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Pandemic Influenza Update


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Title: Pandemic Influenza Update

Pandemic Influenza Update
  • Name, Credentials and Contact Information of

Location and Date
Acknowledgements for Content
  • Jason Eberhart-Phillips, MD, MPH
  • Kansas Department of Health and Environment
  • Centers for Disease Control and Prevention
  • World Health Organization
  • US Health and Human Services

Pandemic Influenza
What is a Pandemic?
A pandemic is a global disease outbreak. An
influenza pandemic occurs when a new influenza A
virus emerges for which there is little or no
immunity in the human population, begins to cause
serious illness and then spreads easily
person-to-person worldwide (, 2009). For
additional information on pandemic influenza
Prerequisites for Pandemic Influenza
  • A new influenza virus emerges to which the
    general population has little/no immunity
  • The new virus must be able to replicate in humans
    and cause disease
  • The new virus must be efficiently transmitted
    from one human to another

Circulating Influenza Strains and Pandemics in
the 20th Century
1918 Spanish Flu
1968 Hong Kong Flu
1957 Asian Flu
1-4 million deaths
20-40 million deaths
1-4 million deaths
  • 1920 1940 1960 1980 2000

What Weve Learned from History
  • Pandemic influenza typically comes in waves. The
    great 1918-1919 pandemic came in 3 distinct
  • The second wave was very different much more
  • Over the summer the virus had changed

The First Flu Pandemic of the 21st Century
  • On June 11, 2009
  • WHO raised pandemic alert level to Phase 6
  • A global pandemic was underway
  • Community-level outbreaks in multiple parts of
    the world
  • Declaration was reflection of the spread of the
    virus not of the severity of the disease it

World Health Organization, Retrieved July 7,
2009, form http//
Influenza A (H1N1) What We Do Know
  • This is an entirely new virus
  • Genetic bits come from flu viruses that infect
    pigs, birds and humans
  • It is easily transmitted among humans, especially
    the young
  • No one, except those who have been infected, is
  • Illness from the virus could become widespread
  • No previous vaccine, including seasonal flu
    vaccine, protects against infection

Seasonal Epidemics vs. Pandemics
  • Seasonal Influenza
  • A public health problem each year
  • Usually some immunity built up from previous
    exposures to the same subtype
  • Infants and elderly most at risk
  • Influenza Pandemics
  • Appear in the human population rarely and
  • Human population lacks any immunity
  • All age groups, including healthy young adults

How the Virus Spreads
  • The same way seasonal flu viruses spread
  • Respiratory droplets
  • Coughs and sneezes
  • Touching objects touched by an infectious person,
    then touching your nose or mouth
  • Droplets arent able to travel long distances
    through the air
  • 3-6 feet maximum
  • Virus survives up to 72 hours on surfaces,
    depending on moisture

The Clinical PictureSo Far
  • Symptoms like other flu infections
  • Abrupt fever, gt100 F
  • Cough, sore throat, runny nose
  • Aches, chills, fatigue
  • Unusual diarrhea and vomiting
  • Almost everyone infected so far has recovered
    fully, but
  • Hospitalization rate higher than expected for
    seasonal flu
  • The virus is affecting younger populations than
    seasonal flu
  • This picture could change, as the virus changes
    its genetic make-up

What can we do to Reduce the Spread of Influenza?
Plan, Prepare, Prevent, Protect - Be Healthy
The Goal of Community Mitigation
Community Measures
Delay onset of outbreak
Reduce the peak burden on hospitals/infrastructure
  • Pandemic Outbreak No Community Measures Used

Decrease a) number of cases of death and illness
and b) overall health impact

Number of Daily Cases
  • Pandemic Outbreak With Measures Taken

Days Since First Case
Key Community Mitigation Messages
  • Wash your hands often with soap and water,
    especially after you cough or sneeze
  • Alcohol-based cleaners okay
  • Cover your nose and mouth when you cough or
  • Not with your bare hands!
  • Use a tissue throw it away
  • Dracula cover is okay, or Sneeze in your

What Social Distancing Means
  • Educating the public
  • To recognize the disease
  • Keeping distance from other people who appear ill
  • Stay home until no longer infectious, except to
    obtain medical care
  • Educating employers and schools
  • To recognize the disease
  • Dismiss workers and students who develop symptoms
  • Consider closing, if severe

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Droplet Precautions Surgical Masks
Source Rosie Sokas, MD MOH UIL at Chicago
Current Status of H1N1 Response
  • No vaccine is currently available, but is being
    produced and will likely be available in October
  • Vaccine will be given first to priority groups
  • Antiviral treatment will be targeted
  • Everyone must practice good hygiene and use
    guidelines to prevent disease

  • During peak periods of peak influenza illness we
    will need to consider how to
  • Care for sick family members
  • Care for children if schools or daycare providers
    are closed
  • Remain home or leave work if ill
  • Keep schools and business open with potentially
    significant absences.
  • Failure to educate the public and be prepared
    could result in increased incidence of viral

Steps We All Can Take
  • Seek guidance on pandemic influenza ask
  • Your state health departments are providing the
    most appropriate and current information
  • In your communities
  • Local health departments
  • Local emergency planning
  • Local physicians and other healthcare providers
  • Be vaccinated with seasonal influenza vaccine

Image source Retrieved July 24, 2009
Use of Vaccine and Medication
Vaccination for Influenza Will Prioritize Groups
at Risk
Pregnant women Health care workers and emergency
medical responders People caring for infants
under 6 months of age Children and young adults
from 6 months to 24 years People aged 25 to 64
years with underlying medical conditions (e.g.
asthma, diabetes)
July 29, 2009, the Advisory Committee on
Immunization Practices (ACIP), http//www.pandemic
Mobilizing for a Vaccine Campaign
  • For public health, a challenge of unprecedented
    scale this fall
  • Planning is already underway

Antivirals arent usually necessary for mild
illness (except perhaps for those who are at high
risk for complications) Rest and fluids work
best Virus is currently sensitive to two
antiviral drugs Tamiflu (pills, liquid) Relenza
(inhaled powder) Should be started early for
maximum effectiveness State/federal stockpiles
have been sent to designated providers
Planning for Staying Healthy
Healthy People, Healthy Families, Healthy
Workforce, Healthy Kansas
What Basic Steps Can You Take to Assure Health?
Eat healthy and get rest
Wash Your Hands the Right Way
  • Wet your hands with clean running water and apply
    soap. Use warm water if it is available.
  • Rub hands together to make a lather and scrub all
  • Continue rubbing hands for 15-20 seconds. Need a
    timer? Imagine singing "Happy Birthday" twice
    through to a friend.
  • Rinse hands well under running water.
  • Dry your hands using a paper towel or air dryer.
    If possible, use your paper towel to turn off the
  • Always use soap and water if your hands are
    visibly dirty.

If Soap and Clean Water Are Not Available Use
Alcohol-based Hand Sanitizer
  • Effective if hands not visibly soiled
  • More costly than soap water
  • Alcohol-based hand rubs significantly reduce the
    number of germs on skin and are fast-acting.
  • When using an alcohol-based hand sanitizer
  • Method
  • Apply appropriate amount to palms (about 1
    coin-sized drop)
  • Rub hands together, covering all surfaces until

Cough etiquette
  • Respiratory etiquette
  • Cover nose / mouth when coughing or sneezing
  • Practice infection prevention by educating and
    displaying posters on respiratory hygiene, cough
    etiquette, and proper hand washing

Steps We All Can Take
  • Know the symptoms of influenza and monitor your
  • Stay home and away from school and workplace
    when sick

What About Home?
Keeping Yourself and Your Family Healthy
What Should Your Home Checklist Include?
  • Personal planning for stockpiles of food, bottled
    water, and medication. Store a two week supply of
    food and water, Periodically check your regular
    prescription drugs to ensure a continuous supply
    in your home.
  • Have any nonprescription drugs and other health
    supplies on hand, including pain relievers,
    stomach remedies, cough and cold medicines,
    fluids with electrolytes, and vitamins.

What Should Your Home Checklist Include?
  • Get vaccinated with seasonal flu and pneumococcal
    vaccine (if indicated)
  • Planning for extended care of family at home
  • Monitoring of own health and staying home when
  • Find healthy ways to deal with stress and anxiety
  • Use PPE and implement infection control guidance
    at home

Patients Cared for at Home
  • Contact a health care provider if pregnant, five
    years of age and under or have a health condition
    such as diabetes, heart disease, or asthma.
  • Get plenty of rest.
  • Drink clear fluids (such as water, broth, sports
    drinks, electrolyte beverages for infants) to
    keep from being dehydrated.
  • A sick person should stay away from other people
    as much as possible.
  • Sick persons should use proper hand hygiene and
    respiratory etiquette.
  • Wear a facemask if available and tolerable
    when sharing common spaces with other household
    members to help prevent spreading the virus to
    others. This is especially important if other
    household members are at high risk for
    complications from influenza. 
  • Stay home until free of fever for at least 24
    hours without the use of fever reducing
    medications such as Tylenol.

Emergency Warning Signs
Be watchful for emergency warning signs that
might indicate you or family members need to
seek medical attention.
  • Get medical care right away if the sick person at
  • has difficulty breathing or chest pain
  • has purple or blue discoloration of the lips
  • is vomiting and unable to keep liquids down
  • has signs of dehydration such as dizziness when
    standing, absence of urination, or in infants, a
    lack of tears when they cry
  • has seizures (for example, uncontrolled
  • is less responsive than normal or becomes
  • Warning! Do not give aspirin (acetylsalicylic
    acid) to children or teenagers who have the flu
    this can cause a rare but serious illness called
    Reyes syndrome.

What about Schools?
Considering Students and Staff
Key Issues for Schools
  • Absenteeism is likely to be increased for
    students and staff.
  • Normal flu produces a 4 to 5 peak rate.
  • Experience in other countries suggests peak may
    be 10 to 15.
  • Infection control policies will be very
  • Aimed at reducing risk of school dismissals and
    unnecessary absenteeism
  • Schools as venues for mass immunization.
  • Coordinate with local health departments

Stepped up Hygiene and Cleaning
  • Frequent hand washing, with adequate facilities
    and time made available.
  • Alcohol-based hand sanitizers can be used others
    if last resort.
  • Respiratory etiquette, modeled by staff
  • Coughing/sneezing into tissues followed by hand
  • Cough or sneeze into sleeve as alternative.
  • Routine cleaning around school.
  • Viruses can be transmitted from flu droplets on
  • Regular detergent cleansers are sufficient.

Primary Strategy
  • Separate ill students and staff from the well
  • Ill students need to remain at home and avoid
    contact with others except to seek necessary
    medical care.
  • Exclude sick students and staff from school until
    24 hours after fever has resolved (without use of
    fever-reducing medications). Antiviral drug use
    does not effect this rule.
  • Rapidly isolate students and staff who become ill
    at school until they can be sent home.
  • Set aside space to separate sick persons until
    they can be sent home.
  • Limit staff assigned to care for ill students
  • Consider providing surgical masks to place on ill

Selective School Dismissal
  • These steps should prevent most schools from
    closing, but
  • If absenteeism in any particular school is too
    large, school dismissal may be necessary
  • Earlier dismissal also may be necessary in
    schools that serve pregnant or medically fragile
    students, if they cannot be protected.
  • Decisions should be made in collaboration with
    local and state health officials
  • Dismissal should last 5 7 days, then reassess.
  • Consider continuing to allow well staff access to
  • Other measures will be recommended if the
    pandemic strain becomes more virulent.

New Mindset
  • Expect the unexpected
  • Parents, teachers and administrators all need to
    work hard to keep schools open, and be ready if
    schools must close suddenly
  • Give up the notion that absences are to be
    avoided at all costs

Immunizations in Schools
  • Immunizing in schools offers advantages
  • Convenient for parents
  • Excludes no one
  • Enables followup
  • Efforts will be made to minimize the disruption
    of normal school activities
  • With cooperation and guidance of school boards
    and administration
  • No child would be immunized without written
    consent from parent or guardian
  • All immunizations would be performed by persons
    qualified to give injections

What About the Child Care?
What can providers and parents do?
Steps Child Care Providers Can Take Now
  • Maintain regular communication with the local
    health department to obtain guidance about
    reporting flu-like illness in child care.
  • Visit the KDHE website at http//
    for additional materials and updated resources.
    Child care providers are encouraged to check the
    website regularly for the most current guidance
    concerning H1N1 flu.
  • The Centers for Disease Control and Prevention
    (CDC) at http//

Steps Child Care Providers Can Take Now
  • Develop a plan to address possible disruptions in
    learning and program operation. A useful planning
    tool is available at http//
    anpdf/child care.pdf
  • Higher absentee rates among children and staff
  • Disruptions in supportive services and the
    delivery of supplies
  • Loss of income or delay in payments
  • Review policies for the exclusion of sick
    children and staff.
  • Review childrens files and update contact

Steps Child Care Providers Can Take Now
  • Make plans for the isolation and supervision of
    sick children, until their parents can pick them
  • Recognize the symptoms of H1N1 flu and exclude
    sick children and staff promptly.
  • Clean toys and commonly shared items, and
    touched surfaces like handrails and doorknobs at
    least daily and whenever visibly soiled.

Steps Child Care Providers Can Take Now
  • Avoid over-crowded conditions.
  • Spread out during story and circle times
  • Allow more than the 2 ft. required by regulation
    between cribs, cots and sleep mats.
  • Place cribs, cots, and sleep mats so that
    children rest head to toe rather than face to
  • Have adequate supplies on hand
  • Hand soap and paper towels
  • Facial tissues and waste containers
  • Cleaning supplies

Steps Child Care Providers Can Take Now
  • Incorporate learning activities that promote
    healthy practices and good hygiene.
  • Teach parents simple things they can do to keep
    their families health and to reduce the spread of
    disease. Check the KDHE website at
    http// and the CDC website
    http// for downloadable
    resource materials.

Parents Can help
  • Parents can help reduce the spread of flu like
    illness and other diseases in child care settings
  • Keeping sick children home. Sick children should
    not attend school, child care or other group
    setting. Children should be fever free, without
    the use of fever-reducing medications for at
    least 24 hours before returning to school, child
    care or other group setting.
  • Having a back up plan in place in case your child
    is sick or in case your school or child care
    closes due to illness
  • Practicing good health habits at home and
    encouraging your children to do the same.

What About the Workplace?
Employer and Employees
Principles of Mitigation Apply
  • Good hygiene practices
  • Social distancing at work
  • Avoid handshakes (and kissing!)
  • Stay home when sick

Considerations for Business, Industry, and
  • Protection of workforce
  • Continuation of service or business
  • Economic impact for organization and employees
  • Consideration of current policy related to sick
  • Alternate plans for conducting business /
    providing services

What About Faith based and Community
Remembering the Most Vulnerable
Faith-Based and Service Organizations
  • Consider suspending faith-based practices or
    rituals that may involve contact with hands, i.e.
    communion, greeting, etc.
  • The impact of school closures and loss of income,
  • differentially impacts low income individuals and
  • In the United States, 48 of workers have no sick
  • Many low income families rely on free and reduced
    breakfast and lunch programs to help feed their
  • Children who are released from school may be left
    unattended and/or be at risk for greater violence
    in their communities

Faith-Based and Service Organizations
  • Other vulnerable populations include
  • Single individuals, especially the elderly, who
    may have no assistance if they fall ill or run
    out of supplies
  • People with disabilities who may rely on others
    for their basic care
  • Individuals who may not speak or understand
  • Shelters serving homeless persons

Plan, Prepare, Prevent, Protect - Be Healthy
What can you do to Reduce Risk of Influenza?
PLAN Take Time to Plan
Vulnerable populations
Family and community
Schools, universities and child care
Work, business and government
PREPARECaring for Self, Family and Community
School closing arrangements
Medications and health supplies
Alternative child care arrangements
Non-perishable foods and water
PREVENTHealthy Habits to Reduce Risk of
Infection and Illness
Cover your cough
Vaccinate against disease
Wash hands often and use alcohol-based hand
Prevent and manage chronic disease
PROTECTResponding to Influenza to Reduce Risk of
Know when to see doctor
Know symptoms of flu
Protect vulnerable people
Breastfeed your baby
Plan, Prepare, Prevent, Protect - Be Healthy!
Learn More!
  • Centers for Disease Control and Prevention
  • Pandemic Flu Planning http//
  • Kansas Department of Health and Environment
  • Things you can do http//
  • Individual Planning http//

Thanks for Listening!
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