Preparing for Pandemic Influenza

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Preparing for Pandemic Influenza
Cherise J Rohr-Allegrini, Ph.D., M.P.H. San
Antonio Metro Health District
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• What is Avian Flu and what do we do about it?
• What is Pandemic Flu?
• How should hospitals prepare?

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is NOT
Avian Flu (H5N1)
Pandemic Influenza
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• Avian flu is caused by avian influenza viruses,
  which occur naturally among birds and
  ocassionally infect humans. Occassionally, a
  highly pathogenic strain emerges H5N1.
• Seasonal flu is a contagious respiratory illness
  caused by influenza viruses infecting humans.
  Generally, most susceptible to severe illness and
  death are very young and very old.
• Pandemic flu a global outbreak, or pandemic, of a
  highly pathogenic strain that spreads easily from
  person to person. Otherwise healthy young adults
  severely affected.
• Currently there is no pandemic flu.

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WHO Criteria for Pandemic Influenza

• The emergence of a disease
• (or strain/subtype) new to a population
• The agent infects humans, causing serious illness
• The agent spreads easily and sustainably among
  humans

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(No Transcript)
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Where are we now?

• Pandemic Alert Phase 3

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12-26-03 to 4-19-06 HUMAN H5N1 CASES
Human infection(s) with a new subtype, but no
human-to-human spread
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Pandemic Period Phase 6

• Increased and sustained transmission in general
  population

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What does that mean for the 1.5 million people
in the San Antonio/Bexar County area?
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• Wave 1
• 25-50 Attack Rate
• 325,000-750,000 infected
• 4 hospitalization
• 13,000-30,000
• 1.5-5 Fatality Rate
• 5000 deaths

• Wave 2
• 5 Attack Rate
• 75,000 infected
• 4 hospitalization
• 3000
• 1.7 Fatality Rate
• 1275 deaths

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Health Systems ResponseDemand for services may
require non-standard approaches

• Discharge of all but critically ill hospital
  patients
• Expansion of hospital capacity by using all
  available space and less than code compliance
  beds
• Increase of patient ratio to hospital staff
• Stop elective procedures
• Set up alternate treatment facilities

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What do Hospitals Need to Do to Prepare NOW?

• Develop Emergency Plan specific for Pandemic
  Influenza
• Educate staff
• Avian vs. Pandemic flu
• Infection control procedures
• Respiratory Hygiene Etiquette
• Policies and Procedures for care of pandemic
  patients
• Training for non-clinical staff to assist
  clinicians
• Personal protective measures

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What do Hospitals Need to Do to Prepare NOW?

• Staffing Concerns
• Determine of staff, report to local SNS
  Coordinator
• Maintain accurate call down lists
• Identify of Reservists on staff
• Medical staff who work at multiple facilities
  should choose a primary
• Identify possible volunteers whose primary
  commitment is to your facility
• Make contingency plans for 20-50 reduction of
  current workforce

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Health Systems Response

• Determine your surge capacity
• Facility Access
• When to limit?
• How to limit?
• Occupational Health
• How to manage ill workers?
• Time-off policies
• Vaccination and antivirals

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Health Systems Response in a Pandemic

• Activate Pandemic Response Plan
• Report to the RMOC
• Number of patients on ventilators
• Number of available ventilators
• Number of beds occupied
• Number of beds available
• Estimates of staffing levels (MDs, nurses)
• Report to SAMHD
• Emergency room visit trends syndromic
  surveillance
• SNS
• If available

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Strategic National Stockpile (SNS)

• A repository of antibiotics, antidotes,
  antitoxins, and life support medications
• Delivered within 12 hrs of request
• If a vaccine is available, administer immediately
  to staff and family members
• Critical Government Officials
• First Responders (Including Hospital Staff)
• Critical Services (City and County, including
  Utilities)
• Volunteers

• Vaccines and medicines will be in short supply
  and will have to be allocated on a priority basis

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Public Information and Communication

• Pre-Pandemic
• Coordinate with SAMHD PIO, COSA PIO, Hospital
  PIOs to generate talking points and community
  education
• Pandemic
• JIC established by COSA EOC to include COSA PIO,
  SAMHD PIO and collaborate with hospital PIOs
• One Message to public

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Summary

• Avian flu (H5N1) is a health concern
• It is NOT pandemic Influenza
• Each Hospital should have a contingency plan
  specific for pandemic influenza to include
• Emergency procedures
• Infection Control
• Public Information
• Vaccine for pandemic flu may or may not be
  available
• If not, focus on personal protective measures

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Pandemic Influenza Planning Group
http//www.sanantonio.gov/health http//www.pandem
icflu.gov