1. Pandemic InfluenzaAvian Influenza Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M.D., M.P.H.

3. Pandemic Influenza &Avian Influenza 101 • Preparedness Efforts

4. 1. Pandemic Influenza & Avian Influenza 101

5. Influenza • Seasonal influenza • Avian influenza • Pandemic influenza

6. All Influenza: • RNA viruses • Genetic engines • A: HemagglutininNeuraminidase

7. Seasonal Influenza • October – April • Influenza Type A • H3N2, H1N1 • Influenza Type B • Vaccine

8. Avian Influenza (Bird Flu) • Influenza A • Domestic poultry – can be deadly • High vs. low pathogenic • Wild birds – carriers • Virus in fecal droppings, saliva/nasal discharge

9. Recent Avian Influenza Outbreaks Affecting Humans • 1997 H5N1 Hong Kong • 1999 H9N2 Hong Kong • 2003 H7N7 Netherlands • 2004 H7N3 Canada • 2004 H5N1 Southeast Asia

10. Pandemic Influenza • Global outbreak • Highly contagious • Deadly

11. Recent Pandemics • 1918 Spanish flu (H1N1) • 5,000 deaths in Maine • 500,00 in U.S. • 40,000,000 worldwide • 1957 Asian flu (H2N2) • 70,000 deaths in U.S. • 1-2,000,000 worldwide • 1968 Hong Kong flu (H3N2) • 34,000 deaths in U.S. • 700,000 worldwide

12. Past Pandemic InfluenzaEstimates for Maine

13. H5N1 • Detected in Asia since 1997 • Deadly – 50% mortality in humans • Transmitted birds to mammals and limited human to human • Evolving quickly

14. H5N1 Activity as of September 29, 2006 • 253 human cases (thru 10/13/06) • In 58 countries • 148 deaths • Mortality rate = 58%

15. Human Infections and Human Deaths by H5N1by Month, October 13, 2006

17. 2. Preparedness Efforts • Avian Influenza Preparedness • Pandemic Influenza Preparedness

18. A. Avian Influenza Preparedness

19. Detection Testing in: • Migratory birds • Poultry industry

20. Preparedness Planning • Poultry workers • Backyard flock owners • Others – bird lovers, hunters

21. General Public • Food safety • Bird handling

22. B. Pandemic Influenza Preparedness • “Pan Flu”

23. Significant Issues forPan Flu Planning • Detection and Tracking • Care for Isolated and Ill • Vaccines and Antivirals • Food and Other Support • Basic Services and Economic Impact • Communication • Quarantine and Isolation

24. Pandemic Assumptions • Attack rate of 25%-35% • Duration of up to year or more in 2 waves • Each wave lasting 6-8 weeks in community • Healthcare system will be severely taxed, if not overwhelmed

25. Social Disruption fromPandemic Influenza • Absenteeism in essential sectors • Health, law enforcement, food and fuel supplies, education • Economic impact • Psychological stress

26. 2006 vs 1918 Advantages in 1918 • Smaller population • Less travel • More self-reliance Advantages in 2006 • Healthier population • Better medical care • Preparedness

27. Federal Preparedness

28. www.pandemicflu.gov

29. Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Antiviral Drugs Community Disease Control Travel-Related Risks of Disease Communications Workforce Support Components of Federal Plan

30. Vaccine Antivirals Community Disease Control Selected Components

31. Vaccines

32. Assumptions for Vaccination • Two doses will be required • Vaccine unavailable for 3-6 months • Production will be 3-5 million doses (15 µg)per week  10,000 doses per week in Maine

33. Vaccine Priority Groups • Vaccine and antiviral manufacturers • Health care providers • Those at high risk for severe disease • Public health emergency response workers • Key government leaders 400,000 in Maine

34. Recommendations for Vaccine and Antivirals may be modified based on: • Virulence • Transmissibility • Drug resistance • Geographic spread • Age-specific attack rates • Morbidity and mortality rates

35. What You Can Do Now • Annual seasonal influenza vaccination • Pneumococcal vaccination

36. Antivirals

37. Antivirals • Adamantanes • Amantadine • Rimantadine • Neuraminidase inhibitors • Oseltamivir (Tamiflu) • Zanamivir (Relenza)

38. Assumptions for Antivirals • Resistance to adamantanes • Neuraminidase inhibitors will be effective in decreasing morbidity and mortality • Current national stockpile = 5 million courses; goal is 80 million courses • ? Maine stockpile

39. Some Antiviral Priority Groups • Patients admitted to hospital • Infected health care workers and EMS providers • Infected high-risk patients • Infected pandemic responders and government decision-makers • Exposed health care workers Equals 40 million courses (150,000 courses for Maine)

40. Cost of Antiviral Treatment5-Day Course for an Adult • Oseltamivir (Tamiflu) $72.10 • Zanamivir (Relenza) $61.80

41. Personal Stockpiles of Antivirals • Supply • Effectiveness • Resistance • Shelf life

42. Stockpiles of Antivirals • Institutional • State

43. Community Disease Control

44. Challenges to Containment • Short incubation period of 1-5 days • Ability of persons with asymptomatic infection to transmit virus • Early symptoms of illness are likely to be non-specific, delaying recognition

45. Goal of Community Disease Control • To limit or slow spread of pandemic influenza • Social Distancing

46. Containment Measures for Ill Individuals • Patient isolation • Management of contacts • Contact tracing • Contact monitoring • Quarantine

47. Containment Measures For Groups of Exposed or At-Risk Persons • Quarantine • Containment measures for specific sites or buildings

48. Containment Measures For Communities • Promotion of community-wide infection control measures • Social distancing (snow days)

49. Unresolved Issues • Role of airborne transmission • Effectiveness of antivirals • Coordination between states and countries

50. State of Maine Preparedness