PANDEMIC INFLUENZA PLANNING

Chicken Little

The End is Near!!!!

Two Sides of Pan Flu Planning

The Ostrich

Types of Flu

Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available.

Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 strain is one of the current strains infecting birds, and unlike most others, is not only deadly to domestic fowl, but can be transmitted from birds to humans (zoonotic). There is no human immunity and no vaccine is available.

Pandemic flu is caused by a novel strain of a virulent human flu that leads to a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. (WHO)

Seasonal Influenzas• Are a Major Public Health

Problem Every Year.• Annual impact (U.S.)

– 36,000 deaths– 200,000 hospitalizations– $37.5 billion in economic costs from

influenza and pneumonia

• Those at greatest risk for serious complications– persons 65 and older– persons with chronic diseases– infants– pregnant women– nursing home residents

Avian Influenza

• The H5N1 strain of avian influenza (bird flu) is present in birds in many countries across several continents.– Bird flu in its present form does not present a

threat of a pandemic• Some human cases of avian influenza have occurred

– After close contact with infected birds– After close contact with infected household

members• No sustained person-to-person transmission• Human case fatality (death) rate is >50%• Virus is changing. 2004 strain is more resistant to

tamilfu than the original 1997 strain

Influenza Pandemic

• A global influenza outbreak caused by a brand new (novel) flu virus

• Because it is a new virus, few or no people would be immune

• Many people would get sick in every part of the world

• Asia is the source of many outbreaks because swine, birds and humans live under the same roof, providing opportunity for viral mixing

Pandemic Does Not Necessarily Mean the 1918-

19 Pandemic

A(H1N1)A(H2N2) A(H3N2)

1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”

World Pop. 1.8 billion

20-40 m deaths

550,000 + US deaths

World Pop. 2.8 billion

2 m deaths

70,000 US deaths

World Pop. 3.6 billion

1-4 m deaths

34,000 US deaths

Credit: US National Museum of Health and Medicine

If It Happened Today: Worst Case Scenario

• Based on observations from previous pandemics, the Centers for Disease Control and Prevention (CDC) has estimated that the economic losses in the United States associated with the next pandemic will range from $71 billion to $166 billion.

• The impact of an influenza pandemic on the healthcare system could be devastating.

• In the United States, between 40 and 100 million will become clinically ill; 18 to 45 million will require outpatient care; 300,000 to 800,000 persons will be hospitalized; and between 88,000 and 300,000 people will die.

• NC Pandemic Influenza Plan 2006

Impact of an Influenza Pandemic North Carolina

• 1.4 million outpatient visits

• 29,000 hospitalizations

• 6,700 deaths

•Assuming 30% attack rate and NC population of 8.5 million people•Based on CDC software FluAid 2.0

Despite . . . – Expanded global and national surveillance – Better healthcare, medicines, and diagnostics

Current risks:– Greater population density– Limited vaccine capability (9 Countries produce all the

world’s flu vaccine, with 1950’s technology).– More elderly and immunosuppressed– More daycare and nursing homes– “Warrior worker” ethic in the workplace leads to disease

spread

Pandemic Flu Is A Risk Today

Reality is That We are More Globally Connected

SARS spread to 5 countries within days of detection and to 30 countries on six continents within a few months.

Worldwide Spread in 6 MonthsWorldwide Spread in 6 Months

69,800 deaths (U.S.)69,800 deaths (U.S.)

Spread of H2N2 Influenza in 1957“Asian Flu”

Spread of H2N2 Influenza in 1957“Asian Flu”

Feb-Mar 1957Apr-May 1957Jun-Jul-Aug 1957

Will Avian Flu Cause the Next Pandemic?

NO ONE KNOWS!

• The H5N1 virus could change to spread more easily among humans-but it might not.

• It could “swap genes” with another animal virus, or with a human flu virus

• It could become less virulent even if it mutates so it can spread person to person easily.

• Another Influenza virus could mutate first.

Pandemic Influenza

Avian Influenza

To date, Avian Influenza (H5N1) is primarily a disease of birds and not

humans.

“However, There is Enough Concern to Warrant a Pandemic Watch”

WHO Pandemic Alert Phases

A Pandemic Requires Person-to-Person Spread

While There is Evidence of Localized Instances of Person to Person Spread, Sustained Person to

Person Transmission is Not Currently Occurring with H5N1

Pandemic Planning

Pandemic Planning Is Tricky

You know that it will happen

But you don’t know:•When it will occur

•What the characteristics of the virus will be

•Who it will affect

•How long it will last

•Whether it will be resistant to antivirals or not

•Whether there will be a vaccine or not (or when)

•How severe the pandemic will be

Hospitals.Hospitals.Medical & Mental Medical & Mental Health Services,Health Services,Public HealthPublic Health

First RespondersFirst RespondersFire/EMSFire/EMSEM, Law,EM, Law,Medical Medical ExaminerExaminer

Business and Business and IndustryIndustry

Agriculture, Agriculture, Cooperative Cooperative Extension,Extension,Vets, CART, Vets, CART, Animal Animal ControlControl

Schools, Schools, Local Local Government,Government,Public Works Public Works and Utilities,and Utilities,Community Community AgenciesAgencies

Pandemic Response is Local and by Necessity

Collaborative

Planning Assumptions• Core prevention and control measures (e.g.,

vaccination and antivirals) will not be available or will be limited

• Non Pharmacological Interventions (NI) will be the primary control disease control strategy

• A pandemic will be global, prolonged and have several waves

• Disruption of key supply chains will likely occur, especially with products with off-shore production or components

• Lack of surge capacity in the medical industry will be a problem

• Response will be local. Mutual aid and outside resources will be minimal or non-existent.

WHO Goals for Pandemic Planning and Response

Pandemic Influenza Response:

• Initial strategy will be early detection and containment. Slow spread, decrease illness and death, buy time

– Antiviral treatment and isolation for people with illness– Quality medical care

– Quarantine for those exposed (antiviral prophylaxis if available)

– Social distancing, travel restrictions, snow days, work at home

– Infection control, hygiene (hand washing….), respiratory etiquette

– Vaccine when it becomes available (6-8 months)

– Plan to maintain essential services – Effective crisis communication can

influence how people react

Weeks

Impact

Prepared

Unprepared

Isolation and Quarantine: Reduces influenza transmission by separating infected

persons from uninfected persons, and exposed persons from non-exposed persons.– Isolation of ill persons will be valuable during all phases of

pandemic influenza– Quarantine of those exposed to ill persons is justified

when there are a limited number of cases – most valuable early in the outbreak when cases are limited

– Quarantine can be voluntary or by order of the County or State Health Director

– Local law enforcement has to enforce quarantine of non-compliant persons

– Persons in quarantine have to be provided with essential services (food, water, medicines)

– Mental health needs are high for those in quarantine

Individual or Group Disease Control

Strategies

Community-Based Infection Control Strategies• Social distancing

– voluntary self-shielding• Cancellation of public events

– concerts, sports events, movies, plays• Closure of schools and workplaces

– office buildings, shopping malls• Closure of recreational facilities

– community swimming pools, youth clubs, gymnasiums

Work and/or School Based Infection Control Strategies

• Snow Days and closures

• Respiratory hygiene/cough etiquette, hand hygiene

• Stay away if ill (staff stay home, students do not go to classes)

• Encourage self-reporting of illness that develops

• Active screening for illness in staff/students

• Send staff/students home(with mask) if ill

• Modify personnel policies that

encourage sick people to

come to work

Hand Hygiene

• Traditional hand washing– Soap and hot water– Minimum of 20 seconds

(the time it takes to sing “Happy Birthday” twice)

• Alcohol based hand rubs– Acceptable means to disinfect/sanitize

EXCEPT when hands are visibly soiled

Respiratory Hygiene and Cough Etiquette

• Cover mouth/nose when sneezing or coughing– If no tissue, use elbow

instead of hands• Use tissues and dispose of

appropriately• Perform hand hygiene

after contact with respiratory secretions

• Distance yourself from others (more than 3 feet)

What About Masks?

• Recommended for:

– Health care workers with direct patient contact

– Those at high risk for complications of influenza

– Symptomatic persons

– Contacts of ill persons

More About Masks

• Benefit of wearing masks by well persons in public settings has not been established– Persons may choose to wear a mask as part of an

individual protection strategy that includes respiratory hygiene/cough etiquette, hand hygiene, and social distancing.• If you wear a mask, keep

your hands away from your face!

• Clean your hands each time you touch your mask!

Businesses, school systems, community infrastructure providers, and other employers should develop plans for continuity of operations (COOP) and for the possibility of having to operate with a significantly reduced workforce. Personnel Policies may have to be modified.

– 25 to 30% of persons may become ill during a 6 to 8 week outbreak.

– An additional 10% of the workforce may be absent due to illness of a family member.

– Others may stay home due to a fear of becoming infected.

Pandemic Influenza Facts (WHO)

• 1. Pandemic influenza is different from avian influenza.• 2. Influenza pandemics are recurring events.

– Pandemics occur every 30-50 years– Another pandemic is a certainty but it cannot be predicted

when it will occur.• 3. The world may be on the brink of another pandemic.

– Concern H5N1 virus could mutate and cause a pandemic.• 4. All countries will be affected.• 5. Widespread illness will occur • 6. Medical supplies will be inadequate • 7. Large numbers of deaths will occur • 8. Economic and social disruption will be great • 9. Every country must be prepared. • 10. WHO will alert the world when the pandemic threat

increases.

Web Resources For Pan Flu• www.cdc.gov

– U.S. public health guidelines• www.pandemicflu.gov

– All kinds of planning info• www.cidrap.unm.edu/

– Example of COOP• http://www.epi.state.nc.us/epi/gcdc/pandemic.html

– NC Pandemic Flu Plan• www.who.int

– Global updates and official case reports• http://

www.cchealth.org/topics/pandemic_flu/school_action_kit/ – Pan Flu Action Kit for Schools