1. Pandemic Flu and You JJ Naponick, MD MPH Administrator/Medical Director Department of Health & Hospitals Office of Public Health Region 6

2. Topics of Discussion Influenza Avian Flu Pandemic Flu Impact & Planning Public Health Role Your Role Resources

3. mild to severe respiratory illness of sudden onset caused by an influenza virus highly infectious spread rapidly from person to person some strains more severe than others occurs every year killing 36,000 people in U.S. What is influenza (flu)?

4. Symptoms of Influenza sudden onset of symptoms fever, headache, aching muscles, weakness respiratory symptoms cough, sore throat, difficulty breathing incubation period = time from exposure to virus to development of symptoms varies for influenza, but generally 1 to 4 days

5. How does influenza spread? Breathing in droplets produced when infected person talks/coughs/ sneezes Touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face

6. Influenza Prevention Vaccination Stay at home when sick Cover your cough Wash hands regularly Avoid touching eyes, nose and mouth Avoid close contact with people who are sick

7. Avian (Bird) Influenza An infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus) Birds wild birds worldwide carry the virus – usually no illness domesticated birds - can become ill and die Humans can become infected with avian influenza -> severe illness and death most cases from close contact with infected poultry very rarely may have spread from one person to another cases/deaths since 2003 = 258/153 2003: 4/4 2004: 46/32 2005: 97/42 2006: 111/75

8. Will H5N1 become the next pandemic? Avian Flu not yet Pandemic Flu current outbreaks of H5N1 Avian Flu in poultry and birds are the largest ever documented Impossible to predict next pandemic flu event If not H5N1, then another Plan now

9. Understanding Pandemic Flu Epidemic: serious outbreak in a single community, population or region Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to

10. Influenza A Virus Hemagglutinin (H)–16 subtypes (attachment, penetration) Neuraminidase (NA)–9 subtypes (release) 8 viral genes (assembly, replication) M2 protein (penetration) Hemagglutinin (H)–16 subtypes (attachment, penetration)

11. Antigenic Drift vs. Shift Antigenic drift: major changes in the form of one or both of the two principle antigens on the viral surface our immune system has greater difficulty recognizing them Antigenic shift: radical changes in the form of the one or both of the two principle antigens on the viral surface our immune system can’t recognize them at all

12. Putting Pandemic Flu into Perspective 2001 terrorist attack with anthrax killed five people 2002 outbreak of West Nile Virus killed 284 people nationally in six months 2003 SARS outbreak killed over 800 people world wide froze Asian economies frightened millions of people into wearing masks on the streets

13. History of Pandemic Influenza 1968-1969 Worldwide 700,000 deaths (34,000 in US) 1957-1958 Worldwide 1.5 million deaths (70,000 in US) 1918 Worldwide 40-50 million deaths (500,000–650,000 in US) Typical Influenza Season 36,000 deaths in US

14. Lessons from Past Pandemics Occurs unpredictably, not always in winter Variations in mortality, severity of illness and pattern of illness Rapid surge in number of cases over brief period of time, often measured in weeks Tend to occur in waves - subsequent waves may be more or less severe

15. Pandemic Flu: Current Status and Requirements 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 population it causes serious illness in people it spreads easily from person to person worldwide

16. Interpandemic Larger clusters, localized Limited spread among humans Pandemic Current Status WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf Pandemic alert Phase 1Phase 2Phase 3 Phase 4 Phase 5Phase 6 New virus in humans Little/no spread among humans Small clusters, localized Limited spread among humans Increased and sustained spread in general human population Current status of H5N1 No new virus in humans Animal viruses low risk to humans No new virus in humans Animal viruses low risk to humans Current H5N1 status

17. Would there be a vaccine? Because the virus will be new, there will be no vaccine ready to protect against pandemic flu A specific vaccine cannot be made until the virus has been identified Seasonal flu vaccine or past flu immunization will not provide protection

18. Medications During Pandemic Flu Antiviral Medications can prevent complications if taken within first 48 hours of illness may not be effective against a pandemic flu virus extremely limited supply now would be prioritized initial use probably only for treatment, not prophylaxis Antiviral Medications Amatadine (Symmetrel) Rimantadine (Flumadine) Zanamivir (Relenza) Oseltamivir (Tamiflu)

19. Isolation and Quarantine isolate ill individuals with certain contagious diseases quarantine contacts (those exposed to such contagious diseases) play a role in the early stages of the pandemic legal measures possible probably would rely on voluntary cooperation once beyond initial cases “stay home when you are sick”

20. Influenza Containment Strategy: Community Response Basic Activities Surveillance and quarantine of early cases Public information and education Promote “respiratory hygiene” and hand washing Enhanced Activities Focused measures to increase social distance Community-wide measures to increase social distance

21. Community Wide Measures Reduce Social Contact by canceling large gatherings, mass transit, school Decision based on location of flu activity: Outbreak not local: large gatherings cancelled Outbreak in local/neighboring county: small gatherings cancelled School closings determined by State Department of Health & Hospitals Department of Education Local School Boards.

22. Pandemic Influenza Impacts Estimated Impact in Louisiana 3 Million infected Between 600,000-1.4 million clinically ill Between 300K-700K requiring outpatient care Between 10,000 – 22,500 hospitalized Between 3,000 – 6,000 deaths Impact on Infrastructure Significant disruption of transportation, commerce, utilities, public safety and communications Limited to no assistance from State and Federal governments due to nation- wide impact

23. Impact on Health Care Illness rates will soar Many people will require some medical care Health care facilities will be overwhelmed Symptoms may be severe Complications: may be more frequent healthy people may be at increased risk

24. Impact on Business Impact on Business Owners Up to 40% employee absenteeism Possible increase/decrease in demand for products or services Disruption of communication & supply chains Fewer employees and customers Issues to Address Modification of: customer/employee interaction sick leave & work location Communication/education Collaboration Infection Control

25. Workforce Support Psychological and physical strain on personnel responding in emergency situation Psychological stress for families Plan for staff to have adequate Sleep Food Access to psychological and spiritual support

26. Guidance Personal/Family Planning Personal protection: Hand hygiene and respiratory etiquette Surgical masks: proven effective for droplet precautions Pneumococcal vaccination per recommended guidelines Stockpiling: One to three week essential water, food, supplies, medicines

27. Guidance School Planning Develop alternative procedures for learning in event of school closures Develop plan for essential office functions payroll, communication with students, families, and staff Infection Control educate & practice

28. Guidance for Faith-based Planning Develop alternative procedures for worship in event of social distancing Develop plan for essential office functions payroll, communication with members and staff Infection Control educate & practice

29. Infection Control - Our Basic Protection Hand Hygiene Wash hands regularly with soap & water If no water available: 60%-95% alcohol-based sanitizer Cover your cough strategy Environmental cleaning 1:10 bleach solution EPA registered disinfectant Gloves & surgical masks

30. Community Goals in Pandemic Flu Limit death and illness Preserve continuity of essential government and business functions Minimize social disruption Minimize economic losses

31. Public Health Role in Pandemic Facilitate planning Disease tracking & control Communication about public health issues Coordinate mass antiviral medication and vaccination clinics Issue isolation and quarantine orders

32. What Can You Do Now? P repare your community – become involved in disaster training & volunteerism. R emember to get enough sleep. E xercise regularly. P revent the spread of infection – wash hands regularly, cough/sneeze into tissue, keep your hands away from your nose/mouth. P ut out cigarettes. A nnual flu shots. N utritious eating. F amily plan and kit. L ook for information about pandemic flu. U tensils, food and beverages should not be shared.

33. Get Informed. Be Prepared. State Draft Pandemic Flu Plan http://www.dhh.state.la.us/offices/publications/http://www.dhh.state.la.us/offices/publications/pubs- 145/Pandemic%20Influenza%20Plan_100906.pdf Family Readiness Guide http://www.dhh.state.la.us/offices/publications/ Official Pandemic Flu Web Site http://www.pandemicflu.gov/ Centers for Disease Control and Prevention http://www.cdc.gov/flu/pandemicflu/ Even though local, state and federal agencies have plans to protect the public, you are responsible for your own safety, even in an emergency!

34. Remember, things will eventually get better!