PANDEMIC INFLUENZA

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PANDEMIC INFLUENZA

• M. Rony Francois, MD, MSPH, PhD
• Secretary, Florida Department of Health
• Bill Tynan, M.D.
• T. R. Belcuore, MS

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Overview

• Threat
• Disease Characteristics
• Pandemic Characteristics
• Preparedness
• Surveillance
• Resources
• Questions

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Threat

• Pandemic Influenza
• History
• 1918 40 50 million deaths
• 1957 2 million deaths
• 1968 1 million deaths
• Frequency every 35 years
• Duration 1 3 years
• Waves 1 3, 4 8 weeks/wave
• Worldwide 6 9 months, 3 months?

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Threat

• Factors Affecting Outbreak Control
• Attack rate 35 of population
• Hospitalization rate 10 of cases
• Case fatality rate 2 - 50
• Asymptomatic, presymptomatic transmission 30
  - 50
• Reproduction number 2 people
• Serial interval 2 4 days
• Infectious period peaks day 2(1-8)
• Incubation period 2 (1 4 days)

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AVIAN FLU BY THE NUMBERS

• 0- number of human and avian US cases
• 2- reproductive value of single flu case
• 1-5 days from exposure to illness
• Communicability 1-2 days before, 4-5 days after
  onset of symptoms
• 1997- year this virus appeared
• 250/115-number of confirmed cases/dead
• 300,000,000- number of birds killed (est.)

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What constitutes a Pandemic?

• 1. Highly virulent organism
• 2. Lack of human immunity to the organism
• 3. Ability to easily transmit from human to human
• H5N1 has the first two but not the third (recent
  cases in Indonesia)

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WHERE ARE WE TODAY?

• PREPAREDNESS
• SURVEILLANCE
• ANTIVIRALS
• VACCINE
• COMMUNICATION

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Preparedness

• National Strategy
• 1. Stopping, slowing or otherwise limiting the
  spread of pandemic to the United States
• 2. Limiting the domestic spread of a pandemic,
  and mitigating disease, suffering and death
• 3. Sustaining infrastructure and mitigating
  impact to the economy and the functioning of
  society

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Preparedness

• Floridas Strategy
• ESF 8 Emerging Event Team (EET)
• Develop Florida Strategy for Pandemic Influenza
• Engage entire emergency management system
• Prepare gap analysis with WHO, HHS Plans
• Review, update existing all-hazards plans
• Develop communications strategy for WHO phases of
  disease to all stakeholder groups and the public

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SURVEILLANCE

• Animals
• Alaska Wild Bird Testing
• Poultry Farm Protocol
• Humans
• Sentinel Physicians
• National Retail Monitoring System
• Five Biosafety Level 3 Laboratories
• Routine Disease Investigations

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Commercial Poultry in Florida
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OVERARCHING GOALS

• Push the epidemic curve to the right
• Reduce the reproductive number
• Minimize antiviral usage
• Minimize hospital burden
• Minimize morbidity/mortality while vaccine is
  developed

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Effect of delaying the onset of the epidemic
No intervention
Six months
Pandemic starts
Infection appears in Florida
Vaccine available
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RESPONSE CONTAINMENT PHASE 6

• CASE REPORTS
• LABORATORY SURGE CAPACITY
• ISOLATION
• QUARANTINE
• TARGETED ANTIVIRALS
• TARGETED PROPHYLAXIS
• TARGETED VACCINATIONS

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THE LOG PHASE

• Individual case finding ceases
• Community Control
• Social Distancing
• Patient Management
• COOP Plans- do you have one?

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COMMUNITY CONTROL

• Stay home if you are sick
• Innovative food purchasing
• Self Isolation
• Family Support Plans

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SOCIAL DISTANCING

• Cessation of public meetings-technology can help
  here
• Church gatherings
• Theatres
• Sporting Events
• Closure of schools and child care
• Use of distance learning

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PATIENT MANAGEMENT

• Home is the primary place to be
• Alternate treatment facilities
• Alternate housing

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VACCINATION PHASE

• Who gets vaccinated first?
• Vaccination Issues
• Plan

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COMMUNICATION

• Rumor control is critical
• Risk communication
• Internet Amplification
• Messenger and message

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PANDEMIC FLU WEBSITES

• Centers for Disease Control Prevention
• http//www.cdc.gov/flu/avian/index.htm
• Florida Department of Health
• http//www.doh.state.fl.us/
• U.S. Department of Health Human Services
• http//www.pandemicflu.gov/