With world health experts predicting a flu pandemic any year now, N.C. health officials have drafted a plan for closing schools and ordering quarantines to prevent the spread of a new and deadly virus.

"We know that from the natural history of flu, these things circulate three or four times in a 100-year period," said N.C. state epidemiologist Dr. Jeffrey Engel. "No one will be immune from this."

The 20th century saw three pandemics, including the 1918-19 flu that killed more than 20 million people worldwide, including many healthy young adults. Others occurred in 1956-57 and 1967-68.

This year, world health officials are carefully watching developments in southeast Asia, where the bird flu killed some 30 people in the last two years. Recent deaths from bird flu in one Thailand family raise concern about what might be the first human-to-human transmission.

"The concern is that one of these bird flu viruses will get into a human simultaneously infected with the human flu," Engel said. Out of that could spring a new virus, for which no one will have immunity and there won´t be a vaccine.

A pandemic is characterized by epidemics of severe infection with a new virus in multiple countries. "SARS was the first pandemic of the 21st century," Engel said.

The state´s draft plan for a flu pandemic will recommend closing schools as soon as a new flu virus is detected in the state. "If you´re waiting until there´s a 30 percent absenteeism rate in schools, then it´s too late," he said.

Closing schools slows the spread of flu by keeping people from large gatherings.

"We call it the snow-day approach," he said. "But can you imagine a snow day that lasts for six weeks? That´s how long a (flu) wave lasts."

Because there is a limited supply of antiviral medicines, such as Tamiflu, the plan recommends that they be given first to essential health-care providers and emergency personnel during a pandemic.

The same would be true for a new vaccine, once it became available.

Engel said he doubts the next pandemic will be as bad as 1918 because antibiotics could prevent so many deaths from bacterial pneumonia.

But he predicts there could be one "at any time. ... Every year we go by without one the chances get likelier."

Keeping records

In response to last year´s early flu season that killed more than 150 children nationwide, all states will be, for the first time, mandating reports of deaths of children under 18 from influenza.The change was recommended by the U.S. Centers for Disease Control and Prevention so that health officials can compare the severity of flu seasons.

Flu deaths have not been confirmed and reported by states in the past, only estimated. Last year, because of the increased awareness, health officials confirmed that nine N.C. children died of the flu in December. "I think that´s probably more than we would expect by chance alone, but we don´t have the statistics to back that up," Engel said.

"Once we begin to really monitor mortality from the flu in children, we might be able to sway vaccine policy in the United States, to recommend it for all kids."

Pandemic Plan

Draft N.C. plan will be available soon at www.epi.state.nc.us/epi/ gcdc.html, under N.C. Communicable Disease Manuals and Rules.