Influenza Pandemic Preparedness

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Influenza Pandemic Preparedness
The Birds Eye View
Dan Rutz drutz_at_cdc.gov
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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

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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

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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

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A Viruses changes over
time
Avian Influenza A Viruses
Human Influenza A Viruses
H1 H16
H1 H3
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Pandemic Strain Emergence
direct infection
Avian virus
Avian Reservoir
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Pandemic Strain Emergence
reassortment of influenza viruses
Human virus
Avian virus
Avian Reservoir
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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

• ?

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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
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• 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

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• U.S. Life Expectancy 1900-1960

70
62
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Life Expectancy
46
38
30
1905
1910
1915
1920
1925
1930
1935
1940
1945
1950
1955
1960
1900
Year
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Confirmed Human H5N1 Cases
WHO (17 April , 2008)
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Avian (Bird Flu) Range
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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

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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
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Poultry and Public Health



environmental / cultural
Jakarta, Indonesia
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Poultry and Public Health



economic

• First, prices plunge
• eggs spoil, chickens starve

Lagos, Nigeria
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Poultry and Public Health



economic

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

Medan, Indonesia
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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
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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
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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
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Poultry and Public Health



occupational / cultural
Abuja, Nigeria
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Poultry and Public Health



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

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Pandemic Plan

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

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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

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WHO Pandemic Preparedness Plan
common basis
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WHO Pandemic Preparedness Plan
practical
objectives
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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

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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
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Targeting Communication
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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

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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

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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

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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

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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.

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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

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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

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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

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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

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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.
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(No Transcript)
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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
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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)

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Media Engagement



Public health advocacy

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

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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
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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

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



Public health advocacy

• Toronto media
• Encouraged quarantine compliance
• Recognized sacrifice
• Boosted morale

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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

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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
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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

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