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Pandemic Influenza Overview and Current Planning Considerations

Pandemic Influenza Overview and Current Planning Considerations. State of Connecticut Department of Public Health Albert L. Geetter, MD Section Chief Office of Public Health Preparedness. Pandemic Influenza. Definitions Bird Flu/Avian Influenza Domestic Poultry Migratory Waterfowl

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Pandemic Influenza Overview and Current Planning Considerations

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  1. Pandemic InfluenzaOverview and Current Planning Considerations State of Connecticut Department of Public Health Albert L. Geetter, MD Section Chief Office of Public Health Preparedness

  2. Pandemic Influenza

  3. Definitions • Bird Flu/Avian Influenza • Domestic Poultry • Migratory Waterfowl • Pandemic Influenza

  4. Implications • Novel Virus • lack of immune “experience”

  5. PATHOGENICITYVSTRANSMISSABILITY

  6. Transmissability • Reassortment via Antigenic Shift • Human and Avian recombinant • in “other” species. • Mutation via Antigenic Drift • Internal Genetic Adaptive Change

  7. Avian virus Avian reassortant virus Reassortment in humans Human virus Avian virus Avian-human pandemic reassortant virus Reassortment in hogs Generation of Pandemic Influenza Reassortmentis where a human & other animal strains can mix and form a new strain

  8. School Household Workplace Who Infects Who? Likely sites of transmission Children/Teenagers 29% Adults 59% Seniors 12% Demographics Glass, RJ, et al. Local mitigation strategies for pandemic influenza. NISAC, SAND Number: 2005-7955J

  9. Current WHO Statistics • Total Human Cases: 387* • Total Human Deaths: 245* • Total Avian (waterfowl /domestic) Deaths: > 500 Million • Viral etiology • Culling • *Politically Driven estimates

  10. Pandemic Influenza: Background & Assumptions • Novel virus, fully susceptible population, efficient and sustained human to human spread • “1918-like” pandemic would result in ~2 million deaths in US • Vaccine (pandemic strain) likely delayed or not available • Antivirals may be insufficient quantity, ineffective and/or difficult to distribute in a timely way • Epidemic over a large geographic area affecting a large proportion of the population

  11. Pandemics of the 20th Century

  12. • The "Spanish influenza", between 1918 to 1919, was due to an A/H1N1 virus related to porcine influenza • • The "Asian influenza", between 1957 to 1958, was due to an A/H2N2 virus • • The "Hong Kong influenza", between 1968 to 1969, was due to an A/H3N2 virus.

  13. 20th Century Influenza Pandemics • 1968-69 “Hong Kong flu,” (H3N2) • 34,000 US deaths (1-4 million worldwide) • 1957-58 “Asian flu,” (H2N2) • 70,000 US deaths (1-4 million worldwide) • 1918-19 “Spanish flu,” (H1N1) • >600,000 US deaths (20-100 M worldwide) • 30-40% infected • 2.5% overall mortality • Most deaths among young, healthy adults

  14. Projected GDP Loss From Severe Pandemic: $10.1 Billion Projected GDP Percent Loss from Severe Pandemic: 5.23 percent Ranking of Percentage Losses Out of 50 States (Highest = 1): 46 Projected Losses Due to Workforce Absenteeism and Deaths: $ 5 billion Projected Losses to State Industries: $3.2 billion Projected Losses Due to Potential Drop in Trade: $1.9 billion Projected Lives Lost: 29,000 Projected Number of Illnesses: 1,039,000

  15. Pandemic Severity Index 1918

  16. Category 5 Category 4 Category 3 Category 2 Category 1

  17. Pandemic Severity Index

  18. March 1918 “On March 30, 1918, the occurrence of eighteen cases of influenza of severe type, from which three deaths resulted was reported at Haskell, Kansas.” Public Health Reports, March, 1918 September 1918 “This epidemic started about four weeks ago, and has developed so rapidly that the camp is demoralized and all ordinary work is held up till it has passed....These men start with what appears to be an ordinary attack of LaGrippe or Influenza, and when brought to the Hosp. they very rapidly develop the most viscous type of Pneumonia that has ever been seen. Two hours after admission they have the Mahogany spots over the cheek bones, and a few hours later you can begin to see the Cyanosis extending from their ears and spreading all over the face, until it is hard to distinguish the coloured men from the white. It is only a matter of a few hours then until death comes, and it is simply a struggle for air until they suffocate. It is horrible. One can stand it to see one, two or twenty men die, but to see these poor devils dropping like flies sort of gets on your nerves. We have been averaging about 100 deaths per day, and still keeping it up. There is no doubt in my mind that there is a new mixed infection here, but what I don’t know.” A physician stationed at Fort Devens outside Boston, late September, 1918

  19. Stages of a Pandemic The World Health Organization (WHO) has developed a global influenza preparedness plan, which defines the stages of a pandemic, outlines the role of WHO, and makes recommendations for national measures before and during a pandemic. The phases are: Page last modified on October 17, 2005

  20. Interpandemic period Phase 1 : No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in animals, the risk of human infection or disease is considered to be low. Page last modified on October 17, 2005

  21. Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease. • Antigenic Shift • Antigenic Drift Page last modified on October 17, 2005

  22. Pandemic alert period Phase 3: Human infection(s) with a new subtype but no human-to-human spread, or at most rare instances of spread to a close contact. Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans. Page last modified on October 17, 2005

  23. Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk). Page last modified on October 17, 2005

  24. Pandemic period Phase 6: Pandemic: increased and sustained transmission in general population. Page last modified on October 17, 2005

  25. Government Response to a Disaster DHS CDC USAMRIID DHHS FEMA DoD DoT PHHS NIH USDA SBCCOM C/B-RRT EPA FBI ATSDR ? AIT NRL NMRI DoE

  26. A tale of two citiesPhiladelphia & St. Louis • In St. Louis, when the first cases of disease among civilians were reported on October 5, city authorities moved quickly to introduce a wide range of measures designed to promote "social distancing," implementing these measures within two days.

  27. A Tale of Two CitiesPhiladelphia & St. Louis • Philadelphia's officials response to the news of the pandemic was to downplay its significance. They allowed large public gatherings to continue taking place - most notably a city-wide parade on September 28, 1918. • Bans on public gatherings, school closures and other NPI's did not begin to be implemented until October 3.

  28. Philadelphia 1918 War Bond Parade

  29. Philadelphia & St Louis • Philadelphia experienced a peak weekly death rate of 257 per 100,000 people and an overall death count of 719 per 100,000. • St. Louis showed much lower totals, with a weekly mortality peak of just 31 per 100,000 and a final mortality count of 347 per 100,000.

  30. Shelter in Place • Food • Water • Flashlight • Battery/Crank Powered Radio • Cooking Utensil • Sterno Powered Fondue Pot • Cell Phone • Written Contact List • Prescriptions Allotment Resupply 80% of production-outsourced

  31. Current Programs in Development • Surveillance • Response/Activation/Mitigation • Surge • Triage • Alternate Care Sites • Antiviral Distribution • Vaccine Development • Non Pharmaceutical Intervention • Cough Etiquette 2. Hand Washing 3. Social Distancing 4. Shelter in Place • Legal • Ethical • Recovery • Restoration

  32. The "Back-up Plan"

  33. Vaccine (pandemic strain) likely delayed or not available • Antivirals may be insufficient quantity, ineffective and/or difficult to distribute in a timely way • Epidemic over a large geographic area affecting a large proportion of the population

  34. Hospitals-32 • Total Staffed Beds~7294 • Professional Staff~14,077 • Support Staff~47,425

  35. Operational Considerations • Maximum surge rate: 48-72 hours • Expected staff depletion rate: 30-40%

  36. Morbidity • Attack Rate 30% • Connecticut Population ~3.5 Million • Acutely Ill ~1 Million

  37. Pandemic Mortality Rate1-2% • projected 10,000-20,000 Deathsover a 10-12 week period

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