Pandemic Influenza What We Need to Know

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Pandemic InfluenzaWhat We Need to Know

• Yvette M. Corral, BS
• Instructional Specialist Coordinator
• Arizona Center for Public Health Preparedness

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Influenza Basics
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The Influenza Virus

• 3 types of Influenza Viruses (A,B,C)
• Influenza A-classified into subtypes on basis of
  two surface glycoproteins
• HA-Hemaggluttinin
• NA-Neuraminidase
• Subtypes of influenza A that are currently
  circulating among people worldwide include H1N1,
  H1N2, and H3N2 viruses

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Antigenic Drift vs. Antigenic Shift

• Antigenic Drift refers to small, gradual
  changes that occur through point mutations in the
  H and N antigens
• Occurs annually or every few years
• Antigenic Shift refers to an abrupt, major
  change to produce a novel influenza A virus
  subtype in humans that was not currently
  circulating among people

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Virus Transmission
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Seasonal Flu

• U.S. an estimated 25-50 million cases of the
  flu are currently reported each year leading to
  150,000 hospitalizations and 30,000 40,000
  deaths yearly.
• Worldwide an average of approximately 1 billion
  cases of flu, around 3-5 million cases of severe
  illness, and 300,000-500,000 deaths annually.

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Pandemic Flu in the 20th Century

• 1918 (H1N1) Spanish Flu
• 675,000 U.S. Deaths
• 50 Million Worldwide Deaths
• 1957-1958 (H2N2) Asian Flu
• 70,000 U.S. Deaths
• 1-2 Million Worldwide Deaths
• 1968-1969 (H3N2) Hong Kong Flu
• 34,000 U.S. Deaths
• 700,000 Worldwide Deaths

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Projections for a Pandemic Flu Today

• 2 million to 7.4 million deaths worldwide based
  on more mild 1957 projections
• The virulent 1918 strain (morality rate of 2.5)
  175350 million deaths worldwide
• Attack rates as high as 25-35
• Decrease in U.S. Gross Domestic Product from
  1-4.25

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Avian Flu

• Highly contagious respiratory disease of birds
• Influenza subtype A virus
• Water fowl are the natural hosts
• Deadly to domestic fowl

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Avian Flu in the World Today
-H5N1-63 Case Fatality Rate overall
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Prevention Measures
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Good Health Habits

• Avoid close contact
• Avoid close contact with people who are sick. If
  sick, keep distance from others to protect them
  from becoming sick
• Stay home when you are sick
• If possible, stay home from work, school, and
  errands when sick. This prevention measure will
  prevent others from catching your illness
• Cover your mouth and nose
• Cover your mouth and nose with a tissue when
  coughing or sneezing. It may prevent those
  around you from becoming sick

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Good Health Habits (cont.)

• Clean your hands
• Washing your hands often will help protect you
  from germs
• Avoid touching your eyes, nose or mouth
• Germs are often spread when a person touches
  something that is contaminated with germs and
  then touches his or her eyes, nose or mouth
• Practice other good health habits
• Get plenty of sleep, be physically active, manage
  your stress, drink plenty of fluids, and eat
  nutritious

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Vaccine Priorities

• Targets groups of people based on occupation,
  type of service, age group or risk level
• 4 Categories
• Homeland Natl Security
• Health Care
• Critical Infrastructure
• General Population
• Tier System
• Within each category based on the pandemic
  severity

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Non-pharmaceutical interventions

• Mitigation guidelines issued by the CDC (February
  2007) include social distancing strategies to
  reduce contact between people
• closing schools
• canceling public gatherings
• planning for liberal work leave policies
• teleworking strategies
• voluntary isolation of cases
• voluntary quarantine of household contacts

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Hospital Considerations

• Surge Capacity
• Staffing
• Bed Capacity
• Consumable and durable supplies
• Continuation of essential medical services
• Security
• Mortuary Issues

U.S. Health and Human Services
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Pharmaceuticals

• Dealing with Shortages
• Vaccine
• Anti-Virals
• Cold and Flu OTCs
• Distribution
• Points of Dispensing (PODs)
• Strategic National Stockpile (SNS)

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Public Health

• Coordinating mass care neighborhood care
  centers
• Coordinating mass dispensing
• Ordering quarantine for those exposed
• Ensuring that those in quarantine have adequate
  resources
• Special populations

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Basics of Isolation and Quarantine

• Isolation
• The separation and restriction of movement of ill
  individuals.
• Quarantine
• The separation and restriction of movement of
  well individuals who have been exposed to an
  infectious agent (contacts) but are not yet ill
  in order to prevent the spread of disease to the
  community
• Both isolation and quarantine can be either
  voluntary or legally mandated by local, state, or
  federal authorities.

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Types of Quarantine

• Home Quarantine for situations where those in
  quarantine can meet their basic needs at home and
  will not run the risk of further exposure by
  staying at home (ie exposing unexposed household
  members)
• Quarantine in Designated Facilities for exposed
  persons who do not have a home environment
  conducive to quarantine or choose not to be
  quarantined at home
• Working Quarantine this applies mainly to
  healthcare workers, public health workers, and
  other essential personnel that have been exposed.
  These individuals would need to follow a home or
  designated facility quarantine outside of work
  but may continue working with appropriate
  infection control practices

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Determining Types of Quarantine

• Severity of disease person was exposed to (for
  example, if the agent is highly lethal and
  disease progresses quickly, it may be important
  to have the person more closely monitored in a
  facility)
• Likelihood the person will obey the quarantine
  order
• Ability of person to monitor their own symptoms
  to determine if they are becoming ill and
• Ease in which public health can provide support
  services

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Arizona State Statutes and Regulations

• ARS 36-624
• Gives counties in AZ the authority to perform
  infectious disease investigations and if
  necessary, adopt quarantine or other sanitary
  measures. Used daily by communicable disease
  investigators and epidemiologists to conduct
  routine infectious disease investigations
• ARS 36-787
• Allows public health certain authorities under a
  public health emergency related to
• A. Public health emergency preparedness
• B. Medicine, Vaccines and Transportation
• C. Mandated treatment and quarantine
• D. Enforcement
• E. HIV exclusion
• F. Limits on quarantine authority
• ARS 36-788
• Specifically addresses isolation and quarantine
  during a state of emergency or state of war
  emergency.
• ARS 36-789
• An I Q order can be issued directly from the
  health department without a court order if any
  delay would pose an immediate and serious threat
  to the public. However, even during the event of
  a declared state of emergency or war emergency,
  those persons who have been ordered into
  isolation and quarantine still have the right of
  due process.

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Planning Issues to Overcome

• Forming relationships early on
• Memorandums of Agreement/ Understanding (MOAs
  MOUs)
• Volunteer registration
• Licensing agreements
• Disruption of supply chains
• Mental health issues

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Preparedness

• Resources
• Planning Checklists
• Planning Tools
• Community Strategy for Pandemic Influenza
  Mitigation
• Pandemic Influenza Preparedness, Response, and
  Recovery Guide for Critical Infrastructure and
  Key Resources
• Hotlines
• Risk Communication
• National Strategy for Pandemic Influenza
  Implementation Plan One Year Summary
• National Strategy
• HHS Pandemic Plan
• Pandemic Preparedness Leadership Forum

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Ethical Issues to Address

• Triage
• Vaccine and Anti-Viral Priorities
• Continuing to work
• Limited supplies
• Decision to treat

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Contact Information

• Yvette M. Corral, BS
• Instructional Specialist Coordinator
• Arizona Center for Public Health Preparedness
• 520-626-4732
• ycorral_at_email.arizona.edu