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Intro to Influenza

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Title: Intro to Influenza Author: Health Last modified by: LebailAE Created Date: 10/21/2005 7:41:24 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Intro to Influenza


1
Pandemic Influenza Larimer County Community
Leaders Awareness Meeting Dec. 6, 2005
2
Larimer County in 1918
  • County population about 27,000
  • Fort Collins population 8,700
  • Loveland population about 5,000

3
Social Environment in 1918
  • Most residents involved in agriculture, directly
    or indirectly
  • World War I was the major news story
  • There was rationing of coal, fuel, food and other
    items needed for war effort
  • Red Cross was very active in community,
    supporting war effort

4
Outbreak begins in military training camps
  • Deaths occurring in training camps in East were
    reported in local newspapers
  • Numerous Larimer County enlistees/ draftees were
    among the fatalities (4 from Camp Dix, NJ in 1
    wk.)

5
Spreading to Civilians
  • Larimer County residents were aware of growing,
    alarming deaths among civilians in Eastern
    cities
  • First cases in CO in Boulder army trainees on
    College campus. (First cases in FC at Ag College)

6
Flu shut down schools and businesses
  • Loveland schools closed on Oct. 8
  • Fort Collins closed schools on Oct. 10
  • They would not reopen until Dec. 30

7
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8
1918 Flu killed young adults
  • Highest number of deaths were in the in late
    teens through the mid 30s

9
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10
By the end of the outbreak
  • Overall, there were 67 deaths in Loveland, a town
    of 5,000 in a 15 week period.
  • This represented an overall death rate of 1.3 of
    the population.

11
Why are we concerned today?
12
We at WHO believe that the world is now in the
gravest possible danger of a pandemic"
  • Shigeru Omi, World Health Organization , 2005

13
Pandemic influenza is thethe most important
threat that we are facing right now.
  • Julie Gerberding, CDC director, 2005

14
  • It will be absolutely essential that local
    communities are well prepared, have a plan, and
    have sorted out who will be responsible for
    what.
  • Michael Leavitt, U.S. HHS director

15
  • Localities should be prepared to rely on their
    own resources to respond.
  • U.S. draft pandemic influenza plan, 2005

16
Influenza
  • Outbreaks yearly, usually in winter months
  • Illness more severe for very young, elderly, or
    those with pre-existing health conditions
  • Yearly, 5-20 of population get the flu
  • Annually causes gt200,000 hospitalizations in US
  • 36,000 deaths yearly in US

17
Influenza Prevention
  • Yearly influenza shot
  • Avoid those who are ill
  • Wash your hands
  • Antivirals (in special circumstances)
  • If you are ill--dont come to work, cover
    coughs and sneezes.

18
Influenza Virus types
  • Type A Infects humans and other animals
  • More severe illness
  • Causes regular epidemics can cause pandemics
  • Type B Infectious only to humans
  • Causes epidemics, but less severe illness

19
Influenza
  • Influenza A is subtyped by surface proteins
  • Hemagglutinin (H)
  • 16 different types
  • Helps virus enter cells
  • Neuraminidase (N)
  • 9 different types
  • Helps virus leave cell to infect others

20
Influenza
  • All known subtypes of Influenza A found in birds
    - 144 possible combinations of Hs and Ns
  • H5 and H7 cause severe outbreaks in birds
  • Human disease usually due to H1, H2, H3 and N1
    and N2.

21
Influenza
  • The flu virus constantly changes
  • When it does, vaccines will be less efficient
  • Immune system may be unable to recognize new
    virus
  • No immunity in population for new viruspotential
    for pandemic

22
Vaccine Development
  • Inactivated trivalent vaccine (killed vaccine)
  • 2 A, 1 B
  • Effectiveness of vaccine depends on match
    between circulating strains and those in vaccine

20052006 Influenza Season
A/California/7/2004-like
A/New Caledonia/20/99-like
(H3N2)
(H1N1)
Influenza Protection
B/Shanghai/361/2002-like
23
InfluenzaVaccine Production
  • Flu vaccines first produced in 1940s
  • 2 manufacturers in US for flu vaccine
  • 80 million doses produced by late September
  • 6-9 months to produce vaccine

24
Influenza Pandemics
  • What is a Pandemic?
  • Outbreak in wide geographic area (global)
  • Effects large of people with serious illness
  • Usually a new virus or one which population has
    not had exposure in a long time
  • May have rapid spread
  • May occur in waves

25
Seasonal Flu vs Pandemic Flu
  • Seasonal
  • Occurs every year
  • Occurs during winter (usually Dec-Mar)
  • Most recover in 1-2 weeks without tx
  • Very young, very old, ill most at risk of serious
    illness
  • Pandemic
  • Occurs infrequently(3 per century)
  • Occurs any time of year
  • Some may not recover, even with tx
  • People of all ages may be at risk

26
Pandemic Influenza
  • Past Pandemics
  • 1968 Hong Kong Flu (H3N2)
  • 1957 Asian Flu (H2N2)
  • 1918 Spanish Flu (H1N1)

27
1918-1919 influenza pandemic
  • Worst of past century
  • Estimated 20-40 of world population ill
  • 40-50 million people died worldwide
  • 600,000 or more deaths in US
  • High mortality in young adults

28
Why did young people die?
  • Over-reaction by the immune system called
    cytokine storm
  • Those with the strongest immune systems affected
  • Older people and youngest often die of bacterial
    pneumonia complicating flu -- treatable now with
    antibiotics
  • Even in 2005, no good treatment for cytokine
    storm.

29
There are severe pandemics and mild pandemics
30
Infectious Disease Deaths 1900s
Deaths per 100,000 per year
1957
1968
1918
31
Pandemics can last for months and come in waves
32
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33
H5N1 Avian Influenza
  • Hong Kong 1997
  • 18 human cases, 6 deaths
  • 1.4 million birds destroyed
  • Dec. 2003 Asia
  • Ongoing extensive outbreak in poultry
  • Limited human to human transmission
  • 125 human cases, 64 fatal
  • July-Aug 2005 Kazakhstan, Russia
  • October 2005 Turkey, Romania, Russia

34
H5N1 Symptoms
  • Symptoms (human)
  • Fever
  • Shortness of breath
  • Cough
  • Pneumonia
  • Acute Respiratory Distress
  • Diarrhea, sometimes severe
  • Life-threatening complications

35
Transmission of flu virus
  • Incubation period of 1-4 days for regular flu -
    not clear if H5N1 might be longer
  • Can be communicable to others 24 hours before
    symptoms begin - and up to 5 days or more after
    onset (adults) or 10 or more days (children)
  • Usually spread through respiratory droplets or
    contaminated objects. May also be airborne, and
    perhaps thru feces.

36
Concern with Avian Influenza
  • Virus mutates rapidly
  • Can acquire genes from viruses infecting other
    species
  • H5N1 has acquired some of genetic changes in the
    1918 virus associated with human-human
    transmission
  • Causes severe disease in humans
  • High fatality rate

37
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38
Are we more or less at risk today compared to
1918?
39
Why at LESS risk in 2005
  • Antibiotics for bacterial pneumonia complications
    of influenza
  • Some antiviral medicines
  • IV fluids, ventilators
  • Greater ability to do surveillance, confirm
    diagnosis of flu

40
Why at LESS risk in 2005
  • Rapid means of communications - internet, TV,
    radio, email
  • More effective personal protective equipment
  • Fewer people living in each household and more
    rooms.

41
Why at MORE risk in 2005
  • A lot more international travel
  • 10 times more people in Larimer County, contact
    with far more people daily
  • Very little surge capacity in health care today
  • Greater reliance on health professionals

42
Why at MORE risk in 2005
  • More elderly and immune-compromised people in
    population
  • Much less self-sufficient than in 1918s
    (households and businesses)
  • Todays society not used to rationing, sacrifice,
    compared to war-time 1918.

43
Why at MORE risk in 2005
  • Far more manufactured goods and raw materials
    come from distant areas, especially Asia
  • Just-in-time ordering of needed supplies
    instead of warehousing critical items on site

44
Overall, are we at more or less risk?
  • Up to individuals, communities, states, and
    nations to decide as they plan for a possible
    pandemic

45
What might happen in a severe pandemic?
46
If it happens soon..
  • There will be little or no vaccine until 6 - 9
    months after the outbreak begins
  • There will be very limited supplies of antiviral
    medicines for treatment (for 1 of populations,
    perhaps less).
  • All communities hit a about the same time
  • We need a plan for the short-term that assumes no
    effective shots or Rx

47
What might occur
  • Health system could be overwhelmed
  • Essential services could be at risk (fuel, power,
    water, food, etc.)
  • Just-in-time supply lines could be disrupted
  • High mortality rates could occur
  • Social disruption could occur

48
Considerations for preparedness
49
Can we maintain our utilities?
  • Recent disasters have showed us the need for
    water, power, telecommuni-cations, heat in an
    emergency
  • Could they operate with 50 of staff?
  • Do they stockpile materials and parts to ensure
    operation for 90-120 days?

50
Who will provide health care?
  • Health workers will be disproportion-ately
    exposed and may become ill
  • Some will not show up due to fear
  • Some will not be able to leave sick family
    members, children out of school
  • Little or no surge capacity nursing shortage
    future of Medical Reserve

51
Will transportation/trade problems impact food
supply?
  • Typical household has food on hand to last 3
    days.
  • Few families have emergency reserves for a
    prolonged period
  • Low-income least able to set supplies aside for
    an emergency
  • Prices may rise quickly in emergency.

52
Who will help us?
  • Little or no state and federal assistance
  • Local government also limited in what it can do
    to assist citizens
  • Churches, neighbors, friends and families would
    need to help each other
  • Vulnerable groups would need extra assistance
  • Advance planning and stockpiling of necessities
    could help.

53
What public agencies and businesses can doas
employers
54
Maintain Essential Services
  • Halt non-essential activities and re-deploy staff
    to fill vacancies in critical services.
  • Cross train Make sure all critical functions can
    be done by several different people.

55
Maintain Essential Services
  • Create written instructions/ procedures for
    critical processes that can be carried out by
    others
  • If possible, keep essential supplies/ parts
    stockpiled in advance to maintain services.

56
Increase Social Distance
  • Determine how to provide services with less
    person-to-person contact whenever possible
  • Increase telecommuting if possible
  • Use phone, web, virtual conferences to replace
    face-to-face meetings
  • Waive non-critical policies if they force
    in-person contact

57
Decrease contact exposures
  • Increase cleaning/sanitizing of locks/ doorknobs,
    faucet and toilet handles, shared keyboards,
    telephones, other equipment
  • Vacuuming/sweeping may stir up infectious
    particles

58
Decrease contact exposures
  • Use/provide tissues, hand sanitizers, disposable
    gloves if available (All could be scarce during a
    pandemic)
  • Increasing humidity may reduce virus

59
Provide Personal Protective Equipment
  • Need will vary with type business
  • Will be difficult to obtain in a pandemic - need
    to secure in advance
  • Masks (N95 or better) may reduce exposure, but
    are difficult to wear for prolonged time or if
    employee has health problems.

60
Teach protective actions
  • Hand washing without recontamination
  • Covering cough, not using hands
  • Avoid putting hands to face, mouth, nose, eyes.
  • Staying home if any signs of illness

61
Prepare Communications Plan
  • How will key managers communicate among
    themselves
  • How will information be conveyed to customers?
  • How will information be conveyed to employees?
  • How will employees know who to call in specific
    situations?

62
Prepare for difficult HR issues
  • If offices are closed, will staff be paid?
  • If staff are needed, can they refuse to come to
    work?
  • If required to report, what protective
    equipment, if any, will be provided?
  • Can employer force someone who may be ill NOT to
    work? (Employees without sick leave may try to
    work while ill.)

63
Prepare for difficult HR issues
  • If an employee is required to work with ill
    people and becomes ill, is ita workers comp
    situation?

64
How Ready Are We?
Used with permission of the Minneapolis
Star-Tribune
65
"Every day a pandemic doesn't happen is another
day we have to prepare. --Michael
Osterholm
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