Title: Pandemic Influenza Avian Influenza
1Pandemic InfluenzaAvian Influenza
- Maine Department of Health Human Services
- Maine Center for Disease Control Prevention
- (formerly Bureau of Health)
- Dora Anne Mills, M.D., M.P.H.
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3- Pandemic Influenza Avian Influenza 101
- Preparedness Efforts
41. Pandemic Influenza Avian Influenza 101
5Influenza
- Seasonal influenza
- Avian influenza
- Pandemic influenza
6All Influenza
- RNA viruses
- Genetic engines
- A HemagglutininNeuraminidase
7Seasonal Influenza
- October April
- Influenza Type A
- H3N2, H1N1
- Influenza Type B
- Vaccine
8Avian Influenza (Bird Flu)
- Influenza A
- Domestic poultry can be deadly
- High vs. low pathogenic
- Wild birds carriers
- Virus in fecal droppings, saliva/nasal discharge
9Recent Avian Influenza Outbreaks Affecting Humans
- 1997 H5N1 Hong Kong
- 1999 H9N2 Hong Kong
- 2003 H7N7 Netherlands
- 2004 H7N3 Canada
- 2004 H5N1 Southeast Asia
10Pandemic Influenza
- Global outbreak
- Highly contagious
- Deadly
11Recent Pandemics
- 1918 Spanish flu (H1N1)
- 5,000 deaths in Maine
- 500,00 in U.S.
- 40,000,000 worldwide
- 1957 Asian flu (H2N2)
- 70,000 deaths in U.S.
- 1-2,000,000 worldwide
- 1968 Hong Kong flu (H3N2)
- 34,000 deaths in U.S.
- 700,000 worldwide
12Past Pandemic InfluenzaEstimates for Maine
Moderate (1957/1968) Severe(1918)
Illness 390,000 390,000
Hospitalization 5,000 40,000
Deaths 1,100 9,100
13H5N1
- Detected in Asia since 1997
- Deadly 50 mortality in humans
- Transmitted birds to mammals and limited human to
human - Evolving quickly
14H5N1 Activity as of September 29, 2006
- 253 human cases (thru 10/13/06)
- In 58 countries
- 148 deaths
- Mortality rate 58
15Human Infections and Human Deaths by H5N1by
Month, October 13, 2006
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172. Preparedness Efforts
- Avian Influenza Preparedness
- Pandemic Influenza Preparedness
18A. Avian Influenza Preparedness
19Detection
- Testing in
- Migratory birds
- Poultry industry
20Preparedness Planning
- Poultry workers
- Backyard flock owners
- Others bird lovers, hunters
21General Public
- Food safety
- Bird handling
22B. Pandemic Influenza Preparedness
23Significant Issues forPan Flu Planning
- Detection and Tracking
- Care for Isolated and Ill
- Vaccines and Antivirals
- Food and Other Support
- Basic Services and Economic Impact
- Communication
- Quarantine and Isolation
24Pandemic Assumptions
- Attack rate of 25-35
- Duration of up to year or more in 2 waves
- Each wave lasting 6-8 weeks in community
- Healthcare system will be severely taxed, if not
overwhelmed
25Social Disruption fromPandemic Influenza
- Absenteeism in essential sectors
- Health, law enforcement, food
- and fuel supplies, education
- Economic impact
- Psychological stress
262006 vs 1918
- Advantages in 1918
- Smaller population
- Less travel
- More self-reliance
- Advantages in 2006
- Healthier population
- Better medical care
- Preparedness
27Federal Preparedness
28www.pandemicflu.gov
29Components of Federal Plan
- Community Disease Control
- Travel-Related Risks of Disease
- Communications
- Workforce Support
- Surveillance
- Laboratory Diagnostics
- Healthcare Planning
- Infection Control
- Clinical Guidelines
- Vaccine
- Antiviral Drugs
30Selected Components
- Vaccine
- Antivirals
- Community Disease Control
31 Vaccines
32Assumptions for Vaccination
- Two doses will be required
- Vaccine unavailable for 3-6 months
- Production will be 3-5 million doses (15 µg)per
week ? 10,000 doses per week in Maine
33Vaccine Priority Groups
- Vaccine and antiviral manufacturers
- Health care providers
- Those at high risk for severe disease
- Public health emergency response workers
- Key government leaders
- 400,000 in Maine
34Recommendations for Vaccine and Antivirals may be
modified based on
- Virulence
- Transmissibility
- Drug resistance
- Geographic spread
- Age-specific attack rates
- Morbidity and mortality rates
35What You Can Do Now
- Annual seasonal influenza vaccination
- Pneumococcal vaccination
36Antivirals
37Antivirals
- Adamantanes
- Amantadine
- Rimantadine
- Neuraminidase inhibitors
- Oseltamivir (Tamiflu)
- Zanamivir (Relenza)
38Assumptions for Antivirals
- Resistance to adamantanes
- Neuraminidase inhibitors will be effective in
decreasing morbidity and mortality - Current national stockpile 5 million courses
goal is 80 million courses - ? Maine stockpile
39Some Antiviral Priority Groups
- Patients admitted to hospital
- Infected health care workers and EMS providers
- Infected high-risk patients
- Infected pandemic responders and government
decision-makers - Exposed health care workers
- Equals 40 million courses
- (150,000 courses for Maine)
40Cost of Antiviral Treatment5-Day Course for an
Adult
- Oseltamivir (Tamiflu) 72.10
- Zanamivir (Relenza) 61.80
41Personal Stockpiles of Antivirals
- Supply
- Effectiveness
- Resistance
- Shelf life
42Stockpiles of Antivirals
43Community Disease Control
44Challenges to Containment
- Short incubation period of 1-5 days
- Ability of persons with asymptomatic infection to
transmit virus - Early symptoms of illness are likely to be
non-specific, delaying recognition
45Goal of Community Disease Control
- To limit or slow spread of pandemic influenza
- Social Distancing
46Containment Measures for Ill Individuals
- Patient isolation
- Management of contacts
- Contact tracing
- Contact monitoring
- Quarantine
47Containment Measures For Groups of Exposed or
At-Risk Persons
- Quarantine
- Containment measures for specific sites or
buildings
48Containment Measures For Communities
- Promotion of community-wide infection control
measures - Social distancing (snow days)
49Unresolved Issues
- Role of airborne transmission
- Effectiveness of antivirals
- Coordination between states and countries
50State of Maine Preparedness
51www.maineflu.gov
52Overarching Roles of Major State Agencies
Involved with Pandemic Influenza Response Planning
- Governor
- Incident Commander
- MEMA
- Coordinator of states planning and response to
all emergencies - Maine CDC
- Develops public health emergency response plans
- Strategy lead in states response to Pandemic
Influenza - Sits with Governor during public health
emergencies - Maine Department of Agriculture
- Develops response plans for zoonoses
- Strategy lead in states response to Avian
Influenza - Sits with Governor during animal health
emergencies
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54What Has Maine Been Doing?
- 1997 2001
- Two statewide Pan Flu Conferences
- Statewide Plan
- Two exercises
- 2001 2005
- Post 9/11 Federal Funds
- Early Detection System
- Communication Systems
- Response System
- December, 2005 Pan Flu Conference
55Maines Planning Efforts 2006
- 3-part process
- Update Maines Pandemic Influenza Plan
- Development of sub-state Pandemic Influenza
plans - County plans
- Hospital plans
- Exercise and drills of the plans
- September 20th Summit - 1,100 attended
56Overarching Framework
- Early detection
- Response systems
- Communications
- Training
- Exercises and drills
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58County Preparedness
- Emergency management
- Healthcare
- Many stakeholders involved
- May-August 2006 plans drafted
- August 2006-2007 exercise plans
- www.maineflu.gov for contact information
59Hospital Preparedness
- 2006 Plans drafted
- 2007 Exercise plans
- www.maineflu.gov for contact information
60http//www.fchn.org/healthreform/documents/fchn5F
pandemicfluplan.pdf
61Pandemic PreparednessCan Be Daunting!
- Need to
- Keep focused on the known
- Be creative
- Dont wait for someone else
62School Preparedness
63School Preparedness - Maine
- 200,744 enrolled in Maine elementary and
secondary schools - 66,000 enrolled in Maine post-secondary schools
64Resources for School Pandemic Influenza
Preparedness
65www.maineflu.gov
www.pandemicflu.gov
66Pandemic Flu K-12 Checklist Format
- Planning and Coordination
- Continuity of Student Learning and Core
Operations - Infection Control Policies and Procedures
- Communication Planning
67http//www.pandemicflu.gov/plan/schoolchecklist.pd
f
68 www.acha.org
69Some Highlights of ACHA Guidelines
- Planning that allows employees to work from home
- Providing for ill students
- Addressing health and safety issues
- Addressing business continuity
- Making contingency plans for completion of
courses
70Some Highlights of ACHA Guidelines (contd)
- Testing and rehearsing the plans
- Identifying key members of the Pandemic Planning
Committee - Identifying appropriate channels of communication
and chain of command - Identifying the role of student health services
- Compiling a list of supplies that would be needed
71Disaster Planning does not equal Public Health
Emergency Planning.
72Preparedness isEveryones Job No one ever died
of preparedness!
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