Presentation on theme: "Pandemic Influenza Planning"— Presentation transcript:
1 Pandemic Influenza Planning Frank J. Welch, MD, MSPHMedical DirectorDepartment of Health and HospitalsOffice of Public HealthHello and welcome to this presentation dealing with a potential pandemic flu event and how this would affect you.My name is Tina Stefanski and I am the Administrator and Medical Director for the Louisiana Department of Health and Hospital’s Region IV Office of Public Health. The Office of Public Health is your state health department. Many of you know the Office of Public Health as the agency that delivers invaluable public health services through the parish health units. However, we are involved in many other important activities outside the four walls of the parish health units. One of these is pandemic flu planning.
2 “We don’t know the timing of the next pandemic, how severe it will be “We don’t know the timing of the next pandemic, how severe it will be. We don’t know what drugs will work. We don’t have a vaccine. Yet we are telling everyone to prepare for a pandemic. It’s tricky…This is scary and we don’t know… That’s the message.” Dick Thompson World Health Organization December 2005
3 Discussion TopicsInfluenza overview20th century pandemicsCurrent threatRole of Public Health in preparedness and responseUnique preparedness issues for a pandemic
5 How do we prepare for this? Explain Spread ScenarioAnimation Courtesy of Mathematica Visualizations – Jeff Bryant
6 http://worldvid. cit. nih. gov/flu/flu. wmv http://worldvid. cit. nih This is an 80-second animation you may wish to review. Each dot represents a census tract (more of nation’s population in the eastern part of the country). The dots start as green and change to red as more people in that tract become infected. The dots change back to green as people recover.Proceedings of the National Academy of Science, April 11, 2006Vol. 103, No. 15: 5935 – 5940.
7 Flu terms Seasonal (or common) flu Avian (or bird) flu Pandemic flu Respiratory illness that can be transmitted person to person. Most people have some immunity; vaccine available. What is left over from previous pandemics.Avian (or bird) fluCaused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. No human immunity and no vaccine.Pandemic fluA virulent human flu (often from mutation of an avian flu) that causes a global outbreak (pandemic) of serious illness. Since little natural immunity, the disease can spread easily from person to person. Currently no pandemic flu.
8 How does influenza spread? Breathing in dropletsProduced when infected person talks/coughs/ sneezesTouching an infected person or surfaceContaminated with the virus and then touching your own or someone else’s faceIncubation period = time from exposure to virus to development of symptomsVaries, but usually 1-4 daysInfluenza is easily passed from person to person through breathing in droplets containing the virus, produced when infected person talks, coughs or sneezes.It is also transmitted by touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face.This picture on the right gives you an idea of the large droplets produced by someone who has influenza when they sneeze and how these droplets can fall on other people or surfaces allowing transmission.These large droplets generally do not remain suspended in the air and only travel about 3 feet through the air.
9 Flu Preventive Steps Vaccination Stay home when sick, 1 week from onset of symptomsCover your coughHand hygieneWash with soap and water regularlyAlcohol-based sanitizer if no water availableAvoid touching eyes, nose and mouthAvoid close contact with people who are sickWhat should we do to prevent the transmission of influenza?Our best protection against seasonal flu is vaccination.However, it is important to stay home when you are sick with the flu, even though your role at work or your attendance in school may be vital.Always remember to cover your cough, wash your hands regularly, and avoid touching your eyes, nose and mouth.Also avoid close contact with people who are sick with the flu as much as possible.As you will learn, these basic measures may be our most powerful weapons when combating pandemic flu.
10 Seasonal and Pandemic Flu Seasonal FluAverage U.S. deaths ~36,000/yr200,000 hospitalizationsSymptoms (sudden onset): fever, cough, runny nose, muscle pain; death often caused by complications like pneumoniaGenerally causes modest societal impactManageable impact on domestic and world economyPandemic FluNumber of deaths could be quite high (1918 death toll ~ 500,000)Symptoms may be more severe and complications more frequentMay cause major impact on societyPotential for severe impact on domestic and world economy
11 Seasonal and Pandemic Flu, cont Seasonal FluOutbreaks follow predictable patterns; annual; usually in winterUsually some immunity from previous exposureComplication risks- young, elderly and underlying health conditionsHealth systems usually meet needsVaccine and antivirals usually availablePandemic FluUnable to predict when; Occurs rarely (three times in 20th century – last 1968)No previous exposure; little or no pre-existing immunityHealthy people may be at increased riskHealth systems may be overwhelmedVaccine not available in early stages and antivirals may be in limited supply
12 20th Century Flu Pandemics 1918 – Spanish FluWorldwide million deaths500,000 deaths in US– Asian FluWorldwide 1-2 million deaths70,000 deaths in US– Hong Kong FluWorldwide 700,000 deaths34,000 deaths in USLooking at some of the flu pandemics in the 20th century,There was one that ran from 1968 to 1969.At least 700,000 people died worldwide.There were 34,000 deaths in US.There was a flu pandemic that occurred from 1957 to 1958.At least 1.5 million people died worldwide.There were 70,000 deaths in US.And the worst pandemic occurred from 1918 to 1919 spreading around the globe in 4-6 months.At least million people died worldwide.And there were 500,000 – 650,000 deaths in the US.During the course of the epidemic, 47% of all deaths were from influenza& its complications.Two major issues: overcrowding & public information withheldAll of this is in comparison to a typical influenza season where we see 36,000 deaths in US.Typical Influenza Season36,000 deaths in US
13 Avian (Bird) Influenza Occurs naturally among birdsWild birds worldwide carry the virus – usually no illnessDomesticated birds - can become ill and dieHumansCan become infected -- severe illness and deathMost cases from close contact with infected poultryMay have rarely spread from one person to anotherCases/deaths since 2003 = 270/164 (60% mortality)Avian influenza is an infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus).Wild birds worldwide carry the viruses in their intestines, but usually do not get sick from them.It can make some domesticated birds, including chickens, ducks, and turkeys, very sick and die.The avian influenza virus has infected some people, causing severe illness and death..Most cases of avian influenza infection in humans have resulted from direct or close contact with infected poultry .In very rare cases, the virus may have spread from one person to another. The very few people who may have gotten bird flu from another person did not pass it on.There have been sporadic human cases:starting in 2003 running through January 29, 2007, there have been 270 cases with 164 deathsmost in young and healthy with case-fatality rate of around 60%
14 Will H5N1 cause the next pandemic? Avian Flu not yet Pandemic FluCurrent outbreaks of H5N1 Avian Flu in poultry and birds are the largest ever documentedImpossible to predict next pandemic flu eventIf not H5N1, then another
15 Lessons from Past Pandemics Occur unpredictably, not always in winterVariations in mortality, severity of illness and pattern of illnessRapid surge in number of cases over brief period of time, often measured in weeksTend to occur in wavesEach wave lasts about 2-3 monthsSubsequent waves may be more or less severeGenerally occur 3-12 months after previous waveLessons that have been learned from past pandemic flu events include the following:These events occur unpredictably and not always in winter.There have been great variations in mortality, or death, severity of illness and pattern of illness, or ages most severely affected.There is a rapid surge in number of cases over brief period of time, often measured in weeks.Again these pandemics tend to occur in waves; and subsequent waves may be more or less severe – Experts agree that there will be 1-6 months between identification of a novel virus and widespread outbreaks in the US.
16 Earlier, you saw computer modeling of a future pandemic, this shows what happened in 1918.
18 Estimated Pandemic Influenza Impact in the US 200 million persons infected38-89 million clinically ill18-42 million requiring outpatient care314,000 – 733,000 hospitalized89,000 – 207,000 deathsLarge US impact will make it difficult to rely on help from other parts of the country.
19 Pandemic Flu: Current Status InterpandemicPandemic alertPandemicPhase 1Phase 2Phase 3Phase 4Larger clusters, localizedLimited spread among humansPhase 5Phase 6No new virus in humansAnimal viruses low risk to humansNo new virus in humansAnimal viruses low risk to humansNew virus in humansLittle/no spread among humansSmall clusters, localizedLimited spread among humansIncreased and sustained spread in general human populationThe current status of the H5N1 bird flu situation places us in what’s called Phase 3 of the World Health Organization pandemic flu classification.As you can see, this means we are in the lowest stage of a pandemic alert.Current H5N1 statusWHO Global Influenza Preparedness Plan, Available at:
20 Requirements for Pandemic Flu For pandemic flu to occur, three conditions must be met:A new influenza A virus appears or “emerges” in the human population The new virus causes serious illness in people The new virus spreads easily from person to person worldwideThere is currently no pandemic influenza in the world.For pandemic influenza to occur, three conditions must be met:a new influenza A virus appears or “emerges” in the human populationit causes serious illness in peopleit spreads easily from person to person worldwide
21 Antiviral MedicinesUsed for treatment of ill individuals, and rarely prophylaxis of contacts of an ill person.Expensive, scarce, have side effects, and inappropriate use can cause viral resistance.Antivirals from the SNS will be distributed to hospitals for patients ill with the PanFlu virus.The SHO and the Office of Public Health will also provide guidelines on appropriate use of antivirals that are distributed. Public education will be very important given the scarcity of this resource.Prioritizing within priority groups will be necessary given the limited supply. As with vaccine, it will be critical to clearly communicate with the public about the rational for priority groups.
22 VaccinesVaccine will likely not be available when the novel virus first affects communities.Current manufacturing procedures require six to eight months before large amounts of vaccine are available for distribution.Once a vaccine becomes available, it will be distributed through the Strategic National Stockpile system:The target population will be the entire Louisiana population.Demand for vaccine will be greater than the supply early in the course of the pandemic.Once vaccine is available, it will need to be distributed as quickly as possible through Point of Dispensing (POD) sites.Immunologic responses is poor to unknown. It is likely that a second (booster) dose of vaccine two to four weeks after the first dose is given will be required.Like antivirals, early in distribution, vaccines will need to be prioritized.
25 Pandemic Flu Preparedness and Response Planning …must move beyond traditional notions of continuity of operations, as a pandemic promises to test the limits of current contingency plans.Pandemic Influenza –Preparedness,Response, and RecoveryGuide for Critical Infrastructure and Key ResourcesPublication Date:
26 How do we plan? Understand roles Education Collaboration Federal, State, LocalHospitals and ClinicsBusiness and IndustrySchools and UniversitiesFaith-Based and Community organizationsIndividuals/familiesEducationCollaboration
29 Federal Checklists Federal planning State and local planning Individual planningBusiness planningCommunity and faith-based organizations planningSchool planningChild Care and PreschoolSchool District (K – 12)Colleges and UniversitiesHealth Care planningEmergency Medical Services and non-emergent medical transportMedical offices and clinicsHome Health CareLong-Term careHospitals
30 Selective recommendations from the Business, Community and School Planning Checklists Plan for up to 40% employee absenteeism for up to 2 months
31 SummaryInfluenza pandemics are naturally recurring events – come in wavesExperts think the world may be on the brink of another pandemicAll countries will be affected; illness will be widespread; mortality rate will be highHealthcare systems will be overwhelmedEconomic and social disruption will be greatRisk minimized through preventive stepsNo vaccine initiallyPlan beyond “traditional notions of continuity of operations”Everyone needs to be prepared
32 When you do not know all the variables, but the risk is extreme, the lesson becomes: Plan for it all. Pandemic Influenza – Preparedness,Response, and Recovery Guide for Critical Infrastructure and Key Resources Publication Date:
33 References State Pandemic Resources Family Readiness Guide Family Readiness GuideOfficial Pandemic Flu Web SitePandemic Influenza Preparedness, Response, and Recovery Guide for Critical Infrastructure and Key Resources