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Pandemic Influenza Planning 2008


A flu pandemic occurs when a new influenza virus emerges for which people have ... to predict when the next influenza pandemic will occur or how severe it will ... – PowerPoint PPT presentation

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Title: Pandemic Influenza Planning 2008

Pandemic Influenza Planning 2008
  • Louie Valenzuela
  • Emergency Planning Coordinator
  • Bioterrorism Preparedness Program
  • 04 June 2008

What is Influenza (Flu)?
  • The flu is a contagious respiratory illness
    caused by influenza viruses. It can cause mild to
    severe illness, and at times can lead to death.
    The best way to prevent the flu is by getting a
    flu vaccination each year.

Key Facts About Influenza
  • Every year in the United States, on average
  • 5 to 20 of the population gets the flu
  • more than 200,000 people are hospitalized from
    flu complications, and
  • about 36,000 people die from flu.

Flu Terms Defined
  • Seasonal (or common) flu is a respiratory illness
    that can be transmitted person to person. Most
    people have some immunity, and a vaccine is
  • Avian (or bird) flu is caused by influenza
    viruses that occur naturally among wild birds.
    The H5N1 variant is deadly to domestic fowl and
    can be transmitted from birds to humans. There is
    no human immunity and no vaccine is available.
  • Pandemic flu is virulent human flu that causes 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.

Person-to-Person Spread
  • Flu viruses spread mainly from person to person
    through coughing or sneezing of people with
  • Sometimes people may become infected by touching
    something with flu viruses on it and then
    touching their mouth or nose.

Background and History
Pandemic Flu Facts
  • A pandemic is a global disease outbreak.
  • A flu pandemic occurs when a new influenza virus
    emerges for which people have little or no
    immunity, and for which there is no vaccine.
  • The disease spreads easily person-to-person,
    causes serious illness, and can sweep across the
    country and around the world in very short time.
  • It is difficult to predict when the next
    influenza pandemic will occur or how severe it
    will be.
  • Wherever and whenever a pandemic starts,
    everyone around the world is at risk.

Pandemics of the 20th Century Estimated U.S.
Global Mortality
  • 1918-19 Spanish Influenza-H1N1
  • U.S. Deaths 500,000-675,000
  • Global Deaths 20-50 million
  • 1957-58 Asian Influenza-H2N2
  • U.S. Deaths 70,000-80,000
  • Global Deaths1-4 million
  • 1968-69 Hong Kong Influenza-H3N2
  • U.S. Deaths 34,000
  • Global Deaths 1-4 million

General Assumptions
  • Susceptibility will be universal.
  • 20 of working adults and 40 of school age
    children will become ill during a community
  • 50 of these people will seek outpatient medical
  • Risk groups for severe and fatal infection cannot
    be predicted.

General Assumptions
  • Persons who become ill may shed virus and can
    transmit infection for up to one day before the
    onset of illness.
  • Pandemic outbreaks will last about 6 to 8 weeks
    in an affected community (multiple waves lasting
    2 to 3 months).

Local Assumptions
  • Hospitals have surged to full capacity.
  • PCHD has opened off-site surge clinics.
  • Supplies and manpower will be quickly expended.
  • No vaccine limited supplies of anti-virals.
  • Public gatherings will be suspended.

Local Assumptions
  • Home quarantine possibly implemented (curfews
  • Community-wide impacts (hospitals, airport,
    private industry, schools, etc)

Requirements for an Influenza Pandemic
  • New virus (antigenic shift)
  • Susceptible population
  • Transmitted from animals to humans
  • Cause disease in humans
  • Efficient person to person transmission

Virus Transmission
National Strategy (Nov. 2005)
  • Step by step approach to address the treat of
    Pandemic Influenza
  • Intent
  • Stopping, slowing, or otherwise limiting the
    spread of pandemic influenza to the US.
  • Limiting the domestic spread of disease.
  • Sustaining infrastructure and mitigating the
    impact on the economy.

National Pandemic Planning Periods Phases
  • Period 1 Inter-Pandemic
  • Phase 1 Circulating influenza virus in animals
    presents zero to low risk of human infections
  • Phase 2 Circulating influenza virus in animals
    presents significant risk to humans
  • Period 2 Pandemic Alert
  • Phase 3 Sporadic human infections have occurred,
    no human to human transmission
  • Phase 4 Small clusters of human infections, no
    human to human transmission, virus not well
    adapted to humans
  • Phase 5 Large clusters of human infections
    suggesting the possibility of human to human
  • Period 3 Pandemic
  • Phase 6 Increased and sustained transmission in
    general population.

H5N1 Avian Influenza (Bird Flu)
  • First caused illness in people in 1997
  • Hong Kong 18 sick, 6 died
  • To control the outbreak, authorities killed about
    1.5 million chickens to remove the source of the
  • In 2003, H5N1 outbreaks in poultry began
    continue (many Asian countries affected)
  • Migratory birds spread H5N1 to new locations

Human H5N1
  • Most cases of avian influenza infection in humans
    are thought to have resulted from direct contact
    with infected poultry or contaminated surfaces
  • So far, the spread of H5N1 virus from person to
    person has been limited and has not continued
    beyond one person
  • In many patients, the disease caused by the H5N1
    virus follows an unusually aggressive clinical
    course, with rapid deterioration and high
  • The incubation period for H5N1 avian influenza
    may be longer than that for normal seasonal
    influenza, which is around two to three days.
    Current data for H5N1 infection indicate an
    incubation period ranging from two to eight days
    and possibly as long as 17 days

Why Should We Be Concerned?
  • The H5N1 virus has raised concerns about a
    potential human pandemic because
  • It is especially virulent
  • It is being spread by migratory birds
  • It can be transmitted from birds to mammals and
    in some limited circumstances to humans, and
  • Like other influenza viruses, it continues to

Avian Influenza (H5N1)
  • Since January 2004, outbreaks of avian influenza
    among poultry have been reported in several parts
    of the world
  • 1. H5N1 has since jumped the species barrier
    (more than 100 people in 2005, 115 in 2006)
  • Extremely contagious in birds and rapidly fatal
  • 2. Avian fatality rate nearly 100, Human
    fatality rate approaching 50

Vaccination and Treatment for H5N1 Virus in
  • Currently there is no commercially available
    vaccine to protect humans against H5N1 virus
  • Vaccine is underdevelopment but no vaccines are
    expected to be widely available until several
    months after the start of a pandemic
  • The H5N1 virus that has caused human illness and
    death in Asia is resistant to amantadine and
    rimantadine, two antiviral medications commonly
    used for influenza

Prevention Measures
Good Health Habits
  • Avoid close contact.Avoid close contact with
    people who are sick. When you are sick, keep your
    distance from others to protect them from getting
    sick too.
  • Stay home when you are sick.If possible, stay
    home from work, school, and errands when you are
    sick. You will help prevent others from catching
    your illness.
  • Cover your mouth and nose.Cover your mouth and
    nose with a tissue when coughing or sneezing. It
    may prevent those around you from getting sick.

Good Health Habits (cont.)
  • Clean your hands.Washing your hands often will
    help protect you from germs.
  • Avoid touching your eyes, nose or mouth.Germs
    are often spread when a person touches something
    that is contaminated with germs and then touches
    his or her eyes, nose, or mouth.
  • Practice other good health habits. Get plenty of
    sleep, be physically active, manage your stress,
    drink plenty of fluids, and eat nutritious food.

Response Plans
  • WHO Pandemic Influenza Plan
  • HHS National Pandemic Influenza Plan
  • Arizona Influenza Pandemic Response Plan
  • Pima County Pandemic Influenza Response Plan

The Plan is More That Paper
  • It is a series of systems and capacities
  • -Surveillance Systems
  • -Mass Vaccination Systems
  • -Communication Systems
  • -Quarantine Authorities
  • -Education and Training
  • -Exercises and Drills

Pandemic Preparedness Elements
PCHD Executive Planning Committee
  • Laboratory
  • Surveillance
  • Immunizations
  • Infection Control
  • Clinical Management
  • Pharmaceutical Management
  • Hospital and Healthcare coordination
  • Community containment
  • Psychosocial issues
  • Risk Communication
  • Public Health Nursing
  • Information Management

Antiviral Usage
  • Uncertain nature of supply and effectiveness of
  • Decisions will have to be made as pandemic
  • AZ plan calls for a task force of Pubic Health
    and Medical Leaders to determine prioritized use
    of AZs resources
  • Treat hospitalized patients with influenza
  • Prophylaxis for healthcare workers, including
    EMS, who have direct patient contact
  • Prophylaxis for highest risk residents
  • Outbreak containment in closed setting

Social Distancing
  • Essentially increase space between people
  • Reduces, but does not eliminate risk
  • May buy time until vaccine can be produced and
  • Snow Days
  • Telecommuting
  • Closure of communal gatherings
  • Schools, sports venues, etc.

Vaccine Delivery
  • Typically provide 1-2 million doses of flu
    vaccine to Arizonans every year
  • Mostly private, some public
  • Hap-hazard, gaps exist
  • County Health Departments have been developing
    mass vaccination programs for years
  • Several have tested capability
  • State has trained and tested capability to
    receive and re-distribute large volumes of SNS
  • Final solution likely to be a hybrid of both

Hospital and Healthcare Preparedness
  • Hospital and Clinic Coordination
  • Alternate care sites and infectious disease
    referral centers
  • Medical Surge Capacity
  • Medical Equipment/Supply Stockpiles
  • Medication Stockpiles
  • Include at-home care
  • Staffing
  • Volunteers, Retirees, etc.
  • Necessary laws to allow for increasing the

  • AZ is currently rolling-out its electronic
    disease surveillance system (MEDSIS)
  • MEDSIS links local and state health departments
    on a single surveillance system that ties to the
    hospitals, clinics and laboratories
  • Will increase ability to rapidly identify cases
    and track outbreaks

November 2002 PCHD Mass Dispensing Clinic Exercise
March 2003 NDMS Mass Casualty Exercise
October 2004 Vaccine Deployment Exercise
Avian Influenza (H5N1)Take Home Message
  • At this time, Avian Influenza is a disease of
  • The risk of a US citizen contracting H5N1 is
    almost non-existent.
  • An exact sequence of genetic shifts must occur to
    cause a pandemic, this likelihood is unknown.
  • H5N1 is not genetically capable of human to human
    spread at this time.

Community - Cooperation
- Partnerships
Pima County Health Department
  • Louie Valenzuela
  • Bioterrorism Preparedness
  • (520) 243-7747
  • http//
  • Disease Control
  • Bioterrorism Preparedness
  • Epidemiology
  • Immunizations