures to 1) limit international spread of the virus (e.g., travel screening and restrictions); 2) reduce spread within national and local populations (e.g., isolation and treatment of ill persons; monitoring and possible quarantine of exposed persons; and social distancing measures, such as cancellation of mass gatherings and closure of schools); 3) reduce an individual person's risk for infection (e.g., hand hygiene); and 4)communicate risk to the public. We discuss the first category; categories2 and 3 are addressed in part 2. We do not address infection control measures for patient care or risk communication.


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