PANDEMIC INFLUENZA

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PANDEMIC INFLUENZA

• BACKGROUND AND GUIDANCE FOR SCHOOLS

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Influenza

• Respiratory infection
• Transmission contact with respiratory secretions
  from an infected person who is coughing and
  sneezing
• Incubation period 1 to 5 days from exposure to
  onset of symptoms
• Communicability Maximum 1-2 days before to 4-5
  days after onset of symptoms
• Timing Peak usually occurs December through
  March in North America

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Common Influenza Symptoms

• Rapid onset of
• Fever
• Chills
• Body aches
• Sore throat
• Non-productive cough
• Runny nose
• Headache

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Influenza is a serious illness

• Annual deaths 36,000
• Annual hospitalizations gt200,000
• Total economic costs 37.5B
• Who is at greatest risk for serious
  complications?
• persons 65 and older
• persons with chronic diseases
• infants
• pregnant women
• nursing home residents

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Definitions

• Epidemic An increase in disease above what is
  normally expected
• Pandemic A worldwide epidemic

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How Do Influenza Pandemics Arise?

• Wild water fowl are natural reservoirs of
  influenza
• They can spread the virus to domestic birds

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How Do Influenza Pandemics Arise?

• When avian flu viruses experience sudden changes
  in genetic structure
• and
• Are capable of infecting humans
• and
• Can reproduce and spread from person to person
  efficiently

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Why Be Concerned About Pandemic Influenza?

• Influenza pandemics are inevitable naturally
  recur at more-or-less cyclical intervals
• Can cause
• High levels of sickness and death
• Drastic disruption of critical services
• Severe economic losses
• There will be little warning time between the
  onset of spread of a pandemic and its arrival in
  the U.S. Outbreaks occur simultaneously in many
  areas
• Impacts will last for weeks to months and likely
  to occur in successive waves
• Pandemics can disproportionately affect younger,
  working-age people
• Current avian influenza outbreak in Asia

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Timeline of Emergence of Influenza A Viruses
in Humans
Avian Influenza
H7
H9
H5
Russian Influenza
H5
H1
Asian Influenza
H3
Spanish Influenza
H2
Hong Kong Influenza
H1
1918
1957
1968
1977
1997
2003
1998/9
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Influenza Pandemics 20th Century
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
20-40 m deaths 675,000 US deaths
1-4 m deaths 70,000 US deaths
1-4 m deaths 34,000 US deaths
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Planning Assumptions Health Care

• 50 or more of those who become ill will seek
  medical care
• Number of hospitalizations and deaths will depend
  on the virulence of the pandemic virus

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The 1918 Influenza Pandemic
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(No Transcript)
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Chicken Little and the Sky is Fallingor The Next
Major Disaster?

• Which is it?

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Current Outbreak Avian Influenza (H5N1)

• Began in fall, 2003.
• At least 252 confirmed human cases in Asia,
  Africa and Europe
• 148 deaths in Asia and Africa
• (World Health Organization, 10/06)
• Mammalian infection (cat, pig)
• No efficient person-to-person transmission
• Isolated Human disease
• Case-fatality rate gt 50
• Outbreak spreading, not controlled

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Current Avian Outbreaks
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Clinical illness with H5N1 compared with typical
human influenza illness

• More severe illness in younger persons
• Primary viral pneumonia appears to be more
  common and with rapid onset
• Incubation period may be longer 1-4 days (up
  to 14 days?)
• Duration of infectious period likely
  longer, particularly in adults 1d. prior to
  7d. after

(in adults children longer)
Adapted from Guillermo Herrera, CDC, 2005
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Pandemic Effects Strain on Resources

• Health care shortages
• Vaccine / Antivirals
• Hospital beds / equipment
• Masks
• Personnel shortages
• Disruption of essential society functions
• Panic

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Vaccines, Antivirals, andMedical Supplies
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Pandemic Influenza Vaccine Questions

• When will it be available?
• How much will there be?
• Who will own it?
• Who should get it?
• How should it be delivered?

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Treatment and Prevention Vaccine

• Vaccines takes 6-8 months to produce following
  the emergence of a new virus
• Supplies will be limited, if available at all
• 2nd dose after 30 days will likely be required
• New vaccine safety and efficacy has unknowns

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Treatment Prevention Antiviral Drugs

• Antiviral agents
• Effective in preventing illness
• Can prevent severe complications
• May not be effective against pandemic virus
• Supplies will be limited
• Treatment over prevention

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Nassau County Department of Health Pandemic
Influenza Preparedness Strategies

• Distribution Planning
• First Responder Prophylaxis
• Municipality operated PODs
• Employer operated PODs (regional)
• DOH operated PODs
• School operated PODs through municipalities

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Points of Distribution

• Community based sites used to distribute vaccines
  or medications to healthy citizens
• Would the schools be used?
• Municipalities will coordinate POD planning
  within their communities.

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Individual and Family Preparedness

• We will have to take care of ourselves and those
  around us.
• During a pandemic, public health will maximize
  resources for the greatest impact on the
  population as a whole.
• Schools should communicate with local/ state
  public health agencies and/or emergency
  responders about the assets/services the
  districts could contribute to the community.

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Influenza Prevention What Can We Do?

• Specific Recommendations
• for Infection Control in
• Schools and Workplaces
• Pandemic preparedness planning
• Distribution of educational messages
• and infection control guidance
• Social distancing people stay home when ill
• Promotion of respiratory etiquette
• Provision of materials for respiratory hygiene/
• etiquette tissues and disposal receptacles

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SOCIAL DISTANCING
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ISSUES FOR SCHOOL DISTRICTS TO THINK ABOUT

• Absenteeism among children AND staff
• Resources limited vendors, buses
• Role of school nurses
• Communication with parents and staff and
  community
• Advantages and disadvantages to closing schools
  (amount of closure time)
• Working with local municipalities
• Implications with State aide
• Policies sending sick children home (isolation
  within the school, masks, etc)
• Policies for allowing previously sick children to
  return to schools

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RESOURCES FOR SCHOOLS

• Nassau County Health Department, with direction
  from the New York State Health and Education
  Departments, will provide guidance to schools
  districts
• To create plans
• To create communication materials for students,
  staff and parents
• To provide guidance for closing schools

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Key Step for District Preparedness

• Incorporate the pandemic influenza plan as an
  annex in the school districts all hazards plan.

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COMMUNICATIONBefore a Pandemic Hits

• Develop strong relationships with your school
  communities
• Build confidence that information will be
  distributed accurately and quickly
• - Consider community meetings that describe
  current plans in place

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COMMUNICATIONBefore a Pandemic Hits

• School Websites
• Lunch Menus
• PTAs
• Letters to the Community
• BOE Meetings
• Marquis
• Proactive

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COMMUNICATIONBefore a Pandemic Hits

• Establish relationship with Public Health
  Officials early on
• Review/update procedures for communicable disease
  reporting

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Pandemic Influenza
Dont worry about it, its probably just a head
cold.
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Acknowledgments

• Presentation compiled and adapted from multiple
  slide sets from the
• Centers for Disease Control and Prevention
• HHS National Vaccine Program Office
• New York State Department of Health
• Connecticut Department of Health
• Kansas Department of Health
• Department of Defense
• Washington Department of Health