Pandemic Flu are we ready

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Pandemic Fluare we ready?

• Tuscarawas County
• Pandemic Flu Business Summit
• Kent State University Tuscarawas Campus
• July 11, 2006
• James G Hubert, DO, MS
• Health Commissioner/Coroner
• Tuscarawas County

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• A brief history of flu pandemics

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Influenza

• Respiratory infection
• Transmission contact with respiratory secretions
  from an infected person who is coughing and
  sneezing
• Incubation period 1 to 5 days from exposure to
  onset of symptoms
• Communicability Maximum 1-2 days before to 4-5
  days after onset of symptoms
• Timing Peak usually occurs December through
  March in North America
• Each year in US
• 5 to 20 of the population get the flu
• Over 200,000 hospitalizations
• Over 36,000 deaths
• Over 10 billion in costs

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Pandemic

• Global disease outbreak
• New or novel virus
• Little or no natural immunity in population
• Generally an A type virus
• Able to spread rapidly from person to person

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Influenza Virus Composition
Type of nuclear material
Neuraminidase
Hemagglutinin
A/Beijing/32/92 (H3N2)
Virus type
Geographic origin
Strain number
Year of Isolation
Virus subtype
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Flu Pandemics in the 20th Century
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1918 Pandemic

• Caused by an A/H1N1 virus
• Believed to have started in Kansas
• Rapidly spread through US and the World
• Over 500,000 deaths in US
• Over 40 million deaths worldwide
• Virus no longer in circulation

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Americas deaths from influenza were greater than
the number of U.S. servicemen killed in any war.
Thousands
Civil WWI 1918-19 WWII
Korean Vietnam War
Influenza War War

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1918 Flu in Stark County

• In 1918-1920, Stark County suffered at least 578
  deaths from the Spanish Flu.
• Hospitals quickly filled. The K of C building
  was offered. It filled in one day.
• The Melbourne Hotel was taken by the Canton City
  Health Department for patient use.
• Schools, churches, stores and saloons were
  closed.
• The McKinley-Massillon Game was canceled!

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Enforced home quarantines were issued.The
Canton Home Guards enforced martial law.
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• Coffins were in short supply.
• Food supplies became scarce.

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Worldwide Spread in 6 Months Spread of H2N2
Influenza in 1957Asian Flu
Feb-Mar 1957Apr-May 1957Jun-Jul-Aug 1957
69,800 deaths (U.S.)
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Asian Flu Timeline

• February 1957
• Outbreak in Guizhou Province, China
• April-May 1957
• Worldwide alert
• Vaccine production begins
• October 1957
• Peak epidemic, follows school openings
• December 1957
• 34 million vaccine doses delivered
• Much vaccine unused
• January-February 1958
• Second wave (mostly elderly)

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Why all the fuss now?
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Avian Flu

• 1997, First appearance of H5N1 virus in humans in
  Hong Kong. 18 hospitalized, 6 deaths
• 2003, Two cases of H5N1 virus in humans in Hong
  Kong residents traveling from China, one death
• 2004, 47 human cases in Thailand, 34 deaths
• 2005, by December 30, 142 cases, 74 deaths in
  southeast Asia.
• 2006, continued spread of human infections. As
  of May 7, 2006 206 cases and 114 deaths (WHO)

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Nations With Confirmed Cases H5N1 Avian
Influenza (April 27)
Source World Health Organization
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Drift and Shift

• A type influenza virus changes with each
  reproductive cycle
• Subtle changes cause a drift in the genetic
  makeup
• Making a vaccine to exactly match the specific
  virus is hard. Must be custom tailored each flu
  season
• Larger changes in genetic makeup is called shift

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• Let me be clear. It is only a matter of time
  before we discover H5N1 in America. The
  migration patterns of the wild fowl that carry
  the virus make its appearance here almost
  inevitable.
• -Secretary Michael Leavitt
• HHS

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U.S. Pandemic Flu Model
Source National Academy of Sciences, April, 2006
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Current ProjectionsOhio

• Deaths
• 6,000 to 16,000
• 50 to 60 death rate
• Hospitalizations
• 26,000 to 67,000
• Seek Care due to Illness
• 1.1 to 2.9 million

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What are we doing?
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Monitoring

• Worldwide network
• Improved rapid lab tests
• FDA approves new 4 hour rapid test kit
• Increased collaboration
• Human health Health and Human Services
• Animal health Department of Agriculture

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Vaccine Development

• Cornerstone of prevention
• Annual cycle of development for delivery by
  summer
• Biggest single federal budget item for Pandemic
  Flu Preparedness
• Increase production
• Stockpiling
• Research into new production techniques (cell
  culture)
• FDA Rules
• Streamlined approval process
• Emergency approval process

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Vaccine Development
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
WHO/CDC)
WHO/CDC/FDA
CDC/FDA
FDA
FDA
FDA
manufacturers
clinic
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Antivirals

• Two types appear effective in early treatment of
  infections
• Olestamivir (Tamiflu)
• Zanamivir (Relenza)
• Part of Strategic National Stockpile
• Current supplies are limited
• State mass dispensing plan approved
• Completing local mass dispensing plan

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Planning

• Including a wide variety of local partners
• Law Enforcement
• Hospital
• Fire/EMS
• EMA
• Social Services
• Mental Health
• Transportation
• And many others..

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Communications

• Selection and training of spokespersons
• Developing messages
• Clear
• Honest
• Complete
• Planning of the use
• Media
• Web (Internet)

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Strategies

• How to limit the spread of a pandemic until a
  suitable vaccine can be developed?

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Control Strategies

• Limit contact between ill and well people
• Isolation
• Alternate care settings
• Neighborhood care centers
• Flu hospitals
• Home care

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Control Strategies

• Hand Hygiene and etiquette
• Social Distancing
• Avoid close contact
• Cover mouth with tissue and discard
• Limit large gatherings
• Closing of schools
• Travel advisories

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• What can you do now!

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Be Informed

• Learn about avian flu from trusted sources
• Keep up to date on information
• Use RELIABLE information
• www.pandemicflu.gov

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Make a Plan

• Use suggested planning checklists
• Practice
• Revise plans when new information becomes
  available

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For a Business

• Up to 40 absenteeism
• How long can you operate without a delivery
• Sick policies
• Pay for extended time off
• Can your employees work at home (2 weeks)
• Work with unions
• Use business planning checklist as a guide

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For Your Home

• Do you have a supply of emergency food and water
• Supply of medications
• Can you care for sick family members
• Learn how to provide care
• Get some medical supplies
• Keep a written medical history
• Other basic needs
• Pay bills online
• Alternate communication (Internet and email)
• Keep some money in savings
• Special emergency use credit card

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Other Considerations

• Spiritual needs
• Support from friends and family
• Know your neighbors that may need special help
• Consider flu a REAL risk, just like weather,
  tornadoes, floods, or other disaster.
• Hope is not a strategy. Gerberding, CDC

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• Pandemics are global in nature, but their impact
  is local. When the next pandemic strikes, at it
  surely will, it is likely to touch the lives of
  every individual, family, and community. Our
  task is to make sure that when this happens, we
  will be a Nation prepared.

Michael O. Leavitt, Secretary U.S. Department of
Health and Human Services January, 2006