What Is Influenza?Respiratory illness caused by a virusSymptomsAbrupt onsetFever / HeadacheChills / Muscle achesFatigueCough / Sore throatSneezing / Runny noseWatery eyes

How Human Influenza Is SpreadUpper Respiratory Spread:Large droplet sneezing / coughing (1 meter)Direct person-to-person contactContact with contaminated hard, non-porous surfaces (24 48 hours)Contact with contaminated cloth / paper or tissue (8 12 hours)Shaking hands (5 minutes, warm hands)The virus survives better in lower humidity (as in winter)

Period of CommunicabilityInfectious 1 day before onset of symptoms and up to 7 days after onset of symptoms

Incubation Period1 3 days

Human ElementsReduced immunity (e.g., fatigue/stress/diet/exercise)Dry membranes and cold exposureCrowding

Strains of Influenza3 types of Influenza A, B and C

Viruses are classified by two surface proteinsH protein (16 types)N protein (9 types)

The H and N types can exist in any combination

Avian, Seasonal or Pandemic???Avian (Bird) FluInfluenza virus carried and spread among birds

Seasonal (Human) FluInfluenza virus carried and spread among humans

Pandemic FluA completely new strain of Influenza virus that easily spreads from human to human

Bird Flu + Human Flu can = Pandemic Flu

The Flu Bug AAntigenic Drift Yearly minor changes in the flu virus which causes yearly flu epidemics occurring Different people will have different degrees of immunity because of previous exposure to cousin flu virusesInfluenza A or BSeasonalAntigenic Shift A major change in the flu virus which can cause pandemicPeople do not have any immunity to this new virusInfluenza A onlyIrregular occurrence

Prerequisites For the Start of a PandemicA novel influenza virus subtype must emerge to which the general population will have no or little immunity

The new virus must be able to replicate in humans and cause serious illness

The new virus must be efficiently transmitted from one human to another

Influenza Pandemics 20th CenturyA(H1N1)A(H2N2)A(H3N2)1918: Spanish Flu1957: Asian Flu1968: Hong Kong Flu20-40 million deaths1-4 million deaths1-4 million deaths Credit: US National Museum of Health and Medicine

Seasonal Influenza Impact in At-Risk IndividualsDuring Influenza Season20 30% of all hospitalizations50% of mortality16% of outpatient visits for pneumonia7% of outpatient visits for all respiratory conditions

Influenza Associated Mobidity & MortalityCanadian5-m (1:6) illness1.5 m lost work days$1 b to Cdn economy50,000 hospitalizations(1:100 >65 years)Up to 4,500 deaths

Seasonal vs. Pandemic InfluenzaSeasonal PandemicEvery year (winter)Every few decadesUp to 4,500 deaths (Canada)100s of thousands of deaths (Canada)*36,000 deaths (USA)0.5 million + deaths (USA)Affects 0.5 - 1 million (globally)Affects millions (globally)*Attack rate 10 - 20%Attack rate 15 - 35%Most people recover 1 2 wks illnessSame recovery period, more severeModerate service disruptionHuge service disruption Most deaths in the at riskAll ages at risk, 20 to 40 maybe moreVaccine availableNo vaccine for minimum of 6 monthsAnti-virals availableTamiflu only, $, no guarantee, ltd supplyEconomic impact Economic impact- $1 billion to Canadian economy- $ billions worldwide

*1918 Pandemic caused an estimated 30 - 50,000 deaths in Canada, and 40 - 50 million deaths globally

Current Influenza SituationsporadicHanoi, February 27, 2005

Pandemicmasses!

DefinitionsEpidemicA disease that affects a significantly large number of people at the same time in a given geographic area

PandemicA disease occurring throughout the population of a country or the world

How do you prepare for a pandemic?Coordination with all sectors, agencies and the community

IT IS EVERYONES RESPONSIBILITY

Get an annual flu immunization

Influenza ImmunizationInactivated, grown in hens eggs70 90% effective in healthy young adultsReduces incidence, severity, duration and sheddingProtects against outbreaks by herd immunity

Influenza Immunization in ElderlyReduces clinical infection by 30 40%Reduces hospitalization / pneumonia by 50 60%Reduces mortality by 85%

Influenza Vaccine Myth Busting!!The vaccine doesnt work I received it previously but still got fluI am in mid pregnancy and shouldnt get the vaccineGuillain Barr syndrome is a common vaccine related adverse eventNow we have good anti virals the influenza vaccination program is not so importantI haven't had the flu for the past few years so why bother I must be immuneThe vaccine causes fluIt causes autism, diabetes, SIDS, and multiple sclerosisIt creates immune system overloadVaccines contain highly noxious chemicalsIts better to receive immunity from natural infectionIt causes impotency

Are masks effective tools for preventing person-to-person spread?

Are border closures effective tools for reducing spread of infection?

Illustration of Rapidity of Spread in 1957

Worldwide Spread of Asian Influenza Pandemic February 1957

Worldwide Spread of Asian Influenza Pandemic June 1957

Worldwide Spread of Asian Influenza Pandemic August 1957

We need toFocus on the whole picture!

The Team Approach

The Pandemic PlanOverall Goal:

To minimize serious illness and overall deaths

To minimize societal disruption among the population that comes with a pandemic

Example of poor planning!

World Health Organization Pandemic PhasesWe are here

Pandemic Influenza Phase

Description

Interpandemic Period

Phase 1

No new influenza subtypes have been detected in humans. The risk is considered low.

Phase 2

No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus poses a substantial risk of human disease.

Pandemic Alert Period

Phase 3

Human infection(s) with a new subtype, but no, or at most rare, human-to-human spread with close contact.

Phase 4

Small cluster(s) with a new subtype, but no human-to-human transmission, but spread is highly localized, suggesting the virus is not well adapted to humans.

Phase 5

Large cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet pose a substantial pandemic risk.

Pandemic Period

Phase 6

Increased and sustained transmission in general population.

Keep in mindA pandemic will last up to 2 years, so there has to be a continuity plan

There will be up to 3 waves, each lasting 6 8 weeks

The second wave is usually the worst for the number of cases and deaths

EthicsA key issue:What ethical choices are to be made when there are limited resources and overwhelming demand??Anti-virals Canada now targeting 55 million dosesVentilatorsVaccineHolding off other servicesStaying at home to look after family, versus assisting with health and community care deliveryWho gets what and why?!

An Overwhelming Task?All are manageable

Small steps

WE ARE NOT JUST PREPARING A PLANWE ARE PLANNING TO BE PREPARED

Do Not Be Passive!Certainly do not sit back and let what may come, come

Nobody else will do it for you!!Katrina 2005

Things you can doGet to know about pandemic, get involved in pandemic planning, and picture what your role(s) will be within your organization and between organizations.

Practice frequent hand hygiene.

Know and teach self-care and personal preparedness at home (e.g., food and water and basics checklists).

Get your annual flu shot and encourage your peers to do the same!

Start / enhance the liaison, collaboration and coordination for pandemic preparedness with fellow stakeholders!

STAY HOME IF YOU ARE ILL

Back to the Basics

WASH EM!!

Personal Preparedness At HomeSource: Public Health Agency of Canada

Personal Preparedness ContdQuick Tips:

Keep prescription medications filled.

Discuss care options with family members and other loved ones.

The Next Influenza Pandemic:No longer a question of ifBut when!We dont know when, but we do know the clock is ticking!

Questions:

Nausea, vomiting and diarrhea sometimes occur in children.Some symptoms are similar to a cold; however, the symptoms of the flu are more severe and sudden in onset.Because the virus survives off the body, it is important to wash hands frequently.Frequent disinfection of surfaces helps to limit spread.

Not all exposed = illness, and many go unexposed, thus millions of cases and billions with no illness in a pandemic.Cold, dry weather causes drying of the mucous membranes, which is the bodys natural defense against influenza.You can develop a subclinical infection where you do not become ill, but the virus is in your throat. You can then spread the disease to others.Circulating strains vary from year to year.Influenza A infects a wide variety of mammals, including man, horses, pigs, ferrets, and birds. Pigs are believed to be particularly important reservoirs.Influenza A viruses are associated with both seasonal and pandemic influenzasInfluenza B infects man and birds. It causes human disease but is generally not as severe as A types.Influenza C infects only humans but does not cause disease.

Strains of Influenza originate in birds but not all of them develop the ability to infect humans and spread from person to personWhen bird flu combines with human flu, it can create a new virus which can lead to a pandemicThese numbers equate to huge annual costs to our healthcare system.Seasonal flu lasts during winter months. Pandemic flu could last up to 2 years.In addition to deaths, Influenza is responsible for 50,000 hospitalizations in Canada every year (1:100 >65 years) +7% of ear infections in 2 6 year olds.36,000 U.S. deaths is equivalent to a September 11, 2001 World Trade Centre disaster every month of every year.Theory re: cytokine storms the healthier the immune system, the greater the response to the viral invasion. In past pandemics, the anti-inflammatory response was so great that it caused a fluid build up and people literally drowned in their own secretions.Cases are occurring worldwide, but it is not widespread.Influenza will be widespread.Current facilities will not be able to handle it.Extra measures need to be put into place to deal with widespread illness.With the rate of international travel, diseases are just a plane ride away.Reasons for annual flu immunization:It is the single-most effective way of preventing influenzaDecrease possibility of mutationOptimize your healthProtect your loved ones you could spread disease toe them if you are not immunizedPossibility of cross-protection to pandemic strainReduce work absenteeismVaccines protect against 3 strains of influenza. If other strains are circulating, you can still get ill from those ones.Vaccine is not live, so it cannot cause illness.You may be immune to some strains of flu, but they change each year, so your luck will run out. You may not always be exposed to the virus.Antivirals are not a substitute for immunization. Immunization is the single-most effective preventative thing you can do. Antivirals are costly and must be taken for the duration of an outbreak. Some antivirals have been shown to be ineffective against circulating strains.Natural immunity comes at a high pricesickness, lost work time, death, passing illness on to family and friends.Guillian-Barr Syndrome was associated with the 1976 Swine Flu vaccine. Improvements to vaccine production technology have been made since then and there have been no further links.Vaccines contain additives to preserve their shelf life. Research has shown no conclusive links between additives and side effects.It is safe for pregnant women to be immunized against Influenza.A flu shot is like a drop in the ocean of the immune system. It is capable of responding to hundreds of bombardments on a daily basis.Research has conclusively shown that there is no link between immunization and autism, diabetes, SIDS, or multiple sclerosis.Masks will be in short supply.There is a limited role for masks for caregivers in a hospital setting. They know infection control techniques and proper disposal of masks.It is unrealistic for the public to wear masks (a pandemic could last for up to 2 years).Most contamination occurs when removing the mask.Improper masks might provide a harbourage for the virus.With the rates and necessity of international travel, it is not feasible to close borders.Pandemic will last up to 2 years. We need to keep goods and services moving.In 1957, it took 6 months for the pandemic to become worldwide.In todays fast-paced environment, it will likely take less than 3 months to be worldwide.We cannot work in isolation of othersNeed to be broad and involve all stakeholders.By working together, even the impossible can get done.Everyone has their own unique contributions.We believe that our plan will position us on the right side of the tree.Worldwide surveillance of Influenza happens year round.Countries cooperate and report new strains of Influenza to the World Health Organization.The goal is to identify the pandemic strain at the earliest possible time so that we can accelerate our preparations so that we are as ready as we can be when it arrives.Population of Canada is 32.6 million peopleAntivirals are not a substitute for immunization. They must be taken once a day for the duration of the outbreak (in a pandemic, this will last several months). There will not be enough antivirals for everyone.There is no guarantee that the current antivirals will be effective against the pandemic strain. Amantadine is an antiviral that has been used to control outbreaks in long term care facilities. It has been shown to be ineffective against currently circulating influenza strains so Tamiflu has to be used.Everyone has a role.Handwashing is one of the single best methods of preventing disease.When soap and water are not available, hand gels with >60% alcohol are effective for clammy hands.Some day-to-day services might be disrupted. Stockpiling essential supplies is important.Remember to rotate the stock.Read up on what the pandemic is.Think about how you can prepare.Ask questions.