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North Florida Region

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... about impact of pandemic flu on the health care system ... 1976 Swine Flu. 1977 Russian Flu. 1997 -1999 Avian Flu. Non-Flu Scare: SARS Multi-Country Outbreak ... – PowerPoint PPT presentation

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Title: North Florida Region


1
North Florida Region Domestic Security Task Force
Pandemic Influenza Workshop
Setting the Pace for Florida's Leadership
11/292/05 Version 3.3
2
Pandemic Influenza Workshop Objectives
  • Raise awareness about impact of pandemic flu on
    the health care system and the community as a
    whole.
  • Increase understanding of the responsibilities
    of all community partners.
  • Determine the adequacy of current plans to
    address the range of anticipated events.
  • Identify gaps in coordination among community
    partners.
  • Promote planning continuity among all community
    partners.

Prior Planning Prevents Pandemic Pandemonium
3
Pandemic Influenza Workshop Format
  • Education Format
  • Influenza Virus Characteristics
  • History
  • Surveillance
  • Planning

Prior Planning Prevents Pandemic Pandemonium
4
Pandemic Influenza Workshop Format
  • Exercise Format
  • Interactive Tabletop
  • 3 Modules
  • Prepare, Respond, Recover, Mitigate
  • Hot Wash
  • Action Plan

Prior Planning Prevents Pandemic Pandemonium
5
Pandemic Definition
Pandemic An infectious disease epidemic that
affects people worldwide or over an extensive
geographical area.
Prior Planning Prevents Pandemic Pandemonium
6
Influenza Virus Characteristics
Primitive life form Only one function
Replication
Prior Planning Prevents Pandemic Pandemonium
7
Influenza Virus Infection
Virus slips in
RNA issues orders
Viruses break out
High efficiency High mutation rate Confuses
body defenses
Stellenbosch University, Tygerberg, South Africa
Prior Planning Prevents Pandemic Pandemonium
8
Influenza Virus Characteristics
Virus Exchange Program Wild Birds --
Chickens Chickens -- Humans Chickens --
Pigs Pigs -- Humans Humans -- Humans
Prior Planning Prevents Pandemic Pandemonium
9
H5N1 Outbreak in Birds12/2003 03/2006
  • Countries Affected (confirmed in poultry)

Cambodia China Indonesia Croatia Slovakia
Kuwait Japan Russia Kazakhstan Switzerland
Korea (Rep. of) Thailand Vietnam Ukraine Hungary
Romania Turkey Mongolia Malaysia Albania
Iraq Nigeria Bulgaria Greece Poland
Italy Iran India Egypt Pakistan
Austria Azerbaijan Germany France Serbia Montenegro
Bosnia Laos Slovenia Niger Burkina Faso
- Only H5 confirmed, neuraminidase not
determined
December 2003-March 2006 Source World Health
Organization
10
(No Transcript)
11
Influenza Virus Transmission
Direct Viral particles are contained in
droplets resulting from an uncovered sneeze or
cough. Breathing them in can result in an
infection.
During a sneeze, millions of tiny droplets of
water, mucus, and virus particles are expelled at
200 mph.
Prior Planning Prevents Pandemic Pandemonium
12
Influenza Virus Transmission
Indirect Viral particles may survive for a
short time on many surfaces (hands, door knobs,
phones). Touching these surfaces may transmit
infection through eyes, nose, or mouth.
What precaution do these transmissions suggest?
Prior Planning Prevents Pandemic Pandemonium
13
History
No disease the world has ever known even
remotely resembles the great influenza epidemic
of 1918. Presumed to have begun when sick farm
animals infected soldiers in Kansas, spreading
and mutating into a lethal strain as troops
carried it to Europe, it exploded across the
world with unequaled ferocity and speed. It
killed more people in twenty weeks than AIDS has
killed in twenty years it killed more people in
a year than the plagues of the Middle Ages killed
in a century. Victims bled from the ears and
nose, turned blue from lack of oxygen, suffered
aches that felt like bones being broken, and
died. In the United States, where bodies were
stacked without coffins on trucks, nearly seven
times as many people died of influenza as in the
First World War.
Prior Planning Prevents Pandemic Pandemonium
14
History -- Images
Prior Planning Prevents Pandemic Pandemonium
15
History Some Statistics
Death Toll Worldwide 40 - 100 Million Death Toll
US 650,000 Normal Season Flu Death Toll
36,000 Normal Sean Flu Hospitalizations
200,000 Most Susceptible Population Age 15-34
Number of Flu-Orphans in NYC 21,000
I had a little bird His name was Enza I opened up
the window And Influenza
Prior Planning Prevents Pandemic Pandemonium
16
History -- Pandemic Spread
  • Exceptionally Virulent Strain
  • New and Rapid Population Mixing (Training Camps)
  • WWI Overseas Deployments
  • Initial Lack of Communications (Sedition Act)
  • Quarantine None early on
  • Weak Public Health Infrastructure

Liberty Bond Rally
Prior Planning Prevents Pandemic Pandemonium
17
History Other Pandemics
1957 Asian Flu -- US Deaths 69,800 1968 Hong
Kong Flu US Deaths 33,800 Pandemic Flu
Scares 1976 Swine Flu 1977 Russian Flu 1997
-1999 Avian Flu Non-Flu Scare SARS
Multi-Country Outbreak
SARS Precautions
Prior Planning Prevents Pandemic Pandemonium
18
Inter-Pandemic Period Phases 1 and 2
  • Inter-Pandemic Period Phases 1 and 2
  • No new influenza virus
  • Develop plans and exercise them
  • Educate the public (throughout all phases)
  • Vaccinate public
  • Surveillance

Prior Planning Prevents Pandemic Pandemonium
19
Pandemic Alert Period Phase 3 The phase we are
currently in
  • Pandemic Alert PeriodPhase 3
  • Human infection with a new subtype
  • No human to human spread
  • Monitor the situation via surveillance systems
    and communication with Florida DOH
  • Communicate with community partners

Prior Planning Prevents Pandemic Pandemonium
20
Pandemic Alert Period Phase 3 The phase we
are currently in
  • Pandemic Alert PeriodPhase 3 Actions
  • Stockpile masks, hand-sanitizer, anti-virals
  • Nationallyencouraging the development of vaccine
  • Nationallydevelop more rapid testing methods
  • State-Increase surge capacity of laboratories

Prior Planning Prevents Pandemic Pandemonium
21
Human Cases of H5N1 Avian Flu 2003-2006
Country Total Cases Deaths
Indonesia 29 22
Cambodia 4 4
Thailand 22 14
Vietnam 93 42
China 15 10
Turkey 12 4
Iraq 2 2
Azerbaijan 7 5
Egypt 7 (4 initial confirmation only) 4
Jordan 2 (initial confirmation only)
Total 193 107
55
As of 04/04/06 Source World Health Organization
(laboratory confirmed cases)
22
Pandemic Alert Period Phase 4
  • Pandemic Alert PeriodPhase 4
  • Limited human to human transmission
  • Isolate / treat the sick
  • Vaccinate / treat close contacts
  • Encourage self-quarantine

Prior Planning Prevents Pandemic Pandemonium
23
Pandemic Alert Period Phase 5
  • Pandemic Alert PeriodPhase 5
  • Larger clusters but still localized
  • Adjust and maximize resourcesquestionable use of
    points of distribution (drugs are trickling in)
  • If available deploy prototype vaccine
  • Questionable use of points of distribution
  • Decision on who to vaccinate (ethics?)
  • Assess staffing issues
  • Travel restrictions
  • Social distancing

Prior Planning Prevents Pandemic Pandemonium
24
Pandemic Alert Period Phase 6
  • Pandemic Period-Phase 6
  • Increased and sustained transmission
  • Alternative treatment sites
  • Ventilator decisions
  • State resources for aid
  • Continue risk management
  • Maintain surveillance, including deaths
  • Morgue surge capacity
  • Funeral supplies may be limited

Prior Planning Prevents Pandemic Pandemonium
25
Human Surveillance
  • Sentinel physicians how many are in your
    county?
  • ESSENCE influenza symptoms, patient load, etc.
  • BIOSENSE military hospitals
  • EpiCom
  • Vital Statistics death rates
  • School absenteeism

Prior Planning Prevents Pandemic Pandemonium
26
Surveillance Partners
  • Sentinel Physicians
  • Hospitals
  • County Health Departments
  • Department of Health and Private Labs
  • Department of Agriculture and Consumer Services
  • Centers for Disease Control and Prevention (CDC)
  • World Health Organization (WHO)
  • Communication! Communication! Communication!

Prior Planning Prevents Pandemic Pandemonium
27
Between Waves
  • Between waves
  • Ensure staff recovery
  • Re-stock supplies/medications
  • Lessons learned to improve

Prior Planning Prevents Pandemic Pandemonium
28
Influenza H5N1 Avian Flu
  • Current Situation -- Avian Flu Phase 3
  • Bird to Human transmission still very rare
  • Vaccine in development for birds for H5N1
  • Vaccine in development for H5N1 for humans this
    is not the same as a human to human virus we are
    planning for
  • Human to Human transmission even more rare
  • We cant develop a vaccine until we know the
    human to human strain
  • Will this be the Big One?

Prior Planning Prevents Pandemic Pandemonium
29
Request to Fund National Strategy
  • Global surveillance 251 million
  • Vaccine technology 2.8 billion
  • Purchase medication
  • and vaccines 800 million
  • Vaccine for HHS 1.5 billion
  • Stockpile anti-virals 1.0 billion
  • Emergency preparedness 644 million
  • Total 7.1 billion

Prior Planning Prevents Pandemic Pandemonium DOH
12/5/05
30
Influenza H5N1 Avian Flu
The thing to Keep in Mind for Now
NOT Recommended.
Prior Planning Prevents Pandemic Pandemonium
31
Surveillance Urgency
The Clock is Ticking. We just dont know what
time it is.
Pandemic Pandemonium
32
Pandemic Planning
Prior Planning Prevents Pandemic Pandemonium
33
Planning Assumptions
  • We will have an epidemic soon of a strain of
    influenza to which none of us is immune.
  • We will likely have only a short window between
    when the strain is clearly causing disease and
    when it starts causing widespread disease where
    we live.
  • Vaccine likely wont be available for 6 to 9
    months after the epidemic starts.
  • Supplies of anti-virals will be far less than
    needed for total-population coverage or even
    coverage of high-priority groups.

Prior Planning Prevents Pandemic Pandemonium
34
Planning Assumptions
  • Predicted Morbidity Range for Palm Beach County
  • 35 Attack Rate
  • Predicted Mortality Rate for Palm Beach County
  • 5 of those infected

Prior Planning Prevents Pandemic Pandemonium
35
Planning Assumptions
Palm Beach Population 1.2 Million
Attack Rate 35 420,000
Seeking Treatment 75 315,000
Hospitalization Rate 10 31,500
Mechanical Ventilation 7.5 23,625
Fatality Rate 5 21,000
Prior Planning Prevents Pandemic Pandemonium
36
Planning Assumptions
  • Once the pandemic takes hold, we have to assume
    that there will be little to No Help from the
    national or state level not just for days, but
    for weeks, and perhaps months.
  • We have to assume that every county and every
    community will be pretty much on its own in an
    influenza pandemic.
  • County Health Department will have ICS Lead.

Prior Planning Prevents Pandemic Pandemonium
37
Planning Questions
  • When a vaccine first becomes available, who
    should get it?
  • How should we use the limited supplies of
    antiviral medications? (Tamiflu 10 doses in
    five days. Must be taken within 48 hours.)
  • Given lack of vaccines and anti-virals, how do
    we approach reducing illness and death?
  • What is the right balance among minimizing
    health burden, economic damage, and societal
    damage?

Prior Planning Prevents Pandemic Pandemonium
38
Planning More Questions
  • Can we hold the fort till we can get vaccine?
  • The longer we can delay the onset of the
    epidemic in our community, the more illness we
    can prevent.
  • This will require vigorously applying measures
    that have limited effectiveness and a strong and
    continuous, risk communication campaign directed
    to all of our citizens.

Prior Planning Prevents Pandemic Pandemonium
39
Planning Isolation
The placement of sick persons with specific
infectious illness in separate rooms from those
who are healthy. This is usually voluntary and
may be at their own home or at a hospital
Prior Planning Prevents Pandemic Pandemonium
40
Planning Quarantine
  • Usually voluntary, but the FDOH Secretary may
    declare a public health emergency and issue a
    quarantine order to separate and restrict
    movement of people who have been exposed to an
    infectious agent, and may therefore become
    infectious

Prior Planning Prevents Pandemic Pandemonium
41
Planning Options for Disease Prevention
  • Isolate the sick
  • Voluntary or legally mandated?
  • Quarantine well, exposed persons
  • Voluntary or legally mandated?
  • Limit personal interactions
  • e.g., close schools and day-care, stop large
    public gatherings

Prior Planning Prevents Pandemic Pandemonium
42
Planning Behavioral Modification Social
Marketing
  • Change social norms about self-quarantine,
    personal hygiene, shaking hands, and masks.
  • Advise travel restrictions.
  • Home management of uncomplicated influenza
  • -- Recognition of complications
  • -- Management of complicated patients

Prior Planning Prevents Pandemic Pandemonium
43
Planning Social Issues
  • Stigmatization of vulnerable groups
  • Equity in access to care and in application of
    isolation and quarantine
  • Civil liberties balanced with effective disease
    control
  • Potential for civil disorder and vigilante
    actions
  • Trust in government and health care system
    institutions, especially if initial measures seem
    to fail
  • Long-term stress and behavioral health

Prior Planning Prevents Pandemic Pandemonium
44
Planning Economic Issues
  • Cost of care and cost of providing preventive
    measures.
  • Impact on essential services and general
    productivity of widespread illness e.g., 10 of
    workforce out sick continuously for many weeks.
  • Curtailment of business travel, shopping, and
    entertainment venues.
  • Shipment of goods, including food, fuel, and
    essential supplies

Prior Planning Prevents Pandemic Pandemonium
45
Planning Communications Issues
  • Lots and lots of issues and opportunities with
    risk communication
  • Prompt, accurate, clear
  • Acknowledge uncertainties
  • Provide frequent updates as new info becomes
    available
  • Manage the level of expectations

Prior Planning Prevents Pandemic Pandemonium
46
Communications
  • For Unusual death in domestic birds call
  • USDA Veterinary Services for Florida at
  • 1-866-536-7593
  • The Florida Department of Agriculture recommends
    that you contact your local agriculture extension
    at Broward County Fish and Game Non-Game
    Division 561-625-5122 Sharon Hood
  • The Florida Dept of Agriculture / Division of
    Animal Industry can be reached at 850-410-0900

47
QUESTIONS?
? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ?
Prior Planning Prevents Pandemic Pandemonium
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