Pandemic Flu and You

1
Pandemic Flu and You

• JJ Naponick, MD MPH
• Administrator/Medical Director
• Department of Health Hospitals
• Office of Public Health
• Region 6

2
Topics of Discussion

• Influenza
• Avian Flu
• Pandemic Flu
• Impact Planning
• Public Health Role
• Your Role
• Resources

3
What is influenza (flu)?

• mild to severe respiratory illness of sudden
  onset caused by an influenza virus
• highly infectious spread rapidly from person to
  person
• some strains more severe than others
• occurs every year killing 36,000 people in U.S.

4
Symptoms of Influenza

• sudden onset of symptoms
• fever, headache, aching muscles, weakness
• respiratory symptoms
• cough, sore throat, difficulty breathing
• incubation period time from exposure to virus
  to development of symptoms
• varies for influenza , but generally 1 to 4 days

5
How does influenza spread?

• Breathing in droplets
• produced when infected person talks/coughs/
  sneezes
• Touching an infected person or surface
• contaminated with the virus and then touching
  your own or someone elses face

6
Influenza Prevention

• Vaccination
• Stay at home when sick
• Cover your cough
• Wash hands regularly
• Avoid touching eyes, nose and mouth
• Avoid close contact with people who are sick

7
Avian (Bird) Influenza

• An infection occurring naturally among birds
  caused by avian influenza viruses (e.g. H5N1
  virus)
• Birds
• wild birds worldwide carry the virus usually no
  illness
• domesticated birds - can become ill and die
• Humans
• can become infected with avian influenza -gt
  severe illness and death
• most cases from close contact with infected
  poultry
• very rarely may have spread from one person to
  another
• cases/deaths since 2003 258/153
• 2003 4/4
• 2004 46/32
• 2005 97/42
• 2006 111/75

8
Will H5N1 become the next pandemic?

• Avian Flu not yet Pandemic Flu
• current outbreaks of H5N1 Avian Flu in poultry
  and birds are the largest ever documented
• Impossible to predict next pandemic flu event
• If not H5N1, then another
• Plan now

9
Understanding Pandemic Flu

• Epidemic serious outbreak in a single community,
  population or region
• Pandemic an epidemic spreading around the world
  affecting hundreds of thousands of people, across
  many countries
• Pandemic flu a pandemic that results from an
  influenza virus strain that humans have not been
  previously exposed to

10
Influenza A Virus
Hemagglutinin (H)16 subtypes(attachment,
penetration)
Hemagglutinin (H)16 subtypes(attachment,
penetration)
Neuraminidase (NA)9 subtypes(release)
8 viral genes(assembly, replication)
M2 protein(penetration)
11
Antigenic Drift vs. Shift

• Antigenic drift major changes in the form of one
  or both of the two principle antigens on the
  viral surface
• our immune system has greater difficulty
  recognizing them
• Antigenic shift radical changes in the form of
  the one or both of the two principle antigens on
  the viral surface
• our immune system cant recognize them at all

12
Putting Pandemic Flu into Perspective

• 2001 terrorist attack with anthrax
• killed five people
• 2002 outbreak of West Nile Virus
• killed 284 people nationally in six months
• 2003 SARS outbreak
• killed over 800 people world wide
• froze Asian economies
• frightened millions of people into wearing masks
  on the streets

13
History of Pandemic Influenza

• 1968-1969
• Worldwide 700,000 deaths (34,000 in US)
• 1957-1958
• Worldwide 1.5 million deaths (70,000 in US)
• 1918
• Worldwide 40-50 million deaths (500,000650,000
  in US)
• Typical Influenza Season
• 36,000 deaths in US

14
Lessons from Past Pandemics

• Occurs unpredictably, not always in winter
• Variations in mortality, severity of illness and
  pattern of illness
• Rapid surge in number of cases over brief period
  of time, often measured in weeks
• Tend to occur in waves - subsequent waves may be
  more or less severe

15
Pandemic Flu Current Status and Requirements

• Currently no pandemic influenza in the world
• For pandemic influenza to occur, three conditions
  must be met
• a new influenza A virus appears or emerges in
  the human population
• it causes serious illness in people
• it spreads easily from person to person worldwide

16
Current Status
Interpandemic
Pandemic
Pandemic alert
Phase 4
Larger clusters, localized Limited spread
among humans
Phase 1
Phase 2
Phase 3
Phase 5
Phase 6
No new virus in humans Animal viruses low risk to
humans
No new virus in humans Animal viruses low risk to
humans
New virus in humans Little/no spread among humans
Small clusters, localized Limited spread among
humans
Increased and sustained spread in general human
population
Current status of H5N1
Current H5N1 status
WHO Global Influenza Preparedness Plan, 2005.
Available at http//www.who.int/csr/resources/pub
lications/influenza/GIP_2005_5Eweb.pdf
17
Would there be a vaccine?

• Because the virus will be new, there will be no
  vaccine ready to protect against pandemic flu
• A specific vaccine cannot be made until the virus
  has been identified
• Seasonal flu vaccine or past flu immunization
  will not provide protection

18
Medications During Pandemic Flu

• Antiviral Medications
• can prevent complications if taken within first
  48 hours of illness
• may not be effective against a pandemic flu virus
• extremely limited supply now
• would be prioritized
• initial use probably only for treatment, not
  prophylaxis

Antiviral Medications
Amatadine (Symmetrel)
Rimantadine (Flumadine)
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
19
Isolation and Quarantine

• isolate ill individuals with certain contagious
  diseases
• quarantine contacts (those exposed to such
  contagious diseases)
• play a role in the early stages of the pandemic
• legal measures possible
• probably would rely on voluntary cooperation
• once beyond initial cases
• stay home when you are sick

20
Influenza Containment Strategy Community
Response

• Basic Activities
• Surveillance and quarantine of early cases
• Public information and education
• Promote respiratory hygiene and hand washing
• Enhanced Activities
• Focused measures to increase social distance
• Community-wide measures to increase social
  distance

21
Community Wide Measures

• Reduce Social Contact by canceling large
  gatherings, mass transit, school
• Decision based on location of flu activity
• Outbreak not local large gatherings cancelled
• Outbreak in local/neighboring county small
  gatherings cancelled
• School closings determined by
• State Department of Health Hospitals
• Department of Education
• Local School Boards.

22
Pandemic Influenza Impacts

• Estimated Impact in Louisiana
• 3 Million infected
• Between 600,000-1.4 million clinically ill
• Between 300K-700K requiring outpatient care
• Between 10,000 22,500 hospitalized
• Between 3,000 6,000 deaths

• Impact on Infrastructure
• Significant disruption of transportation,
  commerce, utilities, public safety and
  communications
• Limited to no assistance from State and Federal
  governments due to nation-wide impact

23
Impact on Health Care

• Illness rates will soar
• Many people will require some medical care
• Health care facilities will be overwhelmed
• Symptoms may be severe
• Complications
• may be more frequent
• healthy people may be at increased risk

24
Impact on Business

• Impact on Business Owners
• Up to 40 employee absenteeism
• Possible increase/decrease in demand for products
  or services
• Disruption of communication supply chains
• Fewer employees and customers

• Issues to Address
• Modification of
• customer/employee interaction
• sick leave work location
• Communication/education
• Collaboration
• Infection Control

25
Workforce Support

• Psychological and physical strain on personnel
  responding in emergency situation
• Psychological stress for families
• Plan for staff to have adequate
• Sleep
• Food
• Access to psychological
• and spiritual support

26
Guidance Personal/Family Planning

• Personal protection
• Hand hygiene and respiratory etiquette
• Surgical masks proven effective for droplet
  precautions
• Pneumococcal vaccination per recommended
  guidelines
• Stockpiling One to three week essential water,
  food, supplies, medicines

27
Guidance School Planning

• Develop alternative procedures for learning in
  event of school closures
• Develop plan for essential office functions
• payroll, communication with students, families,
  and staff
• Infection Control
• educate practice

28
Guidance for Faith-based Planning

• Develop alternative procedures for worship in
  event of social distancing
• Develop plan for essential office functions
• payroll, communication with members and staff
• Infection Control
• educate practice

29
Infection Control - Our Basic Protection

• Hand Hygiene
• Wash hands regularly with soap water
• If no water available 60-95 alcohol-based
  sanitizer
• Cover your cough strategy
• Environmental cleaning
• 110 bleach solution
• EPA registered disinfectant
• Gloves surgical masks

30
Community Goals in Pandemic Flu

• Limit death and illness
• Preserve continuity of essential government and
  business functions
• Minimize social disruption
• Minimize economic losses

31
Public Health Role in Pandemic

• Facilitate planning
• Disease tracking control
• Communication about public health issues
• Coordinate mass antiviral medication and
  vaccination clinics
• Issue isolation and quarantine orders

32
What Can You Do Now?

• Prepare your community become involved in
  disaster training volunteerism.
• Remember to get enough sleep.
• Exercise regularly.
• Prevent the spread of infection wash hands
  regularly, cough/sneeze into tissue, keep your
  hands away from your nose/mouth.
• Put out cigarettes.
• Annual flu shots.
• Nutritious eating.
• Family plan and kit.
• Look for information about pandemic flu.
• Utensils, food and beverages should not be shared.

33
Get Informed. Be Prepared.

• State Draft Pandemic Flu Plan
• http//www.dhh.state.la.us/offices/publications/pu
  bs-145/Pandemic20Influenza20Plan_100906.pdf
• Family Readiness Guide
• http//www.dhh.state.la.us/offices/publications/
• Official Pandemic Flu Web Site
• http//www.pandemicflu.gov/
• Centers for Disease Control and Prevention
• http//www.cdc.gov/flu/pandemicflu/

Even though local, state and federal agencies
have plans to protect the public, you are
responsible for your own safety, even in an
emergency!
34
Remember, things will eventually get better!