Explaining pandemic flu and Avian Influenza L'B' Sandy Rock, MD, MPH Interpretive Consultations, Inc

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Explaining pandemic fluandAvian InfluenzaL.B.
Sandy Rock, MD, MPHInterpretive Consultations,
Inc
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To inform, not inflame.
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What is influenza?

• An acute illness resulting from infection by an
  influenza virus
• Highly infectious
• Can spread rapidly from person to person
• Some strains cause more severe illness than others

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Symptoms

• Generally of sudden onset
• Fever, headache, aching muscles, severe weakness
• Respiratory symptoms e.g. cough, sore throat,
  difficulty breathing

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Not just sniffles
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but a serious, potentially lethal illness.
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Incubation period of influenza

• The range described is from 1 to 4 days
• Incubation periods are about 2-3 days
• May vary depending on the virus type
• Infectious 1 days prior to symptoms and up to
  14 days after

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How influenza spreads

• Easily passed from person to person through
  coughing and sneezing
• Transmitted through
• breathing in droplets containing the virus,
  produced when infected person talks, coughs or
  sneezes
• touching an infected person or surface
  contaminated with the virus and then touching
  your own or someone elses face

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Understanding pandemic

• Epidemic unusual increase in a single
  community, population or region
• Pandemic epidemic spreading around the world
  affecting millions of people, across many
  countries
• of incidence/prevalence disease/disorder

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What is a flu pandemic?

• Flu pandemics are global epidemics of a newly
  emerged strain of flu (a new influenza A subtype)
  
• Three pandemics in the last century
• Worst1918--killed gt50 million worldwide more
  lives lost than during the First World War

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What causes pandemic flu?

• Emergence of a new flu virus
• New virus passes easily from person to person
• Few, if any, people have any immunity
• This allows it to spread widely, easily and to
  cause more serious illness

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Who is at risk?

• Everyone is at risk
• Certain groups may be at greater risk of serious
  illness than others
• Until the virus starts circulating we will not
  know for sure who is at most risk

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Is there a vaccine?
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Is there a vaccine?

• There will be no vaccine ready to protect against
  pandemic flu specific vaccine cannot be made
  until the virus has been identified (and then gt6
  mo before available)
• Cannot be predicted in same way as ordinary
  seasonal flu
• Ordinary flu vaccine will not provide protection

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Death From Influenza

• Viral Pneumonia
• Rapid Destruction of Lung Tissue (inflammatory
  response)
• Secondary Bacterial Pneumonia
• Encephalitis
• 36 thousand die each year

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Lessons from past pandemics

• Occurs unpredictably, not always in winter
• Great variations in mortality, severity of
  illness and pattern of illness or age most
  severely affected
• Rapid surge in number of cases over brief period
  of time, often measured in weeks
• Tend to occur in waves - subsequent waves may be
  more or less severe
• Key lesson unpredictability

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Realities of Community Impact

• Potential High Death and Illness numbers
• Medical system and resources overwhelmed
• Effects on business and other operations
• COOP- business continuity
• Simultaneous impact in communities throughout US
  and other countries

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Realities of Community Impact

• Vaccine will not be readily available.
• Antiviral agents currently in short supply (and
  may not be effective)
• Simultaneous impact in communities throughout US
  and other countries
• Count on No outside resource- We are the
  assistance. (Not from any lack of will or
  wallet. Leavitt)

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Individual/Family Preparedness

• Consider potential circumstances and
  contingencies
• Have an emergency plan for your family
• Have an emergency survival kit
• Include supplies, etc. for at least two to three
  weeks )
• Be prepared to follow social distancing ,
  isolation, quarantine recommendations

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Preventing influenza transmission Community

• Close schools, churches, and public buildings?
• Prevent mass gatherings?
• Reduce hospital visits
• Hand hygiene, tissues (respiratory etiquette)
• Shut down public transportation?
• Mask advisories?
• Voluntary isolation
• Home care
• Vaccine or chemoprophylaxis

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Avian influenza
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If youre a bird, theres a pandemic if youre
human, theres not.

• Michael Leavitt
• Secretary of HHS
• March 20, 2006

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Avian influenzafrom birds to humans
Migratory water birds

• Hong Kong 1997, H5N1
• HK, China 1999, H9N2
• Netherlands 2003, H7N7
• Hong Kong 2003, H5N1
• Viet Nam and Thailand, 2004 H5N1

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Avian influenza

• Highly pathogenic avian flu (A/H5N1) currently
  circulating in poultry in Asia
• Strain of Avian flu has shown ability to transmit
  from poultry to people
• Fear that humans infected with Avian flu could
  also be infected with ordinary flu
• Exchange of genes could lead to emergence of a
  potentially pandemic strain

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Why is H5N1 Influenza so bad?

• The subtype mutates rapidly
• Acquires genes from viruses infecting other
  animal species
• It is stable in the environment
• It causes severe disease in humans, with a high
  case-fatality rate

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The world has changed

• Global population in 1918 was 1.6 billion vs. 6
  billion today
• Intercontinental travel is in hours vs months
  millions of travelers vs hundreds
• Human crowding has increased
• Population health has improved
• Animal husbandry has changed
• Interdependence has increased

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Opportunities for virus emergence and spread

• Modern pig and poultry production create
  conditions for mass animal influenza outbreaks
• Proximity of humans and animals in many markets
  create potential for virus recombination
• Human crowding and travel present opportunities
  for virus spread

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Warning signs

• Experts from WHO believe signs of another
  pandemic are increasing
• Continued outbreaks of Avian H5N1 infection in
  poultry in Southeast Asia
• Linked to human cases of Avian H5N1 flu
• Raised concern virus may be adapting to infect
  people more readily

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Preparedness

• Pandemic Flu Response Plan
• Guidelines on infection control
• Public information messages
• Public vs. Corporate vs. Government
• Exercise/Training

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Preparedness

• daily monitoring federal and international
  health agency health advisories and
  recommendations.
• monitoring travel-related recommendations for
  changes
• updating medical protocols in accordance with CDC
  recommendations.
• working closely with local, regional and state
  health authorities and emergency preparedness
  organizations

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Response

• Surveillance- early detection/response
• Rapid identification of virus infection and
  characterization of subtype
• Implement Pandemic Response Measures
• Contain new viruses, delay spread
• Isolation, quarantine, social distancing
• Risk/public health communication

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National Strategy
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Useful resource links

• http//www.eh.doe.gov/health/avian.html
• http//www.cdc.gov/flu/avian/
• http//www.pandemicflu.gov/
• http//www.doh.wa.gov/panflu/
• http//www.who.int/topics/avian_influenza/en/
• http//www.who.int/topics/influenza/en/

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Hopeis not a strategy, but it helps.