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OBJECTIVES Pandemic Influenza Then and Now Public Health Pandemic Influenza Planning

OBJECTIVES Pandemic Influenza Then and Now Public Health Pandemic Influenza Planning What to expect What not to expect Individual/Employee Pandemic Planning. WHAT IS PANDEMIC INFLUENZA? A global influenza outbreak Caused by a change in a flu virus

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OBJECTIVES Pandemic Influenza Then and Now Public Health Pandemic Influenza Planning

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  1. OBJECTIVES • Pandemic Influenza Then and Now • Public Health Pandemic Influenza Planning • What to expect • What not to expect • Individual/Employee Pandemic Planning

  2. WHAT IS PANDEMIC INFLUENZA? • A global influenza outbreak • Caused by a change in a flu virus • Most severe occur with big changes in the virus • Because it is a drastically changed 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

  3. HOW DOES INFLUENZA VIRUS CHANGE? • Antigenic Drift: • Small changes in virus over time • New strains appear and replace older strains • May not be recognized by antibodies to older strains • Antigenic Shift: • Abrupt, major change (reassortment) • Results in novel strain or new subtype • Can cause pandemic influenza

  4. PANDEMIC INFLUENZA CYCLE • Recognized global outbreaks of influenza since the 1500’s • Historical cycles of 10 to 40 years • Rapid transmission worldwide. • High attack rate for all age groups. • High mortality rates, esp. for young adults.

  5. 1918: Spanish Flu A(H1N1)20-40 m deaths 675,000 US deaths 1957:AsianFlu A(H2N2) 1-4 m deaths 70,000 US deaths 1968: Hong Kong Flu A(H3N2) 1-4 m deaths 34,000 US deaths Influenza Pandemics 20th Century

  6. GLOBAL STATUS OF CURRENT PANDEMIC THREAT • World Health Organization (WHO) defines 3 major periods (broken into 6 phases) of increasing human infection with new flu virus: • Interpandemic (no human infection) • Pandemic Alert(limited human infection) • Pandemic (widespread human infection) • We are at Pandemic Alert • Isolated human infections with a novel influenza strain [H5N1] with no (or rare) person-to-person transmission.

  7. Source World Health Organization

  8. WILL H5N1 BE THE NEXT PANDEMIC? • Impossible to know if or when • If not H5N1, then another will come • The prudent time to plan is now

  9. AVIAN FLU OCCURS REGULARLY IN AVIAN SPECIES SOMETIMES SPREADS TO OTHER SPECIES PANDEMIC FLU OCCURS PERIODICALLY IN HUMANS CAN BE CAUSED BY ANY STRAIN OF INFLUENZA VIRUS

  10. PLANNING ASSUMPTIONS: DISEASE TRANSMISSION • No one immune to virus; 30% of population will become ill • People may be contagious up to 24 hours before they know they are sick • People are most contagious the first 2 days of illness • Sick children are more contagious than adults • On average, each ill person can infect 2 or 3 others (if no precautions are taken)

  11. Medical Burden in Knox CountyBased on 2006 Knox County population estimate of 399,254

  12. HEALTH AND HUMAN SERVICES PLANNING OBJECTIVES • Primary objective: • Minimize sickness and death • Secondary objectives: • Preserve functional society • Minimize economic disruption

  13. INFLUENZA CONTAINMENT STRATEGIES • Routine Activities • Surveillance • 911 calls • ER visits • Sentinel physicians • Public information and education • Promote “respiratory hygiene” and hand washing • Unique Activities • Measures to increase social distancing • Change how we perform our day-to-day business to protect our staff and patients who still need our services

  14. INFLUENZA CONTAINMENT • Very early isolation and quarantine • Reduce social contact • Stay home if you are sick • Canceling large gatherings, mass transit, schools • Decision based on location of flu activity: • Outbreak not local: gatherings >10,000 cancelled • Outbreak in local/neighboring county: >100 • School closings determined by State Commissioner of Health/Board of Education. • Heavy reliance on personal measures

  15. INFLUENZA CONTAIMENT, PERSONAL MEASURES • Hand Hygiene • Frequent washing • 60%-95% alcohol-based sanitizer • Respiratory Hygiene • Cover your cough • Environmental cleaning • 1:10 bleach solution • EPA registered disinfectant • Gloves & surgical masks for direct contact with ill person • These apply at home and at work

  16. Flu Vaccine Production minimum 6 month process:(growing 93 million eggs) HHS priority groups Military and vaccine manufacturers Healthcare workers with direct patient care Persons at highest risk for complications Two doses needed for protection Tamiflu Anti-viral agent Could be used to contain first human outbreak Resistance described Should be used within 48 of infection HHS priority groups: military and hospitalized patients Tamiflu ≠ Preparedness

  17. Guidance for Families • Plan for childcare in the event schools close • Arrangements made for eldercare, pet care • Discuss/develop plan with employer how you might work at home

  18. Guidance for Families • Personal protection: • Hand hygiene and respiratory etiquette • Surgical masks: proven effective for droplet precautions • Pneumococcal vaccination of those for whom it is recommended • Stockpiling: One to three week essential water, food, supplies, medicines

  19. RESOURCES • PandemicFlu.gov • CDC.gov/flu/avian • www.nyhealth.gov • Knoxcounty.org/health • Knoxpanflu@knoxcounty.org

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