Pandemic Preparedness

1. Pandemic Preparedness

2. Objectives of Program At end of this program, the learner will be able to: Define Pandemic State Stages in WHO Pandemic Outbreak Scale Describe Populations at Risk and Stats on Transmission Discuss Strategies for Prevention of Pandemic (H1N1) 2009 influenza List Preparedness Measures for Healthcare Settings

3. Pandemic is Declared!! June 11, 2009 WHO declares Pandemic of Pandemic (H1N1) 2009 influenza

4. What is a Pandemic?? Source: World Health Organization, 2009. • WHO definition: a pandemic can start when three conditions have been met: • emergence of a disease new to a population; • agents infect humans, causing serious illness; and • agents spread easily and sustainably among humans.

5. Examples of Pandemics Recent Pandemics • Pandemic (H1N1) 2009 Influenza -30,000 confirmed cases worldwide from April- June 11th 2009 • AIDS and HIV- 1969 to present; projected deaths by 2025 • Africa 90-100 million • India 31 million • China 18 million Historical Pandemics • Influenza- last pandemic “Hong Kong” 1968-1969 • Cholera- 7th pandemic 1962-1966 • Smallpox- 50 million cases in 1950’s; eradicated in 1979 only ID to be eradicated • Typhus, tuberculosis, etc.

6. Pandemic Phases Source: World Health Organization, 2009.

7. Interpandemic Period Source: World Health Organization, 2009. WHO Phase 1. No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection or disease may or may not be present in animals. If present in animals, the risk of human infection or disease is considered to be low. WHO 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

8. Pandemic Alert Period Source: World Health Organization, 2009. WHO 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. WHO 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. WHO Phase 5: Larger cluster(s) but human-to-human spread still localized, virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk).

9. Pandemic Period WHO Phase 6: Pandemic: increased and sustained transmission in general population.

10. Post Peak Period Source: World Health Organization, 2009. Post-peak period Pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels The post-peak period signifies that pandemic activity appears to be decreasing It is uncertain if additional waves will occur and countries will need to be prepared for a second wave.

11. Post Pandemic Period Source: World Health Organization, 2009. Post-pandemic period Influenza disease activity will have returned to levels normally seen for seasonal influenza It is expected that the pandemic virus will behave as a seasonal influenza A virus It is important to maintain surveillance and update pandemic preparedness and response plans accordingly An intensive phase of recovery and evaluation may be required.

12. Pandemic Influenza Stats….Did You Know? Typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days Persons who become ill may shed virus and can transmit infection for up to one day before the onset of illness until 5-7 days later Viral shedding and the risk of transmission will be greatest during the first 2 days of illness. Children usually shed the greatest amount of virus and therefore are likely to post the greatest risk for transmission.

13. And more…….. Clinical disease attack rate will likely be 30% or higher in the overall population Illness rates will be highest among school-aged children (about 40%) and decline with age Among working adults, an average of 20% will become ill during a community outbreak. In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak

14. More Stats……. Of those who become ill with influenza, 50% will seek outpatient medical care (w/antiviral drugs available may be higher) Number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios Risk groups for severe and fatal infection are likely to include infants, the elderly, pregnant women, and persons with chronic medical conditions

15. And lastly……………. On average, infected persons will transmit infection to approximately two other people In an affected community, a pandemic outbreak will last about 6 to 8 weeks Multiple waves (periods during which community outbreaks occur across the country) of illness could occur with each wave lasting 2-3 months What do these stats mean to you?

16. Preparedness • Pandemics affect everyone: • Healthcare Professionals • Public Services • Communities • Schools • Families • Workplaces • Government • Pandemic planning requires that people and entities not accustomed to responding to health crises understand the actions and priorities required to prepare for and respond to these potential risks.

17. Basic Infection Prevention Preparedness • Regardless of your environment or occupation, there are general infection prevention guidelines to prevent transmission of H1N1: • Hand Hygiene • Respiratory Etiquette and other Personal Protective Equipment (PPE) • Environmental Surface Disinfection • Isolation Practices • Education of Healthcare Providers, Patients, and Visitors

18. Hand Hygiene… Source: Guideline for Hand Hygiene in Healthcare Settings, Centers for Disease Control and Prevention, 2002. Wash your hands often with soap and water, especially after you cough or sneeze Alcohol-based hand cleaners such as alcohol impregnated wipes are also effective if soap/water is not available Hand sanitizers with 60-95% alcohol are preferred

19. Respiratory Etiquette Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. Hand sanitize. Cough/sneeze into your arm/shoulder if tissues are not available Avoid touching your eyes, nose or mouth. Germs spread this way. Try to avoid close contact with sick people or put on a mask if you are sick and sneezing/coughing

20. Surface Disinfection…. Source: Guideline for Disinfection and Sterilization in Healthcare Settings, Centers for Disease Control and Prevention, 2008. Studies have shown that influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. To prevent the spread of influenza virus it is important to keep surfaces (especially high touch surfaces) clean by wiping them down with a disinfectant according to directions on the product label. Influenza virus is destroyed by heat (167-212°F [75-100°C]) several chemical germicides, including chlorine, hydrogen peroxide, quat/alcohol and alcohols are effective if used in proper concentration for a sufficient length of time

21. Isolation Practices….. Source: Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings, Centers for Disease Control and Prevention, 2007. If you live in areas where people have been identified with novel H1N1 flu and become ill with influenza-like symptoms, including fever, body aches, runny or stuffy nose, sore throat, nausea, or vomiting or diarrhea, you should stay home and avoid contact with other people CDC recommends that you stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. This means avoiding normal activities, including work, school, travel, shopping, social events, and public gatherings (no Swine Flu parties!)

22. Education…Spread the Word, not the Flu!! • Educate yourself, family members, co-workers, friends, students on prevention measures and vaccination for the flu • Spread the word, not the Flu!! • Use resources found on CDC and WHO websites • www.cdc.gov • www.who.int

23. Where Do YOU Fit in?? Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Steps to take during Pandemic Period in U.S. Maintain close contact with key public health, healthcare, and community partners Implement hospital surveillance for pandemic influenza in incoming patients and previously admitted patients Implement a system for early detection/treatment of healthcare personnel who might be infected with the pandemic strain of influenza Reinforce infection control procedures to prevent the spread of influenza

24. Pandemic Preparedness Plan Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Accelerate staff training in accordance with the facility’s pandemic influenza education and training plan Implement activities to increase capacity, supplement staff, and provide supplies and equipment Post signs for respiratory hygiene/cough etiquette. Maintain high index of suspicion that patients presenting with influenza-like illness could be infected with pandemic strain If pandemic strain is detected in local patient, community transmission can be assumed; hospital would move to next level of response

25. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Emergency department (ED) Establish segregated waiting areas for persons with symptoms of influenza. Implement phone triage to discourage unnecessary ED/outpatient department visits Enforce respiratory hygiene/cough etiquette Access controls Limit number of visitors to those essential for patient support Screen all visitors at point of entry to facility for signs and symptoms of influenza

26. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Limit points of entry to facility; assign clinical staff to entry screening Hospital admissions Defer elective admissions and procedures until local epidemic wanes Discharge patients as soon as possible Cohort patients admitted with influenza Monitor for nosocomial transmission

27. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Staffing practices Consider furlough or reassignment of pregnant staff and other staff at high risk for complications of influenza. Consider re-assigning non-essential staff to support critical hospital services or placing them on administrative leave; cohort staff caring for influenza patients Consider assigning staff recovering from influenza to care for influenza patients Implement system for detecting and reporting signs and symptoms of influenza in staff reporting for duty; provide staff with antiviral prophylaxis, according to HHS guide

28. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Nosocomial transmission Close units where there has been nosocomial transmission. Cohort staff and patients. Restrict new admissions (except for other pandemic influenza patients) to affected units. Restrict visitors to the affected units to those who are essential for patient care and support.

29. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Widespread transmission in community/hospital Redirect personnel resources to support patient care (e.g., administrative clinical staff, clinical staff working in departments that have been closed) Recruit community volunteers (e.g., retired nurses and physicians, clinical staff working in outpatient settings). Consider placing on administrative leave all non-essential personnel who cannot be reassigned to support critical hospital services. Close units where there has been nosocomial transmission.

30. Pandemic Influenza in local area Source: Department of Health and Human Services Pandemic Influenza Plan, 2009. Widespread transmission in community/hospital Cohort staff and patients Restrict new admissions (except for other pandemic influenza patients) to affected units Restrict visitors to the affected units to those who are essential for patient care and support For more information on healthcare and other preparedness plans, visit the CDC website: www.cdc.gov or www.hhs.gov.pandemicflu

31. In Summary……… Pandemic H1N1 is here Everyone is at risk of infection and can be source of transmission Infection prevention practices are key to minimizing virus transmission

32. In Summary……. Healthcare providers should be leaders in Pandemic Preparedness Plans Knowing the measures to take and when to implement is a key component to being prepared ARE YOU PREPARED???