PANDEMICS

1. PANDEMICS AND UNIVERSAL PRECAUTIONS MARILYN EVANS CAPITAL DISTRICT FIREFIGHTERS IN-HOUSE TRAINING Dec.12, 2005

3. OBJECTIVES • Understand the Virus • Review the history • Understanding of the epidemiology • Our roles • Exercise

4. UNDERSTANDING THE VIRUS

5. WHAT IS INFLUENZA? • INFLUENZA – Acute onset of respiratory illness with fever (>38 C,100.4 F) and cough with one or more of the following – sore throat, joint pain, muscle aches, headache, malaise. • Severe illness lasting 7 to 10 days • In people 65 and older, fever may not be present. • Other symptoms in the elderly may include change in behavior, chest congestion, decrease in appetite.

6. COMMUNICABLE DISEASES • DISEASES MAY BE TRANSMITTED FROM PERSON TO PERSON BY SEVERAL ROUTES: • DIRECT CONTACT • INDIRECT CONTACT • BLOOD AND BLOODY BODY FLUIDS • VECTORS • DROPLET INFECTIONS • AIRBORNE INFECTIONS

7. Modes of Disease Transmission • Airborne • a more common method of transmission • bacteria or viruses suspended in air, water droplets, or dust particles (coughing, sneezing) • can be widely scattered via air currents • examples: TB, rubeola (measles), chicken pox • Direct Contact • straight from one person to another • examples: kissing, sexual contact, blood dripping into a wound, touching feces, eating or smoking with contaminated hands

8. Modes of Disease Transmission • Indirect contact • touching a contaminated surface & most likely bringing your hands to your face • examples: telephones, door handles, steering wheels, faucets, B/P cuffs, EKG cables, swimming in contaminated water • Vector-borne • infectious agent transferred by common carrier (animal & insect bites, blood transfusions, needle stick injuries, transplants) from 1 person/source to another • examples: rabies, lyme disease, malaria, West Nile disease, HBV, HIV

9. About Influenza Period of Communicability • 􀂃24 hours before onset • 􀂃3-5 days after onset • 􀂃Hard surfaces 24-48 hours • 􀂃Porous surfaces 8-12 hours • 􀂃Hands 5 minutes Incubation • 􀂃1-3 days

10. Influenza Virus • There are three types of influenza viruses: Types A, B, and C • The viruses are transmitted among humans by respiratory secretions through sneezing, coughing and contact with contaminated articles

11. Influenza Virus Type C influenza Virus • Restricted to humans • Relatively Stable • Causes mild, sporadic illness among humans

13. Influenza Virus Type B influenza Virus • Restricted to humans • Can change slowly over time • More Stable than Influenza A • Has been associated with widespread illness among humans • Causes milder disease than influenza A

14. Influenza virus Type A influenza Virus • Many different sub-types • Various subtypes infect humans, pigs, horses, aquatic animals, birds and most recently dogs. • Can change frequently and dramatically • Can sweep across continents and around the world in massive epidemics called pandemics • Causes excess mortality and mordidity

15. Affects a large population in a geographic area Abrupt onset Rapid spread Occurs at unpredictable intervals Not seasonal Epidemic Pandemic • Massive global epidemic caused by a antigenic shift in the Influenza A virus • Pandemics are usually worldwide

16. Recipe for a Pandemic • 􀂃Bird flu virus can mix with human flu virus and create new subtype of virus • 􀂃The world would have little or no immunity to this new virus • 􀂃If this virus replicates in humans and causes serious disease…………. AND • 􀂃If this virus can be spread from person to person efficiently, then it may cause a….PANDEMIC

17. Phases of an Influenza Pandemic

18. Phase Definition 2 Regional and Multi-Regional Epidemics: Outbreaks and epidemics in multiple countries around the world 3 End of First Pandemic Wave: Influenza activity stops in initially affected regions and continues elsewhere 4 Second or Later Waves: 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak 5 End of Pandemic: Infection rates return to pre-pandemic levels, no more large scale “waves” of infection expected. May take 2 or more years. Phases of an Influenza Pandemic

19. Review Pandemic History

20. Past Influenza Pandemics

21. Mortality during the pandemic of1918-19A/H1N1 – Spanish influenza • 􀂃 3 epidemic waves in close succession • 􀂃 March 1918, Sept 1918, Feb 1919 • 􀂃 Est 40 million deaths world-wide,

22. Pandemic Influenza 1918 Influenza Pandemic • 20-40 million persons died worldwide, possibly more • Death rate 25 times higher than previous epidemics • Ten times as many Canadians died of flu than died in WW I • The epidemic preferentially affected and killed younger, healthy persons • The epidemic was so severe that the average life span in Canada was depressed by 10 years

23. Understanding of the epidemiology

24. Where does it start? • Evidence suggests most epidemics emerge from China • Close mingling of pigs, chickens, ducks, and humans allows reassortment of viruses

25. Antigenic Variation • Influenza viruses change frequently • Changes or mutations in the virus are referred to as “antigenic variation” • These variations cause epidemics and pandemics

26. Antigenic Variation • Antigenic variation is referred to as driftorshift, depending on whether the variation is small or great • The drift affects both Influenza A and B viruses and occurs every 1-3 years within a subtype and can result in significant epidemics

27. Antigenic Variation • Antigenic shift affects the Influenza A virus only and causes major changes within the virus. This can occur every 10-40 years leading to a pandemic • There is no relationship between the surface antigens of the old and the new virus, therefore a new virus subtype emerges • The population will have no immunity to the new subtype

28. The current reality

29. “Don’t worry about it, it’s probably just a head cold.”

30. Pandemic InfluenzaOutbreak of Avian Influenza A (H5N1) in Asia • "We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemic…" • Dr. Shigeru Omi, the WHO's Western Pacific Regional Director, 23 February 2005

33. PANDEMIC ? • “The pandemic clock is ticking – we just don’t know what time it is.” Edgar Marcuse University of Washington School of Medicine

34. The Pandemic Challenge Senior officials are being asked to: – Cope with present realities • An avian influenza epidemic – Prepare for an uncertain future • A human influenza pandemic – Be ready for major disruption • Reaction to the pandemic

35. Pandemic InfluenzaPotential Impact of Pandemic Influenza inCanada. • Vaccine and antiviral drugs will be in short supply • 6-8 month lag-time needed for vaccine availability • Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population • Healthcare system will be overwhelmed • Risk of sudden shortages of key personnel in critical community services: police, fire, power/utilities, transportation, air traffic controllers, etc.

36. What do we know…. • • Pandemic influenza will happen (at some point) • • It is more likely now than three years ago • • It could be mild • • It could be severe • • It could be extremely severe • • It affects younger age groups than "normal" influenza

37. Are You Prepared? What is known….. • An influenza pandemic will happen • The timing and pattern will be unpredictable • A short lead time will exist from first identification to full scale pandemic • Outbreaks will occur simultaneously, in multiple waves with devastating societal impact

38. What do we know - Two • • It could come once or in waves • • It will probably come quickly • • Work forces will be badly affected • • Maybe infectious before symptoms appear • • There are infections with no symptoms

39. What do we know - Three • • An effective vaccine will take several months to develop • • There will probably be few anti-viral medicines available and the emergence of resistance is possible

41. What do we know - Four • • Influenza is infectious – but not as highly infectious as measles • • Not everyone will be infected • • There are ways of reducing the numbers affected • • If an infectious and damaging virus emerges, containment of people may be justified • • Need for epidemiological information

42. Pandemic Impact Health Care System • Extreme staffing shortages • Shortage of beds, facility space, supplies • Hospital morgues, Medical Examiner and mortuary services overwhelmed Infrastructure • Significant disruption of transportation, public works, commerce, utilities, energy, and communications, emergency response

43. Our roles Safeguarding front-line personnel Educate and Inform Continuity of Operations Planning

44. UNIVERSAL PRECAUTIONS

45. “The only thing more difficult than planning for an emergency is having to explain why you didn’t.”

47. Vaccinations • not all are mandatory, many available to protect the individual

48. Infection Control Precautions and PPE for the EMS Provider at Suspected Infectious Disease Incident Standard infection control practices are taught to all Emergency Response Providers and should be reviewed regularly by agency internal training that includes: • Standard Precautions • Contact Precautions • Airborne Precautions • Droplet Precautions

49. Standard Precautions • apply to blood, all body fluids, secretions, non-intact skin, mucous membranes and excretions for all patients. Gloves and gowns (if soiling of clothing is likely) should be used to prevent exposure to blood and other potentially infectious fluids. Mask and eye protection or face shields should be used during procedures or activities that may likely generate splashes of blood or body fluids. Appropriate hand hygiene is always necessary.

50. Contact Precautions • include the use of gloves and a gown if clothing is likely to have contact with patient, environmental surfaces or patient care equipment.