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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
2
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

3
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.

4
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

5
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

6
Influenza
  • All known subtypes of Influenza A found in birds
  • H5 and H7 cause severe outbreaks in birds
  • Human disease usually due to H1, H2, H3 and N1
    and N2.

7
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

8
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
9
Prior Year January February March April
Surveillance on circulating strains Selection
of specific strains Preparation and
distribution of virus stock to
manufacturers Seed pools inoculated into eggs
n engl j med 35120 www.nejm.org november 11,
2004
10
May June July August September October
Harvest and concentration of fluids Vaccine
inactivated and purified Vaccine blended,
content verified Packaging, labeling, delivery
n engl j med35120 www.nejm.org november 11, 2004
11
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

12
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

13
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

14
Pandemic Influenza
  • Past Pandemics
  • 1968 Hong Kong Flu (H3N2)
  • 1957 Asian Flu (H2N2)
  • 1918 Spanish Flu (H1N1)

15
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

16
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17
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.

18
There are severe pandemics and mild pandemics
19
Infectious Disease Deaths 1900s
Deaths per 100,000 per year
1957
1968
1918
20
Pandemics can last for months and come in waves
21
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22
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

23
H5N1 Symptoms
  • Symptoms (human)
  • Fever
  • Shortness of breath
  • Cough
  • Pneumonia
  • Acute Respiratory Distress
  • Diarrhea, sometimes severe
  • Life-threatening complications

24
Concern with Avian Influenza
  • Virus mutates rapidly
  • Has shown ability to 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

25
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26
What might happen in a severe pandemic?
27
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

28
Are we more or less at risk today compared to
1918?
29
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

30
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.

31
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
  • More elderly and immune-compromised people in
    population

32
Why at MORE risk in 2005
  • Much less self-sufficient than in 1918s
    (households and businesses)
  • 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

33
Why at MORE risk in 2005
  • Unlike 1918, todays society not used to
    rationing, sacrifice.(In 1918, because of WWI,
    fuel, coal, and food were already being rationed,
    and community groups, like the Red Cross, were
    very active supporting the war effort)

34
Overall, are we at more or less risk?
  • Up to individuals, communities, states, and
    nations to decide as they plan for a possible
    pandemic

35
What might occur - fictional but possible
  • Closing of borders, shutting down trade
  • Fuel shortages/restrictions due to ? in oil
    imports
  • Closing of schools, events, and businesses where
    large numbers of people congregate
  • Businessses/workers upset about loss of income

36
What might occur
  • High mortality, especially among young adults
  • People working at home when possible others
    taking paid or unpaid leave
  • Absenteeism of 30 to 50
  • High numbers of cases, hospitalizations, and
    deaths

37
What might occur
  • Not enough hospital beds, health care workers, or
    ventilators
  • High numbers of cases and hospitalizations.
    Death rates - 2.5
  • Death rate for pregnant women is 20
  • Inadequate amounts of antiviral meds, leading to
    violence at treatment sites

38
What might occur
  • Sick people who live alone, or with small
    children only, in dire straits
  • Young children trying to take care of sick
    parents, with no support
  • Children neglected because parent(s) too sick to
    provide care
  • Orphaned children whose parent(s) have died

39
What might occur
  • Mortuaries and crematoria unable to keep up with
    deaths
  • Funeral home workers unwilling to handle corpses
    of influenza patients
  • Makeshift hospitals established in churches and
    schools
  • Shortages of fuel, food, essential supplies
    prices skyrocket.

40
What might occur
  • Utilities having trouble with staff shortages,
    inability to replace supplies and parts. Spot
    failures occurring.
  • Care shifted from hospitals to being taken care
    of by family/friends/people in neighborhood.
  • Some neighborhoods organized, collaborative
    others disorganized with individuals hoarding

41
What might occur
  • Protective face masks that sold for 1 are now
    going for 20 each
  • Sanitizers and chlorine are sold out of the
    stores
  • Availability of other Rx drugs is reduced
  • Flu outbreak severe in detention center, with 1/2
    the usual number of staff

42
What might occur
  • Courts largely shut down no one willing to serve
    on a jury
  • Fear, distrust, mourning/depression, are
    widespread
  • Church facilities are closed when people most
    need spiritual comfort
  • Some flee cities to National Forests to wait out
    the outbreak

43
What might occur
  • In the end, after several waves and 3-4 months,
    the outbreak is declared to be over in Larimer
    County.
  • Over 80,000 became ill and over 2,000 deaths
    occurred in about 12 weeks.
  • Great economic loses from closed businesses.

44
What might occur
  • 12,000 needed hospitalization, although many were
    cared for in the community
  • With the completion of McKees new wing AND the
    completion of Medical Center of the Rockies,
    Larimer County will have about 635 licensed
    hospital beds.

45
Considerations for preparedness
46
Can we maintain our utilities?
  • Recent disasters have showed us the need for
    water, power, telecommuni-cations, heat in an
    emergency
  • Can they operate with 50 of staff?
  • Do they stockpile materials and parts to ensure
    operation for 90-120 days?

47
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 will rise quickly in emergency.

48
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 MRC?

49
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 will
    need to help each other out
  • Vulnerable groups will need extra assistance
  • Advance planning and stockpiling of necessities
    could help.

50
What County Depts and businesses can do
51
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.

52
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.

53
Increase Social Distance
  • Determine how to provide services with less
    person-to-person contact whenever possible
  • Increase telecommuting/Citrix access
  • Use phone, web, virtual conferences to replace
    face-to-face meetings
  • Waive non-critical policies if they force
    in-person contact (WIC, FP)

54
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
  • Use/provide tissues, hand sanitizers, disposable
    gloves if available (All could be scarce during a
    pandemic)
  • Increasing humidity may reduce virus

55
Provide Personal Protective Equipment
  • Need will vary with type business
  • Will be difficult to obtain in a pandemic
  • Masks (N95 or better) may reduce exposure, but
    are difficult to wear for prolonged time or if
    employee has health problems.

56
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

57
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?

58
Prepare for thorny 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.)

59
Prepare for thorny HR issues
  • If an employee is required to work with ill
    people and becomes ill, is ita workers comp
    situation?

60
Some County-specific issues
  • Vital stats-Issuing death certificates -
    additional assistance may be needed
  • Coroners office issues - volume, unclaimed
    bodies, etc.
  • Clarification of legal issues - both county
    attorney and district attorney
  • Child protection issues when parents too ill to
    care for children

61
Some County-specific issues
  • IT assistance may be needed to rapidly deploy
    systems to track cases
  • Human Services - many low income may have trouble
    with getting food
  • Detention center - potential for outbreaks in
    close quarters
  • Fairgrounds - Events and conventions cancelled.
    Other use of buildings?

62
Some County-specific issues
  • Solid Waste - Disposal of household infectious
    waste issues
  • Fleet - May assist with transportation needs/fuel
  • Workforce center - may be source to recruit
    workers or volunteers
  • Community Corrections - similar issues with other
    residential facilities

63
Some County-specific issues
  • Parks - may be dealing with campers/poachers on
    county lands may help supplement law enforcement
  • Sheriff - Challenges of maintaining law and order
    in face of fear, shortages, decreased staff

64
How Ready Are We?
Used with permission of the Minneapolis
Star-Tribune
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