1. PANDEMIC INFLUENZA M. Rony Francois, MD, MSPH, PhD
Secretary, Florida Department of Health
Bill Tynan, M.D.
T. R. Belcuore, MS

2. Overview Threat Preparedness Questions Disease Characteristics
Pandemic Characteristics
Preparedness
Surveillance
Resources
Questions

3. Threat Pandemic Influenza History Frequency ~ every 35 years
– 50 million deaths
million deaths
million deaths
Frequency ~ every 35 years
Duration 1 – 3 years
Waves 1 – 3, 4 – 8 weeks/wave
Worldwide 6 – 9 months, 3 months?

4. Threat Factors Affecting Outbreak Control
Attack rate 35% of population
Hospitalization rate 10% of cases
Case fatality rate ~2 - 50%
Asymptomatic, presymptomatic transmission ~30% - 50%
Reproduction number ~2 people
Serial interval ~2 – 4 days
Infectious period ~peaks day 2(1-8)
Incubation period ~2 (1 – 4 days)

5. AVIAN FLU BY THE NUMBERS
0- number of human and avian US cases
2- reproductive value of single flu case
1-5 days from exposure to illness
Communicability: 1-2 days before, 4-5 days after onset of symptoms
1997- year this virus appeared
250/115-number of confirmed cases/dead
300,000,000- number of birds killed (est.)

8. What constitutes a Pandemic?
1. Highly virulent organism
2. Lack of human immunity to the organism
3. Ability to easily transmit from human to human
H5N1 has the first two but not the third (recent cases in Indonesia)

9. WHERE ARE WE TODAY? PREPAREDNESS SURVEILLANCE ANTIVIRALS VACCINE
COMMUNICATION

10. Preparedness National Strategy
1. Stopping, slowing or otherwise limiting the spread of pandemic to the United States
2. Limiting the domestic spread of a pandemic, and mitigating disease, suffering and death
3. Sustaining infrastructure and mitigating impact to the economy and the functioning of society

11. Preparedness Florida’s Strategy ESF 8 Emerging Event Team (EET)
Develop Florida Strategy for Pandemic Influenza
Engage entire emergency management system
Prepare gap analysis with WHO, HHS Plans
Review, update existing all-hazards plans
Develop communications strategy for WHO phases of disease to all stakeholder groups and the public

12. SURVEILLANCE Animals Alaska Wild Bird Testing Poultry Farm Protocol
Humans
Sentinel Physicians
National Retail Monitoring System
Five Biosafety Level 3 Laboratories
Routine Disease Investigations

13. Commercial Poultry in Florida13

14. OVERARCHING GOALS Push the epidemic curve to the right
Reduce the “reproductive number”
Minimize antiviral usage
Minimize hospital burden
Minimize morbidity/mortality while vaccine is developed

15. Effect of delaying the onset of the epidemic
Delay three months
No intervention
Delay and contain
Six months
Pandemic starts
Infection appears in Florida
Vaccine available

16. RESPONSE & CONTAINMENT PHASE 6
CASE REPORTS
LABORATORY SURGE CAPACITY
ISOLATION
QUARANTINE
TARGETED ANTIVIRALS
TARGETED PROPHYLAXIS
TARGETED VACCINATIONS

17. THE LOG PHASE Individual case finding ceases Community Control
Social Distancing
Patient Management
COOP Plans- do you have one?

18. COMMUNITY CONTROL Stay home if you are sick Innovative food purchasing
Self Isolation
Family Support Plans

19. SOCIAL DISTANCING
Cessation of public meetings-technology can help here
Church gatherings
Theatres
Sporting Events
Closure of schools and child care
Use of distance learning

20. PATIENT MANAGEMENT Home is the primary place to be
Alternate treatment facilities
Alternate housing

21. VACCINATION PHASE
Who gets vaccinated first?
Vaccination Issues
Plan

22. COMMUNICATION Rumor control is critical Risk communication
Internet Amplification
Messenger and message

23. PANDEMIC FLU WEBSITES Centers for Disease Control & Prevention
Florida Department of Health
U.S. Department of Health & Human Services