Pandemic Influenza

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Pandemic Influenza

• March 6, 2007
• Josh Clayton
• SD Department of Health
• 800-592-1861

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Overview

• Difference between seasonal, bird (avian), and
  pandemic influenza
• How influenza spreads
• Current avian influenza situation
• Death toll of past pandemics
• Estimates of future pandemic impact
• Pandemic planning
• DOH Pandemic Plan

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Whats the Difference?

• Seasonal influenza
• Respiratory illness caused by human flu viruses
• Avian influenza
• Flu virus which is naturally found in birds
• Pandemic influenza
• Global flu outbreak
• Occurs when new influenza A virus emerges
• Little of no immunity in humans
• Enormous numbers of people become ill and
  millions die
• NO CURRENT PANDEMIC

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How Influenza spreads

• Virus in respiratory droplets produced while
  coughing, sneezing, talking.
• Usually spreads person to person. Sometimes
  spread via contaminated object.
• You get sick 1-3 days later.
• You are able to infect others 1 day before
  becoming ill or up to 7 days after getting ill.

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Influenza Virus
16 Hemagglutinin antigens9 Neuraminidase antigens
N neuraminidase
H hemagglutinin
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Generation of a Pandemic Influenza Virus
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Current H5N1 Human/Bird Distribution
As of 2-2007. From www.pandemicflu.gov
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Avian influenza A (H5N1) status

• of countries with H5 or H5N1 (poultry/wild
  birds) 56
• of countries with H5N1 (human) 12
• Azerbaijan, Cambodia, China, Djibouti, Egypt,
  Indonesia, Iraq, Laos, Nigeria, Thailand, Turkey,
  Viet Nam
• Human cases 277
• Human deaths 167
• Death rate 60
• Several instances of non-sustaining
  person-to-person transmission.
• One instance of secondary transmission in
  Indonesia (Aunt to boy to his father )
• 6 out of 7 cases in extended family were fatal
• As of March 1, 2007 (www.who.int)

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H5N1 Human Cases
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Epidemiology of H5N1 Cases

• Data from Dec 2003 to April 30, 2006 (205 cases)
• 50 of cases occurred in people lt20 years
• 90 of cases occurred in people lt40 years
• Overall case fatality 56 (highest in 10 to 39
  year olds)
• Illness pattern not changed in 3 years
• Incidence of human cases peaks during
  winter/spring

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Pandemics of the 20th Century

• United States Mortality
• 1918
• 500,000 deaths
• 1957
• 69,800 deaths
• 1968
• 33,800 deaths

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Emergency Hospital Camp Funston, Fort Riley, KS
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(No Transcript)
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Flu PreventionThen (1918) . . . . And Now
(2006)
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Infectious Disease Mortality, United States -
20th Century
Armstrong, et al. JAMA 199928161-66.
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Influenza and Pneumonia Deaths by Age
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Planning Process
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Challenges

• Pandemics can be delayed -- but not stopped.
• Healthcare system overload.
• Shortage of staff and hospital beds.
• High death rates.
• Inadequate medical supplies.
• Vaccine supply shortfall.
• Antiviral shortfall.
• Economic and social disruption.
• Worker absenteeism.
• Closings, cancellations, quarantines.

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Pandemic Influenza Plans

• Released November 2005 Revised
  March 2006
• www.pandemicflu.gov www.state.sd.us/doh/flu/
  pandemic

Basis For -gt
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Pandemic Influenza Checklists

• State and Local
• Business
• Individual and Family
• Preschool
• Schools (K-12)
• Colleges Universities
• Faith and community-based organizations

• Medical offices and clinics
• Home Health
• Emergency Medical Services and Transport

Available at www.pandemicflu.gov
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Community Mitigation
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Pandemic Severity Index

• Category 4 5 Up to 12 week school dismissal
• Category 2 3 Up to 4 week school dismissal
• Category 1 Dismissal not recommended

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DOH Community Planning Grants

• 600,000 was available to develop local pandemic
  response plans
• 21 healthcare, city, county, and tribal entities
  received funding (32 of 66 counties)
• Phase 2 Grants planned for this year
• http//www.state.sd.us/doh/flu/pandemic

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Plan at www.state.sd.us/doh/flu/pandemic
Pandemic Influenza Plan
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Influenza Pandemic Phases
Current Phase
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Main Components

• Command Control
• Laboratory Surveillance
• Vaccine Antiviral Medication
• Disease Containment Travel-Related Risk
• Healthcare Planning
• Workforce Support
• Education Communication

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Command and Control

• Use Incident Command System to
• Identify operational priorities
• Mobilize resources
• State Law gives public health emergency powers to
  Governor and Secretary of Health
• DOH participates in state agency and Continuity
  of Operations planning groups

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Laboratory and Surveillance

• Pandemic Monitoring
• Human Surveillance
• Testing at SDPHL, rapid antigen aggregate
  reports, pediatric mortality, outbreak reporting
• Bird Surveillance
• Wild and domestic bird testing at ADRDL
• Investigation of cases and contacts
• Make isolation/quarantine recommendations

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Vaccine and Antiviral Drug

• DOH adopted HHS Vaccine and Antiviral Drug
  Priority Group Recommendations
• Point of dispensing (POD) sites may administer
• Vaccine, antiviral drug, antibiotics, other
  interventions
• Availability
• Vaccine 8 million doses federally held
• Antivirals 2.3 million courses Tamiflu
  federally held and 54,000 courses ordered for
  state stockpile

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Vaccine priority groups (D-13)

• TIER 1
• A. Vaccine manufacturers
• A. Medical workers
• B. gt65 yrs with risk factor
• B. 6 m - 64 yrs with 2risks
• B. Other high risk
• C. Pregnant women
• C. Household contacts
• C. Household contacts
• D. Public health response
• D. Key government leaders

• TIER 2
• A. Healthy gt65 yrs
• A. 6 mo - 64 yrs with 1 risk
• A. Healthy 6-23 mo
• B. Public health
• B. Public safety
• B. Utility workers
• B. Transportation workers
• B. Telecommunication workers
• TIER 3
• Key health decision makers
• Funeral workers
• TIER 4
• Healthy persons 2 64 years old not included in
  any above.

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Antiviral Drug priority groups (D-21)

• TX Patients admitted to hospital.
• TX Health care workers with direct patient
  care.
• TX Highest risk outpatients.
• TX Public health, public safety, government
  decision makers.
• TX Increased risk outpatients.
• PEP Nursing/residential homes.
• Prophylaxis Critical health care workers
• TX Societal responders
• TX Other outpatients
• Prophylaxis High risk outpatients
• Prophylaxis Other health care workers

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Disease Containment and Travel-Related Risk

• DOH will recommend social distancing measures
• Includes isolation/quarantine, business/school
  closure
• Airports should develop triage protocol for ill
  travelers
• SD no international, but flights from 7 states
• DOH monitors and disseminates CDC Travel
  Advisories

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Social Distancing

• Progressive containment
• Isolation and quarantine Infected/exposed
  individuals
• Building closure Public events/recreational
  facilities
• Snow days Non-essential workers stay home
• Business closure Close schools, mall, public
  transit
• Community Quarantine legal action keeps people
  home

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Current CDC Travel Recommendations

• During travel to affected area
• Avoid direct contact with poultry
• Practice hand hygiene (soap and water or alcohol
  gel)
• Thoroughly cook poultry and eggs
• If ill, seek medical attention
• After you return
• Monitor health for 10 days
• If ill with fever plus cough, sore throat, or
  difficulty breathing consult a doctor
• Notify doctor of symptoms, travel history, and
  poultry contact

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Healthcare Planning

• Facility pandemic plans should be developed for
  hospitals, clinics, long-term care facilities,
  and home healthcare organizations
• May include
• Triage clinics
• Temporary medical care sites
• Isolation/quarantine facilities
• DOH adopted HHS Infection Control recommendations
  and Clinical Guidelines

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Workforce Support

• Response agencies should develop psychosocial
  support plans for workers, including
• Resiliency teams trained in Psychological First
  Aid
• Policies established for employee compensation
  and absences unique to a pandemic
• Identify local behavioral and mental health
  professionals
• Disseminate pandemic planning materials

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Education and Communication

• Health Alert Network, media, and website keep
  partners informed
• Disseminate educational materials from CDC and
  others to educate workers
• Identify spokesperson(s) for your facility
• Target special populations nearby
• Native American
• Refugee and Foreign-born
• Elderly

• Disabled or Visually impaired
• Mentally ill

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National strategy for pandemic influenza

• While your government will do much to prepare for
  a pandemic, individual action and individual
  responsibility are necessary for the success of
  any measures. Not only should you take action to
  protect yourself and your families, you should
  also take actions to prevent the spread of
  influenza if your or anyone in your family
  becomes ill.
• G.W. Bush, 1 Nov 2005

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What people can do

• Get your flu shot
• Stop it Dont spread it (good influenza
  prevention)
• Cover your mouth when coughing or sneezing
• Wash your hands
• Stay home if sick
• Get healthy ----- Stay healthy
• Prepare for a snow day or snow week
• Yes, you may eat chicken
• Follow travel advisories
• Support local planning effort

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Useful Websites

• www.pandemicflu.gov
• Federal Pandemic Website
• http//sdces.sdstate.edu/avianflu/
• SDSU Cooperative Extension Website
• www.state.sd.us/doh/flu/pandemic/
• SD DOH Website

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Questions?