What is the treat?

1. What is the treat? Pandemic Flu

3. Reality or Hype? • CDC making Avian Flu research #1 priority • Trust for America’s Health suggested pandemic flu was tantamount to a Cat 5 viral storm hitting every state • Michael Leavitt HHS “We are overdue, and we are under prepared”

4. Reality or Hype? • Tom Ridge former Homeland Security said that two issues kept him awake-food defense and a flue pandemic. • President Bush declared his full support for a plan to deal with pandemic flu in November 2005.

5. Public Awareness Levels • Most agree that they are somewhat frightened by the potential for a pandemic. • Many people know some of the “dots,” but few know how the dots connect to the big picture. • The current flood of information is overwhelming. Who to believe?

6. Pandemic, Avian, and Seasonal Influenza (flu) Differences • Pandemic influenza: Currently there is no pandemic flu. A flu pandemic is a global outbreak that occurs when a new influenza A virus causes serious human illness and spreads easily from person to person. • Avian influenza: “Bird flu” is caused by avian influenza viruses, which occur naturally among birds. • Seasonal influenza: The flu is a contagious respiratory illness caused by influenza viruses & occurs seasonally as a generally mild influenza.

7. Threat Levels for PlanningWorld Health Organization

8. Current Summary • Pandemic Influenza Alert Phase remains unchanged at Level 3 (no or very limited human-to-human transmission). • Limited human-to-human transmission possible among close contacts. • No evidence to suggest that the H5N1 virus has acquired any of the characteristics of a pandemic virus.

9. Countries with documented human cases

10. Areas with confirmed H5N1 in poultry & wild birds since 2003

11. Affected areas with confirmed human cases since 2003

12. Current Assessment of Situation • The avian influenza A (H5N1) epizootic (animal outbreak) in Asia and parts of Europe is not expected to diminish significantly in the short term. • It is likely that H5N1 infection among birds has become endemic in certain areas and that human infections resulting from direct contact with infected poultry will continue to occur.

13. Current Assessment of Situation • So far, the spread of H5N1 virus from person-to-person has been rare and has not continued beyond one person. however, the epizootic in Asia continues to pose an important public health threat. • There is little pre-existing natural immunity to H5N1 infection in the human population. If these H5N1 viruses gain the ability for efficient and sustained transmission among humans, an influenza pandemic could result.

14. Current Assessment of Situation • Research suggests that currently circulating strains of H5N1 viruses are becoming more capable of causing disease) in mammals than were earlier H5N1 viruses. • One study found that ducks infected with H5N1 virus are now shedding more virus for longer periods without showing symptoms of illness. This finding has implications for the role of ducks in transmitting disease to other birds and possibly to humans as well.

15. Current US Summary • Pennsylvania, Maryland, and Michigan have low pathogenic avian influenza (LPAI) in wild birds. • LPAI often circulates in wild birds without mutating into highly pathogenic strains, and without infecting commercial flocks. • The discoveries in Pennsylvania, Maryland, and Michigan suggest that US surveillance for all forms of avian influenza works.

16. Current US Summary • Maryland • 􀂃 Mallard ducks in Maryland have tested positive for a common, less pathogenic strain of avian influenza that poses no risk to humans, the United States Agriculture and Interior departments said on Friday [01 September 2006]. • 􀂃 The H5N1 avian influenza virus was found in fecal samples from “resident wild” mallards in Queen Anne’s County in Maryland. • 􀂃 “Testing has ruled out the possibility of this being the highly pathogenic H5N1 strain.

17. Current US Summary • Pennsylvania • 􀂃 Mallard ducks in Crawford County, Pennsylvania have tested positive for a low-pathogenic strain of the H5N1 avian influenza virus, the U.S. Agriculture and Interior departments said on Saturday [2 Sep 2006], adding to cases detected recently in Maryland and Michigan.

18. Current US Summary These reports constitute the second and third known instances of low pathogenic avian influenza (LPAI) within the US in 2006. On 14 August 2006, the virus was found in two mute swans in Michigan. LPAI commonly occurs in wild fowl.

23. Migratory Bird Route Worldwide

24. Migratory Bird Route U.S.

25. Migratory Bird Routes

31. Principles of Community Containment Containment measures encompass a range of strategies: • “Snow days” or “shelter-in-place” • Suspension or restrictions on group assembly • Cancellation of public events • Closure of mass public transit • Closing of public places • Restriction or scaling back of nonessential travel • Cordon sanitaire

32. Definitions: Quarantine • Separation and restriction of movement of wellpersons presumed to have been exposed to contagion • often at home or residential facility • may be voluntary or mandatory

33. Definitions: Isolation • Separation and restricted movement of illpersons with contagious disease • Often in a hospital setting • Primarily individual level, may be applied to populations • Often voluntary, but may be mandatory • Fundamental, commonly used public health practice

35. Protection of Workers • Educate workers about the importance of strict adherence to and proper use of hand hygiene after contact with infected or exposed poultry, contact with contaminated surfaces, or after removing gloves. • Hand hygiene should consist of washing with soap and water for 15-20 seconds or the use of other standard hand-disinfection procedures as specified by state government, industry, or USDA outbreak-response guidelines. • Ensure that personnel have access to appropriate personal protective equipment (PPE), instructions and training in PPE use, and respirator fit-testing

36. Protection of Workers • Disposable gloves made of lightweight nitrile or vinyl or heavy duty rubber work gloves that can be disinfected should be worn • Protective clothing, preferably disposable outer garments or coveralls, an impermeable apron or surgical gowns with long cuffed sleeves, plus an impermeable apron should be worn.

37. Protection of Workers • Disposable protective shoe covers or rubber or polyurethane boots that can be cleaned and disinfected should be worn. • Safety goggles should be worn to protect the mucous membranes of eyes. • Disposable particulate respirators (e.g., N-95, N-99, or N-100) are the minimum level of respiratory protection that should be worn. This level or higher respiratory protection may already be in use in poultry operations due to other hazards that exist in the environment (e.g., other vapors and dusts)

38. Protection of Workers • Workers must be fit-tested to the respirator model that they will wear and also know how to check the face-piece to face seal. Workers who cannot wear a disposable particulate respirator because of facial hair or other fit limitations should wear a loose-fitting (i.e., helmeted or hooded) powered air purifying respirator equipped with high-efficiency filters.

39. Protection of Workers • Disposable PPE should be properly discarded, and non-disposable PPE should be cleaned and disinfected as specified in state government, industry, or USDA outbreak-response guidelines. Hand hygiene measures should be performed after removal of PPE.

40. Monitoring of Workers • Instruct workers to be vigilant for the development of fever, respiratory symptoms, and/or conjunctivitis (i.e., eye infections) for 1 week after last exposure to avian influenza-infected or exposed birds or to potentially avian influenza-contaminated environmental surfaces.

41. Monitoring of Workers • Individuals who become ill should seek medical care and, prior to arrival, notify their health care provider that they may have been exposed to avian influenza. In addition, employees should notify their health and safety representative. • With the exception of visiting a health care provider, individuals who become ill should be advised to stay home until 24 hours after resolution of fever, unless an alternative diagnosis is established or diagnostic test results indicate the patient is not infected with influenza A virus.

43. Questions?