Pandemic Influenza

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Pandemic Influenza

• Current status
• Potential scenarios
• Role of PAHO
• Disaster preparedness/response and communicable
  diseases addressing the pandemic

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Pandemic Influenza

• Annual Influenza
• Avian Influenza
• Pandemic Influenza

H1-16 N1-9
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Influenza epidemics and pandemics
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Requirements for emergence of a pandemic
influenza strain

• Total lack of immunity in world population
• Be able to cause disease in humans
• Efficient person-to-person transmission of the
  virus

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Avian Influenza
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H5N1 Wild Bird Flu OutbreaksFebruary 2006
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H5N1 Wild Bird Flu OutbreaksFebruary 2006
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Avian Influenza H5N1
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Worldwide occurrence of newly infected countries
with H5N1 in 2006(including date of 1st official
notification to OIE)

• Cameroon (13/MAR/2006)
• Afghanistan (10/MAR/2006)
• Pakistan (03/MAR/2006)
• Serbia Montenegro (02/MAR/2006)
• Hungary (01/MAR/2006)
• Niger (28/FEB/2006)
• Azerbaijan (27/FEB/2006)
• Switzerland (26/FEB/2006)
• Slovakia (24/FEB/2006)
• Malaysia (23/FEB/2006)

• Bosnia Herzegovina (20/FEB/2006)
• Egypt (19/FEB/206)
• India (18/FEB/2006)
• France (17/FEB/2006)
• Germany (06/FEB/2006)
• Iran (14/FEB/2006)
• Greece (13/FEB/2006)
• Bulgaria (12/FEB/2006)
• Slovenia (12/MAR/2006)
• Italy (11/FEB/2006)
• Nigeria (08/FEB/2006)
• Iraq (02/FEB/2006) Included Human Cases

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Human cases of Avian Influenza
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Cumulative Numbers of Confirmed Human Cases of
Avian Influenza A/H5N1 A (H5N1) Reported to WHO
March 10, 2006
WHO reports only laboratory-confirmed cases.
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Status of National Influenza Pandemic
Preparedness Plans in the Americas
Finalized
Draft
In progress
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Potential scenarios
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Expected deaths in LAC due to pandemic influenza
8-week outbreak scenario 1968
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Expected deaths in LAC due to pandemic
influenza8-week outbreak scenario 1918.
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Avian Influenza Economic implications
Major Global poultry exporters, 2004
Source USDA, JM Ovalle
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Potential Impact of Avian Influenza in LAC

• Population at risk
• 600 million people in LAC
• 194 million people living in rural areas
• 5 billion domestic birds in LAC
• Economy
• Poultry production (around US 18,5 billion
  dollars).
• Egg production (around US 5 billion dollars).
• Imposition of barriers to commerce.
• Food Safety
• Poultry comprises 40 of the animal protein
  
  consumed in the Region.
• Employment in poultry production chain
  
  
• Environment (carcass disposal)
• Tourism
• The tourism sector in the Caribbean contributes
  to
  31 for the
  Gross Domestic Product and employs 500,000 people.

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Start of a Pandemic
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Start of a pandemic

• Once the first cases of pandemic flu are
  reported, countries will probably declare public
  health alert or emergency
• Countries with validated and rehearsed pandemic
  plans will be in best position to make decisions
  and take actions rapidly.

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Spread

• It may not be possible to stop a pandemic once it
  begins
• The pandemic virus can spread rapidly causing
  outbreaks around the world affecting up to 30 of
  the population.
• Better hygiene, nutritional status, and drugs can
  mitigate some of the impact but international
  spread could be more rapid than previous
  pandemics.

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Pandemic scenario

• Lack of vaccines in the first several months.
• Health services overwhelmed by public seeking
  medical assistance if they present typical
  influenza like symptoms and other severe and
  life-threatening complications.
• Many countries will need to convert health
  services, including emergency and intensive care
  units for increased demand.
• There may be a need to temporarily close schools,
  grocery stores and other public gathering places
  and facilities.
• Reduced capacity in essential services as
  health-care, law enforcement, transportation due
  absenteeism.
• Not enough antiviral drugs to protect all
  citizens. Drug delivery may create conflicts.

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PAHOs actions

• PAHO Director established an inter-programmatic
  and multidisciplinary Task Force on Epidemic
  Alert and Response
• Advise, Enable, Coordinate, and Monitor
• PAHO activities for influenza pandemic
  preparedness and response
• Implementation of the International Health
  Regulations in the Region
• Responsible for drafting the PAHO Strategic and
  Operational Plan for responding to pandemic
  influenza

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Task Force on Epidemic Alert Response
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National Influenza Centers (NICs) in the Americas
25 NICs in the Region
Countries with multiple NICs
Labs that are not NICs but send samples to CDC
Source Flunet

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Strengthening Epidemiologic Surveillance
Capacities

• Active involvement of the Influenza related WHO
  Collaborating Centers and National Influenza
  Centers in the Global Influenza Network
• Training in surveillance and diagnosis of
  influenza viruses
• Support NICs for viral characterization
• Supply of reagents for Influenza virus diagnosis

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Strengthening national capacity

• Increase national, subregional and regional
  awareness on pandemic influenza and other health
  related emergencies and disasters.
• Meetings and workshops on pandemic influenza for
  health sector network of epidemiologists,
  disaster coordinators, health services,
  veterinary health and others.
• Development of pandemic influenza table top
  simulation exercises including health and other
  key roles as agriculture, civil protection,
  tourism, transportation, foreign affairs, Red
  Cross, etc.

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Regional and national emergency response

• Key activities
• Execute the PAHO Contingency Plan
• Activate EOC at PAHO HQ and in Country Offices.
• Mobilize multisectoral capacity for quick
  readiness and response.
• Mobilize Emergency Response Teams.
• Mobilization of financial resources for pandemic
  response.
• Implement emergency logistic procedures and
  mechanisms.

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Pandemic Influenza

• Challenge
• and
• Opportunity