2. Pandemic Planning: A Nation Prepared U.S. Department of Health and Human Services Mike Leavitt, Secretary

4. HHS Pandemic Influenza Preparedness Planning ADM John O. Agwunobi Assistant Secretary for Health ADM John O. Agwunobi Assistant Secretary for Health

7. Pandemics Do Happen! H1 H3 H2 H7 * H5 * H9 * 1918 Spanish Influenza H1N1 1957 Asian Influenza H2N2 1968 Hong Kong Influenza H3N2 1980 1997 1915 * Avian Flu 2003 2004 1977 19962002 192519351945195519651975198519952005 2003-2006 19981999 2003

9. 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

14. Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006)

15. Phases of a Pandemic: Where We Are Now

16. HHS Pandemic Influenza Plan Support the National Strategy for Pandemic Influenza Outlines planning assumptions and doctrine for health sector pandemic preparedness and response Public Health Guidance for State and Local Partners 11 Supplements with detailed guidance

18. HHS Pandemic Influenza Doctrine: Saving Lives Prevent or at least delay introduction into the United States –May involve travel advisories, exit or entry screening –For first cases, may involve isolation / short-term quarantine of arriving passengers

20. HHS Pandemic Influenza Doctrine: Saving Lives Clearly communicate to the public –Prepare people with information –Encourage action steps to prepare now –Provide updates when new information emerges –Use trusted messengers –Coordinate to ensure consistent messages –Address rumors and inaccuracies

23. Challenges in Pandemic Vaccine Preparedness Expand production of current (egg-based) vaccine Evaluate dose-sparing technology (adjuvants, intramuscular vs. intradermal route) Accelerate development of modern (non-egg) vaccines Target new antigens

25. Avian Influenza Vaccine Production Working with the National Institutes of Health –Current H5N1 Vaccine – 40 million doses being produced –Second Clade 2 Avian Influenza vaccine

26. Antivirals and Medical Supplies: Influenza Treatments Stockpile –Tamiflu: 5+ million treatment courses in Strategic National Stockpile (SNS) with 12.4 million treatment courses ordered –Tamiflu oral suspension: 97,000 courses in SNS with an additional 260,000 on order (arrival date to be determined) –Relenza: 84,000 courses in SNS with 1.75 million treatment courses ordered Strategy –Procure 81 million courses of antivirals 6 million courses to be used to contain an initial U.S. outbreak 75 million courses to treat 25 percent of U.S. population Accelerate development of promising new antiviral candidates

27. Antivirals and Medical Supplies: Influenza Treatments  $350 million appropriated in FY 2006 to upgrade state and local response capacity for pandemic influenza  $100 million of the funding is scheduled to be awarded to all 50 states; 7 territories; Puerto Rico; Washington, D.C.; New York City; Chicago; and Los Angeles County and allocated according to a base + population formula  $250 million will be awarded later this year. Application for funding is supplemental to current cooperative agreements

28. State and Local Pandemic Influenza Planning Checklist Community Leadership and Networking Surveillance Health System Partnerships Infection Control and Clinical Care Vaccine Distribution and Use Antiviral Drug Distribution and Use Community Disease Control and Prevention Communications Workforce Support

32. www.pandemicflu.gov Complacency is the enemy of health protection!

34. Protecting American Agriculture 34 Avian Influenza (AI) Preparedness and Response Veterinary Services March, 2006

35. Protecting American Agriculture Topics Covered Avian Influenza Overview USDA’s AI Interventions Targeted surveillance Border protection Trade restrictions & OIE guidelines Outreach & education Preparedness & response

36. Protecting American Agriculture Avian Influenza Overview Avian influenza (AI) - identified in the early 1900s High pathogenic avian influenza (HPAI) – causes contagious illness, death in birds; Low pathogenic (LPAI) causes mild to no illness Vast majority of AI viruses found in birds do not represent a public health concern

37. Protecting American Agriculture Avian Influenza Overview (cont.) Virus is characterized by H and N type (surface proteins). 144 different characterizations of the virus, based on 16 H types and 9 N types AI viruses mutate easily; only H5 and H7 viruses have the potential to mutate from an LPAI to an HPAI form. AI viruses vary widely in pathogenicity from strain to strain. Therefore not all H5N1 viruses are infectious for people or pathogenic to poultry. HA PB1 PB2 PA NP NA MA NS M2 HemagglutininNeuraminidase M1 Matrix

38. Species Affected Genetic Reservoirs Intermixing H1, H3 H1, H2, H3 H3, H7 Commercial, LBMs Others H1-12 H14-15 H1-2, 4-7, H9-13, 15-16 H10 H1, H3, H4, H7, H13 Other Aquatic Birds? H5N1

39. Protecting American Agriculture How is the virus spread among birds? Direct contact between healthy and infected birds Infected fecal matter Can be found on surface of unwashed egg shells from infected birds

40. Protecting American Agriculture Three HPAI Findings in U.S. 1924 – “Fowl Plague” affected live bird markets in the Northeastern U.S. 1983 – destruction of 17 million birds in PA 2004 – quickly contained and eradicated in TX

41. Protecting American Agriculture AI Surveillance APHIS and States conduct surveillance through: National Poultry Improvement Plan (NPIP) State and University laboratories Export testing at slaughter State movement requirements

42. Protecting American Agriculture AI Surveillance (cont.) APHIS’ safeguarding system encompasses: Targeted surveillance Cooperative efforts with States and Industry Outreach and education Trade restrictions Anti-smuggling programs

43. Protecting American Agriculture LPAI Surveillance and Control Plan Federally-coordinated and State-assisted LPAI H5/H7 LPAI Control Program  Commercial poultry  Live bird marketing system Since 1986, APHIS and States have monitored live bird markets (LBMs) in Northeast U.S.

44. Protecting American Agriculture Surveillance: NPIP Establishes standards for evaluation of poultry breeding stock and hatchery products “Avian influenza free” certification for commercial companies New LPAI program that will provide for H5 and H7 AI monitoring

45. Protecting American Agriculture Surveillance: NPIP (cont.) New LPAI program that will provide for H5 and H7 AI monitoring Program components: “AI monitored” program, surveillance specifications, and State LPAI response and containment plans

46. Protecting American Agriculture LBMs – Surveillance Uniform Standards published in 2004 provide guidelines for markets, dealers and producers: Licensing requirements and education Bird testing and recordkeeping Sanitation and biosecurity Surveillance and inspections LPAI positive facilities

47. Protecting American Agriculture LBMs – Surveillance (cont.) States enforce LPAI program standards Federal indemnification provided for participating States with positive diagnosis of H5 or H7 LPAI APHIS initiated cooperative agreements with 21 States

48. Protecting American Agriculture LPAI Surveillance – National Animal Health Laboratory Network (NAHLN) 37 States participate in the network. NAHLN labs: Provide laboratory services nationwide Provide laboratory data for reporting Respond to foreign animal disease outbreaks Focus on animal diseases

49. Protecting American Agriculture Border Protection & Risk of Introduction of Asian Strain of H5N1 USDA works closely with DHS to prevent smuggling of illegal poultry and poultry products. USDA’s Smuggling Interdiction and Trade Compliance unit and DHS’ Customs and Border Patrol actively monitor U.S. ports. Legally imported birds from other countries are tested for AI.

50. Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1 Genetic separation of H5 AI viruses between New & Old World Asian birds rarely get off course and go to N. America Risk from wild birds is low Migratory Birds – Overlap of summer breeding grounds in Alaska, Northeast Canada

51. Protecting American Agriculture Trade Restrictions USDA maintains trade restrictions on countries affected by H5N1:  Albania, Azerbaijain, Cambodia, Cameroon, People’s Republic of China, Egypt, France (VS defined restricted zone only), India, Indonesia, Iraq, Iran, Italy, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Myanmar, Niger, Nigeria, Poland, Romania, Russia, Slovakia, Slovenia, Switzerland, South Korea, Taiperi China, Thailand, Turkey, Ukraine and Vietnam Poultry and poultry products from those countries are strictly prohibited. USDA works with trading partners and the World Organization for Animal Health (OIE) to maintain safe trade.

52. Protecting American Agriculture World Organization for Animal Health (OIE) – Reporting and Guidelines OIE guidelines state that: HPAI and all H5/7 LPAI must be reported to the OIE. Poultry meat and table eggs do not transmit LPAI  Trade in poultry and poultry products can continue despite a finding of LPAI Recommends certain health measures for the trade in poultry and poultry products based on risk and AI status Compartmentalization allows countries to document separation based on biosecurity

53. Protecting American Agriculture Outreach & Education USDA’s Biosecurity for the Birds Campaign is an extensive and far-reaching outreach initiative designed to:  Educate non-commercial poultry owners about the signs of AI & other poultry diseases  Promote the importance of practicing biosecurity  Encourage rapid reporting of clinical signs of disease and/or unexpected deaths

54. Protecting American Agriculture USDA AI Web Site www.usda.gov/birdflu Information about “Biosecurity for the Birds” program Links to other Federal entities working on AI Fact Sheets and other information resources Q&A on AI News Releases Technical Briefings

55. Protecting American Agriculture Preparedness in the Event of an Outbreak Key is early detection and rapid response USDA maintains a comprehensive emergency response structure:  Partnerships with local, State, and Federal organizations  Integration with the National Response Plan  Continual collaboration with HHS, DHS and other Federal entities  Diagnostic capabilities

56. Protecting American Agriculture Response to an Outbreak in Poultry Guidelines Stamping out National Response Plan First responders Vaccines

57. Protecting American Agriculture Response for AI in Wild Birds Manage wildlife threats Assess risk wildlife poses to susceptible livestock and poultry Containment, survey and surveillance, and population management

58. Protecting American Agriculture Questions?

60. Convention Center Floor Plan 2 – Exhibit Hall and Ballrooms BREAK OUT SESSIONS ROOM LOCATIONS Community/Volunteer Groups E 21B Private Sector/Business E 21C Schools K-12 E 21 A

61. Convention Center Floor Plan 1 – Exhibit Hall and Break out Sessions BREAK OUT SESSIONS -- ROOM LOCATIONS Assisted Living/Long Term CareE 10C Colleges and UniversitiesE 10D Community/Volunteer GroupsE 21B (see floor plan 2) Fire/EMSE 11A HealthcareE 10 A&B Law Enforcement/JudiciaryE 11C Local GovernmentE 11B Private Sector/BusinessE 21C (see floor plan 2) Schools K-12E 21 A (see floor plan 2) LUNCH Exhibit Hall B