1. Introduction to Pandemic Influenza
Public Health emergencies and international disaster response

2. Objectives To understand the pattern of infectious disease outbreaks
To understand the historical significance and impacts of pandemic influenza outbreaks
To learn the WHO protocols and guidelines for combating infectious diseases
To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics

5. World Health Organization Phases of a Pandemic
WHO has six phases for a pandemic that are under review following the H1N1 pandemic
Each Phase has specific activities recommended to governments
Each phase has communication recommendations
International Health Regulations of 2005
Novel virus and severity of the virus must be linked in new phase release

8. How do we identify infected individuals
Epidemiology
SARS
5 to 7 days
1 to 2 weeks
When symptomatic
All ill
Incubation period about 1 to 4 days
2-3 days for H1N1, 2-8 days for H5N1
Infective for about 5 to 7 days
up to 2 weeks in high-risk individuals
Infectious up to 24 hours BEFORE symptoms
May be asymptomatic ( %)
How do we identify infected
individuals
Picture:

10. Clinical Features Fever (3 - 7 days) Dry cough Sore throat Weakness
Muscle aches
Runny nose
Loss of appetite
Headache
Blocked nose
Lethargy (2 weeks)
Pneumonia

11. High Risk Populations Schools Military facilities Incarcerated
Children have longer viral shedding period
Greater opportunities for spread
Military facilities
Close living quarters
Field hygiene
Incarcerated
Prisons
Mental facilities
Elderly care facilities

12. Who is a “close contact”?
People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.

13. Picture: http://www. molecularlab

14. Droplet Precautions Prevent infection by large droplets from Examples
Sneezing
Coughing
Talking
Examples
Neisseria meningitidis
Pertussis
Influenza
Avian influenza (probable)

15. Rapid Response
Strong Surveillance systems will provide the opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response
Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS
Logistical support and trained personnel
A Risk Communication Plan and support from the local authorities
Plan for 6 weeks of support for 10,000 people

17. Rapid Containment Cannot Be “Business as Usual”
Start containment
Country and WHO involved
Results from WHO lab
“When is it too late to contain?”
Specimen to WHO lab
Results from national lab
Specimen to national lab
Initial investigation
Detection of Index Cluster
Report to local office
Start of Index Cluster
Onset of first case

19. Societal Impacts School closures
Air transportation and general movement of goods
Potential Border Closures (Tourism decline)
Economic slow down
Health system overload from flu patients
Care for normal sick is reduced
Supplies and staff become over burdened

20. Sustaining Essential Services
Planning estimates are that 40% of the work forces will be affected
Essential services will deteriorate slowly
Health services (patient care and Public Health)
Water and Sanitation
Food and agriculture production
Power (fuel and power grids)
Communications
Banking and finance
Transportation
Rule of law (police, courts, prisons, and national security

21. Non-Pharmaceutical Interventions
Infection controls
Voluntary isolation of sick people
Voluntary quarantine of healthy contacts
School closures
Social distancing
Travel restrictions
Mask use
Hand washing

22. Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months
Enough eggs? Strain selection? Adjuvants? Repeat doses? Expiration?

23. Potential Strategies to Decrease the Impact of a Pandemic
Prevent or delay introduction, slow spread
Decrease illness and death
Vaccine when available
Antiviral treatment and isolation for people with illness
Non-pharmaceutical interventions
Weeks
Impact
Prepared
Unprepared

24. Summary Combating a Pandemic; the three keys to success
Knowledge of the virus is critical
Mutations and movement
Laboratory testing capabilities (Field and Lab testing)
Vaccines (6-9 months)
Development
Manufacturing
Distribution
Non-Pharmaceutical interventions
Population compliance or non-compliance