CommunityWide Mitigation Strategies in Pandemic Planning

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Community-Wide Mitigation Strategies in Pandemic
Planning
VDH Pandemic Influenza Advisory Committee
Meeting April 23, 2007
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Influenza Transmission
Facemasks, cough etiquette
Viruses
Humidifiers, handwashing
Social distance, cohorting
Leave original host
Facemasks, handwashing
Survive in transit
Vaccination, antiviral
Delivered to a susceptible host
Reach a susceptible part of the host
Escape host defenses
Multiply and cause illness
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Potential Tools in Our Toolbox

• Best countermeasure vaccine
• Likely unavailable during the first wave of a
  pandemic
• Antivirals tx may improve outcomes
• Modest effects on transmission
• Antiviral prophylaxis may significantly reduce
  transmission
• Limited supply
• Infection control and social distancing should
  reduce transmission
• Strategy needs clarification, preparation

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Community-Based Interventions
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A Layered Approach
Individual / Household Hand hygiene Cough
etiquette Infection control Living space
control Isolation of ill Designated care
provider Facemasks
Community Isolation of ill Treatment of
ill Quarantine of exposed Prophylaxis of
exposed School closure Social distancing -
Community - Workplace Liberal leave
policies Snow days Travel restrictions
International Containment-at-source Support
efforts to reduce transmission Travel
advisories Layered screening of travelers Health
advisories Limited points of entry
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Value of Combining Strategies
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Community Actions May Significantly Reduce
Illness and Death

• Early and uniform implementation of
• Social distancing at work and in the community
• Encouraging
• Voluntary home isolation by ill
• Voluntary home quarantine by household contacts
• Treating the ill and providing targeted antiviral
  prophylaxis to household contacts
• Implementing measures early and in a coordinated
  way

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Economic Analysis

• Preliminary analyses of community-wide
  interventions predict a range from a decrease in
  overall economic impact to a modest increase
• If an economic value is assigned to lives lost
  during a severe pandemic, community-wide
  interventions result in a 5-10 fold decrease in
  overall cost

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Community Containment

• For an influenza pandemic, what strategies will
  limit illness, hospitalization, and death?
• Some preferred characteristics
• Simple
• Effective
• Rapidly implemented
• Readily available
• Minimally resource intensive
• Practical
• Minimal personal/social and economic disruption

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Pandemic Influenza Strategy

• Strategy released on Nov 1, 2005
• Plan released on May 3, 2006
• Provides guidance on implementation of the
  Strategy
• Interim Community Strategies 2007
• VDH draft pandemic influenza plan developed based
  on Federal plan
• Community mitigation (and others) updated April
  2007

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VDH Plan

• Key activities
• Modernizing legal preparedness (e.g., IQ)
• Developing community social distancing measures
  (e.g., school dismissal)
• Planning for containment of localized clusters
• Planning community education and,
• Developing data collection and management tools

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Pandemic Severity Index
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Epidemiology Drives Approach
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Issues (Examples)

• IQ limited role, but requires planning
• Schools important, but many factors
• Other community social distancing
• Workers compensation
• Business guidance for increased absenteeism
• Guidance and tools for public
• Animals
• Containment (antiviral use)
• Public information
• Hotlines, websites, community leaders, etc.
• Data collection for response
• Additional studies/research needed
• Mask/respirator effectiveness (and cost/benefit)

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Conclusions

• Partially effective interventions, when used in a
  layered manner, may be highly effective in
  controlling the spread of influenza in a
  community
• Mitigation strategies appear to be most effective
  when implemented in a uniform manner early in an
  outbreak
• gt Pre-planning!!