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Chance Favors the Prepared Community: Preparing for a Flu Pandemic

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Title: Projections: U.S. Pandemic Author: mlevine Last modified by: vdhuser Created Date: 11/21/2005 6:18:49 PM Document presentation format: On-screen Show – PowerPoint PPT presentation

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Title: Chance Favors the Prepared Community: Preparing for a Flu Pandemic


1
Chance Favors the Prepared CommunityPreparing
for a Flu Pandemic
  • February 14, 2007
  • Mark J. Levine, MD MPH

2
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3
BIRD FLU PANDEMIC?
4
Influenza Virus
  • Single-stranded RNA virus
  • Surface membrane spiked with 2 types of protein
  • Hemagglutinin (H)
  • Neuraminidase (N)

5
Influenza Virus Composition
Type of nuclear material
Neuraminidase
Hemagglutinin
A/Beijing/32/92 (H3N2)
Virus type
Geographic origin
Strain number
Year of Isolation
Virus subtype
6
The pandemic clock is ticking, we just dont
know what time it is
  • E. Marcuse

7
Pandemic influenza definition
  • Pandemic influenza, or flu, is a global outbreak
    of disease that occurs when a new influenza A
    virus appears in humans, causes serious illness
    and then spreads easily from person to person.

8
A pandemic is the viral equivalent of a
perfect storm. There are three essential
conditions, which rarely converge, and they are
impossible to predict.
Michael Specter, The
New Yorker
9
The three conditions
  • A new subtype that has not infected people in
    the past
  • Causes severe illness in people
  • Sustained transmission from person to person
  • Emergence of pandemic strain most significant
    public health emergency caused by a naturally
    occurring pathogen

10
Timeline of Emergence of Influenza A Viruses
in Humans
Avian Influenza
H7
H9
H5
Russian Influenza
H5
H1
Asian Influenza
H3
Spanish Influenza
H2
Hong Kong Influenza
H1
1918
1957
1968
1977
1997
2003
1998/9
11
Effects of Typical Flu Season (U.S.)
  • 5-20 ill
  • 200,000 hospitalizations
  • 36,000 deaths

12
Impact of Past Influenza Pandemics/Antigenic
Shifts
Pandemic, or Antigenic Shift Excess Mortality Populations Affected
1918-19 (A/H1N1) 500,000 Persons lt65 years
1957-58 (A/H2N2) 70,000 Infants, elderly
1968-69 (A/H3N2) 36,000 Infants, elderly
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Pandemic Prediction U.S.A.
  • Planning Assumptions
  • 30 attack rate
  • 50 or more of those who become ill will seek
    medical care
  • Number of hospitalizations and deaths will depend
    on the virulence of the pandemic virus

Moderate (1957-like) Severe (1918-like)
Illness 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
15
Pandemic Prediction Central Region
  • Planning Assumptions
  • 30 attack rate
  • 50 or more of those who become ill will seek
    medical care
  • Number of hospitalizations and deaths will depend
    on the virulence of the pandemic virus

Moderate (1957-like) Severe (1918-like)
Illness 360,000 (30) 360,000 (30)
Outpatient medical care 180,000 (50) 180,000 (50)
Hospitalization 3,460 39,600
ICU care 519 5,940
Mechanical ventilation 260 2,970
Deaths 836 7,612
16
Sudden surge from a immediate event
17
Biological attack or Pandemic ?
Care in the community
Slowly growing surge from a rolling event
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The Influenza Pandemic of 1918-1919
1918 Pandemic
25-30 percent of the worlds population fell
ill500,000 deaths in the US
25-30 percent of the worlds population fell
ill500,000 deaths in the US
25-30 percent of the worlds population fell
ill500,000 deaths in the US
24
Avian Influenza H5N1as of February 7, 2007
  • 55 countries with documented H5N1 avian influenza
    in bird populations
  • 11 countries with documented human cases of H5N1

25
Nations With Confirmed Cases H5N1 Avian
Influenza (Feb 07)
26
Cumulative Number of Confirmed Human Cases of
Avian Influenza A/(H5N1) Reported to WHO as of
02/06/07
Country 2003 2004 2005 2006 2007 Total
cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths
Azerbaijan 0 0 0 0 0 0 8 5 0 0 8 5
Cambodia 0 0 0 0 4 4 2 2 0 0 6 6
China 1 1 0 0 8 5 13 8 0 0 22 14
Djibouti 0 0 0 0 0 0 1 0 0 0 1 0
Egypt 0 0 0 0 0 0 18 10 2 2 20 12
Indonesia 0 0 0 0 19 12 56 46 6 5 81 63
Iraq 0 0 0 0 0 0 3 2 0 0 3 2
Nigeria 0 0 0 0 0 0 0 0 1 1 1 1
Thailand 0 0 17 12 5 2 3 3 0 0 25 17
Turkey 0 0 0 0 0 0 12 4 0 0 12 4
Viet Nam 3 3 29 20 61 19 0 0 0 0 93 42
Total 4 4 46 32 97 42 116 80 9 8 272 166
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Integrated Planning for a Large Scale Health
Emergency
29
The Public Health System
Accountants!
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Pandemic Flu Preparedness for Individuals and
Families
  • http//www.pandemicflu.gov

32
Pandemic Flu Preparedness for Businesses
  • http//www.pandemicflu.gov

33
In a Pandemic
  • Despite all preparedness efforts, Virginia will
    not be spared from a flu pandemic.
  • All businesses, hospitals and government agencies
    will feel the effects of a pandemic.
  • Ten to 25 percent of the workforce may be ill at
    any one time.

34
  • Unlike other disasters, a flu pandemic will touch
    every population in every part of the country.
    Moving operations to another location may not be
    a viable option.
  • A flu pandemic could cost the U. S. economy
    billions of dollars in lost productivity and
    medical expenses. During a pandemic, it will not
    be business as usual.

35
The number one thing you can do to prepare for a
pandemic is to learn as much as you can and
personally plan ahead of time
36
Local Emergency Planning and Response Framework
37
Health Districts in Virginia
38
Preparing for Emergencies in the Face of
Uncertainty
39
Hope?
  • Hope is not a strategy

Julie Gerberding, Director, Centers for Disease
Control and Prevention
40
Chance Favors the Prepared Mind
  • Louis Pasteur

41
Chance Favors the Prepared Community
  • Mark Levine

What is a Prepared Community?
42
Incident Command Structure
43
Unified Command
44
Components of Local Response
  • Communication/Awareness
  • Surveillance/Investigation
  • Containment/Control
  • Distribution of antivirals/vaccine
  • Healthcare Surge

45
Components of Local Response
  • Communication/Awareness
  • Surveillance/Investigation
  • Containment/Control
  • Distribution of antivirals/vaccine
  • Healthcare Surge

46
Communication/Awareness
  • Virginia Department of Health
  • http//www.vdh.virginia.gov/pandemicflu/
  • Henrico County Health Department
  • http//www.co.henrico.va.us/health/
  • CDC
  • Travel http//www.cdc.gov/travel/
  • Avian flu http//www.cdc.gov/flu/avian/

47
Continued
  • Education/Information Exchange
  • Public Health Epi-X, CDC
  • Medical community Public Health Bytes
  • www.publichealthbytes.org
  • General community Promote individual/family
    preparedness
  • www.pandemicflu.gov
  • Media spots
  • Health Department Web site info

48
Components of Local Response
  • Communication/Awareness
  • Surveillance/Investigation
  • Containment/Control
  • Distribution of antivirals/vaccine
  • Healthcare Surge

49
Surveillance and Detection-current status-
  • Surveillance is a routine function of the Health
    Department and is always ongoing
  • Influenza surveillance is not something new and
    is already very extensive
  • Enhanced surveillance experience/process already
    in place

50
Additional Surveillance Efforts
  • Syndromic Surveillance
  • Surveillance for symptoms of disease rather than
    actual cases
  • May detect a disease outbreak sooner

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Ongoing issues
  • Communication/Awareness
  • Surveillance/Investigation
  • Containment/Control
  • Infection Control measures
  • Distribution of antivirals/vaccine
  • Healthcare Surge

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62
NPI
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65
Summary of NPI
  • Isolation and treatment of people infected with
    pandemic flu strain
  • Voluntary home quarantine of members of
    households with pandemic flu strain
  • Social distancing
  • Children school closure and out of school social
    activity suspension
  • Adults Cancellation of public gatherings
    alteration of workplace environments

66
CDC Pandemic Severity Index
67
Meteorology Meteorology Geology
Saffir-SimpsonHurricane Scale FujitaTornadoScale RichterEarthquakeScale
0 - 73 MPH 0 - 39 MPH 0  
Category 1 gt74 MPH F0 40 - 72 MPH 1 No damage
Category 2 gt96 MPH F1 73 - 112 MPH 2 No damage
Category 3 gt111 MPH F2 113 - 157 MPH 3 Little damage
Category 4 gt131 MPH F3 158 - 206 MPH 4 Light damage
Category 5 gt155 MPH F4 207 - 260 MPH 5 Moderate damage
F5 261 - 318 MPH 6 Mod.-Heavy damage
F6 319 - 379 MPH 7 Heavy Damage
8 Very Heavy Damage
9 Total destruction
10 Unheard - never seen
68
  Pandemic Severity Index Pandemic Severity Index Pandemic Severity Index
Interventions by Setting 1 2 and 3 4 and 5
Interventions by Setting      
Home      
Voluntary isolation Recommend Recommend Recommend
Voluntary quarantine Generally not recommended Consider Recommend
School      
Child Social Distancing      
School closure Generally not recommended Consider lt 4 weeks Recommend lt 12 weeks
Out of school activity restrictions Generally not recommended Consider lt 4 weeks Recommend lt 12 weeks
Workplace/Community      
Adult Social Distancing      
Decrease number of social contacts Generally not recommended Consider Recommend
Increase distance between people Generally not recommended Consider Recommend
Modify/Postpone public gatherings Generally not recommended Consider Recommend
Modify workplace schedules Generally not recommended Consider Recommend
69
Ongoing issues
  • Communication/Awareness
  • Surveillance/Investigation
  • Containment/Control
  • Distribution of antivirals/vaccine
  • Healthcare Surge

70
HENRICO MEDICAL RESERVE CORPS
  • http//www.vdh.virginia.gov/LHD/henrico/myweb/mrc.
    asp

71
Goal of Planning for Large Scale Health
Emergencies
  • Enhance our capacity and ability to better
    perform our day to day tasks and build capacity
    to ramp up for large scale health issues

72
Questions to Ask
  • How will you maintain your business operations
    when 10 to 25 percent of the workforce falls ill
    at one time?
  • How can you adapt your existing continuity of
    operations plans to reflect this kind of human
    resources impact?
  • How will you cope when the other businesses and
    suppliers you rely on experience the same
    absentee rates?

73
Continued
  • How will you adapt to disruptions in the supply
    chain for the raw materials you need and how will
    you get your product to the consumer if your
    distribution network is hit with high absentee
    rates?
  • How can existing return-to-work and travel
    policies be adapted to control the spread of this
    virus among employees?
  • How will you limit the economic impact of a flu
    pandemic on your business?

74
Chance Favors the Prepared Mind
  • Louis Pasteur

Chance Favors the Prepared Community
Mark Levine
75
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