PANDEMIC INFLUENZA PLANNING

1. PANDEMIC INFLUENZA PLANNING

2. Two Sides of Pan Flu Planning The Ostrich Chicken Little The End is Near!!!!

3. Types of Flu Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 strain is one of the current strains infecting birds, and unlike most others, is not only deadly to domestic fowl, but can be transmitted from birds to humans (zoonotic). There is no human immunity and no vaccine is available. Pandemic flu is caused by a novel strain of a virulent human flu that leads to a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. (WHO)

4. Seasonal Influenzas • Are a Major Public Health Problem Every Year. • Annual impact (U.S.) • 36,000 deaths • 200,000 hospitalizations • $37.5 billion in economic costs from influenza and pneumonia • Those at greatest risk for serious complications • persons 65 and older • persons with chronic diseases • infants • pregnant women • nursing home residents

5. Avian Influenza • The H5N1 strain of avian influenza (bird flu) is present in birds in many countries across several continents. • Bird flu in its present form does not present a threat of a pandemic • Some human cases of avian influenza have occurred • After close contact with infected birds • After close contact with infected household members • No sustained person-to-person transmission • Human case fatality (death) rate is >50% • Virus is changing. 2004 strain is more resistant to tamilfu than the original 1997 strain

6. Influenza Pandemic • A global influenza outbreak caused by a brand new (novel) flu virus • Because it is a new virus, few or no people would be immune • Many people would get sick in every part of the world • Asia is the source of many outbreaks because swine, birds and humans live under the same roof, providing opportunity for viral mixing

7. Credit: US National Museum of Health and Medicine Pandemic Does Not Necessarily Mean the 1918-19 Pandemic 1957: “Asian Flu” 1968: “Hong Kong Flu” 1918: “Spanish Flu” A(H2N2) A(H3N2) A(H1N1) World Pop. 2.8 billion 2 m deaths 70,000 US deaths World Pop. 1.8 billion 20-40 m deaths 550,000 + US deaths World Pop. 3.6 billion 1-4 m deaths 34,000 US deaths

8. If It Happened Today: Worst Case Scenario • Based on observations from previous pandemics, the Centers for Disease Control and Prevention (CDC) has estimated that the economic losses in the United States associated with the next pandemic will range from $71 billion to $166 billion. • The impact of an influenza pandemic on the healthcare system could be devastating. • In the United States, between 40 and 100 million will become clinically ill; 18 to 45 million will require outpatient care; 300,000 to 800,000 persons will be hospitalized; and between 88,000 and 300,000 people will die. • NC Pandemic Influenza Plan 2006

9. Impact of an Influenza PandemicNorth Carolina • 1.4 million outpatient visits • 29,000 hospitalizations • 6,700 deaths • Assuming 30% attack rate and NC population of 8.5 million people • Based on CDC software FluAid 2.0

10. Pandemic Flu Is A Risk Today Despite . . . • Expanded global and national surveillance • Better healthcare, medicines, and diagnostics Current risks: • Greater population density • Limited vaccine capability (9 Countries produce all the world’s flu vaccine, with 1950’s technology). • More elderly and immunosuppressed • More daycare and nursing homes • “Warrior worker” ethic in the workplace leads to disease spread

11. Reality is That We are More Globally Connected SARS spread to 5 countries within days of detection and to 30 countries on six continents within a few months.

17. Worldwide Spread in 6 Months Spread of H2N2 Influenza in 1957“Asian Flu” Feb-Mar 1957Apr-May 1957Jun-Jul-Aug1957 69,800 deaths (U.S.)

18. Will Avian Flu Cause the Next Pandemic? NO ONE KNOWS! • The H5N1 virus could change to spread more easily among humans-but it might not. • It could “swap genes” with another animal virus, or with a human flu virus • It could become less virulent even if it mutates so it can spread person to person easily. • Another Influenza virus could mutate first.

19. Pandemic Influenza To date, Avian Influenza (H5N1) is primarily a disease of birds and not humans. Avian Influenza

20. “However, There is Enough Concern to Warrant a Pandemic Watch”

21. WHO Pandemic Alert Phases

22. A Pandemic Requires Person-to-Person Spread While There is Evidence of Localized Instances of Person to Person Spread, Sustained Person to Person Transmission is Not Currently Occurring with H5N1

23. Pandemic Planning

24. Pandemic Planning Is Tricky You know that it will happen • But you don’t know: • When it will occur • What the characteristics of the virus will be • Who it will affect • How long it will last • Whether it will be resistant to antivirals or not • Whether there will be a vaccine or not (or when) • How severe the pandemic will be

25. Pandemic Response is Local and by Necessity Collaborative First Responders Fire/EMS EM, Law, Medical Examiner Hospitals. Medical & Mental Health Services, Public Health Schools, Local Government, Public Works and Utilities, Community Agencies Agriculture, Cooperative Extension, Vets, CART, Animal Control Business and Industry

26. Planning Assumptions • Core prevention and control measures (e.g., vaccination and antivirals) will not be available or will be limited • Non Pharmacological Interventions (NI) will be the primary control disease control strategy • A pandemic will be global, prolonged and have several waves • Disruption of key supply chains will likely occur, especially with products with off-shore production or components • Lack of surge capacity in the medical industry will be a problem • Response will be local. Mutual aid and outside resources will be minimal or non-existent.

27. WHO Goals for Pandemic Planning and Response

28. Unprepared Impact Prepared Weeks Pandemic Influenza Response: • Initial strategy will be early detection and containment. Slow spread, decrease illness and death, buy time • Antiviral treatment and isolation for people with illness • Quality medical care • Quarantine for those exposed (antiviral prophylaxis if available) • Social distancing, travel restrictions, snow days, work at home • Infection control, hygiene (hand washing….), respiratory etiquette • Vaccine when it becomes available (6-8 months) • Plan to maintain essential services • Effective crisis communication can influence how people react

29. Individual or Group Disease Control Strategies Isolation and Quarantine: Reduces influenza transmission by separating infected persons from uninfected persons, and exposed persons from non-exposed persons. • Isolation of ill persons will be valuable during all phases of pandemic influenza • Quarantine of those exposed to ill persons is justified when there are a limited number of cases – most valuable early in the outbreak when cases are limited • Quarantine can be voluntary or by order of the County or State Health Director • Local law enforcement has to enforce quarantine of non-compliant persons • Persons in quarantine have to be provided with essential services (food, water, medicines) • Mental health needs are high for those in quarantine

30. Community-Based Infection Control Strategies • Social distancing • voluntary self-shielding • Cancellation of public events • concerts, sports events, movies, plays • Closure of schools and workplaces • office buildings, shopping malls • Closure of recreational facilities • community swimming pools, youth clubs, gymnasiums

31. Work and/or School Based Infection Control Strategies • Snow Days and closures • Respiratory hygiene/cough etiquette, hand hygiene • Stay away if ill (staff stay home, students do not go to classes) • Encourage self-reporting of illness that develops • Active screening for illness in staff/students • Send staff/students home(with mask) if ill • Modify personnel policies that encourage sick people to come to work

33. Hand Hygiene • Traditional hand washing • Soap and hot water • Minimum of 20 seconds (the time it takes to sing “Happy Birthday” twice) • Alcohol based hand rubs • Acceptable means to disinfect/sanitize EXCEPT when hands are visibly soiled

34. Respiratory Hygiene and Cough Etiquette • Cover mouth/nose when sneezing or coughing • If no tissue, use elbow instead of hands • Use tissues and dispose of appropriately • Perform hand hygiene after contact with respiratory secretions • Distance yourself from others (more than 3 feet)

35. What About Masks? • Recommended for: • Health care workers with direct patient contact • Those at high risk for complications of influenza • Symptomatic persons • Contacts of ill persons

36. More About Masks • Benefit of wearing masks by well persons in public settings has not been established • Persons may choose to wear a mask as part of an individual protection strategy that includes respiratory hygiene/cough etiquette, hand hygiene, and social distancing. • If you wear a mask, keep your hands away from your face! • Clean your hands each time you touch your mask!

37. Businesses, school systems, community infrastructure providers, and other employers should develop plans for continuity of operations (COOP) and for the possibility of having to operate with a significantly reduced workforce. Personnel Policies may have to be modified. • 25 to 30% of persons may become ill during a 6 to 8 week outbreak. • An additional 10% of the workforce may be absent due to illness of a family member. • Others may stay home due to a fear of becoming infected.

39. Pandemic Influenza Facts (WHO) • 1. Pandemic influenza is different from avian influenza. • 2. Influenza pandemics are recurring events. • Pandemics occur every 30-50 years • Another pandemic is a certainty but it cannot be predicted when it will occur. • 3. The world may be on the brink of another pandemic. • Concern H5N1 virus could mutate and cause a pandemic. • 4. All countries will be affected. • 5. Widespread illness will occur • 6. Medical supplies will be inadequate • 7. Large numbers of deaths will occur • 8. Economic and social disruption will be great • 9. Every country must be prepared. • 10. WHO will alert the world when the pandemic threat increases.

40. Web Resources For Pan Flu • www.cdc.gov • U.S. public health guidelines • www.pandemicflu.gov • All kinds of planning info • www.cidrap.unm.edu/ • Example of COOP • http://www.epi.state.nc.us/epi/gcdc/pandemic.html • NC Pandemic Flu Plan • www.who.int • Global updates and official case reports • http://www.cchealth.org/topics/pandemic_flu/school_action_kit/ • Pan Flu Action Kit for Schools