Pandemic Flu: Could it Hit Job Corps?

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Pandemic Flu Could it Hit Job Corps?

• Gary Strokosch, MD,Regional Medical Consultant
• Job Corps National Health and Wellness Conference
• April 26, 2007
• Denver, Colorado

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Could a pandemic happen in the near future?
What would be its impact at my JC center?
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Pandemic Flu(Global Disease Outbreak)

• New influenza virus emerges
• No immunity in the human population
• Causes serious illness
• Spreads easily person-to-person

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Pandemic Death Toll-Since 1900-

• 1918-1919
• USA gt675,000 deaths
• Worldwide gt50,000,000 deaths
• 1957-1958
• USA gt70,000 deaths
• Worldwide gt1-2,000,000 deaths
• 1968-1969
• USA gt34,000 deaths
• Worldwide gt700,000 deaths

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THERE IS CURRENTLY NO PANDEMIC
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Additional Information Needed to Predict a
Pandemic

• Virulence of the virus
• Disease transmissibility
• Clinical manifestation
• Drug susceptibility
• Risks to different age groups

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• The Difference Between Seasonal Influenza,
  Pandemic Influenza, and Avian Influenza

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Seasonal Influenza

• Periodic outbreaks
• Respiratory illness
• Fall and winter in the US
• Outbreaks are limited geographically
• Some immunity to virus strains
• The very young, the elderly and those with health
  conditions most at risk for serious complications
• 5-20 of population sick with c. 36,000 deaths

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Human Infection

• Human flu virus refer to subtypes that spread
  widely among humans
• Those are H1N1, H1N2 and H3N2
• It is likely that some genetic parts came from
  birds
• H5N1 is one of the few to have crossed the
  species barrier and is the most deadly

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Pandemic Influenza

• Worldwide outbreak
• New strain of the virus
• Ability to infect humans
• Spread from person to person
• Healthy adults may be at risk for serious
  complications

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Avian Influenza Viruses

• Bird flu is caused by influenza A viruses that
  occur naturally among birds
• Hemagglutinin and neuraminidase proteins of the
  surface of the virus combine in different ways
  and produce subtypes of A
• All known subtypes of influenza A can be found in
  birds
• The H5N1 subtype is of current concern

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Avian Influenza (Bird Flu)

• The virus infects wild birds and domestic poultry
• Since 1997 there have been a number of confirmed
  cases of human infection from bird flu viruses
• Divided into two groups
• Low pathogenic
• Highly pathogenic

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Avian Influenza (Bird Flu)

• Wild birds worldwide asymptomatically carry bird
  flu in the GI tract
• It is shed in their saliva, nasal secretions and
  feces
• Domesticated birds may get infected by direct
  contact or through contact with surfaces, water
  or feed that have been contaminated with the
  virus

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Avian Influenza (Bird Flu)

• The low pathogenic form may go undetected and
  cause only mild symptoms such as ruffled feathers
  or a drop in egg production
• The highly pathogenic form may cause disease that
  affects multiple organs with mortality of 90-100
  within 48 hours
• The H5N1 is highly pathogenic

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Avian Influenza (Bird Flu)

• Since 2003, a growing number of human H5N1 cases
  have been reported
• More than half of the people have died
• Most are believed to have been caused by exposure
  to infected poultry
• There has yet been no sustained human to human
  transmission of the disease

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(No Transcript)
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Confirmed Cases of H5N1 in 2006

• 115 cases reported by WHO
• 79 deaths reported by WHO
• Indonesia accounted for 55 45
• Egypt accounted for 18 10
• China accounted for 13 8
• Turkey accounted for 12 4

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Prevention and Treatment of H5N1

• No vaccine available
• The virus must first emerge and be identified
• Some of the medications for flu virus should work
  for avian flu infection
• The current H5N1 in Asia is resistant to
  amantadine and rimantadine
• Oseltamavir and zanamavir would probably work,
  but studies need to be done

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Avian Influenza Low Pathogenicity

• Occurs in wild birds and can spread to domestic
  birds
• Usually causes no signs of infection or only
  minor symptoms in birds
• Pose little threat to human health
• H5 H7 strains have the potential to mutate into
  highly pathogenic strains and are, therefore,
  closely monitored

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Avian Influenza High Pathogenicity

• Spreads rapidly
• High death rate in birds
• H5N1 strain is rapidly spreading in birds in some
  parts of the world

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H5N1 Avian Viral Strain

• One of the few strains to have crossed the
  species barrier
• One of the most deadly strains to infect humans
• Human cases have resulted from contact with
  infected poultry or surfaces contaminated with
  secretions/excretions from infected birds
• As of Feb. 2007 person-to-person spread limited
  to rare sporadic cases
• Little or no immunity to H5N1

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Influenza Spread Between People

• Spread by large droplets and aerosols
• To a lesser degree, spread by touching objects
  contaminated with flu virus
• Produced by cough, sneeze or talk
• Inoculation by direct contact with nose, mouth or
  eyes

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Pandemic Influenza Compared to Natural Disasters

• WIDESPREAD affecting multiple areas of the US
  and other countries at the same time
• EXTENDED EVENT multiple waves of outbreaks in
  the same geographic area
• WAVES OF OUTBREAKS may occur over a year of more

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Pandemic Influenza Exposure Categories at Work

• Very high exposure risk
• High exposure risk
• Medium exposure risk
• Lower exposure risk

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Very High Exposure Risk

• Healthcare employees performing aerosol
  generating procedures on known or suspected
  pandemic patients
• Healthcare or laboratory personnel collecting or
  handling specimens from known or suspected
  pandemic patients

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High Exposure Risk

• Healthcare delivery and support staff exposed to
  known or suspected pandemic patients
• Medical transport of known or suspected pandemic
  patients in enclosed vehicles
• Performing autopsies on known or suspected
  pandemic patients

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Medium Exposure Risk

• Employees with high frequency contact with the
  general population

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Lower Exposure Risk

• Employees who have minimal occupational contact
  with the general public and other coworkers

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JC Exposure Risk

• Very high exposure risk staff
• None
• High exposure risk staff
• Health and wellness staff
• Drivers that transport ill students in center
  vehicles
• Medium exposure risk staff
• Most of the non-health staff on center
• Lower exposure risk staff
• Few

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Disaster Plan Realities

• Prepare for reduced workforce
• Cross-train or develop ways to function in the
  absence of some of the staff
• Plan to be without some supplies
• Sick leave policy should not penalize employees
  for having to stay home
• Minimize exposure of employees

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Pandemic Flu Dilemma

• Reality would dictate planning for downsizing
  services because of the factors mentioned in last
  slide, but anticipate a surge in need for health
  and wellness services if ill students remain on
  center

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Control Measures

• Good hygiene
• Cough etiquette
• Social distancing
• Personal protective equipment
• Staying home from work

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Minimize Exposure of Employees

• Educate and train employees in proper
• Hand hygiene - frequent washing or sanitizing and
  avoid touching mouth, nose and eyes
• Cough/sneeze etiquette - cover with a tissue or
  into upper sleeve
• Social distancing techniques - separation of at
  least 6 feet and avoid shaking hands

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Minimize Exposure of Employees

• Personal protective equipment (PPE) will probably
  be limited to surgical masks. They are used as a
  physical barrier to protect employees from
  hazards and also prevent contamination by the
  wearer, protecting other people against infection
  from the person wearing the mask.

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Minimize Exposure of Employees

• Keep work surfaces, telephones, computer
  equipment and other frequently touched surfaces
  and office equipment clean.
• Discourage employees from using other employees
  phones, desks, offices or other work tools and
  equipment.
• Minimize situations where groups of people are
  crowded together, such as in a meeting

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For More Information

• www.pandemicflu.gov
• www.cdc.gov

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National Job Corps Pandemic Influenza Planning

• Kelley J. Clark, MS, Sr. EHS Specialist
• Tidewater, Inc. / National Office of Job Corps

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Agenda

• Information Notice No. 06-8
• National Job Corps Pandemic Planning Stages
• Job Corps Center Pandemic Planning
• Pandemic Influenza Resources
• National Job Corps Contacts

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Information Notice No. 06-08

• Pandemic Influenza Preparedness for Job Corps
  Centers
• Issued September 11, 2006
• Requires Centers to update emergency response
  plans to include
• Strategies for evacuating sick students without
  spreading virus to others
• Strategies for preventing spread of virus on
  center
• Establishing relationships with local health
  departments
• Reporting virus outbreaks (significant incident)
  to National Office with information copy to
  Regional Office

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Information Notice No. 06-08 (continued)

• Pre-planning to arrange for physicians or
  qualified health professional to confirm cases
• Reporting confirmed cases to local health
  department important to local response efforts

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Information Notice No. 06-08 (continued)

• The Job Corps Pandemic Influenza Planning
  Checklist has been provided to assist with
  preparing pandemic response plans
• Use the websites listed in Attachment B for
  planning guidance

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National Job Corps Pandemic Flu Planning

• Job Corps Pandemic Planning in 4 steps
• Step 1- Information Notice 06-8
• Step 2- Forthcoming Information Notice requesting
  quarterly updates and on-going discussions with
  other Federal agencies
• Step 3- Review of center pandemic flu status
  reports
• Step 4- Develop draft National Job Corps Pandemic
  Flu Response Guide

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Job Corps Center Pandemic Planning

• Preliminary planning process can be done in 6
  Steps
• Evaluation of current emergency response plan
• Assemble a pandemic planning committee
• Identify essential center functions and personnel

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Job Corps CenterPandemic Planning (continued)

1. Establish the Chain-of-Command and appoint an
   Incident Commander.
2. Establish the role of health services

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Influenza Resources

• State and Local Government Planning Response
  Activities, http//www.pandemicflu.gov/plan/states
  /index.html
• State-by-State Pandemic Information
• State Pandemic Plans
• Antiviral Allocations by State
• State Contacts

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Influenza Resources

• The Centers for Disease Control and Prevention,
  Interim Pre-Pandemic Planning Guidance,
  http//www.pandemicflu.gov/plan/community/index.ht
  ml
• The Centers for Disease Control and Prevention,
  Patient and Provider Education Materials,
  http//www.cdc.gov/flu/protect/covercough.htm
• The Centers for Disease Control and Prevention,
  Interim Guidance on Planning for the Use of
  Surgical Masks and Respirators in Health Care
  Settings During an Influenza Pandemic,
  http//www.pandemicflu.gov/plan/healthcare/maskgui
  dancehc.html
• U.S. Food and Drug Administrations Center for
  Devices and Radiological Health, Personal
  Protective Equipment and Influenza Outbreaks,
  including Bird Flu (Avian Influenza)
  http//www.fda.gov/cdrh/ppe/fluoutbreaks.html)

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National Office of Job Corps Safety Contacts

• Marsha Fitzhugh, Team Leader, Division of IT and
  Program Support, [phone]
• Heather Edmonds, Environmental Health Safety
  Specialist, [phone]
• Kelley Clark, Sr. Environmental Health Safety
  Specialist, [phone]

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QUESTIONS?
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Thank You.