PANDEMIC INFLUENZA

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PANDEMIC INFLUENZA

• BACKGROUND AND GUIDANCE FOR SCHOOLS

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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

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Common Influenza Symptoms

• Rapid onset of
• Fever
• Chills
• Body aches
• Sore throat
• Non-productive cough
• Runny nose
• Headache

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Influenza is a serious illness

• Annual deaths 36,000
• Annual hospitalizations gt200,000
• Total economic costs 37.5B
• Who is at greatest risk for serious
  complications?
• persons 65 and older
• persons with chronic diseases
• infants
• pregnant women
• nursing home residents

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Definitions

• Epidemic An increase in disease above what is
  normally expected
• Pandemic A worldwide epidemic

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How Do Influenza Pandemics Arise?

• Wild water fowl are natural reservoirs of
  influenza
• They can spread the virus to domestic birds

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How Do Influenza Pandemics Arise?

• When avian flu viruses experience sudden changes
  in genetic structure
• and
• Are capable of infecting humans
• and
• Can reproduce and spread from person to person
  efficiently

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Why Be Concerned About Pandemic Influenza?

• Influenza pandemics are inevitable naturally
  recur at more-or-less cyclical intervals
• Can cause
• High levels of sickness and death
• Drastic disruption of critical services
• Severe economic losses
• There will be little warning time between the
  onset of spread of a pandemic and its arrival in
  the U.S. Outbreaks occur simultaneously in many
  areas
• Impacts will last for weeks to months and likely
  to occur in successive waves
• Pandemics can disproportionately affect younger,
  working-age people
• Current avian influenza outbreak in Asia

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Timeline of Emergence of Influenza A Viruses
in Humans
Avian Influenza
H7
H9
H5
Russian Influenza
H5
H1
Asian Influenza
H3
Spanish Influenza
H2
Hong Kong Influenza
H1
1918
1957
1968
1977
1997
2003
1998/9
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Influenza Pandemics 20th Century
1918 Spanish Flu
1957 Asian Flu
1968 Hong Kong Flu
A(H1N1)
A(H2N2)
A(H3N2)
20-40 m deaths 675,000 US deaths
1-4 m deaths 70,000 US deaths
1-4 m deaths 34,000 US deaths
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Planning Assumptions Health Care

• 50 or more of those who become ill will seek
  medical care
• Number of hospitalizations and deaths will depend
  on the virulence of the pandemic virus

Moderate (1957-like) Severe (1918-like)
Illness 90 million (30) 90 million (30)
Outpatient medical care 45 million (50) 45 million (50)
Hospitalization 865,000 9, 900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000
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The 1918 Influenza Pandemic
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(No Transcript)
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Chicken Little and the Sky is Fallingor The Next
Major Disaster?

• Which is it?

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Current Outbreak Avian Influenza (H5N1)

• Began in fall, 2003.
• At least 252 confirmed human cases in Asia,
  Africa and Europe
• 148 deaths in Asia and Africa
• (World Health Organization, 10/06)
• Mammalian infection (cat, pig)
• No efficient person-to-person transmission
• Isolated Human disease
• Case-fatality rate gt 50
• Outbreak spreading, not controlled

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Current Avian Outbreaks
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Clinical illness with H5N1 compared with typical
human influenza illness

• More severe illness in younger persons
• Primary viral pneumonia appears to be more
  common and with rapid onset
• Incubation period may be longer 1-4 days (up
  to 14 days?)
• Duration of infectious period likely
  longer, particularly in adults 1d. prior to
  7d. after

(in adults children longer)
Adapted from Guillermo Herrera, CDC, 2005
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Pandemic Effects Strain on Resources

• Health care shortages
• Vaccine / Antivirals
• Hospital beds / equipment
• Masks
• Personnel shortages
• Disruption of essential society functions
• Panic

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Vaccines, Antivirals, andMedical Supplies
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Pandemic Influenza Vaccine Questions

• When will it be available?
• How much will there be?
• Who will own it?
• Who should get it?
• How should it be delivered?

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Treatment and Prevention Vaccine

• Vaccines takes 6-8 months to produce following
  the emergence of a new virus
• Supplies will be limited, if available at all
• 2nd dose after 30 days will likely be required
• New vaccine safety and efficacy has unknowns

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Treatment Prevention Antiviral Drugs

• Antiviral agents
• Effective in preventing illness
• Can prevent severe complications
• May not be effective against pandemic virus
• Supplies will be limited
• Treatment over prevention

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Nassau County Department of Health Pandemic
Influenza Preparedness Strategies

• Distribution Planning
• First Responder Prophylaxis
• Municipality operated PODs
• Employer operated PODs (regional)
• DOH operated PODs
• School operated PODs through municipalities

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Points of Distribution

• Community based sites used to distribute vaccines
  or medications to healthy citizens
• Would the schools be used?
• Municipalities will coordinate POD planning
  within their communities.

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Individual and Family Preparedness

• We will have to take care of ourselves and those
  around us.
• During a pandemic, public health will maximize
  resources for the greatest impact on the
  population as a whole.
• Schools should communicate with local/ state
  public health agencies and/or emergency
  responders about the assets/services the
  districts could contribute to the community.

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Influenza Prevention What Can We Do?

• Specific Recommendations
• for Infection Control in
• Schools and Workplaces
• Pandemic preparedness planning
• Distribution of educational messages
• and infection control guidance
• Social distancing people stay home when ill
• Promotion of respiratory etiquette
• Provision of materials for respiratory hygiene/
• etiquette tissues and disposal receptacles

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SOCIAL DISTANCING
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ISSUES FOR SCHOOL DISTRICTS TO THINK ABOUT

• Absenteeism among children AND staff
• Resources limited vendors, buses
• Role of school nurses
• Communication with parents and staff and
  community
• Advantages and disadvantages to closing schools
  (amount of closure time)
• Working with local municipalities
• Implications with State aide
• Policies sending sick children home (isolation
  within the school, masks, etc)
• Policies for allowing previously sick children to
  return to schools

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RESOURCES FOR SCHOOLS

• Nassau County Health Department, with direction
  from the New York State Health and Education
  Departments, will provide guidance to schools
  districts
• To create plans
• To create communication materials for students,
  staff and parents
• To provide guidance for closing schools

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Key Step for District Preparedness

• Incorporate the pandemic influenza plan as an
  annex in the school districts all hazards plan.

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COMMUNICATIONBefore a Pandemic Hits

• Develop strong relationships with your school
  communities
• Build confidence that information will be
  distributed accurately and quickly
• - Consider community meetings that describe
  current plans in place

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COMMUNICATIONBefore a Pandemic Hits

• School Websites
• Lunch Menus
• PTAs
• Letters to the Community
• BOE Meetings
• Marquis
• Proactive

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COMMUNICATIONBefore a Pandemic Hits

• Establish relationship with Public Health
  Officials early on
• Review/update procedures for communicable disease
  reporting

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Pandemic Influenza
Dont worry about it, its probably just a head
cold.
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Acknowledgments

• Presentation compiled and adapted from multiple
  slide sets from the
• Centers for Disease Control and Prevention
• HHS National Vaccine Program Office
• New York State Department of Health
• Connecticut Department of Health
• Kansas Department of Health
• Department of Defense
• Washington Department of Health