1. PANDEMIC INFLUENZA BACKGROUND AND GUIDANCE FOR SCHOOLS

2. Influenza Respiratory infection Transmission: contact with respiratory secretions from an infected person who is coughing and sneezing Incubation period: 1 to 5 days from exposure to onset of symptoms Communicability: Maximum 1-2 days before to 4- 5 days after onset of symptoms Timing: Peak usually occurs December through March in North America

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

4. Influenza is a serious illness Annual deaths: 36,000 Annual hospitalizations: >200,000 Total economic costs: $37.5B Who is at greatest risk for serious complications? –persons 65 and older –persons with chronic diseases –infants –pregnant women –nursing home residents

5. Definitions Epidemic: An increase in disease above what is normally expected Pandemic: A worldwide epidemic

6. How Do Influenza Pandemics Arise? Wild water fowl are natural reservoirs of influenza They can spread the virus to domestic birds

7. How Do Influenza Pandemics Arise? When avian flu viruses experience sudden changes in genetic structure and Are capable of infecting humans and Can reproduce and spread from person to person efficiently

8. Why Be Concerned About Pandemic Influenza? Influenza pandemics are inevitable: naturally recur at more-or-less cyclical intervals Can cause: –High levels of sickness and death –Drastic disruption of critical services –Severe economic losses There will be little warning time between the onset of spread of a pandemic and its arrival in the U.S. Outbreaks occur simultaneously in many areas Impacts will last for weeks to months and likely to occur in successive waves Pandemics can disproportionately affect younger, working-age people Current avian influenza outbreak in Asia

9. Timeline of Emergence of Timeline of Emergence of Influenza A Viruses in Humans 19181957196819771997 1998/9 2003 H1 H3 H2 H7 H5 H9 Spanish Influenza Asian Influenza Russian Influenza Avian Influenza Hong Kong Influenza

10. Influenza Pandemics 20 th Century A(H1N1)A(H2N2)A(H3N2) 1918: “Spanish Flu”1957: “Asian Flu”1968: “Hong Kong Flu” 20-40 m deaths 675,000 US deaths 1-4 m deaths 70,000 US deaths 1-4 m deaths 34,000 US deaths Credit: US National Museum of Health and Medicine

11. Planning Assumptions: Health Care Moderate (1957-like)Severe (1918-like) Illness90 million (30%) Outpatient medical care45 million (50%) Hospitalization865,0009, 900,000 ICU care128,7501,485,000 Mechanical ventilation64,875745,500 Deaths209,0001,903,000 50% or more of those who become ill will seek medical care Number of hospitalizations and deaths will depend on the virulence of the pandemic virus

12. The 1918 Influenza Pandemic

14. Chicken Little and the Sky is Falling or The Next Major Disaster? Which is it?

15. Current Outbreak: Avian Influenza (H5N1) Began in fall, 2003. At least 252 confirmed human cases in Asia, Africa and Europe 148 deaths in Asia and Africa ( World Health Organization, 10/06 ) Mammalian infection (cat, pig) No efficient person-to-person transmission Isolated Human disease Case-fatality rate > 50% Outbreak spreading, not controlled

16. Current Avian Outbreaks

17. Clinical illness with H5N1 compared with typical human influenza illness More severe illness in younger persons Primary viral pneumonia appears to be more common and with rapid onset Incubation period may be longer 1-4+ days (up to 14 days?) Duration of infectious period likely longer, particularly in adults 1d. prior to 7d. after Adapted from Guillermo Herrera, CDC, 2005 (in adults; children ~longer)

18. Pandemic Effects: Strain on Resources Health care shortages –Vaccine / Antivirals –Hospital beds / equipment –Masks Personnel shortages Disruption of essential society functions Panic

19. Vaccines, Antivirals, and Medical Supplies

20. Pandemic Influenza Vaccine Questions When will it be available? How much will there be? Who will own it? Who should get it? How should it be delivered?

21. Treatment and Prevention: Vaccine Vaccines takes 6-8 months to produce following the emergence of a new virus Supplies will be limited, if available at all –2 nd dose after 30 days will likely be required –New vaccine safety and efficacy has “unknowns”

22. Treatment & Prevention: Antiviral Drugs Antiviral agents –Effective in preventing illness –Can prevent severe complications –May not be effective against pandemic virus Supplies will be limited –Treatment over prevention

23. Nassau County Department of Health Pandemic Influenza Preparedness Strategies Distribution Planning –First Responder Prophylaxis –Municipality operated PODs –Employer operated PODs (regional) –DOH operated PODs –School operated PODs through municipalities

24. Points of Distribution Community based sites used to distribute vaccines or medications to healthy citizens Would the schools be used? Municipalities will coordinate POD planning within their communities.

25. Individual and Family Preparedness –We will have to take care of ourselves and those around us. –During a pandemic, public health will maximize resources for the greatest impact on the population as a whole. –Schools should communicate with local/ state public health agencies and/or emergency responders about the assets/services the districts could contribute to the community.

26. Influenza Prevention: What Can We Do? Specific Recommendations for Infection Control in Schools and Workplaces: Pandemic preparedness planning Distribution of educational messages and infection control guidance Social distancing: people stay home when ill Promotion of respiratory etiquette Provision of materials for respiratory hygiene/ etiquette: tissues and disposal receptacles

28. ISSUES FOR SCHOOL DISTRICTS TO THINK ABOUT Absenteeism among children AND staff Resources limited: vendors, buses Role of school nurses Communication with parents and staff and community Advantages and disadvantages to closing schools (amount of closure time) Working with local municipalities Implications with State aide Policies sending sick children home (isolation within the school, masks, etc) Policies for allowing previously sick children to return to schools

29. RESOURCES FOR SCHOOLS Nassau County Health Department, with direction from the New York State Health and Education Departments, will provide guidance to schools districts To create plans To create communication materials for students, staff and parents To provide guidance for closing schools

30. Key Step for District Preparedness Incorporate the pandemic influenza plan as an annex in the school district’s all hazards plan.

31. Develop strong relationships with your school communities –Build confidence that information will be distributed accurately and quickly - Consider community meetings that describe current plans in place COMMUNICATION Before a Pandemic Hits

32. School Websites Lunch Menus PTAs Letters to the Community BOE Meetings Marquis Proactive COMMUNICATION Before a Pandemic Hits

33. Establish relationship with Public Health Officials early on Review/update procedures for communicable disease reporting

34. Pandemic Influenza “Don’t worry about it, it’s probably just a head cold.”

35. Acknowledgments Presentation compiled and adapted from multiple slide sets from the:  Centers for Disease Control and Prevention  HHS National Vaccine Program Office  New York State Department of Health  Connecticut Department of Health  Kansas Department of Health  Department of Defense  Washington Department of Health