1. Pandemic Influenza Preparedness Kentucky Department for Public Health Department for Public Health

2. DEFINITION An influenza pandemic (or global epidemic) occurs when a new virus subtype appears, against which no one is immune. This may result in several simultaneous epidemics worldwide with high numbers of cases and deaths. With the increase in global transport and urbanization, epidemics caused by the new influenza virus are likely to occur rapidly around the world.

3. Impact of Past Influenza Pandemics 1968-69 Hong Kong Flu (H3N2) 34,000 deaths US 1957-58 Asian Flu (H2N2) 70,000 deaths US 1918-19 Spanish Flu (H1N1) >500,000 deaths US 20-50 million worldwide

4. NOT IF, BUT WHEN… Are you prepared to prevent or minimize the human morbidity and mortality, the social disruption and the economic consequences caused by an influenza pandemic?

5. Catastrophic Events  1994 Northridge, CA = 51 deaths  2004 hurricanes = 152 US deaths  1995 Oklahoma City = 168 deaths  1974 tornadoes = 330 deaths  2001 Terror = 2,992 deaths  1916 polio epidemic = 7,000 deaths  2004 Tsunami = est. 300,000 deaths

6. Estimated Impact of a Future Influenza Pandemic in the U.S.*  Deaths: 89,000 - 207,000  Hospitalizations: 314,000 - 734,000  Outpatient visits: 18 - 42 million  Additional illnesses: 20 - 47 million  Economic impact: $71.3 - 166.5 billion * Model assumes attack rates of 15-35 % and is based on the 1968 pandemic, and a US population of 290 million persons. Meltzer M, et al. Emerging Infectious Diseases 1999;5:659-671.

7. Why Prepare? Planning may help to reduce transmission of the pandemic virus strain, to decrease cases, hospitalizations and deaths, to maintain essential services and to reduce the economic and social impact of a pandemic.

8. Estimated Time Frame? It would be unrealistic for any state to consider that it could prepare and implement a detailed and comprehensive pandemic plan in weeks, or even months.

9. Pandemic Phases (World Health Organization)  Interpandemic (phases 1-2): No new influenza virus subtypes in humans  Pandemic alert (phases 3-5): –Phase 3: human infection with new subtype, no h-t-h* spread –Phase 4: small clusters, limited h-t-h transmission, localized spread –Phase 5: h-t-h spread still localized, larger clusters  Pandemic (phase 6): sustained transmission in general population *h-t-h: human to human spread

10. A Multisectoral Approach A multisectoral approach means the involvement of many levels of government, and of people with various specialties including policy development, legislative review and drafting, animal health, public health, patient care, laboratory diagnosis, laboratory test development, communication expertise and disaster management.

11. Community Involvement Community involvement means making optimal use of local knowledge, expertise, resources and networks. It is a powerful way to engage people and to build the commitment needed for policy decisions.

12. Vaccines to Protect Against Pandemic Influenza Viruses A vaccine probably would not be available in the early stages of a pandemic. Once a potential pandemic strain of influenza virus is identified, it takes several months before a vaccine will be widely available.

13. Vaccine Availability Start of Influenza Pandemic No Vaccine Available 6 Months Initial Introduction of Influenza Vaccine 1 Year into Pandemic Adequate Amounts Produced to Vaccinate U.S. Population with 1 Dose 2 Years into Pandemic Adequate Amounts Produced to Vaccinate U.S. Population with 2 Doses 2 Doses will be necessary for adequate immunity Best Case Scenario

14. Pandemic Influenza Uniqueness  The pandemic will last much longer than most other emergency events and may include “waves” of influenza activity separated by months  The numbers of health-care workers and first responders available to work can be expected to be reduced  Because of how widespread an influenza pandemic would be, resources in many locations could be limited

15. No Time to Waste…