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Pandemic and Avian Influenza

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Title: Pandemic and Avian Influenza


1
Pandemic and Avian Influenza
  • James A. Luken
  • Health Commissioner
  • Miami County Health District
  • October 11, 2006

2
Pandemic Avian Influenza
  • What is is?
  • What is being done to prepare?

Miami County Health District October 11, 2006
3
Overview of This Presentation
  • What is pandemic flu
  • Has this happened before?
  • Avian influenza (bird flu)
  • Impact of a pandemic
  • Public Health role
  • What can you do now
  • Helpful resources

4
Germs
5
What Is Pandemic Flu?
  • Global or worldwide disease outbreak
  • Occurs when a new influenza A virus emerges for
    which there is little or no immunity in humans,
    causes serious illness, and easily spreads for
    person to person
  • Past pandemics have led to high levels of
    illness, death , social disruption and economic
    loss

6
Pandemic Flu in the 20th Century
  • 1918 Spanish Influenza
  • 40 to 50 million people died worldwide
  • 500,000 died in U.S.
  • Struck all age groups

7
Pandemic Flu In the 20th Century
  • 1957-1958 Asian Flu
  • At least 1.5 million people died worldwide
  • 70,000 deaths in US
  • 1968-1969 Hong Kong Flu
  • At least 700,000 people died worldwide
  • 34,000 deaths in US
  • Typical Influenza Season
  • 36,000 deaths in US

8
Current Outbreak of Avian Influenza (Bird Flu) in
the World
  • As of May 29, there are 224 cases 127 deaths
    in Azerbaijan, Cambodia, China, Djibouti, Egypt,
    Indonesia, Iraq, Thailand, Turkey and Vietnam

9
How Likely is a Flu Pandemic?
  • Historical patterns indicate that it happens
    every 30 to 40 years.
  • Historical patterns indicate that it is less
    pathogenic over time
  • No one really knows with any degree of certainty
    when the next one will occur, but CDC feels that
    it will at some point.

10
U.S. Deaths from Influenza
11
Why the decline in deaths over the years?
  • Better sanitation
  • Better understanding of virus transmission
  • For the patient, the flu often transitions into
    pneumonia, of which they die.
  • Flu is a virus, for which there is no treatment
  • Pneumonia is a bacteria, for which there are now
    antibiotics which werent available in 1918

12
Pandemic Flu vs. Avian (Bird) Flu
  • H5N1 virus
  • Avian flu generally affects only birds
  • These bird viruses occur naturally among birds.
    Wild birds carry viruses in their intestines, but
    usually do not get sick from them.
  • However, it is very contagious and pathogenic to
    domestic birds such as chickens, turkeys, ducks,
    etc.

13
Current Outbreak of Avian Influenza (Bird Flu) in
the World
  • Most cases of avian influenza infection in humans
    have resulted from direct or close contact with
    infected poultry (e.g., domesticated chicken,
    ducks, and turkeys).

14
Can Avian Flu Kill Humans?
  • Other cultures have more intimate contact with
    chicken and duck saliva and secretions
  • It is highly unlikely in the U.S. due to our
    culture of raising poultry

15
Avian Flu
  • H5N1 is a new virus for humans
  • Causes Serious Illness
  • It is NOT easily spread from birds to humans or
    from humans to humans

16
Human Pandemic Influenza
  • There is currently no human pandemic influenza
    in the world

17
Food Safety
  • Eating properly handled and cooked poultry is
    safe
  • Poultry products imported into the US meet all
    safety standards
  • No poultry from countries with confirmed bird flu
    (H5N1) can imported into the U.S.

18
Hungry?
19
Impact of A Flu Pandemic U.S.
Characteristic Moderate (1958/68 like) Severe (1918 like)
Illnesses 90 Million (30) 90 Million (30)
Outpatient Medical Care 45 million (50) 45 million (50)
Hospitalization 865,000 9,900,000
ICU Care 128,750 1,485,000
Mechanical Ventilation 64,875 745,500
Deaths 209,000 1,903,000
20
Impact of Pandemic Flu Miami County
Characteristic Moderate (1958/68 like) Severe (1918 like)
Illnesses 30,000 (30) 30,000 (30)
Outpatient Medical Care 15,000 (50) 15,000 (50)
Hospitalization 1,920 3,300
ICU Care 285 495
Mechanical Ventilation 173 248
Deaths 70 634
21
Influenza over time in Miami County(Worst Case
Scenario)
22
Can we handle the deaths?
  • Up to 100 deaths per week for one to two weeks
  • Miami has 12 funeral homes
  • They have indicated that they can handle the crowd

23
Prevention Strategies
  • Keep in mind that the purpose of Public Health is
    to PREVENT illness, injury and death.
  • We take care of well people and make sure that
    they stay well
  • Medical care system takes care of sick people

24
Prevention Strategies
  • Surveillance
  • Communication
  • Quarantine, Isolation, and Limitations on
    Movement
  • Immunization
  • Public Information and Education

25
Surveillance
  • Ohio Disease Reporting System (ODRS)
  • RODS Surveillance of prescription and
    non-prescription sales and hospital admissions
  • Each Health District has an epidemiologist on
    staff

26
Communication
  • HAN Health Alert Network from CDC
  • OPHCS Ohio Public Health Communication System
  • Broadcast faxes
  • Use of Media

27
Quarantine, Etc.
  • Quarantine is the limitation of movement of
    person(s) suspected of being exposed to a disease
  • Isolation is the limitation of movement of
    person(s) actually having the disease.

28
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29
Quarantine Legalities
  • Health Commissioner has the ability to call a
    quarantine, backed up by formal Board of Health
    resolution at their next meeting.

30
Quarantine
  • Is effective only for individuals or small groups
    of people.
  • The effectiveness of quarantine is inversely
    proportional to to size and geographical scope of
    the group.
  • Was ineffective during 1918 Spanish Flu
  • Not used much today

31
Quarantine Issues
  • Board of Health is responsible for the care and
    feeding of persons under quarantine.
  • In small groups, Red cross can deliver meals.
  • In larger groups, it becomes unmanageable and
    leaky.
  • Remember, these people dont have a disease they
    may have been exposed to the disease.

32
Quarantine and Law Enforcement
  • Board of Health may hire quarantine guards to
    assist in enforcing the quarantine.
  • How far should law enforcement go in enforcing
    the quarantine? Use whatever policy you normally
    use in keeping other people in line.

33
Social Distancing
  • A form of voluntary quarantine
  • Staying at home when you feel sick
  • Avoiding unnecessary large gatherings of people,
    such as events and functions, public
    transportation
  • Safe at Home Days, etc.
  • Make only necessary trip to grocery no mall
    shopping, etc.

34
Work Quarantine
  • Essential jobs, such as health care
  • Employees required to wear PPE, such as gloves,
    gowns and/or N95 masks.
  • Some workers work in solitary environment

35
Flu Shots
36
Immunizations
  • The Health District is practiced and proficient
    in providing immunizations to large numbers of
    people throughout the county in a short period of
    time
  • Be that as it may

37
Immunizations (part 2)
  • The odds of producing and distributing a safe and
    effective vaccine before the pandemic strikes in
    the community is between zero and nil
  • Currently no system exists to ensure that public
    health departments will receive any vaccine that
    is produced
  • However, there is a priority list of persons who
    will receive it first, in the nil chance that a
    limited supply exists. Law enforcement?

38
What about Anti-virals
  • Tamilflu and Relenza
  • Lessens severity and length of illness
  • Is a treatment, not a prophylaxis for influenza
  • Must be given by a physician to a sick person at
    the second day of illness
  • Since it is treatment and not prevention, it is
    the province of the medical care establishment in
    the community

39
Influenza Prevention(and colds, too!)
  • Stay at home when you are sick
  • Cough into your sleeve
  • Wash your hands regularly
  • Avoid sick people
  • Eat healthy, exercise and get plenty of sleep

40
Other Considerations
  • Business planning
  • Disruption due to illness of key personnel
  • Disruption of supplies
  • What will you do?

41
Bird Flu Hits Florida
42
Questions?
  • The Most Important Resource
  • www.pandemicflu.gov
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