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Avian Influenza: Bird of a Different Feather A Primer to Pandemic Influenza Preparedness

Avian Influenza: Bird of a Different Feather A Primer to Pandemic Influenza Preparedness

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Avian Influenza: Bird of a Different Feather A Primer to Pandemic Influenza Preparedness

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  1. Avian Influenza: Bird of a Different Feather A Primer to Pandemic Influenza Preparedness Office of Surveillance and Public Health Preparedness Houston Department of Health and Human Services

  2. Agenda • Medical overview • Business continuity planning • What HDHHS is doing

  3. Medical Overview

  4. Types of Influenza • Seasonal Influenza: Annual event (type A and type B strains) • 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 Influenza: flu in bird populations (wild and domestic) • Avian flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 type A variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available. • Pandemic Influenza: a new type A strain that causes serious illness and death, and spreads easily from person to person worldwide • Pandemic flu is virulent human flu that causes 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.

  5. Seasonal Influenza • Viral Infection of the respiratory tract • Occurs seasonally • Three types A, B and C • Particular nomenclature • Originates in wild aquatic birds • Evades immunity through drift and shift

  6. Pathology of Influenza Infection 3. Replication 1. Binding to Sialic Acid 2. Entering Cell 4. Release From Cell

  7. Clinically Relevant Influenza Viruses Type A Potentially severe illness Epidemics and pandemics Rapidly changing Type B Usually less severe illness Epidemics More uniform Type C Usually mild or asymptomatic illness Minimal public health impact

  8. RNA Hemagglutinin Neuraminidase Antibodies Sialic Acid Antigenic Drift

  9. Antigenic Shift

  10. Avian Influenza • Influenza A subtype • Designated H5N1 • Related to bird migratory patterns, smuggling and travel • Presence of the virus does not signal avian pandemic • Human infections related to close contact • No evidence of sustained human-to-human transmission

  11. Pandemic Influenza • Global outbreak of disease that occurs when a new influenza A virus appears or “emerges” in the human population • May be of avian origin • Caused by new subtypes that have never circulated among people, or by subtypes that have not circulated among people for a long time • Characterized as highly contagious, spreading from person to person, worldwide and causes social and economic disruption • Occurs approximately three times every century

  12. 20th Century Influenza Pandemics 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” 20-40 million deaths 1 million deaths 1 milliondeaths H3N2 H2N2 H1N1 H1N1 1920 1940 1960 1980 2000

  13. Influenza Statistics • 5% to 20% of population every year • >200,000 hospitalizations due to complications • 10,000 deaths per epidemic are common • 20,000 to 40,000 deaths during recent epidemics MMWR. 2000;49:1.

  14. Economic Cost of Influenza • Total annual costs of influenza are estimated at $14.6 billion in the US • 10%: Direct costs of increased medical care • 90%: Indirect costs (lost productivity, employee absenteeism) American Lung Association. Fact Sheet – Influenza. Available at

  15. Surveillance • Three systems coordinated by the CDC • Pneumonia and influenza deaths • Influenza-like illnesses • Physician reporting • Syndromic surveillance

  16. Pneumonia and Influenza Mortality in 122 US Cities CDC. 1999-2000 influenza season summary. Available at:

  17. Nasopharynx Trachea Signs and Symptoms of Influenza • Sudden fever, usually over 100°F • Muscle aches and pains • Nasal congestion • Dry cough • Chills and/or sweats • Headache • Sore throat • Potentially severe, persistent malaise • Substernal soreness, photophobia, and ocular problems

  18. Risk Factors for Influenza Complications (CDC) • Age 50 yrs • Residence in nursing home/chronic care facilities • Chronic pulmonary disease (eg, asthma, COPD) • Chronic cardiovascular disease • Chronic metabolic diseases, renal dysfunction, hemoglobinopathy • Immunosuppression • Long-term aspirin therapy (ages 6 mos-18 yrs) • Second or third trimester pregnancy MMWR. 2000;49:6-7.

  19. Prevention and Treatment • Vaccination • Antivirals

  20. Inactivated Influenza Virus Vaccine Content Updated yearly to protect against anticipated strains, consists of type A (2) and type B (1) Process Grown in embryonated chicken eggs and formalin inactivated

  21. Live Attenuated Influenza Vaccine (LAIV) • Licensed for use in the U.S. begins in 2003 • The protective mechanisms are not completely understood • Children and adults can shed vaccine viruses for >2 days after vaccination • Advantages include: • Induce a broad mucosal and systemic immune system • Acceptability of an intranasal route of administration

  22. Influenza Virus Vaccine • Efficacy • Varies with age and immunocompetence • Depends on match between projected vs actual strains • Children/Teens • Stimulates high HA-inhibition antibody titers • Prevents infection • Elderly • Produces lower HA-inhibition antibody titers • May not eliminate URTI susceptibility • May reduce LRTI morbidity/mortality MMWR. 2000;49:5.

  23. Effectiveness of Influenza Vaccine • Most effective (70%-90%) in preventing illness in persons aged <65 yrs • 30%-40% in preventing illness in frail elderly • Overall significantly protects against the severe complications of influenza: hospitalizations and death

  24. Get the Influenza Vaccine • October through November in the Fall • Only one shot is needed for older children and adults • Two does may be required for unvaccinated children aged less than nine years

  25. Who Should Receive Influenza Vaccine (CDC) • Persons aged 50 yrs • Persons at increased risk (age 6 mos) • Hospital and outpatient employees • Nursing home employees with patient contact • Home health care providers working with high-risk persons • Household members of high-risk persons • Pregnant women in 2nd or 3rd trimester • Persons desiring to avoid influenza infection MMWR. 2000;49:6-7.

  26. Side Effects of the Influenza Vaccine • Soreness at injection site (common, mild, and transient) • Systemic and febrile reactions, esp in young children (infrequent) • Immediate hypersensitivity reactions to egg protein (rare) • Guillain-Barré syndrome (rare) MMWR. 2000;49:11-12.

  27. Who Should Not Receive the Vaccination • An allergic reaction to chicken eggs (welts, tongue swelling, difficulty breathing, loss of blood pressure, etc.) • A previous serious reaction to an influenza shot • A rare paralytic disorder called Guillain-Barré Syndrome which was thought to be cause by a pervious influenza shot • A current illness with fever

  28. Influenza A Influenza A and B • Amantadine • Rimantadine • Zanamivir • Oseltamivir Phosphate Treating Influenza with Antivirals

  29. What To Do If You Develop Influenza • If symptoms present less than two days, discuss specific antiviral treatment with your physician • For fever and muscle aches: • Aspirin if you are 18 years of age or older • Or Acetaminophen • Or Ibuprofen • Liquids and nutrition • Rest • See your physician if symptoms worsen

  30. Prevention: Simple Steps • Vaccine • Hygiene • Public Health Measures • Cover Your Cough. • Wash Your Hands. • Get your seasonal flu shot. • Keep all your immunizations current.

  31. Business Continuity Planning

  32. Reputation People Organization Protect Information Customers Operation Goals • Containment of disease • Reduction of the impact by controlling the spread of disease • Maintenance of essential services

  33. Evaluation • Identification of essential business activities • Mitigation of business / economic disruptions • Minimizing illness

  34. Strategy • Communication • Containment • Continuity

  35. Programs Insurers Health Plans Materials Healthcare Providers Strategies PH Agencies Communication Plan Other Business Entities Communication Internal Communication / Education External Coordination

  36. Containment • Restrict workplace entry • Emphasize personal hygiene • Social distancing • Manage staff

  37. Cover Your Cough • Cover nose and mouth when sneezing • Use a tissue and dispose once used • Keep hands away from nose, mouth and eyes • Ask people to do the same

  38. Hand Washing • The most important action can do • Soap and water (10-20 seconds) • Alcohol-based sanitizer (15 seconds)

  39. Work Place Disinfectant • Influenza viruses inactivated by alcohol or chlorine • Surfaces touched by hands should be cleansed daily • 1:5 dilution of hospital grade bleach • Granular chlorine • 70% isopropyl alcohol • 60% ethyl alcohol

  40. Social Distancing • Avoid face-to-face meetings • Avoid congregations • 3 Feet rule • Ghost shifts

  41. Manage Staff • Encourage, manage and track influenza vaccination • Establish healthcare resources • Flexible scheduling • Encourage working from home • Oversee travel

  42. Continuity • Identification of core people and skills • Business planning for absence • Knowledge management • Communication

  43. Identification of Core People and Skills • What are the essential parts of the business • Who are the core people required to keep the business running • What are the core skills required • Who are the back-ups • Who will manage the pandemic component

  44. Business Planning for Absence • What is the minimal number of staff required • Where can additional staffing be found • Can operations be shifted • Plan for essential incidentals: food, water, gas

  45. Knowledge Management • Develop a plan • Key operating and emergency management information needs to be readily accessible • Implement exercises and drills to practice • Test plan regularly