PANDEMIC INFLUENZA PLANNING

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PANDEMIC INFLUENZA PLANNING
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Two Sides of Pan Flu Planning
The Ostrich
Chicken Little
The End is Near!!!!
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Types of Flu Seasonal (or common) flu is a
respiratory illness that can be transmitted
person to person. Most people have some immunity,
and a vaccine is available. Avian (or bird) flu
is caused by influenza viruses that occur
naturally among wild birds. The H5N1 strain is
one of the current strains infecting birds, and
unlike most others, is not only deadly to
domestic fowl, but can be transmitted from birds
to humans (zoonotic). There is no human immunity
and no vaccine is available. Pandemic flu is
caused by a novel strain of a virulent human flu
that leads to a global outbreak, or pandemic, of
serious illness. Because there is little natural
immunity, the disease can spread easily from
person to person. Currently, there is no pandemic
flu. (WHO)

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Seasonal Influenzas

• Are a Major Public Health Problem Every Year.
• Annual impact (U.S.)
• 36,000 deaths
• 200,000 hospitalizations
• 37.5 billion in economic costs from influenza
  and pneumonia
• Those at greatest risk for serious complications
• persons 65 and older
• persons with chronic diseases
• infants
• pregnant women
• nursing home residents

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Avian Influenza

• The H5N1 strain of avian influenza (bird flu) is
  present in birds in many countries across several
  continents.
• Bird flu in its present form does not present a
  threat of a pandemic
• Some human cases of avian influenza have occurred
• After close contact with infected birds
• After close contact with infected household
  members
• No sustained person-to-person transmission
• Human case fatality (death) rate is gt50
• Virus is changing. 2004 strain is more resistant
  to tamilfu than the original 1997 strain

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Influenza Pandemic

• A global influenza outbreak caused by a brand new
  (novel) flu virus
• Because it is a new virus, few or no people would
  be immune
• Many people would get sick in every part of the
  world
• Asia is the source of many outbreaks because
  swine, birds and humans live under the same roof,
  providing opportunity for viral mixing

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Pandemic Does Not Necessarily Mean the 1918-19
Pandemic
1957 Asian Flu
1968 Hong Kong Flu
1918 Spanish Flu
A(H2N2)
A(H3N2)
A(H1N1)
World Pop. 2.8 billion 2 m deaths 70,000 US deaths
World Pop. 1.8 billion 20-40 m deaths 550,000
US deaths
World Pop. 3.6 billion 1-4 m deaths 34,000 US
deaths
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If It Happened Today Worst Case Scenario

• Based on observations from previous pandemics,
  the Centers for Disease Control and Prevention
  (CDC) has estimated that the economic losses in
  the United States associated with the next
  pandemic will range from 71 billion to 166
  billion.
• The impact of an influenza pandemic on the
  healthcare system could be devastating.
• In the United States, between 40 and 100 million
  will become clinically ill 18 to 45 million will
  require outpatient care 300,000 to 800,000
  persons will be hospitalized and between 88,000
  and 300,000 people will die.
• NC Pandemic Influenza Plan 2006

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Impact of an Influenza Pandemic North Carolina

• 1.4 million outpatient visits
• 29,000 hospitalizations
• 6,700 deaths

• Assuming 30 attack rate and NC population of 8.5
  million people
• Based on CDC software FluAid 2.0

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Pandemic Flu Is A Risk Today

• Despite . . .
• Expanded global and national surveillance
• Better healthcare, medicines, and diagnostics
• Current risks
• Greater population density
• Limited vaccine capability (9 Countries produce
  all the worlds flu vaccine, with 1950s
  technology).
• More elderly and immunosuppressed
• More daycare and nursing homes
• Warrior worker ethic in the workplace leads to
  disease spread

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Reality is That We are More Globally Connected

• SARS spread to 5 countries within days of
  detection and to 30 countries on six continents
  within a few months.

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Worldwide Spread in 6 Months
Spread of H2N2 Influenza in 1957Asian Flu
Feb-Mar 1957Apr-May 1957Jun-Jul-Aug 1957
69,800 deaths (U.S.)
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Will Avian Flu Cause the Next Pandemic?

• NO ONE KNOWS!
• The H5N1 virus could change to spread more easily
  among humans-but it might not.
• It could swap genes with another animal virus,
  or with a human flu virus
• It could become less virulent even if it mutates
  so it can spread person to person easily.
• Another Influenza virus could mutate first.

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Pandemic Influenza
To date, Avian Influenza (H5N1) is primarily a
disease of birds and not humans.
Avian Influenza
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However, There is Enough Concern to Warrant a
Pandemic Watch
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WHO Pandemic Alert Phases
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A Pandemic Requires Person-to-Person Spread
While There is Evidence of Localized Instances of
Person to Person Spread, Sustained Person to
Person Transmission is Not Currently Occurring
with H5N1
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Pandemic Planning
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Pandemic Planning Is Tricky You know that it will
happen

• But you dont know
• When it will occur
• What the characteristics of the virus will be
• Who it will affect
• How long it will last
• Whether it will be resistant to antivirals or
  not
• Whether there will be a vaccine or not (or when)
• How severe the pandemic will be

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Pandemic Response is Local and by Necessity
Collaborative
First Responders Fire/EMS EM, Law, Medical
Examiner
Hospitals. Medical Mental Health
Services, Public Health
Schools, Local Government, Public Works and
Utilities, Community Agencies
Agriculture, Cooperative Extension, Vets, CART,
Animal Control
Business and Industry
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Planning Assumptions

• Core prevention and control measures (e.g.,
  vaccination and antivirals) will not be available
  or will be limited
• Non Pharmacological Interventions (NI) will be
  the primary control disease control strategy
• A pandemic will be global, prolonged and have
  several waves
• Disruption of key supply chains will likely
  occur, especially with products with off-shore
  production or components
• Lack of surge capacity in the medical industry
  will be a problem
• Response will be local. Mutual aid and outside
  resources will be minimal or non-existent.

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WHO Goals for Pandemic Planning and Response
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Pandemic Influenza Response

• Initial strategy will be early detection and
  containment. Slow spread, decrease illness and
  death, buy time
• Antiviral treatment and isolation for people with
  illness
• Quality medical care
• Quarantine for those exposed (antiviral
  prophylaxis if available)
• Social distancing, travel restrictions, snow
  days, work at home
• Infection control, hygiene (hand washing.),
  respiratory etiquette
• Vaccine when it becomes available (6-8 months)
• Plan to maintain essential services
• Effective crisis communication can
• influence how people react

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Individual or Group Disease Control Strategies

• Isolation and Quarantine
• Reduces influenza transmission by separating
  infected persons from uninfected persons, and
  exposed persons from non-exposed persons.
• Isolation of ill persons will be valuable during
  all phases of pandemic influenza
• Quarantine of those exposed to ill persons is
  justified when there are a limited number of
  cases most valuable early in the outbreak when
  cases are limited
• Quarantine can be voluntary or by order of the
  County or State Health Director
• Local law enforcement has to enforce quarantine
  of non-compliant persons
• Persons in quarantine have to be provided with
  essential services (food, water, medicines)
• Mental health needs are high for those in
  quarantine

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Community-Based Infection Control Strategies

• Social distancing
• voluntary self-shielding
• Cancellation of public events
• concerts, sports events, movies, plays
• Closure of schools and workplaces
• office buildings, shopping malls
• Closure of recreational facilities
• community swimming pools, youth clubs, gymnasiums

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Work and/or School Based Infection Control
Strategies

• Snow Days and closures
• Respiratory hygiene/cough etiquette, hand hygiene
• Stay away if ill (staff stay home, students do
  not go to classes)
• Encourage self-reporting of illness that develops
• Active screening for illness in staff/students
• Send staff/students home(with mask) if ill
• Modify personnel policies that
• encourage sick people to
• come to work

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Hand Hygiene

• Traditional hand washing
• Soap and hot water
• Minimum of 20 seconds (the time it takes to sing
  Happy Birthday twice)
• Alcohol based hand rubs
• Acceptable means to disinfect/sanitize EXCEPT
  when hands are visibly soiled

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Respiratory Hygiene and Cough Etiquette

• Cover mouth/nose when sneezing or coughing
• If no tissue, use elbow instead of hands
• Use tissues and dispose of appropriately
• Perform hand hygiene after contact with
  respiratory secretions
• Distance yourself from others (more than 3 feet)

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What About Masks?

• Recommended for
• Health care workers with direct patient contact
• Those at high risk for complications of
  influenza
• Symptomatic persons
• Contacts of ill persons

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More About Masks

• Benefit of wearing masks by well persons in
  public settings has not been established
• Persons may choose to wear a mask as part of an
  individual protection strategy that includes
  respiratory hygiene/cough etiquette, hand
  hygiene, and social distancing.
• If you wear a mask,
  keep your hands away
  from your face!
• Clean your hands each time you touch your mask!

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• Businesses, school systems, community
  infrastructure providers, and other employers
  should develop plans for continuity of operations
  (COOP) and for the possibility of having to
  operate with a significantly reduced workforce.
  Personnel Policies may have to be modified.
• 25 to 30 of persons may become ill during a 6 to
  8 week outbreak.
• An additional 10 of the workforce may be absent
  due to illness of a family member.
• Others may stay home due to a fear of becoming
  infected.

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Pandemic Influenza Facts (WHO)

• 1. Pandemic influenza is different from avian
  influenza.
• 2. Influenza pandemics are recurring events.
• Pandemics occur every 30-50 years
• Another pandemic is a certainty but it cannot be
  predicted when it will occur.
• 3. The world may be on the brink of another
  pandemic.
• Concern H5N1 virus could mutate and cause a
  pandemic.
• 4. All countries will be affected.
• 5. Widespread illness will occur
• 6. Medical supplies will be inadequate
• 7. Large numbers of deaths will occur
• 8. Economic and social disruption will be great
• 9. Every country must be prepared.
• 10. WHO will alert the world when the pandemic
  threat increases.

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Web Resources For Pan Flu

• www.cdc.gov
• U.S. public health guidelines
• www.pandemicflu.gov
• All kinds of planning info
• www.cidrap.unm.edu/
• Example of COOP
• http//www.epi.state.nc.us/epi/gcdc/pandemic.html
• NC Pandemic Flu Plan
• www.who.int
• Global updates and official case reports
• http//www.cchealth.org/topics/pandemic_flu/school
  _action_kit/
• Pan Flu Action Kit for Schools