Planning for a Severe Influenza Pandemic: Implications for Post Secondary Institutions

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Planning for a Severe Influenza Pandemic
Implications for Post Secondary Institutions
NACAS Web Conference in Conjunction with NACAS
South Annual Conference May 7, 2007
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Todays Presenter

• Diane Allensworth, PhD, RN
• Associate Director, Education Sector
• Division of Private and Public Partnerships
• Centers for Disease Control
• dda6_at_cdc.gov
• The findings and conclusions in this
  presentation are those of the authors and do not
  necessarily represent the views of the Centers
  for Disease Control and Prevention/the Agency for
  Toxic Substances and Disease Registry."

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Agenda

• Influenza Epidemiology
• The Probability of an Influenza Pandemic
• National Preparedness
• Community Preparedness
• Planning Assumptions
• University Preparedness
• Personal Preparedness

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Definition of Influenza

• A contagious disease caused by the influenza
  viruses a specific group with well-defined
  characteristics.
• Primarily affects the respiratory tract
• Can cause severe illness and lead to life-
  threatening complications
• An annual public health problem
• A global infectious disease threat

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• Cause Influenza A Viruses

• Subtypes based on surface glycoproteins
• 16 hemagglutinins (HA)
• 9 neuraminidases (NA)

HA
NA
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Influenza Viruses

• Naturally infects many animal species
• Birds mammals, including humans
• Wild birds are main reservoir for influenza A
  viruses
• All known A subtypes circulate in wild birds
• Infect wild and domesticated birds
• People usually infected only by human viruses

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Influenza Terms Defined

• Seasonal (or common) flu
• Transmitted person to person
• Most people have some immunity
• Vaccine is available
• Pandemic flu
• Novel virus emerges
• Little or no natural immunity
• Can spread easily from person to person causes
  illness
• No vaccine available

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Seasonal Influenza

• Seasonal Influenza
• 36,000 deaths annually,
• (Usually in those 65)
• 53 million lost k-12 school
• days each year

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Pandemics Happen!
H9
1998
1999
H5
2003
1997
2003-2005
H7
1980
1996
2002
2003 2004
H1
H3
H2
H1
1977
1915
1925
1935
1945
1955
1965
1975
1985
1995
2005
1918 Spanish Flu H1N1
1957 Asian Flu H2N2
1968 Hong Kong Flu H3N2
Avian Flu
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The Probability of an Influenza Pandemic

• Outbreaks of avian influenza
• (bird flu) in Asia and Europe
• Global increase in population density and
  human/animal closeness
• Increased global transport

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Avian Influenza

• Avian influenza or bird flu is an infection in
  birds caused by several varieties or subtypes of
  influenza.
• One subtype is H5N1.
• .

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Spread Avian H5N1 InfectionJan-May 2006 (BBC Web
Site)
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Spread Human H5N1 InfectionJan-May 2006 (BBC Web
Site)
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Human Pandemic Influenza Global Outbreak

• Conditions Supporting Pandemic Influenza
• New influenza type emerges
• Causes serious human illness
• Spreads easily from person to person

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Currently there is no human pandemic influenza in
the world.

• Scientists can not predict if the H5N1 virus
  might start a human pandemic.
• Scientists can not predict when the next human
  pandemic might start.

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1918-19 Pandemic Influenza (Type A H1N1)

• More than 500,000 deaths in the US.
• Up to 50 million may have died world wide.

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A 1918 Pandemic Today Would Exact a Horrible Toll

• 50 or more of those who become ill will
• seek medical care

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Questions?
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CDC Prepares for a Possible Pandemic

• Issues
• An Influenza pandemic may
• emerge with little warning.
• A vaccine will not yet be
• available.
• The supply of anti-viral drugs
• will be limited.

CDC
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Implementation Plan for the National Strategy

• Strategy released on Nov 1, 2005
• Provides guidance on implementation on the
  development of Department plans
• Communicates expectations of non-Federal entities

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www.pandemicflu.gov
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State-level Pandemic Flu Plansat Pandemicflu.gov
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Typical Checklist
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Planning Assumptions Epidemiologic
Characteristics

• Incubation Period
• 1-4 days (average 2 days)
• Viral Shedding and Transmission
• Viral shedding and the risk of transmission will
  be greatest during the first 2 days of illness
• Asymptomatic transmission
• May persist up to 10 days
• Children shed more viruses

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Planning Assumptions Continued Epidemiologic
Characteristics

• Viral Shedding and Transmission Continued
• Children usually shed more virus and cause more
  transmission
• On average, infected persons will transmit
  infection to approximately two other people
• Course of the Pandemic
• Outbreaks in communities will last about 6 to 8
  weeks.
• Multiple waves may occur with each wave lasting
  2-3 months.

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Models Predict Profound Domestic Effects

• 25-30 of US population could develop disease
• If like 1918 9.9 million would need
  hospitalization ( if like 1958-68 865 thousand)
• ICU Care 130 thousand 1.5 million
• Deaths 209 thousand 1.9 million
• In any community, 10 or more of adults unable to
  work during peak
• Direct and indirect health care costs 181
  billion
• National economic cost trillions

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Planning Assumptions Absenteeism

• In a severe pandemic
• Absenteeism may reach 40 during the peak weeks
  of a community outbreak
• Public health measures will increase rates of
  absenteeism
• Dismissing students from day care, K-12 schools
  and colleges
• Quarantining household contacts of infected
  individuals

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Potential Tools in Our Toolbox

• The best countermeasure vaccine will probably
  be unavailable during the first wave of a
  pandemic.
• Antiviral treatment
• May improve outcome for patient
• Will have more substantial effects on reducing
  transmissions.
• Infection control and social distancing should
  also reduce transmission.

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Tools in the Toolbox Continued Infection
Control / Social Distancing

• Transmission Interventions (Infection Control)
• Cough etiquette
• Hand hygiene
• Contact Interventions (Social Distancing)
• Day care/School/College student dismissal
• Telecommuting
• Liberal leave

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Using the Tools Community-Based Interventions
1. Delay outbreak peak 2. Decompress peak
burden on hospitals/infrastructure 3. Diminish
overall cases and health impacts
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Youth Social Distancing Not the Norm!
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Combining Strategies Glass Model Targeted
Social Distancing
Glass, RJ, et al. Local mitigation strategies for
pandemic influenza. NISAC, SAND Number
2005-7955J
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What do the Modeling Results Mean?

• Not proof of efficacy or effectiveness, BUT offer
  reason for optimism in regard to community tools
  - Non-Pharmaceutical Interventions (NPIs).
• Suggest that maximal effectiveness will be
  achieved by appropriate layering and timing.
• Need to be evaluated based upon assumptions
  validated against experience

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A Targeted and Layered Approach for Using
Community Intervention Tools (NPIs) Modeling
Suggests that Community Actions May Significantly
Reduce Illness and Death Before Vaccine is
Available
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A Layered Approach
Individual / Household
Community
International
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A Layered Approach
Individual/Household Hand hygiene Cough
etiquette Infection control Isolation of
ill Designated care provider Facemasks
Community
International
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A Layered Approach
Community Isolation of ill Treatment of
ill Quarantine of exposed Prophylaxis of
exposed Student dismissal Protective
sequestration of children Social distancing
Community Workplace Liberal leave policies
International
Individual / Household
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A Layered Approach
Individual / Household
Community
International Containment-at-source Efforts to
reduce transmission Travel advisories Layered
screening of travelers Health advisories Limited
points of entry
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Questions?
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Recommendations for colleges and universities

• Draft key documents identifying
• Legal authority for action
• (quarantine, isolation,
• movement restriction)
• Opening and closing schools
• Continuity of instruction options
• Communication to staff, students
• and families

UNCG
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Resources1) www.pandemicflu.gov 2) College
and Universities Checklist3) Individual and
Family Checklist4) Business Checklist5)
Community Strategy for Pandemic Influenza
Mitigation
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Additional Resources

• Sample Campus Response PlansCarnegie Mellon
  University, Pennsylvania
•  http//ehs-alert.fms.bap.cmu.edu/EHSWebSite/Emerg
  encyOperations/PandemicPlanning/Avian_Influenza/Av
  ian20Influenza20Response.php
• University of Maryland
• http//www.umd.edu/emergencypreparedness/pandemic_
  flu/avfplan.cfm
• University of Minnesota
• http//www.ahc.umn.edu/about/admin/oer/pandemic/ho
  me.html
• American College Health Association
• http//www.acha.org/info_resources/pandemic_flu.cf
  m

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Crisis Planning The Basic Steps

• Prevention
• Preparedness
• Response
• Recovery

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Prevention

• Reducing and/or eliminating risk to life and
  property of a particular environment.
• Implement prevention
• programs
• Institute policies to
• reduce impact

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Preparedness

• Constructing a plan to properly handle a
  situation prior to its occurrence.
• University level

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Preparedness

• 1. Identify a team to integrate the management
  plan into existing crisis management plans
• Coordinate with local/state health department/
  emergency responders ensuring compatibility
• Contribute to the local plan for surge capacity
  of health
• care and other services

UNCG
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Preparedness

• Identify process and procedures for
• Continuity of student learning
• Web based instruction
• Telephone trees
• Radio/TV instruction
• Mailed lessons
• Core operations

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• Written Policies
• Non-punitive sick leave
• Housing international students
• Environmental hygiene/Isolation
• Supporting community health care needs

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Preparedness Communication

• Create and test an effective means of
  communication with staff, students, families and
  the media
• Determine means of communication
• (Telephones, radio, TV, e-mails, mail, etc.)
• Develop partnerships with media, community
  agencies and law enforcement

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Issues Particular to Residential Post Secondary
Institutions

• Refunds of housing funds
• Maintaining housing food for selected
  groups/Identifying processes for infection
  control
• Contracts with vendors
• Payment of faculty, other staff
• Recruiting freshman (Will a cohort graduate
  H.S.?)
• Difficulty in shifting calendar
• Allowing shift of coursework from lab classes

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Health Protection Preparedness SystemIt
takes a NETWORK!

• Local - state - federal
• Domestic international
• Multisector integration
• Public private
• Health protection homeland security economic
  protection

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Are You Personally Prepared?

• Prepared for quarantine?
• Developed alternative sources for critical
  supplies?
• Identified possibilities for tele-work?
• Instituted aggressive infection-control practices
  for family and friends?
• Advocated for community action, especially a
  safety net for those unable to protect
  themselves?

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Acknowledgements

• Carter Mecher (VA)
• Rajeev Venkayya (HSC)
• Richard Hatchett (NIH)
• Camille Welborn (DoEd)
• CDC
• Martin Meltzer
• Richard Dixon
• Ralph Cordell

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Questions?