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Pandemic Influenza A Local Perspective Pandemic Influenza A Local Perspective David Goodfriend, MD,MPH, Director Loudoun County Health Department

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Presentation on theme: "Pandemic Influenza A Local Perspective Pandemic Influenza A Local Perspective David Goodfriend, MD,MPH, Director Loudoun County Health Department"— Presentation transcript:

1 Pandemic Influenza A Local Perspective Pandemic Influenza A Local Perspective David Goodfriend, MD,MPH, Director Loudoun County Health Department July 20, 2007

2 Why Are We Here? An influenza pandemic is different from other public health disasters: −Simultaneous outbreaks can occur across many regions −Sharing of human resources or supplies from other communities is less likely Key elements that will affect the public include: −Human Impact Pandemics disproportionately affect younger people Potential for high levels of:  Sickness and death  Disruption of critical services  Economic loss −Business Continuity (COOP) −Communication

3 Impact on Business Functions Key Assumptions: − Economic impact nationwide could range from $71.3 to $166.5 billion − The epidemic could persist for two months or longer − Psychological impacts on the workforce will be extreme − Community containment measures may be implemented to minimize spread Will Return: SEP MAR DEC JUN

4 Pandemic Influenza

5 1918 Influenza Pandemic Spread around the globe in 4 - 6 months Death rate 25-times higher than previous epidemics 40 – 100 million people died worldwide Majority of deaths were in persons 18 to 40 years old


7 1918 Flu in the Washington Area (from the Washington Post, October 4-11, 1918) “Theaters Closed to Stay Influenza…Movies and Public Dance Halls also in [Closure] Order, Churches Next Likely” “Pandemic Extends from Coast to Coast” “Shortage of Coffins and Grave Diggers” “Universities Close Classes” “Ban on Public Funerals” “2,174 New Cases Reported in City” “Stagger Hours for Food and Fuel”

8 Excess US Deaths in Previous Influenza Pandemics 1918-19: 500,000 - 650,000 Ten times as many Americans died of flu than died in WW I 1957-58: 70,000 1968-69: 40,000 Typical annual influenza season: 36,000

9 Definitions EPIDEMIC:EPIDEMIC: An increase in disease above what is normally expected PANDEMIC:PANDEMIC: A worldwide epidemic

10 Influenza Clarification Seasonal Influenza:Seasonal Influenza: −A contagious respiratory illness caused by various influenza viruses creating a public health problem every year −Viruses circulate throughout the human population −Spread easily from person to person Avian Influenza A (H5N1):Avian Influenza A (H5N1): −Devastating global outbreak in poultry −Causes severe but rare human infections −Does NOT spread easily from person to person Pandemic Influenza:Pandemic Influenza: −Currently there is no pandemic of influenza −Appears in the human population periodically −H5N1 is a likely candidate, but is not a pandemic virus to date −Wide geographic spread

11 Viruses TypeCharacteristics A Affects Multiple Species including humans Avian Influenza is type A Most Virulent Virus: Although not all strains cause clinical disease Classified by surface antigens into subtypes: Hemagglutinin (H), Neuraminidase (N) Composed of 8 segments of RNA: Segments make it easier for ‘reassortment’ to occur B Mostly in humans Not categorized into subtypes Common and less severe then A Epidemics occur less often than A Human seasonal vaccine: Two strains of type A; one strain of type B C Humans and swine Rare, with mild to no symptoms By age 15, most people have antibodies

12 Pandemic Phases 1 Inter-pandemic phase Low risk of human cases 2 New virus in animals; no human cases Higher risk of human cases 3 Pandemic alert No or very limited human-to-human transmission 4 Virus causes human cases Evidence of increased human-to-human transmission 5 Evidence of significant human-to-human transmission 6 PandemicEfficient & sustained human-to-human transmission You Are Here

13 Situation Report: Avian Influenza Widespread and spreading prevalence in migratory birds; broad host range Continued outbreaks among domestic poultry Mammalian infection (cats, pigs, tigers, ferrets) lethal Virus is evolving Sporadic human cases Mostly in young and healthy persons 317 human cases, 191 deaths (~60% mortality rate) Rare person-to-person transmission Sustained and rapid person-to-person transmission

14 H5N1 Status -- June 2007

15 Cumulative Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO as of June 29, 2007 Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases Country 20032004200520062007Total CasesDeathsCasesDeathsCasesDeathsCasesDeathsCasesDeathsCasesDeaths Azerbaijan000000850085 Cambodia000044221177 China110085138322516 Djibouti000000100010 Egypt00000018101953715 Indonesia000020135545262210180 Iraq000000320032 Laos000000002222 Nigeria000000001111 Thailand0017125233002517 Turkey00000012400 4 Viet Nam332920611900209542 Total4446329843115795433317191

16 The Disease Droplets

17 Influenza (Flu) SymptomsSymptoms − Sudden headache − Dry cough − Runny nose − Sore throat − Muscle aches (myalgia) − Fatigue/malaise − Fever up to 104°F (40°C) Incubation - 24 to 72 hours Most people feel better within days Fatigue and cough can last for 2+ weeks Patients most infectious 24 hours before symptoms

18 Viral ‘Shedding’ The incubation period can vary from 1 to 4 days, but symptoms normally appear 2 days after exposure to the virus. Patients are most infectious 24 hours prior to the onset of symptoms. Viral shedding, the period when persons are contagious, lasts 5 to 7 days in adults. Persons can also be infected from environmental surfaces contaminated from infected respiratory secretions. The virus can survive outside a host cell for up to 48 hours on nonpenetrable surfaces and up to 12 hours on cloth, tissue, or paper.

19 Treatment or Prophylaxis ? Antivirals −Adamantanes (Amantadine, Rimantadine) −Neuraminadase inhibitors (Zanamivir, Oseltamivir) Therapy more efficient than prophylaxis in preventing adverse health outcomes −Uses less drug −Focuses on those who are ill and will directly benefit from medication Prophylaxis more effective than therapy in maintaining quality health care and public safety −Prevents absenteeism from fear of illness −Prevents time lost from work while ill

20 Lessons From Past Pandemics Large variations in mortality, severity of illness, pattern of illness, and age groups Rapid surge in number of cases over brief period of time (weeks) Tend to occur in waves - subsequent waves may be more or less severe Key Lesson – Unpredictability


22 Surveillance: Seasonal Influenza-Like-Illness Trends

23 Animal Surveillance Federal monitoring programs −Poultry farm surveillance State programs −Wild bird surveillance −Dead bird surveillance Local surveillance −Dead bird surveillance

24 Role of Public Health in Pandemics FEDERAL DHHS Pandemic Influenza Plan, 11/2005 Development of laboratory tests and reagents Development of reference strains for vaccines Vaccine evaluation and licensure Recommendations on target populations and priorities Deployment of federally purchased vaccine Mass vaccination clinic guidelines Evaluation of vaccine safety STATE (Response Plan – 2002, revised 3/2006) Surveillance Community Disease Control Immunization Antiviral medications Public Information Medical Care Planning Public Health Laboratory Infection Control Clinical Guidance Maintenance of Essential Health and Medical Services Travel associated risk Workforce Support

25 Role of County in Pandemic: Local All Response is local! Loudoun Pandemic Flu Preparedness Task Force Craft Public Messages Recruit Medical Reserve Corps members Develop Plan (available on Exercise Plan −July 2006: ‘Flu the COOP’ – tested county business continuity −October 2006: ‘Code Flu 06’ - exercise of mass prophylaxis POD plan −2007: Alternate Care; Non-Medical POD exercise

26 Role of County in Pandemic: Local Seminars & Educational Outreach Meetings −County and Town government organizations −Medical offices −Private businesses (Nissan North America, AOL, Costco, Lufthansa, Lockheed Martin, etc.) −First responders (police, fire, EMS) −Public and private schools, PTA's −Retirement communities and senior centers −Homeowners associations −Fraternal and civic organizations −Health fairs

27 Planning Being Able to Work May Be Difficult or Impossible −Ask your employer how business will continue during a pandemic −Discuss staggered shifts or working at home with your employer −Discuss telecommuting possibilities and needs, accessing remote networks, and using portable computers −Discuss possible flexibility in leave policies −Discuss with your employer how much leave you can take to care for yourself or a family member −Plan for possible loss of income if you are unable to work or the company you work for temporarily closes

28 Planning Plan for the possibility that usual services may be disrupted −Could include services provided by hospitals, other healthcare facilities, banks, restaurants, government offices, telephone and cellular phone companies, and post offices Stores may close or have limited supplies −Planning checklists can help you determine what items you should stockpile to help you manage without these services Transportation services may be disrupted and you may not be able to rely on public transportation −Plan to take fewer trips and store essential supplies

29 Planning Public gatherings, such as volunteer meetings and worship services, may be canceled Prepare contact lists including conference calls, telephone chains, and email distribution lists, to access or distribute necessary information Consider that the ability to travel, even by car if there are fuel shortages, may be limited

30 Planning Food and Water Supplies May Be Interrupted and Limited −Temporary shortages could occur −You may also be unable to get to a store Food −Store 2 weeks of nonperishable food −Select foods that do not require refrigeration, preparation (including the use of water ), or cooking −Insure that formulas for infants and any child's or older person's special nutritional needs are a part of your planning Water −Store two weeks of water, 1 gallon of water per person per day. (2 quarts for drinking, 2 quarts for food preparation/sanitation), in clean plastic containers −Avoid using containers that will decompose or break, such as milk cartons or glass bottles

31 Family Emergency Health Information Sheet Think ahead about issues that could affect you & your family If a mass vaccination clinic is set up you may need to provide medical histories. Example: Family Member Blood Type Allergies Past/Current Medical Conditions Current Medications & Dosages JohnO NegPenicillin High Blood Pressure Back surgery Lasix 20 mg daily Aspirin 85 mg daily JaneAB PosNonePregnant Pre-natal vitamin daily SuzyO PosMilk Eggs AsthmaInhaler as needed

32 Emergency Contacts Form ContactsName/Phone Number Local Personal emergency contact Out-of-town personal emergency contact Hospitals near: Work School Home Family physician(s) Loudoun County Health Department 703-777-0234 Pharmacy School(s) contact & emergency information Employer(s) contact & emergency number

33 Planning Schools and Daycare Centers May Be Closed for an Extended Period of Time Talk to teachers, administrators, and parent- teacher organizations about your school's pandemic plan, and offer your help Plan now for children staying at home for extended periods of time, as school closings may occur along with restrictions on public gatherings, such as at malls, movie theaters

34 Planning Medical Care for People with Chronic Illness Could be Disrupted −In a severe pandemic, hospitals and doctors' offices may be overwhelmed. −If you have a chronic disease, such as heart disease, high blood pressure, diabetes, asthma, or depression, you should continue taking medication as prescribed by your doctor. −Make sure you have necessary medical supplies such as glucose and blood-pressure monitoring equipment. −Talk to your healthcare provider to ensure adequate access to your medications. −If you receive ongoing medical care such as dialysis, chemotherapy, or other therapies, talk with your health care provider about plans to continue care during a pandemic.

35 Planning Stay Informed −Knowing the facts is the best preparation Identify sources you can count on for reliable information If a pandemic occurs, having accurate and reliable information will be critical Alert Loudoun ( −Check for information on your local and state government Web sites −Listen to local and national radio, watch news reports on television, and read your newspaper and other sources of printed and web-based information −Talk to your local health care providers and public health officials

36 Strategies for Preventing Pandemic Influenza Vaccination −May not be widely available Early Detection & Treatment −Surveillance −Antiviral drugs may be limited or ineffective Infection Prevention & Control MeasuresInfection Prevention & Control Measures


38 REMEMBER… Prepare Family Emergency Plans, Ensure Early Recognition of Staff/Family Members at Risk Prevent Transmission by implementing appropriate Infection Control Precautions Consult your local health department with suspect or actual cases More Information at: flu@loudoun.govSubmit additional thoughts or questions to or call me at 703-771-5829

39 Questions…

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