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Texas Pandemic Influenza Preparedness Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant.

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Presentation on theme: "Texas Pandemic Influenza Preparedness Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant."— Presentation transcript:

1 Texas Pandemic Influenza Preparedness Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant

2 Agenda Everything you wanted to know about pandemic influenza but couldnt find anyone to ask What you can do to prepare your family What you can do to prepare your school What you can do to prepare your students & their families

3 Everything you wanted to know... Definitions Examine reasons pandemics occur Look at the progress of Avian H5N1 Influenza Discuss why we are concerned Review current prevention efforts Consider the state of the science

4 Avian vs Pandemic Influenza

5 Epidemiology of Avian flu in humans Avian (Bird) Flu is a disease of birds All Avian Flu viruses are endemic in waterfowl & do not harm them Wild birds mix with domestic chickens in back yard farms Domestic chicken flocks mix in live poultry markets People mix with sick or dead chickens People catch Avian Flu

6 Seasonal vs Pandemic Flu Seasonal Annually Known virus Vaccine available (usually) High mortality young & old esp. w/ health problems Pandemic Irregular intervals Novel virus No or mismatched vaccine High mortality in year olds; mortality in young similar to seasonal flu

7 Pandemics of the 20 th Century YearNameStrainDeaths 1918SpanishH1N1>50 million (US 675,000) 1957AsianH2N21 – 2 million 1968Hong KongH3N2700,000

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9 Composition of Seasonal Vaccines 2004 – 2005 A / New Caledonia / 99 / H1N1 A / Fugian / 02 / H3N – 2006 A / New Caledonia / 99 / H1N1 A / California / 03 / H3N – 2007 (recommended) A / New Caledonia / 99 / H1N1 A / Wisconsin / 05 / H3N2

10 Pandemics of the 20 th Century YearNameStrainDeaths 1918SpanishH1N1>50 million (US 675,000) 1957AsianH2N21 – 2 million 1968Hong KongH3N2700,000

11 Antigenic change Antigenic drift occurs in HA and NA Associated with seasonal epidemics Continual development of new strains secondary to genetic mutations Antigenic shift occurs in HA and NA Associated with pandemics Appearance of novel influenza A viruses bearing new HA or both HA & NA

12 Human virus virus Reassortedvirus Non-humanvirus Mechanisms of Antigenic Shift Direct Infection Indirect Infection Reassortment in humans

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18 Countries with H5N1 Influenza in animals & humans Countries with H5N1 influenza in animals Through June 15, Countries with H5N1 influenza in humans

19 Bird and Human Cases H5N1 Bird CasesHuman Cases June 13, 2006

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21 The H5N1 Flu Threat to Humans 1.A new virus to which humans have no immunity - Yes 2.The virus causes significant human illness or death - Yes 3.The virus spreads easily from person-to-person – NO The Avian Flu (H5N1) virus has 2 out of 3 of these today…

22 Why the Concern with H5N1? 1918 (H1N1) flu and H5N1 avian flu are the only kissing cousins among the 169 known avian flu viruses.

23 1918 Influenza Pandemic million persons died worldwide, possibly more Death rate 25 times higher than previous epidemics ,000 deaths in the U.S.: Ten times as many Americans died of flu than died in WW I The epidemic preferentially affected and killed younger, healthy persons The epidemic was so severe that the average life span in the U.S. was depressed by 10 years

24 MOST FATAL EVENT IN THE LAST 300 YRS U.S. LIFE EXPECTANCY AT BIRTH

25 1918 H5N1Incident rate (0-75) 15 55

26 Case fatality rate comparison (0- 75) 15 55

27 Case fatality rate comparison

28 Cytokine Storm Has been suggested as an explanation for the devastating nature of the 1918 flu Is an over reactive immune response that causes multiple organ system failure Evidence indicates H5N1 deaths are caused by this

29 Worst Case Scenario Patient Severe (1918-like) NationalTexas Number sick150M11.5M Outpatient75M (50%)5.75M Hospitalized16.5M (11%)1,265,000 ICU Care2.5M (15%)199,750 Ventilator1.25M (50%)94,780 Death3.225M (2.15%)247,250 Absenteeism50% of workforce over 1 year

30 Pandemic wave mortality

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32 Animal intervention

33 Society during a pandemic Healthcare system Work School Travel Supplies Services

34 Prevention & Containment – Nonpharmaceutical Public Health population focused measures Personal protective measures Business contingency planning Care of sick at home

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36 Potential Community Measures to Decrease Transmission Travel advisories/limit travel to affected areas Screening travelers from affected areas* Limit large public gatherings; close schools Encourage telecommuting Limit availability of public transportation Hand hygiene, respiratory hygiene/cough etiquette Quarantine of exposed persons* Education to allow early identification and isolation of cases* * Note: Some measures may be most useful early in outbreak and with strains that are not efficiently transmitted

37 Evidence for use of masks Limited evidence available on benefits of masks in preventing healthcare or community influenza transmission Use prudent at least in healthcare settings SARS studies have shown clear benefit mask use in healthcare setting

38 Influenza Antiviral Drug Questions How much supply will there be? Will feds or state have control over distribution decisions? How should it be used? Who should get it? How can it be delivered? Where does the $$ come from?

39 12/07?? 50 million courses

40 Influenza Antiviral Drug Questions How much supply will there be? Will feds or state have control over distribution decisions? Where do the $$ come from? How should it be used? Who should get it? How can it be delivered?

41 Influenza Vaccine Questions When will it be available? How much will there be? How effective will it be? Who will own it? How should it be delivered? Who should get it? Who will pay for it?

42 Current method 1950s technology Depends on eggs and chicks Shortages often due to problems here Requires 4-6 months for vaccine production

43 Pandemic wave mortality

44 New method Cell cultures Less room More dependable Requires 4-6 weeks for vaccine production

45 Vaccine Consumption Source: WHO Global Influenza Program

46 Vaccine Production Capacity

47 Texas Plan Challenges In Health Systems Response Assuring essential workers are prophylaxed and/or vaccinated Surge Capacity Emergency Systems for Advance Registration of Volunteer Health Professionals Program (ESAR-VHP) Availability of PPE Disaster Mental Health Dead bodies

48 Texas Plan Challenges In Communication Risk Communication Pre-event message preparation for the public Educating decision makers Communication technology Interoperability

49 How can you prepare? Visit the DSHS website at: Follow the Pandemic Influenza link to the states plan. Appendix F Personal Protective Strategies

50 How can you prepare? Get seasonal flu vaccine Stay informed Stockpile supplies, food, & some $$ Talk to MD and RPh about extra routine meds Dont forget pets Have a family plan Know your business continuity plan

51 Websites l/change

52 Planning Takes Partnerships

53 Considerations in School Planning THE ROLES OF SCHOOLS IN THE COMMUNITY COMMUNICATING/COORDINATING WITH PUBLIC HEALTH/GOVERNMENT OFFICIALS UPDATING SCHOOL CRISIS PLANS LEARNING ABOUT PREVENTING INFECTIONS EDUCATING PARENTS, KIDS, STAFF INFORMING/COUNTERING DISINFORMATION MAINTAINING THE LEARNING ENVIRONMENT

54 Local Planning Is Critical Planning must be broad/interactive/cross- cutting/coordinated: city government, civil agencies health departments, community centers, medical providers, businesses, schools, private/voluntary/faith based organizations

55 Resources to Assist in Crisis Planning

56 Federal and State Resources Focus on Local Planning

57 Mitigation and Prevention Activities Liaison with state/local health officials Liaison with state/local health officials Clear Roles/responsibilities of staff Roles of school nurses Assign key roles Review health needs of students Improve health activities

58 Pandemic Preparedness Update crisis plans Educate staff, students & parents Account for Procedures Delegate Crisis Communication/Authority

59 Local School Considerations Maintain operations & the learning environment Triage/isolate students and staff Use good health practices: handwashing, disinfect, etc. Address misinformation Plan for school closure Disseminate community information Utilize schools as clinics, hospitals, morgues, vaccination sites or vaccine storage sites

60 School Houses were turned into temporary hospitals during the 1918 Influenza Pandemic

61 Pandemic Recovery Period Allocate time for recovery Involve kids & parents Counsel Debrief Plan anniversaries Facility remediation

62 School Specific Websites

63 Questions?


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