1. Pandemic Influenza Planning Update Your County Department of Health Spring 2006

2. Overview Seasonal Influenza Seasonal Influenza Avian Influenza Avian Influenza Pandemic Influenza Pandemic Influenza What we are doing to prepare What we are doing to prepare

3. Influenza

4. Influenza Respiratory infection Respiratory infection Spread through coughing, sneezing Spread through coughing, sneezing 1 to 5 days from exposure to onset of symptoms 1 to 5 days from exposure to onset of symptoms Spread 1 day before illness up to 7 days after Spread 1 day before illness up to 7 days after Seasonal influenza traditionally occurs October through April Seasonal influenza traditionally occurs October through April

5. Influenza Symptoms Rapid onset of: Rapid onset of: –Fever –Chills –Body aches –Sore throat –Non-productive cough –Runny nose –Headache

6. Seasonal Influenza 36,000 deaths nationally every year; 800-1000 in MN36,000 deaths nationally every year; 800-1000 in MN Vaccine availableVaccine available High risk for complications include:High risk for complications include: –Very young –Very old –Fragile immune systems –Pregnant women

7. AVIAN INFLUENZA

8. Avian Influenza (Bird Flu) Birds of all species thought to be susceptible Birds of all species thought to be susceptible Two forms Two forms –Mild –Severe Signs and Symptoms Signs and Symptoms –Mild: ruffled feathers, reduced egg production –Severe: extremely contagious, rapidly fatal, case fatality rate ~ 100%

9. Avian Influenza - H5N1 Infection in Humans Remains an avian flu strain Remains an avian flu strain Living quarters are close to animals Living quarters are close to animals Transmission Transmission –Contact with manure –Handling chickens –Walking through live poultry markets

10. Avian Influenza - H5N1 Why do we care? Spreading among birds quickly and across countries Spreading among birds quickly and across countries Jumping hosts (across animal groups) Jumping hosts (across animal groups) High case fatality rate among people (141 documented cases, 73 deaths) as of February 2006 High case fatality rate among people (141 documented cases, 73 deaths) as of February 2006 Mutating little by little Mutating little by little Has potential to mutate dramatically into a human strain Has potential to mutate dramatically into a human strain

11. Pandemic Pandemic Pandemic –Widespread infection –No immunity within a population Epidemic Epidemic –Localized to one population –Low immunity within the population

12. Prerequisites for a Pandemic A new virus transmitted to humans (no immunity within the community) A new virus transmitted to humans (no immunity within the community) Virus must be able to cause illness in humans Virus must be able to cause illness in humans Virus must be able to pass easily from human to human Virus must be able to pass easily from human to human

14. Could the H5N1 be the cause of the next flu pandemic? Possibly… Possibly… but so far the virus cannot pass easily from human to human

15. World Health Organization Influenza Pandemic Phases Interpandemic Period Novel subtypes in animals but not humans Phase 1 Circulating subtypes in animals posing threat to humans Phase 2 Pandemic Alert Period Novel subtypes in humans, but no human-to-human transmission Phase 3 Limited human-to-human transmission Phase 4 Localized clusters of human cases Phase 5 Pandemic Period Increased and sustained transmission in the general population on a large scale Phase 6

16. Current Pandemic Flu Planning Assumptions Attack rate (30%) (30%) 1,544,000 cases in MN Hospitalization rate (1 to 10+% of cases) 15,000 to 172,000 hospital patients in MN Case-fatality rate (.2 – 2% of cases) 3,600 to 32,900 deaths in MN

17. Local Impact Insert local numbers on this slide Insert local numbers on this slide

18. Federal, State, Local Plans General All Hazards Pandemic Flu general National Response Plan (NRP) The National Strategy for Pandemic Influenza (White House) health ESF #8: Public Health and Medical Services HHS Pan Flu Plan generalMEOP HSEMs Pan Flu Plan health MDH All Hazards Plan MN Public Health Pan Flu Plan general Local All Hazards Plans Local Pan Flu Plan health Health component of All Hazards Plans LPH Pan Flu Plan Federal State Local

19. Protective Actions Governor is state decision maker Governor is state decision maker –Close schools –Cancel large gatherings –Encourage people to limit exposure to others –Assure continuation of infrastructure –Make decisions about use of limited resources

20. Goals of MN Planning Maintain the elements of the community infrastructure necessary to carry out pandemic response Maintain the elements of the community infrastructure necessary to carry out pandemic response Minimize social disruption and economic loss Minimize social disruption and economic loss Reduce morbidity Reduce morbidity Minimize mortality Minimize mortality Stay flexible as the situation unfolds Stay flexible as the situation unfolds

21. Goals of Regional and Local Planning Limit the spread of disease Limit the spread of disease Create & test plans Create & test plans Integrate non-health entities in planning Integrate non-health entities in planning Establish community stockpiles & distribution systems Establish community stockpiles & distribution systems Identify spokespersons Identify spokespersons Provide effective public education Provide effective public education

22. Goals of Regional and Local Planning (cont) Maintain community infrastructure Maintain community infrastructure Minimize social disruption Minimize social disruption Reduce morbidity/mortality Reduce morbidity/mortality Response is community based, and flexible Response is community based, and flexible

23. Partnerships Our health department is working with: Homeland Security and Emergency Management Homeland Security and Emergency Management County and city emergency managers County and city emergency managers Schools Schools Law enforcement/military Law enforcement/military Voluntary organizations Voluntary organizations Regional hospital coalition Regional hospital coalition Clinics Clinics Emergency Medical Services Emergency Medical Services Media Media

24. Health & Medical Planning __ County, Tribal and City Public __ County, Tribal and City Public Health Agencies Health Agencies ___Hospitals ___ Clinics ___Hospitals ___ Clinics Emergency Management Emergency Management Emergency EmergencyMedicalServices Other Other Community Community partners partners Insert your regional map Insert your regional map

25. Local and Regional Public Health Planning Education Education –Businesses, schools, clinics, community groups –Community stakeholders Trainings Trainings –Infection control education for law enforcement, first responders –Psychological First Aid –Communication –Drills/Exercises

26. Working with community partners to address Disease surveillance Disease surveillance Clinical issues Clinical issues Laboratory Laboratory Infection control Infection control Health care planning Health care planning Vaccine and antiviral agents Vaccine and antiviral agents

27. Working with community partners to address (cont) Community disease control and prevention Community disease control and prevention Communications Communications Animal health collaboration Animal health collaboration Care of the deceased Care of the deceased Legal issues Legal issues Ethical issues Ethical issues

28. Localize this slide Of the following series (29-40) of slides we suggest you select 2-3 that are relevant to your regional and/or local planning efforts, and are reflected in your previous slide. Of the following series (29-40) of slides we suggest you select 2-3 that are relevant to your regional and/or local planning efforts, and are reflected in your previous slide.

29. Disease Surveillance Tracking influenza Tracking influenza disease on disease on ongoing basis ongoing basis Maintain high Maintain high alert for H5N1 alert for H5N1 Monitor activity Monitor activity in other in other countries countries

30. Clinical Issues Clinicians will questionClinicians will question travel history and travel history and poultry exposure on poultry exposure on influenza-like cases influenza-like cases Clinicians will reportClinicians will report critical influenza in critical influenza in young, healthy young, healthy individuals individuals DevelopingDeveloping treatment and treatment and care protocols care protocols

31. Laboratory Developing capacity for rapid testing and confirmation Statewide network of clinical Statewide network of clinical laboratories Monitoring agricultural testing Monitoring agricultural testing Sharing information quickly Sharing information quickly Connection to CDC Connection to CDC

32. Infection Control What are effective measures?What are effective measures? Maintaining stockpiles of suppliesMaintaining stockpiles of supplies Reuse, disposalReuse, disposal Air handlingAir handling Handwashing!!Handwashing!!

33. Health Care Planning Hospitals in 8 regions working together Hospitals in 8 regions working together Predicting and managing surge in demand Predicting and managing surge in demand Protecting workers and patients Protecting workers and patients Off-site care facilities Off-site care facilities Home care Home care Minnesota Responds, Medical Reserve Corps Minnesota Responds, Medical Reserve Corps

34. Vaccine and Antiviral Agents Strategic National Stockpile system Strategic National Stockpile system Mass dispensing clinics Mass dispensing clinics Vaccine for prevention Vaccine for prevention Antivirals potentially for prevention and treatment Antivirals potentially for prevention and treatment Get needed material/supplies to the public quickly Get needed material/supplies to the public quickly

35. Community Disease Control and Prevention Respiratory hygiene Respiratory hygiene Business continuation Business continuation School closing School closing Limit interaction of people Limit interaction of people Home care Home care Isolation and quarantine Isolation and quarantine

36. Communications Need many ways to reach people Need many ways to reach people Consistent, understandable, complete messages Consistent, understandable, complete messages Reaching non-English speakers Reaching non-English speakers Hotlines, web, TV, community organizations and many other means Hotlines, web, TV, community organizations and many other means

37. Animal Health Collaboration Animal health leaders and industry are planning for bird outbreak Animal health leaders and industry are planning for bird outbreak Protecting poultry workers Protecting poultry workers Disposal of birds Disposal of birds Economic impact Economic impact

38. Care of the Deceased Manage death certificates Manage death certificates Mortician collaboration Mortician collaboration Cremations and burials Cremations and burials Safe, compassionate Safe, compassionate Limit interaction Limit interaction

39. Legal Issues Governors authority to manage an emergency Governors authority to manage an emergency Liability issues Liability issues Being able to move quickly Being able to move quickly Licenses, sharing resources Licenses, sharing resources Isolation and quarantine Isolation and quarantine

40. Ethical Issues What if theres not enough __________? Who should get the limited supply? What if theres not enough __________? Who should get the limited supply? Antivirals – treatment or prevention? Antivirals – treatment or prevention? Economic impact of closing a business or limiting interaction Economic impact of closing a business or limiting interaction Does response change with length of event? Does response change with length of event? Reduced types of health care because of increased demand Reduced types of health care because of increased demand

41. Priority Activities for 2006 Review the federal plan and plans from other states Review the federal plan and plans from other states Update and expand state plans Update and expand state plans Support planning by others Support planning by others Education and training Education and training Public education Public education Exercising! Exercising!

42. Business Planning Forecast and allow for absences Forecast and allow for absences Modify the frequency of face-to-face contact Modify the frequency of face-to-face contact Encourage annual flu shots Encourage annual flu shots Evaluate access to healthcare Evaluate access to healthcare Identify employees and key customers with special needs Identify employees and key customers with special needs

43. Is Your County Ready? More today than yesterday More today than yesterday More tomorrow than today More tomorrow than today Continuing process Continuing process Requires everyone to participate Requires everyone to participate –State and local government –Businesses –Faith-based and community organizations –Individuals/families

44. Recommended Web Sites www.health.state.mn.uswww.hsem.state.mn.uswww.ready.gov www.pandemicflu.govwww.fema.gov/areyoureadywww.ed.gov/emergencyplanwww.weprevent.org/usa/cover.pdf