PANDEMIC INFLUENZA PLANNING:

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PANDEMIC INFLUENZA PLANNING WHAT SCHOOLS NEED TO
KNOW
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EVERYONE IS WORRYING ABOUT INFLUENZA (KIDS,
PARENTS, TEACHERS...)
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THINKING ABOUTPANDEMIC INFLUENZA

• ? INTRO BACKGROUND
• ? WHAT IS PANDEMIC INFLUENZA?
• ? WHAT IS AVIAN INFLUENZA?
• ? WHAT IS OUR STATE OF KNOWLEDGE?
• ? WHAT SHOULD WE DO TO PREPARE?
• Mitigation Prevention Response
• Preparedness Recovery

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WHAT IS A PANDEMIC?AN EPIDEMIC IS A DISEASE
THAT OCCURS WITH GREATER FREQUENCY THAN EXPECTED
A PANDEMIC IS AN EPIDEMIC THAT SPREADS ALL OVER
THE WORLD, OR A MAJOR REGION OF THE WORLD (E.G.,
A CONTINENT) EPIDEMICS AND PANDEMICS EPI
UPON DEMIC "THE PEOPLE"PAN "ALL OVER"
DEMIC "THE PEOPLE"WELL-KNOWN PANDEMICS
INCLUDE AIDS, TB, MALARIA (IN ALL TROPICAL
REGIONS) AND THE "BLACK DEATH" OF THE 14TH
CENTURY (BUBONIC/PNEUMONIC PLAGUE)
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PANDEMICS OF INFLUENZAINFLUENZA PANDEMICS OCCUR
PERIODICALLY WHEN A NEW INFLUENZA VIRUS APPEARS
THEY ARE ALWAYS UNPREDICTABLEOVER THE PAST 300
YEARS, THERE HAVE BEEN 11 INFLUENZA PANDEMICS
OCCURING AT INTERVALS OF AS LITTLE AS 8 AND AS
MANY AS 65 YEARSPANDEMIC VIRUSES APPEAR, CAUSE
PANDEMICS, AND THEN KEEP REAPPEARING TO CAUSE
ANNUAL MILDER WINTER EPIDEMICSTHE LAST 4
INFLUENZA PANDEMICS WERE IN 1889, 1918, 1957 AND
1968THE 1918 PANDEMIC WAS THE MOST FATAL EVENT
IN HUMAN HISTORY, KILLING AN ESTIMATED 50-100
MILLION PEOPLETHE 1918 INFLUENZA VIRUS CAME
BACK ANNUALLY UNTIL 1957, WHEN IT WAS REPLACED BY
AN OFFSPRING VIRUS THAT HAD "PICKED UP" NEW BIRD
INFLUENZA GENES THE 1968 PANDEMIC WAS CAUSED BY
A FURTHER DESCENDANT OF THE 1957 VIRUS
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MOST FATAL EVENTIN HUMAN HISTORY WORLDWIDE
FATALITIES50-100 MILLION US
FATALITIES675,000
U.S. LIFE EXPECTANCY AT BIRTH
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ILLUSTRATION BY W. THORNTON SHIELLS, MOH, GREAT
BRITAIN, 1919
"HELIOTROPE CYANOSIS", PRECEDING DEATH
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1918 influenza lung pathology (Case 2) Primary
influenza pneumonia with acute massive pulmonary
edema and bronchopneumonia A/New York/1/18
SLIDE COURTESY OF JK TAUBENBERGER, AFIP
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WHAT IS "BIRD FLU"?"BIRD FLU" IS A
SLANG TERM FOR AVIAN INFLUENZAIT IS NOT A GOOD
TERM BECAUSE1) THERE IS NO SUCH DISEASE AS
"FLU", A COLLOQUIAL TERM FOR A VARIETY OF
DIFFERENT STOMACH AND RESPIRATORY UPSETS2) ALL
HUMAN INFLUENZA A VIRUSES ARE DESCENDANTS OF
AVIAN INFLUENZA VIRUSES, BUT DIFFER FROM THEM IN
HAVING LEARNED THE TRICK OF JUMPING INTO
HUMANS3) ALL AVIAN INFLUENZA VIRUSES ARE
ADAPTED TO THEIR HOSTS - WILD WATERFOWL (DUCKS
AND GEESE), AND DO NOT HARM THEMH5N1 IS ONE OF
MANY TYPES OF AVIAN INFLUENZA (E.G., H7N7, H5N2)
BUT IS OF INTEREST BECAUSE IT HAS BEEN SPREADING
RAPIDLY AND KILLING CHICKENS. SOME EXPERTS FEAR
IT WILL TURN INTO A PANDEMIC BY JUMPING FROM
CHICKENS TO HUMANS. BUT OTHER EXPERTS DOUBT THIS
WILL HAPPEN.
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HOW DO AVIAN VIRUSES OF DUCKS GEESE BECOME
HUMANIZED?
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• Sequence analysis predicted the importance of
  the change at residues 190 225 for human
  adaptation
• The 1918 HA receptor-binding site shows that
  the Glu190Asp mutation leads to a slight increase
  in the pocket size that increases affinity for
  a(2,6) linkages
• This has been tested experimentally

SLIDE COURTESY OF JK TAUBENBERGER, AFIP
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UPDATE
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HUMAN H5N1 CASES ( ) DEATHS ( )
CUMULATIVE , GLOBAL TOTAL, WHO-CONFIRMED
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WHAT IS THE CURRENT STATE OF KNOWLEDGEABOUT
AVIAN INFLUENZA?

• ? EVOLVING "STORY", CHANGES DAILY
• ? NO PRECEDENT FOR THIS
• ? HOW INFLUENZA SWITCHES TO HUMANS
• IS COMPLETELY UNKNOWN
• ? THE EXPERTS ARE UNSURE AND
• DO NOT AGREE ON KEY POINTS
• ? NO GOOD DATA ON WHAT WILL WORK
• TO PREVENT OR MITIGATE A PANDEMIC

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SCHOOLS FACE TOUGH PANDEMIC QUESTIONS
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SCHOOL PANDEMIC PLANNINGTHINGS TO THINK
ABOUT?THE ROLES OF SCHOOLS IN THE COMMUNITY ?
COMMUNICATING WITH PUBLIC HEALTH AND GOVERNMENT
OFFICIALS ? UPDATING SCHOOL CRISIS PLANS ?
LEARNING ABOUT PREVENTING INFECTIONS ?
EDUCATING PARENTS, KIDS, STAFF ?
INFORMING/COUNTERING DISINFORMATION ?
MAINTAINING THE LEARNING ENVIRONMENT
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PANDEMIC PLANNINGSTATEWIDEFEDERAL
LOCAL
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FRAMEWORK FOR PANDEMIC PLANNING?LOCAL
SCHOOL/DISTRICT COMMUNITY CRISIS
PLANNING?STATE PANDEMIC PLANNING
ACTIVITIES?FEDERAL PLANNING AND
GUIDANCEDepartment of Homeland
SecurityDepartment of Health Human
ServicesDepartment of Educationmany other
federal agencies ?Planning must be
broad/interactive/cross-cuttinggovernment
executive, civil agencies, health departments,
medical providers, businesses, schools,
private/voluntary/faith based organizations
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BEFORE THE PANDEMICMITIGATION
PREVENTION ?Liaison with state/local health
officials ?Roles/responsibilities of
staff?Roles of school nurses school
physicians ?Assign key roles?Review health
needs of students?Improve health activities
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BEFORE THE PANDEMICPANDEMIC PREPAREDNESS ?Updat
e crisis plans?Educating staff, students
parents?Procedures to Account for
Students/Staff?Crisis Communication/Authority
Delegation
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DURING THE PANDEMICPANDEMIC RESPONSE
?Maintaining operations the learning
environment?Triage of ill students
Isolation?Hygiene, sanitation/disinfection,
good health practices?Disease prevention
(masks, hand washing)?Communications
countering misinformation?School closure?Role
of schools in disseminating community
informationUse of schools as clinics, hospitals,
morgues, vaccination sites or vaccine
storage sites?Dealing with fears, losses
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AFTER THE PANDEMICPANDEMIC RECOVERY ? Allocate
time for recovery ? Involve kids parents?
Counseling ? Debriefings/lessons learned ?
Plan anniversaries? Facility remediation
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ACKNOWLEDGEMENTSTHANKS TO THE MANY WONDERFUL
FOLKS AT THE US DEPARTMENT OF EDUCATION,
INCLUDING BILL MODZELESKI, DANA CARR, DEBBIE
PRICE, CAMILLE WELLBORN, AND A CAST OF
(LITERALLY) THOUSANDS...
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HOMEWORK ASSIGNMENT

• IDENTIFY
• AND CALL YOUR KEY LOCAL
• PUBLIC HEALTH OFFICIAL

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UNUSUAL FEATURES OF THE1918 INFLUENZA PANDEMIC

• ? 3 successive waves within 9 months
• ? Unexpectedly high mortality at all ages
• ? Paradoxical mortality
• low in wave 1, high in waves 2 3
• ?in young/healthy, ?in elderly
• ? Severe bronchopneumonia cyanotic collapse
• ? Caused by a novel H1N1 virus

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Q5 WHAT KILLED INFLUENZA VICTIMS?
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U. S. Army training camp and other military
outbreaks were deadly but well studied medically/e
pidemiologically
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SCHOOL HOUSES WERE TURNED INTO TEMPORARY HOSPITALS
DURING THE 1918 INFLUENZA PANDEMIC
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SCHOOL CLASS, 1918
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EXTENSIVE PUBLIC HEALTH EXPERIENCE WITH TB
CONTROL HEAVILY INFLUENCED INFLUENZA
PREVENTION EFFORTS IN THE U. S.
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INDOOR CHURCH SERVICES WERE BANNED BY HEALTH
DEPARTMENTS
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