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Pandemic influenza: medical counter-measures


Can reduce duration of flu symptoms by 24 hours if taken within the first 48 hours of illness. Can reduce chance of getting flu if exposed ... – PowerPoint PPT presentation

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Title: Pandemic influenza: medical counter-measures

Pandemic influenza medical counter-measures
Jo Hofmann, MD Communicable Disease Epidemiology
Section Washington State Department of
Health July 2006

Influenza - overview
  • Review the difference between seasonal, avian
    and pandemic influenza
  • Update on avian influenza (H5N1) situation in
    Asia, Europe, Middle East and Africa
  • Discuss the use of medical interventions to
    control the spread of pandemic influenza

Seasonal, avian or pandemic?
  • Seasonal influenza
  • Flu that circulates each winter the virus
    changes a little from year-to-year
  • Avian influenza
  • A common infection of birds but virus may also
    infect other species
  • Pandemic influenza
  • A widespread, multi-continental outbreak of
    serious human influenza
  • Caused by a new virus adapted to spread quickly
    between people

How is influenza spread?
  • Flu virus infects cells in nose and throat
  • Virus can be spread 24 hours before a person is
    ill until 5-7 days later
  • Spread by coughing, sneezing and surfaces
    contaminated with flu virus

Influenza virus subtypes
Neuraminidase N
  • Proteins determine characteristics of a virus
  • Which species it infects
  • How deadly it is to host
  • 2 proteins on surface determine virus subtype
  • Hemagglutinin (H)
  • Neuraminidase (N)
  • Virus subtypes designated by H and N numbers
  • For example -- H5N1, H3N2

Hemagglutinin H
Influenza virus
  • Infects people, animals and/or birds
  • Has a simple genetic structure
  • Likes to share genes and evolves by
  • Mutation
  • Reassortment

RNA genes
Areas with confirmed H5N1 influenza in poultry
and/or wild birds, 2003-06
As of August 2, 2006
Areas with confirmed H5N1influenza in people,
As of August 9, 2006 Total cases 241 Total
deaths 141
Avian influenza and pandemics
  • All 20th century pandemics were caused by a virus
    closely related to avian influenza
  • Genetic fingerprint of the 1918-1919 Spanish
    influenza pandemic virus looks avian-like but
    the actual source of the virus is unknown

Controlling the spread of influenza
Medical counter-measures
  • List is small
  • Influenza vaccine
  • Antiviral medications

(No Transcript)
Annual process of developing, manufacturing and
distribution of influenza vaccine May-October
Source Treanor, J. N Engl J Med
Problems with vaccine in a pandemic
  • Current technology cant produce vaccine without
    knowing virus structure
  • Is H5N1 a future pandemic virus?
  • Vaccine unlikely to be available until months
    into pandemic
  • Federal govt will probably control distribution
    of limited vaccine supplies to state and local
    government agencies

Influenza antivirals
  • Medications to treat or prevent influenza
  • M2 inhibitors - amantidine, rimantidine
  • First approved in 1976
  • No longer recommended due to resistant influenza
  • Neuraminidase inhibitors oseltamivir,
    zanamivir (Tamiflu, Relenza)
  • First approved in 1999

Antivirals how they work
M2 inhibitors (amantidine, rimantidine)
Neuraminidase inhibitors (oseltamivir, zanamivir)
Neuraminidase inhibitors
  • Compared with M2 inhibitors, fewer side effects
    but more
  • Can reduce duration of flu symptoms by 24 hours
    if taken within the first 48 hours of illness
  • Can reduce chance of getting flu if exposed
  • None shown to reduce the complications associated
    with flu
  • Seasonal influenza viruses and H5N1 have been
    identified that are resistant to oseltamivir

Problems with antivirals in a pandemic
  • Pandemic virus could be resistant
  • Antivirals may not prevent flu complications or
  • HHS stockpile enough to treat only 25 of the US
  • Waiting list for state/local stockpiles orders is
  • Current guidelines are for treatment, not
    prevention of influenza

  • No magic bullets for the pandemic
  • We need more research and improved technology for
    vaccine and antiviral production
  • We need more information on how well other
    prevention measures work
  • A combination of measures will be needed to limit
    a pandemic

The estimated impact of a pandemic on the US and
Washington State
Moderate (1957/68-like) Moderate (1957/68-like) Severe (1918-like) Severe (1918-like)
  US Washington US Washington
Outpatient care 2354 million .5 1.1 million 45 million 943,000
Hospital Care .51.2 million 10-24,000 9.9 million 210,009
ICU care 77180,000 153600 1.5 million 31,500
Deaths 117270,000 235400 1.9 million 40,400
Modern Quarantine
Oh, Jim you romantic fool of course Ill wear
my CDC Division of Global Migration and
Quarantine Electronic Locator Ring
Honey - will you join me in registering our
whereabouts with the appropriate government