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Pandemic Influenza Avian Influenza

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Title: Pandemic Influenza Avian Influenza


1
Pandemic 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.

2
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3
  1. Pandemic Influenza Avian Influenza 101
  2. Preparedness Efforts

4
1. Pandemic Influenza Avian Influenza 101
5
Influenza
  • Seasonal influenza
  • Avian influenza
  • Pandemic influenza

6
All Influenza
  • RNA viruses
  • Genetic engines
  • A HemagglutininNeuraminidase

7
Seasonal Influenza
  • October April
  • Influenza Type A
  • H3N2, H1N1
  • Influenza Type B
  • Vaccine

8
Avian Influenza (Bird Flu)
  • Influenza A
  • Domestic poultry can be deadly
  • High vs. low pathogenic
  • Wild birds carriers
  • Virus in fecal droppings, saliva/nasal discharge

9
Recent Avian Influenza Outbreaks Affecting Humans
  • 1997 H5N1 Hong Kong
  • 1999 H9N2 Hong Kong
  • 2003 H7N7 Netherlands
  • 2004 H7N3 Canada
  • 2004 H5N1 Southeast Asia

10
Pandemic Influenza
  • Global outbreak
  • Highly contagious
  • Deadly

11
Recent 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

12
Past Pandemic InfluenzaEstimates for Maine
Moderate (1957/1968) Severe(1918)
Illness 390,000 390,000
Hospitalization 5,000 40,000
Deaths 1,100 9,100
13
H5N1
  • Detected in Asia since 1997
  • Deadly 50 mortality in humans
  • Transmitted birds to mammals and limited human to
    human
  • Evolving quickly

14
H5N1 Activity as of September 29, 2006
  • 253 human cases (thru 10/13/06)
  • In 58 countries
  • 148 deaths
  • Mortality rate 58

15
Human Infections and Human Deaths by H5N1by
Month, October 13, 2006
16
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17
2. Preparedness Efforts
  1. Avian Influenza Preparedness
  2. Pandemic Influenza Preparedness

18
A. Avian Influenza Preparedness
19
Detection
  • Testing in
  • Migratory birds
  • Poultry industry

20
Preparedness Planning
  • Poultry workers
  • Backyard flock owners
  • Others bird lovers, hunters

21
General Public
  • Food safety
  • Bird handling

22
B. Pandemic Influenza Preparedness
  • Pan Flu

23
Significant 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

24
Pandemic 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

25
Social Disruption fromPandemic Influenza
  • Absenteeism in essential sectors
  • Health, law enforcement, food
  • and fuel supplies, education
  • Economic impact
  • Psychological stress

26
2006 vs 1918
  • Advantages in 1918
  • Smaller population
  • Less travel
  • More self-reliance
  • Advantages in 2006
  • Healthier population
  • Better medical care
  • Preparedness

27
Federal Preparedness
28
www.pandemicflu.gov
29
Components 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

30
Selected Components
  • Vaccine
  • Antivirals
  • Community Disease Control

31

Vaccines
32
Assumptions 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

33
Vaccine 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

34
Recommendations for Vaccine and Antivirals may be
modified based on
  • Virulence
  • Transmissibility
  • Drug resistance
  • Geographic spread
  • Age-specific attack rates
  • Morbidity and mortality rates

35
What You Can Do Now
  • Annual seasonal influenza vaccination
  • Pneumococcal vaccination

36
Antivirals

37
Antivirals
  • Adamantanes
  • Amantadine
  • Rimantadine
  • Neuraminidase inhibitors
  • Oseltamivir (Tamiflu)
  • Zanamivir (Relenza)

38
Assumptions 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

39
Some 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)

40
Cost of Antiviral Treatment5-Day Course for an
Adult
  • Oseltamivir (Tamiflu) 72.10
  • Zanamivir (Relenza) 61.80

41
Personal Stockpiles of Antivirals
  • Supply
  • Effectiveness
  • Resistance
  • Shelf life

42
Stockpiles of Antivirals
  • Institutional
  • State

43
Community Disease Control

44
Challenges 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

45
Goal of Community Disease Control
  • To limit or slow spread of pandemic influenza
  • Social Distancing

46
Containment Measures for Ill Individuals
  • Patient isolation
  • Management of contacts
  • Contact tracing
  • Contact monitoring
  • Quarantine

47
Containment Measures For Groups of Exposed or
At-Risk Persons
  • Quarantine
  • Containment measures for specific sites or
    buildings

48
Containment Measures For Communities
  • Promotion of community-wide infection control
    measures
  • Social distancing (snow days)

49
Unresolved Issues
  • Role of airborne transmission
  • Effectiveness of antivirals
  • Coordination between states and countries

50
State of Maine Preparedness
51
www.maineflu.gov
52
Overarching 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

53
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54
What 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

55
Maines 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

56
Overarching Framework
  • Early detection
  • Response systems
  • Communications
  • Training
  • Exercises and drills

57
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58
County Preparedness
  • Emergency management
  • Healthcare
  • Many stakeholders involved
  • May-August 2006 plans drafted
  • August 2006-2007 exercise plans
  • www.maineflu.gov for contact information

59
Hospital Preparedness
  • 2006 Plans drafted
  • 2007 Exercise plans
  • www.maineflu.gov for contact information

60
http//www.fchn.org/healthreform/documents/fchn5F
pandemicfluplan.pdf
61
Pandemic PreparednessCan Be Daunting!
  • Need to
  • Keep focused on the known
  • Be creative
  • Dont wait for someone else

62
School Preparedness
63
School Preparedness - Maine
  • 200,744 enrolled in Maine elementary and
    secondary schools
  • 66,000 enrolled in Maine post-secondary schools

64
Resources for School Pandemic Influenza
Preparedness
65
www.maineflu.gov
www.pandemicflu.gov
66
Pandemic Flu K-12 Checklist Format
  • Planning and Coordination
  • Continuity of Student Learning and Core
    Operations
  • Infection Control Policies and Procedures
  • Communication Planning

67
http//www.pandemicflu.gov/plan/schoolchecklist.pd
f
68
                                                                                                                                                                                                                                                                                                               
                                                          
                                                          
                                                          
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
www.acha.org
69
Some 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

70
Some 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

71
Disaster Planning does not equal Public Health
Emergency Planning.
72
Preparedness isEveryones Job No one ever died
of preparedness!
73
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