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Influenza Pandemic Preparedness

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Title: Influenza Pandemic Preparedness


1
Influenza Pandemic Preparedness
The Birds Eye View
Dan Rutz drutz_at_cdc.gov
2
Seasonal Flu commonly
misunderstood
  • Influenza is a viral illness that is easily
    confused with other infections, such as
  • Colds
  • Other respiratory infections
  • Influenza usually is self-limited to about a week
    of illness
  • Complications from influenza can contribute to
    serious secondary infections

3
Influenza in the News
types and terms
  • Seasonal Influenza
  • Globally 250,000 to 500,000 deaths each year
  • Fall / Winter onset (Year round in Tropical
    Climates)
  • Avian Influenza ( Bird Flu)
  • High Path.
  • Low Path.
  • Pandemic Influenza

4
Influenza in the News
types and terms
  • Seasonal Influenza
  • Fall / Winter onset (Year round in Tropical
    Climates)
  • Avian Influenza ( Bird Flu)
  • High Path.
  • Low Path.
  • Pandemic Influenza

5
A Viruses changes over
time
Avian Influenza A Viruses
Human Influenza A Viruses
H1 H16
H1 H3
6
Pandemic Strain Emergence
direct infection
Avian virus
Avian Reservoir
7
Pandemic Strain Emergence
reassortment of influenza viruses
Human virus
Avian virus
Avian Reservoir
8
Influenza Differences
  • Seasonal influenza strains
  • Change gradually
  • Greater native immunity
  • Allow for identification, production, and
    dissemination of specific influenza vaccines
  • Pandemics
  • Result from sudden shifts in a viruss structure
  • Can occur at any time
  • Cause illness and death in large proportions of
    global population
  • Cause large-scale disruptions of economic and
    social support systems
  • ?

9
Emergence of Influenza A Viruses in Humans
H7
H9
H5
H5
H5
H1N1
H2N2
H1N1
H3N2
Asian Influenza
Spanish Influenza
Hong Kong Influenza
Russian Influenza
Avian Influenza
1977
1997
2003
1918
1968
1957
1998/9
2004
Influenza A reservoir
Ag drift
?
Ag shift
10
  • Pandemics are rare
  • but
    deadly
  • 1918-19 Spanish Flu (H1N1)
  • gt500,000 deaths US
  • 20-50 million worldwide
  • 1957-58 Asian Flu (H2N2)
  • 70,000 deaths US
  • 2-million worldwide
  • 1968-69 Hong Kong Flu (H3N2)
  • 50,000 deaths US
  • 1-million worldwide

11
  • U.S. Life Expectancy 1900-1960

70
62
54
Life Expectancy
46
38
30
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1900
Year
12
Confirmed Human H5N1 Cases
WHO (17 April , 2008)
13
Avian (Bird Flu) Range
14
Avian Flu The Current Threat
where do we stand now?
  • A disease of animals, rarely of humans
  • Transmission from animal to human apparently
    inefficient
  • Transmission from human to human even more
    inefficient
  • But highly lethal to humans when they do get it
  • Bird Flu carries risk to some, fear to many
  • Poultry producers, processors might be vulnerable
  • Food safety questioned economic harm assured
  • That, too, is of public health concern

15
Strategy for Managing H5N1
  • Limit Animal Infections
  • Improving farming practices to reduce contact
    between wild and domestic birds
  • Culling sick/exposed farms animals to limit
    further spread
  • Vaccinating poultry to limit infection/transmissio
    n
  • Resolving compensation to farmers issues
  • Prevent Human Infections
  • Using protective gear when working with sick
    animals
  • Conducting public awareness campaigns
  • Coordinate Preparedness
  • Disease surveillance / shared research
  • Preparedness planning, interagency/donor
    coordination
  • Stockpiling medicines, protective gear, animal
    vaccines, etc.

governments working together to
16
Poultry and Public Health



environmental / cultural
Jakarta, Indonesia
17
Poultry and Public Health



economic
  • First, prices plunge
  • eggs spoil, chickens starve

Lagos, Nigeria
18
Poultry and Public Health



economic
  • First, prices plunge
  • eggs spoil, chickens starve
  • producers, retailers suffer

Medan, Indonesia
19
Poultry and Public Health



economic / nutrition
  • First, prices plunge
  • eggs spoil, chickens starve
  • producers, retailers suffer
  • Next, prices soar
  • pricing people out of market

Abuja, Nigeria
20
Poultry and Public Health



economic / nutrition
  • First, prices plunge
  • eggs spoil, chickens starve
  • producers, retailers suffer
  • Next, prices soar
  • pricing people out of market
  • interrupting favored protein

Lagos, Nigeria
21
Poultry and Public Health



economic / nutrition
  • First, prices plunge
  • eggs spoil, chickens starve
  • producers, retailers suffer
  • Next, prices soar
  • pricing people out of market
  • interrupting favored protein
  • including eggs

New Delhi, India
22
Poultry and Public Health



occupational / cultural
Abuja, Nigeria
23
Poultry and Public Health



occupational / cultural
Abuja, Nigeria
24
Influenza Pandemic Response
the goal
To limit death and illness from influenza and
its complications and to minimize social
disruption and economic loss

25
Pandemic Plan
  • Support the National Strategy for Pandemic
    Influenza
  • Outlines planning assumptions and doctrine for
    health sector pandemic preparedness and response
  • Living Documents

26
Pandemic Influenza Response
whats in a plan ?
  • Defines and recommends preparedness activities
  • Describes federal coordination / collaboration
    with states and localities
  • Describes effective interventions
  • Guides state and local preparedness and response
    plans
  • Provides technical information
  • Facilitates international cooperation /
    collaboration

27
WHO Pandemic Preparedness Plan
common basis
28
WHO Pandemic Preparedness Plan
practical
objectives
29
Directors Emergency Operations Center

DEOC
  • Monitors CDC/ATSDRs global involvement in major
    public health events
  • Serves as CDCs incident management center
  • LIFELINE TO CDC during an emergency
  • 24 hour emergency contact number -- (770)
    488-7100

30
Department of Health and Human ServicesAssistant
Secretary for Public Affairs
CDC Communications Leadership Team
Emergency Communication System(ECS)
Information Management Team
Communication Monitoring and Research Team
Clinicians Communications Team
Web Team
Health Education Team
Hotline Team
Public Health Communications Team
Federal Governmental Communications Team
Media Team
31
Targeting Communication
32
The Next Pandemic
clear challenges
  • Scientific, economic, safety, and legal hurdles
    in producing vaccines and antiviral agents
  • Sheer quantity of vaccines and antiviral agents
    needed lead time to develop and test products
  • Global population is more urbanized than in past
  • Increasing number of elderly and people with
    chronic medical conditions
  • Rapid, increased international travel allow virus
    to spread faster than in past

33
Pandemic Response
low tech strategy
  • Social distancing closed schools, sporting
    venues
    public transportation, events
  • Isolation of ill individuals
  • Quarantine of well, but exposed persons
    (voluntary)
  • Hand / cough hygiene (masks?)
  • Emphasis on supportive care for minimally ill
  • Travel / border restrictions
  • window of efficacy limited

34
Emergency Public Health Response
the integrated approach
  • Science needs communication expertise
  • Connect with those who matter most
  • Gain cooperation
  • Relieve tensions
  • Avoid misunderstandings
  • Amplify the efforts that define accomplishment
  • Achieve better results

35
Effective Emergency Communication
public concerns
  • Gain wanted facts
  • Empower decisionmaking
  • Involved as a participant, not spectator
  • Provide watchguard over resource allocation
  • Recover or preserve well-being and normalcy

36
Health Communication Principles
practical matters
  • Build public trust with timely, science-based
    information.
  • Coordinate messages and release of information.
  • Address rumors and stigma promptly. Use objective
    data.
  • Ensure that information is technically correct,
    supports public policies, and is not patronizing.
  • Community members need to know how to protect
    themselves and their families during a crisis.
  • Educate healthcare workers to recognize infection
    and control disease.

37
Comprehensive Public Health Response
journalists role is critical
  • We all need an enlightened media corps
  • Journalists find out (first) whats going on
  • Mass media is efficient and far reaching
  • Credible information reduces stress
  • Essential information can save lives
  • Misleading information can endanger life
  • Successful response takes full involvement
  • Everyones a Stakeholder

38
What Makes a Story Hot?


adjustment reaction
  • New anxieties prompt predictable responses
  • Apathy Denial
    Oh No..
  • Response may objectively be deemed excessive
  • Apply Outbreak Communication Principles here
  • Acknowledge and respect (public) reaction to
    the threat
  • Accept that immediate return to status quo is
    unlikely
  • Strive, instead, to shorten the adjustment
    reaction
  • Offer options frame the issue in familiar
    context
  • Dont over-reassure or minimize risk
  • Strive for consistency in messaging across
    partnerships
  • Empathize

39
What Makes a Story Hot?


adjustment reaction
  • New anxieties prompt predictable responses
  • Apathy Denial
    Oh No..
  • Response may objectively be deemed excessive
  • Apply Outbreak Communication Principles here
  • Acknowledge and respect (public) reaction to
    the threat
  • Accept that immediate return to status quo is
    unlikely
  • Strive, instead, to shorten the adjustment
    reaction
  • Offer options frame the issue in familiar
    context
  • Dont over-reassure or minimize risk
  • Strive for consistency in messaging across
    partnerships
  • Empathize
  • Everyone is subject to an Adjustment Reaction

40
Avian Influenza (HiPath H5N1) Spreads



the cost of getting it wrong
  • Sustained media coverage thats intense,
    dramatic, hostile
  • poultry consumption drops precipitously stays
    down
  • economic, public health consequences ensue
  • official / industry responses are antagonistic
  • poultry workers / keepers subject to
    stigmatization
  • period of turmoil is tense, and prolonged
  • distrust of leadership is similarly protracted

41
Updated Wed. Mar. 26 2008 230 PM ET Chickens
vanishing in Egypt in fight against bird flu

The Associated Press
TAWFIQIYA, Egypt -- Chickens used to roam every
dusty street in every village across Egypt, and
many of its city alleys too. But bird flu is
changing that. / / /
Chicken once provided 43 per cent of Egyptians'
protein needs, but egg and chicken prices are
doubling.
42
(No Transcript)
43
Public Health Communication



Bio-Security
Front Page Bird Flu Spreading Fast No safety
measure at city poultry markets Mahbuba Zannat
Meanwhile, when this correspondent drew the
attention of the DCC authorities to the issue,
they said they are unable to take any legal steps
against the poultry stall owners who do not
conform to biosecurity measures because most of
them do not possess any trade licence."We cannot
take any legal steps against them as 90 percent
of the poultry traders have no licence. Taking
advantage of this, they have been selling poultry
by either going door to door or by setting up
stalls here and there, said Ajmat Ali,
veterinary officer of DCC.
emphasis added
44
Comprehensive Public Health Response
avian influenza coverage
  • news media can be expected to
  • Relay public safety information
  • poultry husbandry guidelines, e.g.,
    bio-security
  • safer poultry handling and preparation
    guidelines
  • managing avian influenza outbreaks
  • Social Responsibility
  • reporting poultry outbreaks
  • isolating infected farms / culling
  • poultry transport / marketing guidelines
  • Explain National / Global Roles
    Responsibilities
  • WHO member-state surveillance and response Aid
  • International Health Regulations (IHR)

45
Media Engagement



Public health advocacy
  • New Orleans media
  • brought voice to desperation
  • cooperation over competition
  • boosted morale

46
Media Engagement



Public health advocacy
To Dick Lewis And The United Radio Broadcasters
Of New Orleans You Were Awesome! (11/21/05)By
Reed Bunzel, Editor-in-Chief In the days
following Hurricane Katrina's devastating
landfall, a dedicated coalition of broadcasters
illustrated radio's reciprocal bond with the
local communities it serves. From helping to save
families stranded in their homes, to providing
accurate accounts of the devastation, to serving
as a mouthpiece for government officials solving
problems or lambasting others for their
ineffectiveness, an ad hoc group of broadcasters
formed to serve the people of southern Louisiana
and outlying areas of the Gulf Coast.
emphasis added
47
Strategy and Commitment

WHO guiding
principles
  • Trust motive, honesty, competence
  • Timely notice i.e. first frequent
  • Transparency candor accountability
  • Two-way communication surveillance (listen)
  • Top-down commitment Sr. Leadership on board

48
negative consequences
Discernable Outcomes
You cannot not communicate
Thom Berry Past President,
NPHIC
especially with your partners
49
Media Engagement



Public health advocacy
  • Toronto media
  • Encouraged quarantine compliance
  • Recognized sacrifice
  • Boosted morale

50
The Next Influenza Pandemic

  • factors that can help
  • Coordinated planning and consistent
    implementation (as demonstrated during SARS
    outbreaks)
  • Public health emergency information and response
    programs to guide and assist states and
    communities
  • Global surveillance and international scientific
    study of novel influenza strains
  • Medical research that leads to alternative
    vaccine and antiviral production methods

51
Pandemic Influenza Doctrine
saving lives
  • Slow spread, decrease illness and death, buy time
  • Antiviral treatment and isolation for people with
    illness (if available and if drugs are
    effective)
  • Quarantine for those exposed
  • Social distancing
  • Vaccine when available
  • Local decisions

Unprepared
Impact
Prepared
Weeks
52
Message Themes
pandemic alert period
  • Scientists say an influenza pandemic is likely
  • Impossible to predict when prudent to plan
  • May or may not be linked to current bird flu
    outbreaks
  • HHS, WHO, and other partners are engaged
  • U.S. plan requires citizen participation
  • We care.
  • Were in this together.
  • Government cant do it all
  • Difficult options require broad discussion
  • Now is the time to identify and work out issues

53
Complacency is the enemy of health protection!
www.cdc.gov www.pandemicflu.gov
54
Influenza Pandemic Preparedness
Thank You
Comments in this presentation do not
necessarily reflect official US Government
positions
Dan Rutz drutz_at_cdc.gov
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