Pandemic Influenza

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Pandemic Influenza

• Department Safety Representatives
• May 18, 2007
• Nianne VanFleet RN MS/Janet Corson-Rikert, MD

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Media coverage
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Agenda

• Influenza
• Pandemic Influenza
• Avian Influenza
• Planning For a Pandemic
• Questions

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Influenza
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What is Influenza?

• Most of what is commonly referred to as the flu
  is not influenza
• Viral illness that affects respiratory system
• Contagious, epidemic illness
• Occurs worldwide
• Considerable illness and death each year

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Symptoms of Influenza

• Abrupt onset
• Fever, headache, muscle aches for 35 days
• Cough and lack of energy 2 weeks or more
• Possible nasal congestion and sore throat
• Can cause pneumonia and other life-threatening
  complications

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Transmission of Influenza

• Incubation 2 8 days
• Viral shedding starts 1-3 days before symptoms
  and may last for 1-2 weeks
• Transmission mostly through droplet spread

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Influenza Treatment

• Most healthy individuals recover without medical
  intervention
• Antiviral medications may be effective if started
  early (resistance increasing)
• Antibiotics for secondary bacterial infection

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Influenza Vaccination

• Effective preventive
• High risk individuals prioritized
• Chronic disease
• Age 6-23 months
• Age 50 or older
• Pregnant women
• Health care workers
• Must be repeated on annual basis

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Types of Influenza Viruses

• Influenza A viruses
• Affect birds and humans
• Cause more severe illness of longer duration
• Can cause pandemics
• Influenza B viruses
• Affect humans only
• Cause milder illness
• Do not cause pandemics

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Influenza A Viruses

• Virus subtype based on surface glycoproteins
• Hemagglutinin (H) 1-16
• Neuraminidase (N) 1-9
• Current human subtypes
• H1N1
• H1N2
• H3N2
• Other 141 subtypes in animals

NA
HA
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Changes in Influenza Viruses

• Virus regularly mutates, with new strains
  circulating each influenza season
• Immunity is specific to strain
• Vaccine must be developed annually to target
  strains predicted to dominate
• Takes 6 months to develop
• Effectiveness varies with success of prediction

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Pandemic Influenza

• Gradual drift or sudden shift ? novel strain
• No human immunity anywhere in world
• Global outbreak or pandemic 3x per century

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Pandemic Influenza in 20th Century
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
2040 m deaths 675,000 US deaths
14 m deaths 70,000 US deaths
14 m deaths 34,000 US deaths
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In 1918 Americas deaths from influenza were
greater than the number of U.S. soldiers killed
in any war
Thousands
Civil WWI 1918-19 WWII
Korean Vietnam War
Influenza War War

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Avian Influenza
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Avian Influenza

• Caused by influenza A viruses that occur
  naturally among wild birds
• Humans have no immunity
• Low pathogenic strains not harmful to humans

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H5N1 Avian Influenza

• H5N1 variant deadly to domestic fowl
• Can be transmitted from birds to humans
• Emerged in 1997, with outbreaks among birds in
  Asia, Africa, Middle East, Europe
• Cumulatively, 306 cases of transmission to
  humans in 12 countries
• Mostly rural poultry farmers and their families
• Infection through direct contact with infected
  birds or contaminated surfaces near birds

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Public Bird Markets
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Larger Scale Poultry Farmers
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Close Contact with Sick Birds
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H5N1 Avian Influenza Human Cases

• Severe pneumonia
• Multi-organ failure
• Limited effectiveness of anti-viral medicine
• Mortality gt60
• Young, previously healthy individuals
• Human infection rare
• Human to human transmission more rare

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Next Pandemic H5N1?

• Uniquely pathogenic to poultry
• Transmissible to humans, with high mortality
• Rapid spread along bird migration routes
  increases opportunity for further mutation
• May see avian flu in waterfowl in US this year,
  but unlikely to present major risk to humans in
  current form
• We DONT know if H5N1 will mutate into a pandemic
  form

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WHO Pandemic Phases
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Planning for a Pandemic
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A different kind of emergency

• Scope whole world at once
• Duration weeks to months

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Governmental Agencies

• World Health Organization
• US National Strategy
• Centers for Disease Control
• New York State Department of Health
• Tompkins County Health Department

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Pandemic flu will be a shared responsibility
requiring public and private sector cooperation
Healthcare Delivery System
International Partners
Local/State/Federal Public Health System

Educational Institutions
Homeland Security and Economic Protection
Partners
Private Sector Business
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Modified from NYSDOH Pandemic Flu Facts
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Pandemic Influenza Planning Assumptions

• Will arrive with little warning, likely from
  overseas
• Simultaneous outbreaks throughout US
• Quarantine limited in effectiveness
• May come in waves of 6 - 8 weeks duration over 12
  - 18 month period

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Health Planning Assumptions

• Widespread illness - 2530 of population
• Vaccine delayed
• Antiviral agents in short supply
• Outpatient medical facilities overwhelmed
• 50 of ill will seek medical care
• Hospitalizations may vary 10-fold
• up to 10
• Mortality 1 to 2

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Severe Pandemic Impact on Commerce

• Social and economic disruption
• Peak workplace absence 40-50
• Supply shortages
• Service interruptions
• Transportation disruption
• World Bank estimates
• Potential 2 Trillion impact on global economy

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WHO Strategy

• Prioritize research on avian flu vaccine
• Boost production of antiviral agents
• Coordinate international surveillance
• Contain at point of pandemic onset
• Isolation, quarantine, ? travel restrictions
• Goal to delay worldwide spread
• Time for planning, vaccine development

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Planning for Pandemic Influenza at Universities
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Particular Challenges for Universities

• Duration, scope of crisis
• Size and decentralization of institution
• Students numbers, communal living, away from
  family supports
• International community
• Research, animals

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Pandemic Flu Planning at CU

• Pandemic Flu Task Group charged and convened in
  February 2006.
• Plans for this specific emergency to be developed
  in context of general emergency preparedness
  planning

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Pandemic Flu Steering Committee

• Steering Committee
• Health Services
• Environmental Health and Safety
• Risk Management
• Police
• IT
• Facilities
• Residential / Dining
• Dean of Students
• Academic / Research

• Executive Vice Presidents Office
• Business / Finance
• Purchasing
• Human Resources
• Payroll
• Communications
• Counsel
• College reps (CVM, CALS)

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Steering Committee Charge

• Develop policies and both short- and long-term
  procedures to guide university's preparedness for
  an outbreak of pandemic flu
• Identify critical resources and supplies and
  address how best to procure them
• Identify key factors or conditions that will
  trigger critical decision-making, and recommend
  who should make those decisions

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General Approach

• Unified philosophy and centralized oversight
• Executive Committee on Campus Health and Safety
• Pandemic Steering Committee
• Central Emergency Planning Team
• Community mitigation strategies
• Case containment
• Social distancing
• Infection control

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Goals of Community Mitigation
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Campus Public Health Measures

• Individual
• Seasonal flu vaccination
• Social distancing
• Voluntary isolation, treatment per guidelines
• Voluntary quarantine
• Hygiene

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Cough Etiquette and Hand Hygiene

• Cover mouth/nose when sneezing or coughing
• Use elbow instead of hands, if no tissue
• Wash hands or use alcohol-based hand rub after
  contact with respiratory secretions

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Campus Public Health Measures(scaled to severity
of pandemic)

• Social distancing
• Cancellation of classes and public gatherings
• Evacuation of residential students
• Suspension of university-sponsored travel
• Workplace measures
• Discontinuation of non-essential operations
• Modification of schedules and practices
• Avoidance of face-to-face meetings

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Campus Public Health Measures

• Infection control
• Mass vaccination
• Antiviral agents per NYSDOH recommendations
• Personal protective equipment for at-risk
  personnel

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Personal Protective Equipment

• Surgical masks for patients suspected of pandemic
  flu infection
• N-95 respirators for workers with close patient
  contact

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Masks for Well People?

• Benefit of mask use by well persons not yet
  established
• Must keep hands away from mask

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• Very High Exposure Risk
• Healthcare employees engaged in high-risk
  procedures
• High Exposure Risk
• Healthcare delivery and support staff
• Medical transport
• Medium Exposure Risk
• Employees with high-frequency close contact with
  general population
• Lower Exposure Risk (Caution)
• Office employees

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Sub-group Planning(Initial focus on severe
pandemic)

• Student Services
• Evacuation of students in residence
• Food and shelter for remaining students
• Health Services
• Public health guidelines
• Screening protocols
• Surge operations
• Coordination with local agencies

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Sub-group Planning

• Communications
• Internal and external
• Essential Infrastructure
• Police, safety, utilities, IT, transportation
• Human Resources
• Payroll policy, staff support
• Academics / Research
• Animal care
• Prioritization of research

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Timeline

• Central plan completed June 07
• College and Unit planning underway
• Ongoing development

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Ongoing Issues for Leadership Consideration

• Financial investment
• How risk averse do you want to be?
• How will you compensate employees who are asked
  to stay home relative to those who work and those
  who work with additional risk?
• Research
• If resources are inadequate to maintain all
  research, how will it be prioritized?

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Remember
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We dont know

• Whether the next pandemic will be caused by H5N1
  
• When it will happen
• If it will be mild or severe
• How long it will last

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We do know

• PANDEMIC FLU WILL OCCUR
• Advance planning will be critical
• Planning will be useful for other emergencies
• Preparedness begins with individuals and families
• Each of us will have an important role
• Community welfare will depend on the caring and
  commitment of each member

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Pandemic Flu Planning Introduction If you pay
attention to media of any kind, you've surely
learned something about avian influenza ("bird
flu") and preparations for the possibility of a
flu pandemic. Government websites, newspapers,
morning and evening news shows, scientific
journals, even TV drama reflect a growing
awareness and concern about the spread of avian
influenza among birds and the potential threat to
people. No one knows whether the
current epidemic of avian flu (H5N1) will develop
into a human flu pandemic, or under what
circumstances. However, history does teach us
that we should expect a global flu pandemic at
some point and must prepare for it. The
U.S. Department of Health and Human Services has
a pandemic flu plan, as do the New York State and
Tompkins County Health Departments. Communities,
health services organizations, educational
institutions, and businesses across the country
are engaged in planning that will enable them to
protect and care for individuals, anticipate and
respond to community needs, and deliver essential
services.
On this site - Cornell preparedness - Facts
about flus (avian,    pandemic, seasonal)  -
Travel to areas affected    by avian influenza 
- Resources News The next Director-General of
the World Health Organiza- tion (WHO) will be
Dr. Margaret Chan of China, a leader in
international avian flu surveillance and pandemic
flu prevention and preparedness.
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http//www.gannett.cornell.edu/campushealth/pandem
icflu.html
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www.gannett.cornell.edu

• Information about avian flu and pandemic flu
  links to resources, FAQs
• Personal and family emergency planning resources,
  check-lists
• Seasonal flu prevention, vaccination, treatment
  information
• Seasonal flu posters to download, messages to
  include in newsletters, etc.

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Questions?