Pandemic Flu Preparedness is Good Business Karen Seidman, RN, MPH Consultant, Cuyahoga County Board

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Pandemic Flu Preparedness is Good BusinessKaren
Seidman, RN, MPHConsultant, Cuyahoga County
Board of Health
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Agenda

• Influenza viruses introduction
• What makes a pandemic
• History of pandemics
• How a future pandemic might look
• Preparing for pandemic influenza
• Preparing your agency for pandemic influenza

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Influenza (or flu)

• The flu is a contagious respiratory illness
  caused by a virus.
• It can cause mild to severe illness, and at times
  can lead to death.
• A person infected with the flu virus can transmit
  it one-two days before they have symptoms.
• A person infected with the flu virus can transmit
  it four-five days after symptoms start.

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Influenza spread

• Spread by contact with an infected person
  through
• Sneezing
• Coughing
• Touching items recently contaminated by a person
  with the flu virus

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Influenza symptoms

• Symptoms include
• Fever (usually high) and chills
• Extreme tiredness (fatigue)
• Body aches
• Sore throat
• Non-productive cough (dry)
• Runny or stuffy nose
• Headache
• Diarrhea (rare in seasonal flu)

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Seasonal flu

• Occurs yearly during the winter months
• Every year in the US on average
• gt200,000 people are hospitalized
• 36,000 people die
• Most people who get the flu recover within 1-2
  weeks without medical treatment

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The difference between seasonal flu and pandemic
flu

• Seasonal flu is predictable while pandemic flu is
  not predictable
• Pandemic flu is caused by a new flu virus strain
  so everyone is susceptible
• Pandemic flu infects large numbers of people of
  different ages all over the world and causes
  serious illness and deaths

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Epidemic

• The occurrence in a community or region of cases
  of an illnessclearly in excess of
  expectancyrelative to usual frequency of the
  disease in the same area.
• Control of Communicable Disease in Man, Abram S.
  Benenson, editor, American Public Health
  Association, 15th edition, 1990.

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Pandemic

• A worldwide outbreak of disease in numbers
  clearly in excess of normal.
• Characteristics
• A new influenza virus emerges (H5N1 meets this
  criteria)
• It can infect humans, causing serious illness
  (H5N1 meets this criteria)
• It spreads easily and sustainably among humans
  (H5N1 does NOT meet this criteria)

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How influenza viruses change

• Drift gradual mutation of the virus allowing
  human to human transmission

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How new influenza viruses emerge

• Shift genetic material is exchanged between
  human and avian viruses during co-infection of a
  human or a pig - reassortment

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Past influenza pandemics
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Pandemic waves

• Pandemics occur in multiple waves of disease
  outbreaks
• The first wave in a local area is likely to last
  six to eight weeks
• The time between pandemic waves varies and can
  not be easily predicted.
• The severity of illness may vary among waves

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Avian influenza

• Normal reservoir is wild bird population
• H5N1 is a new avian influenza virus
• H5N1 currently is found in birds in Asia, Europe
  and Africa but not in North America
• H5N1 might cause pandemic influenza

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High pathogenic vs. low pathogenic

• Low Pathogenic Avian Influenza (LPAI) virus
  common in wild birds with no symptoms or minor
  symptoms, not a risk to human health
• High Pathogenic Avian Influenza (HPAI) virus
  also found in wild birds, can cause severe
  illness and death in domestic birds, can spread
  rapidly, capable of causing severe disease and
  death in humans

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Transmission of virus from birds to humans

• Wild birds carry the virus in gastrointestinal
  tract and excrete it in their feces.
• Domestic birds (chickens) become infected by
  drinking water or eating food contaminated with
  the virus
• The virus becomes aerosolized during defeathering
  or processing the chicken.
• Humans become infected by inhaling the virus.
• Humans can safely eat infected chicken if
  internal temperature has reached 165 degrees

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Current concerns aboutavian (bird) flu

• Historically unprecedented disease outbreak in
  poultry caused by H5N1
• Human cases reported as of
• February 27, 2007
• 275 cases
• 167 deaths
• No sustained human to human transmission
  identified.

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WHO Phases of Pandemic Alert
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Avian flu in the United States

• At this time (HPAI) H5N1 has not been detected in
  North America
• The US Fish Wildlife Service monitors migratory
  patterns of wild birds
• The Ohio Department of Agriculture monitors and
  tests poultry to ensure food safety
• US Department of Agriculture has imposed import
  restrictions on birds and bird products

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What to expect from pan flu

• Unlike other disasters
• Will not damage property or cause obvious damage
  like a natural disaster
• If people are absent from work, public services
  may be interrupted
• Daily routines may be disrupted and you may be
  asked to take actions to limit the spread of the
  virus

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Protection against the fIu

• A vaccine to protect people from pandemic flu is
  not available now.
• A vaccine may not be available at the start of a
  flu pandemic.
• Antivirals will also be in limited supply and
  might not be effective against a new flu virus
• The best protection is to practice healthy
  hygiene to stay well now and during a flu
  pandemic.

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Practice healthy hygiene

• Clean hands often
• Wash with soap and water or
• Clean with hand sanitizer
• Cover mouth and nose when you sneeze or cough and
  clean hands afterwards
• Keep hands away from face
• Stay away from people who are sick

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Prepare at home

• Plan now to care for yourself or loved ones who
  get the flu.
• Determine what supplies you will need to provide
  care at home.
• Plan how you will care for someone in your
  household who becomes sick.
• Remember your pets when planning.

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Stock up now

• Reduce your need to go out during a local flu
  pandemic (self shielding) by stocking extra food,
  water and supplies at home.
• If you do get sick and have extra supplies on
  hand, you will help reduce the spread of pandemic
  flu by staying home.
• If stores are open during pandemic flu they may
  be poorly stocked.

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Home Care

• Call for advise
• Separate ill person from others
• Practice healthy hygiene
• Wash dishes, laundry and surfaces as usual
• Masks effectiveness of protection not
  documented

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Start planning now

• Delegate responsibility for planning to one
  person and a back up Pandemic Coordinator
• Form a team to assist
• Include representatives of all departments
• Include a labor/employee representative
• Meet regularly

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Plan

• Differentiate essential services from
  nonessential services
• Plan to provide essential services with reduced
  work staff
• Identify source of additional staff (cross train,
  volunteers)
• Will pandemic flu increase or decrease demand for
  your services?

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Communication

• Establish contact with your local health
  department
• Identify other key contacts, especially
  employees, clients, other agencies, outside
  providers
• Establish redundant communication systems

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Impact on Employees

• Expect 25 to 40 absenteeism
• Besides illness, employees may experience
  disruption of normal activities, making it
  difficult for them to be at work
• Transportation services may disrupted
• Schools and day care centers may be closed
• Grocery stores may be poorly stocked or closed
• Other services may be disrupted

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Pandemic influenza employment policies

• Institute a temporary liberal, nonpunitive
  absenteeism policy
• Provide for continuation of health care coverage
  and salary for employees unable to work
• Identify trigger

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Protecting Employees at Work

• Ensure availability of hand washing supplies,
  disposable tissues, regular cleaning of the
  workplace
• Adjust structure to provide social distancing
• Add distance between workers
• Limit trips into the community
• Provide education now

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Recovery

• Identify trigger for end of local wave
• Recall employees
• Inform customers / clients of return to normal
  operations
• Offer emotional / psychological support to
  employees
• Resume prior employee services and policies
• Reevaluate and revise plan

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Reaching into the Community

• Make contact with your local health department
  for guidance during pandemic influenza
• Encourage employees to participate in CERTs and
  the MRC

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Resources

• Ohio Department of Health Pandemic Flu Plan
  http//www.ohiopandemicflu.gov
• Cuyahoga County Response Plan www.ccbh.net
• U.S. Dept. of Health Human Services
• www.pandemicflu.gov
• World Health Organization Current Information
• http//www.who.int/csr/disease/avian_influenza/en

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Contacts

• Cuyahoga County Board of Health (216)
  201-2000
• Cleveland Department of Public Health (216)
  664-2324
• Lakewood Health Department (216)
  529-7690
• Shaker Heights Health Department (216)
  491-1480
• American Red Cross Cleveland Chapter (216)
  431-3010

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Thank you

• Please remember to wash your hands.