Influenza

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Influenza What in the world do YOU need to know?
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Influenza

• Seasonal
• Avian
• Pandemic

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What is Seasonal Influenza?

• Acute, febrile respiratory illness affecting
  nose, throat, bronchial tubes and lungs
• Epidemics caused by influenza viruses A and
  B(Type C uncommon in people no epidemics)
• Occurs worldwide, causing considerable morbidity
  (illness) and mortality (death) each year

• Symptoms appear rapidly

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How You Get the Flu?

• Typical incubation 2 days Range 1-4 days
• Viral shedding
• Can begin 1 day before symptom onset
• Peak shedding first 3 days of illness
• Correlates with temperature
• Subsides after 5 days in adults, can be 10 days
  in children

Transmission is predominately droplet spread
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The Burden of Seasonal Influenza

• Globally 250,000 to 500,000 deaths each year
• In the United States each year
• 36,000 deaths
• gt200,000 hospitalizations
• 37.5 billion in economic costs from influenza
  and pneumonia

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What is Avian Influenza?

• All flu is bird flu
• Current concern is H5N1
• Worldwide poultry outbreak
• Rare, but severe in humans
• NOT EASILY SPREAD HUMAN TO
• HUMAN

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Nations With Confirmed Cases H5N1 Avian
Influenza (May 19, 2006)
Source http//www.pandemicflu.gov/map
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Current H5N1 situation in humans

• 229 human cases, world-wide since December of
  2003 (as of 7/4/06)
• 130 deaths
• 57 mortality rate (fatality)

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Situation Summary Avian Influenza

• Widespread occurrence in migratory birds
• Continued outbreaks among domestic poultry
• Asymptomatic infections in domestic ducks
• Lethal infections in mammals (cat, pigs)
• Still lacks ability to travel easily human to
  human, but every infection provides another
  opportunity for the virus to change

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How Influenza Viruses Change?

• Antigenic Drift
• Small changes in virus over time
• New strains appear and replace older strains
• May not be recognized by antibodies to older
  strains
• Antigenic Shift
• Abrupt, major change (reassortment)
• Results in novel strain or new subtype
• Can cause pandemic influenza

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Will Avian (Bird) 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

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What is Pandemic Influenza ?

• A global influenza outbreak
• Caused by a brand new (novel) flu virus
• Can occur at any time of year
• 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

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Influenza Pandemics 20th Century
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
20-40 m deaths 675,000 US deaths
1-4 m deaths 70,000 US deaths
1-4 m deaths 34,000 US deaths
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If a Pandemic Happens What to expect

• At the peak of a moderate pandemic influenza
  outbreak (i.e. 35 attack rate, 6 week duration),
  New York State (excluding New York City) can
  expect
• 14,916 influenza-related hospital admissions per
  week
• 3,728 influenza-related deaths per week
• 2,609 deaths in the hospital
• Influenza patients will most likely utilize
• 63 of hospital bed capacity
• 125 of intensive care capacity
• 65 of hospital ventilator capacity.

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What is New York State doing to prepare?
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HHS Pandemic Influenza Doctrine Saving Lives

• 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
• Infection control
• Vaccine when available
• Maintain essential services
• Local decisions
• Communication

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Public Health Emergency Preparedness - A Shared
Responsibility!

• Local state federal
• Domestic international
• Public private
• Multi-sector
• Animal human
• Health protection homeland security economic
  protection

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What is Ontario County doing to prepare?

• Public Health Emergency Planning since 2003
• White Powder Plan
• ChemPak Plan
• Medical Reserve Corps
• Isolation and Quarantine Protocol
• Strategic National Stockpile Plan
• 9 County Public Health Mutual Aid Agreement
• Points of Distribution Plan
• Surveillance Program in Hospitals and Schools
• Pandemic Flu Plan

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Pandemic Flu Plan

• Based on NYSDOH Guidelines
• Involves Multiple Local Stakeholders
• Joint Planning with other counties in our region
• to create a standardized plan

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General Assumptions in a Pandemic

• Vaccine may not be available initially
• Antivirals may be limited or ineffective
• Neighboring communities will also be affected
• We need to prepare

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Community-Based Infection Control Strategies

• Social Distancing
• Voluntary self-shielding
• Stay at home
• 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

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• Businesses, school systems, community
  infrastructure providers, and other employers
  should develop plans for continuity of essential
  operations and modified operation with a
  significantly reduced workforce.
• 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.

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Work or School Based Infection Control Strategies

• 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 homeif ill

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What can YOU do to prepare?
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What is Respiratory Hygiene/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)

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What is 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

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Individual and Family Preparedness Checklist

• Store a supply of food and water
• General emergency supplies
• Flashlight, batteries, radio, etc.
• Have non-prescription drugs and other health
  supplies on hand
• Get involved in your community
• Talk to your families, friends and neighbors
  
• DO IT NOW!!!!!

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On-Line Resources

• www.pandemicflu.gov
• www.ontariocountypublichealth.com
• Ontario County Public Health
• 585-396-4343
• 1-800-299-2995

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God Bless You!
Achoo!