Avian Influenza and the Coming Pandemic

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Avian Influenza and the Coming Pandemic

• By
• Matt Zahn, MD
• 502-574-6570
• Matt.zahn_at_louisvilleky.gov
• September 20, 2006

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Avian Influenza

• December 2003 September 2006
• 244 human cases of avian influenza A (H5N1)
• 143 deaths
• 10 countries involved
• Vietnam with 93 cases in 2003-5
• Indonesia with 44 cases in 2006

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Avian Influenza Clinical Characteristics

• Fever
• Cough
• Sore throat
• Muscle aches
• Rapid progression of pulmonary disease

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In North America

• No human cases
• No avian cases
• Few cases of person-to-person transmission have
  occurred worldwide

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But

• Avian influenza likely to come to North America
  at some point
• Eventually a new pandemic will occur, whether
  H5N1 or some other strain

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Influenza Pandemics

• 1918 --- (H1N1)Spanish Flu
• 1957 --- (H2N2)"Asian Flu
• 1968 --- (H3N2)"Hong Kong Flu"

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1918 Influenza Pandemic

• 30 million killed
• Single most lethal infectious outbreak to occur
  worldwide over a 1-year period
• Affected young adults disproportionately

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Influenza Epidemiology

• Survive on surfaces, objects
• Incubation period 1-3 days
• Low inoculum needed to establish infection
• Up to 25 of population affected every year
• 30,000 deaths occur annually

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U. S. Pandemic Projections

• 300 million person population
• Up to 200 million persons infected
• 38--89 million clinically ill
• 18--42 million requiring outpatient care
• 314,000--733,000 hospitalized
• 89,000--207,000 deaths

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Louisville Projections

• 700,000 person population
• Up to 500,000 persons infected
• 95225,000 ill
• 45105,000 requiring outpatient care
• 7851830 hospitalized
• 222--520 deaths

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Influenza Pandemic Response
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Oseltamivir

• Federal government plans to order enough
  oseltamivir for 25 percent of United States
  population
• 1 million doses being stockpiled for Kentucky
• May be available by mid-2007
• 40-60 for a five-day course

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Influenza Pandemic and Vaccine

• Global immune susceptibility likely
• Currently, fewer than 500 million doses can be
  produced
• Get your flu vaccine every year!

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Vaccine Production

• February
• April
• June
• September

• Viral strains established

• Grown in eggs

Antigens isolated
Vaccine produced
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H5N1 Vaccine

• 30 trials ongoing
• Vaccine at least 3 years away from production
• Likely new vaccine model will be necessary to
  provide adequate vaccine quickly enough

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National Pandemic Influenza Preparedness Plan

• It is impossible to predict how quickly the
  novel virus will arrive in the U.S. Because of
  the six to eight month production period to
  produce a vaccine, it should be anticipated that
  demand for vaccine will be greater than the
  supply early in the course of the pandemic. It is
  also possible that no vaccine will be available.

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Maximize Health Care Resources!

• Targeted vaccine and antivirals to high risk
  groups
• Use inpatient and outpatient resources for those
  who are most ill
• Provide timely and accurate information to the
  public

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Other Measures
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Quarantine

• Legal authority for quarantine does exist
• Rarely used in last 100 years
• Voluntary quarantine often more effective than
  forced quarantine
• SARS in Toronto latest example

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Social Distancing

• Public gatherings will be limited
• Schools, day cares will be closed
• Work sites will be limited to critical personnel
• Travel will be extremely difficult
• The sick will be encouraged to stay home

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Personal Hygiene

• Wash hands frequently.
• Cover your mouth and nose with a tissue when you
  cough or sneeze.
• Cough or sneeze into your upper sleeve if you
  don't have a tissue.
• Clean your hands after coughing or sneezing.
• Use soap and water or an alcohol-based hand
  cleaner.

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Stock Food and Water Supply

• Stock foods that
• Are nonperishable
• Don't require refrigeration
• Are easy to prepare in case you are unable to
  cook
• Require little or no water

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www.pandemicflu.gov Business Pandemic Influenza
Planning Checklist is available at
www.pandemicflu.gov/plan/businesschecklist.html