Pandemic Influenza Renee Frauendienst, RN, PHN, BSN Division Director Public Health Division Stearns County Human Services

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Pandemic InfluenzaRenee Frauendienst, RN, PHN,
BSNDivision DirectorPublic Health
DivisionStearns County Human Services

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Preparing for Pandemic Influenza Business will
not be as Usual
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Recent Pandemics

• 1918/1919 Spanish Influenza
• 40/50 million deaths worldwide
• 1957 Asian Flu
• 2 million deaths worldwide
• 1968 Hong Kong Flu
• 1 million deaths worldwide

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1918 Spanish Flu

• Devastating
• Hospitals filled up and soon became overwhelmed
  as doctors and nurses got sick. Children lost
  their parents, and people hid in their homes to
  avoid a new and mysterious virus. So many people
  died that there was no time to make coffins many
  victims had to be buried in mass graves.
• Shops, offices and factories shut down without
  enough staff to keep them going, and schools,
  hotels and theatres were closed by order of the
  government.

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Pandemic Flu Planning

• strong evidence that the 1918 flu virus was
  derived wholly from an ancestor that originally
  infected birds Andreas von Bubnoff (Nature)
• Two subsequent influenza pandemics one in 1957
  and one in 1968 have also been linked to avian
  flu viruses.

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Avian Influenza (Bird Flu)

• Viral infection of birds
• Believed to be spread by co-mingling of wild and
  domestic birds
• Controlled by culling infected and exposed birds
  (Over 200 million birds destroyed to date)

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Bird to Human Transmission

• Predominantly via contact with feces from
  infected birds
• Handling infected poultry
• Disposing of dead infected poultry
• No sustained human to human transmission to date

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Avian Influenza - H5N1Why do we care?

• 238 documented cases, 139 deaths as of August
  14, 2006 (58)
• Mutating little by little
• Has potential to mutate into a human strain

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Conditions of a Pandemic

• Widely spread without early detection
• Novel virus highly infectious to humans, with no
  immunity
• Virus strain is easily transmissible human to
  human
• Virus causes serious illness
• There is no adequate supply of vaccine
  immediately available
• Supply of antiviral medication is limited

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Could the H5N1 virus cause the next pandemic?

• Possibly
• So far the virus cannot pass easily from human
  to human.
• But
• Eventually, there will be another pandemic, we
  just cant be sure it will be caused by this H5N1
  virus

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World Health Organization Influenza Pandemic
Phases
Interpandemic Period Interpandemic Period
Novel subtypes in animals but not humans Phase 1
Circulating subtypes in animals posing threat to humans Phase 2
Pandemic Alert Period Pandemic Alert Period
Novel subtypes in humans, but no human-to-human transmission Phase 3
Limited human-to-human transmission Phase 4
Localized clusters of human cases Phase 5
Pandemic Period Pandemic Period
Increased and sustained transmission in the general population on a large scale Phase 6
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Projected Pandemic Impact Based on 2004 U.S.
Population Estimate of 294 Million(0.05 of
World Population)
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Projected Pandemic Impact Based on 2004 Minnesota
Population Estimate of 5.1 Million (1.75 of
U.S. Population)
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Assumptions

• Not a matter of if but when
• All countries will be impacted
• Medical supplies and care may be inadequate
• Impacts will last for weeks to months

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Assumptions

• Two to three waves of illness
• Pandemics can disproportionately affect
  younger people creating workforce issue
• Potential for high levels of
• Sickness and death
• Disruption of critical services
• Economic loss

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Goals of Pandemic Planning and Response

• Maintain community infrastructure
• Minimize social disruption
• Reduce morbidity/mortality
• Provide effective public education (before,
  during and after)

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Public Health Messages

• Off site care facilities
• Home care activities
• Social distancing
• Snow Days
• Active Surveillance
• Isolation and Quarantine
• Vaccines and antivirals

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Planning Priorities

• Family/Individual Planning
• Business Continuity Planning
• Community Planning

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Family Emergency Preparedness Awareness

• Food and water
• Change of clothes for each person
• Sleeping bags or blankets
• First aid kit
• Battery powered radio and flashlight with extra
  batteries
• Social distancing or snow day preparations

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Key Elements of Preparedness From a Business
Perspective

• Business Continuity Planning
• Prioritize critical functions
• Identify functions that could be suspended for up
  to two months
• Identify positions needed to carry out critical
  functions
• Build depth through cross training
• Plan for alternative work schedules
• Explore telecommuting capabilities large scale

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Regional and Local Planning Considerations

• Integrate non-health entities in planning and
  response
• Establish community stockpiles (e.g. of vaccine
  and antivirals) distribution systems
• Identify spokespersons
• Provide effective public education
• Surveillance systems

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Priority Activities for 2006

• Review the federal and state plans
• Plans from other states
• Update local plans
• Assure response is community based, and flexible

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Planning Priorities

• Community meetings
• Education and training staff
• Creating messages ahead of time regarding
  response
• Stockpiles of anti-virals and vaccines
• How to get them distributed-local vs. regional
• Who will get them- essential personnel
• Where to distribute

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Planning Priorities

• Coordinated information to public and other
  partners
• HAN-health alert network
• Special and vulnerable populations
• Vaccinations/prophylaxis
• Messaging
• Community resources
• Community surveillance-early, during, expanded
  sites
• Mass fatalities

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Planning Priorities

• Working with healthcare regarding
• Continuity of services
• Supply contingency plans
• Surge capacity
• Isolation/Quarantine of compliant/non-compliant
• Protection for workers
• Mortuary Services

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Are We Ready?

• More today than yesterday
• More tomorrow than today