PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE Frank Agodi PhD student Walden University PUBH: 8165-2 Instructor: Dr. Raymond Thron Spring, 2011
Transcript
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Frank Agodi PhD student Walden University PUBH: 8165-2
Instructor: Dr. Raymond Thron Spring, 2011
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AGENDA Introduction What is Pandemic Influenza? Review
Influenza Basics History of influenza Epidemiology of Influenza
Routes of transmission How does Seasonal Flu defer from Pandemic
Flu? Data statistics of Influenza Prevention of Influenza
Conclusion Questions Feedback References Supplemental Reading
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INTRODUCTION For the past 400 years, epidemics resembling
influenza have been recorded in many countries. Epidemics from as
early as the 16th Century in England and the 18th Century in the
USA are recognizable as influenza, even in the absences of precise
knowledge of their causative In 1997 and again since 2003, there
has been concern about the Influenza A(H5N1) virus which continues
to circulate causing outbreaks in birds and occasional human
infections http://www.unicef.org/avianflu/index.html
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Pandemic = worldwide epidemic New influenza virus No immunity
Spreads from person-to-person Presumed to be like seasonal flu:
respiratory droplets Can cause severe disease Incubation Period
Presumed like seasonal flu: 1 to 5 days Contagious Period Presumed
to be similar to seasonal flu Timing Waves that last weeks and
could begin anytime WHAT IS PANDEMIC INFLUENZA?
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FLU BASICS VIRAL INFECTION Fever Headache Muscle aches Extreme
fatigue Dry cough Sore throat Runny or stuffy nose CDC Public
Health Image Library
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FLU BASICS VIRAL INFECTION - Flu Complications CDC Public
Health Image Library Bronchitis Pneumonia Dehydration Worsening of
chronic illness Sinus or ear problems in children Death ~65/100,000
infections 80-90% >65 y/o
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HISTORY OF INFLUENZA 1976 to 2006 deaths range 3,000-49,000
First flu pandemic in 40 years, 2009-2010 United States mortality
12,000 January 2-8, 2011, WHO, (2011) reported worldwide 4,331
specimen, 706 positive influenza A Four deaths, (two influenza A;
two influenza B) CDC. 2011. Flu view: A weekly influenza
surveillance report prepared by the influenza division. Retrieved
from http://www.cdc.gov/flu/keyfacts.htm#whatis
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HISTORY OF INFLUENZA Pandemics of the 20 th CenturyYear US
Mortality 1918-19 Spanish flu 550,000 1957-58 Asian 69,800 1968-69
Hong Kong 33,800 1977-78 Russian 8,300
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EPIDEMIOLOGY OF INFLUENZA - Influenza pandemic occurs when
major mutation happens It happens in two ways: Genetic
re-assortment Repeated transmission
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Does Age Matter? Age at death, per 100,000 persons in each age
group, United States, 19111918 -JK Taubenberger and DM Morens.1918
Influenza: the Mother of All Pandemics. EID, Jan. 2006 EPIDEMIOLOGY
OF INFLUENZA -
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ROUTES OF TRANSMISSION Novel virus Human-to-human transmission
R 0 = number of people an infected person infects Severity of
illness Case fatality ratio (CFR) More distance between persons
spread of germs less likely Transmission Respiratory droplets An
infected person infects ~1.53 others
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HOW DOES SEASONAL FLU DIFFER FROM PANDEMIC FLU? Seasonal Flu
outbreaks follow predictable seasonal patterns; occurs annually,
usually in winter, in the temperate climates. Usually some immunity
are built up from previous exposure Healthy adults usually not at
risk for serious complications; the very young, the elderly and
those with certain underlying health conditions at increased risk
for serious complications. http://www.cdc.gov/flu/ We can get more
info about seasonal flu in CDC site above.
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HOW DOES SEASONAL FLU DIFFER FROM PANDEMIC FLU? Pandemic Flu
occurs rarely (three times in 20 th century last in 1968). No
previous exposure Little or no pre-existing immunity Healthy people
may be at increased risk for serious complications.
http://www.cdc.gov/flu/ Info about how seasonal flu differ from
pandemic flu can be read from the CDC site above.
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SEASONAL FLU Occurs annually and is caused by influenza virus
Strikes in the fall and winter Usually less severe than pandemic
flu because many people may have developed some immunity Vaccines
developed based on known flu strains and available annually
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PANDEMIC FLU Usually, there is no pre-existing immunity or
previous exposure. Flu shots will not be available at first they
have to made. It may take 4 to 6 months or longer to prepare a flu
shot for this virus
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PANDEMIC FLU - Avian Influenza H5N1: Key Facts Transmission to
humans: Rare Extensive contact with infected birds Contagiousness
Very rarely spread between humans Spread among birds: increasing
Birds and poultry in Southeast Asia, Asia, Indonesia, Europe,
Africa, Middle East Severity Of 281 people infected with H5N1 Avian
Flu, 169 (60%) have died
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DATA STATISTICS OF INFLUENZA The WHO has reported cases of
influenza A (H1N1) Asia, Africa, Pacific and Europe Indonesia and
Vietnam have the highest In Egypt they reported 121 confirmed cases
40 have been fatal WHO. 2011. Global Alert and Response.CDC
Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths
in the United States, April 2009 March 13, 2010.
Retreivedromhttp://www.who.int/csr/don/2011_01_20/en/index.htmlhttp://www.who.int/csr/don/2011_01_20/en/index.html
CDC shows the statistics for hospitalization and deaths due to
H1N1
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Pandemic Flu Vaccine and Drugs Vaccine Delayed production May
require two doses Drugs Supplies: limited Distribution: unfamiliar
Prioritization rationing fear
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How To Slow a Pandemic: Latest CDC Guidance 1. Ill persons
should be treated and stay away from others 2. Exposed persons
should stay away from others and receive prophylaxis 3. More social
distance between children in schools and childcare 4. More social
distance between adults at work and play
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Prevention and Planning It Begins At Home The more you prepare
yourself and your family, the more likely you can fulfill roles in
an emergency
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PREVENTION OF INFLUENZA Stay home if you are sick until 24
hours after fever (100 F or 37.8 C)is gone
[http://pandemicflu.gov/indivi dualfamily/prevention/index. html]
Limit contact with others Cover your nose and mouth when you sneeze
or cough (use tissue or bend of your arm) Throw away used tissue
Use alcohol hand sanitizer Avoid touching your eyes, nose or mouth
Centers for Disease Prevention and Control. (2010). CDC says take 3
actions to fight the flu. Retrieved from
http://www.cdc.gov/flu/protect/jpreventing.htmhttp://www.cdc.gov/flu/protect/jpreventing.htm
U. S. Department of Health and Human Service. Flu.gov. (2011).
Prevention and treatment. Retrieved from
http://pandemicflu.gov/individualfamily/prevention/index.htmlhttp://pandemicflu.gov/individualfamily/prevention/index.html
Note! Preventive steps are provided in the links above.
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PREVENTION OF INFLUENZA Annual vaccination Injection
Inactivated Nasal mist Live attenuated Prophylactic medicines Avoid
ill persons Respiratory hygiene & etiquette: Cover your cough
southbirminghampct.nhs.uk
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PREVENTION OF INFLUENZA Step 1 Flu Vaccine 1 st (most
important) Protects against the three viruses Influenza A - H3N2
Influenza B 2009 - H1N1 High risk populations As early as 6 months
of age Children younger than 6 months can not receive the vaccine
Person caring (vaccinated) Centers for Control Disease and
Prevention. (2010). CDC says take 3 actions to fight the flu
Retrieved from
http://www.cdc.gov/flu/protect/preventing.htmhttp://www.cdc.gov/flu/protect/preventing.htm
Note! Info on steps to prevent spread of influenza could be read on
the above link.
Overall Goals Reduce deaths Reduce illnesses Reduce social
disruption
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Current Pandemic Planning Assumptions Well have some notice
Dont expect federal or state response Duration of event: weeks to
months Absenteeism Plan for 30-40% for at least 2 weeks Vaccine
Late, limited Anti-virals Insufficient stockpile for preventive
treatment Sufficient for some treatment
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Federal and State Public Health Roles Leadershipin
collaboration with emergency management Informationregular updates,
interim guidance Coordinationwith multiple agencies and
jurisdictions, e.g. counties, state agencies Evaluationmeasure
interventions effects
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Public Healths Legal Authorities CDC State Public Health County
or City Health Departments Federalguidance only www.pandemicflu.gov
www.cdc.gov Stateguidance and legal authority
http://www.cdph.ca.gov/Pages/DEFAULT.aspx County/Local Health
Departmentswhere guidance and legal authority meet real people
http://www.acphd.org/
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Federal Guidance DHS/HHS/CDC leadership All Federal Cabinet
Level Agencies Justice Defense Commerce Treasury
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Pandemic Severity CDCs Pandemic Severity Index Category 1 mild
Category 3 moderate Category 5 catastrophic Interventions Severity
Index Category 1 Ill persons stay home Schools generally not closed
Category 5 Almost everyone stays home!
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CONCLUSION The pandemic wave passes through Public Health
impacts Illnesses and deaths Other impacts are losses to business
sector Plans refined Vaccine or anti-flu drugs become
available
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REFERENCES Georgia State University. 2010. Office of Emergence
Management. H1N1 General Info. Retrieved from
http://www.gsu.edu/oem/37808.html http://www.gsu.edu/oem/37808.html
Centers for Disease Prevention and Control. (2010). CDC says take 3
actions to fight the flu. Retrieved from
http://www.cdc.gov/flu/protect/jpreventing.htm
http://www.cdc.gov/flu/protect/jpreventing.htm
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REFERENCES Centers for Disease Prevention and Control. (2010).
Cold versus flu. Retrieved from
http://www.cdc.gov/flu/about/qa/couldflu.htm
http://www.cdc.gov/flu/about/qa/couldflu.htm Louie, J. K., Acosta,
M., Jamieson, D. J. & Honein, M. A. (2010). Severe 2009 H1N1
influenza in pregnant and postpartum women in California. New
England Journal of Medicine. 362, 27-35.
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REFERENCES Payaprom, Y., Bennett, P., Burnard, P., Alabaster,
E. & Tantipong. (2009). Understandings of influenza and
influenza vaccination among high risk urban Dwelling Thai adults: a
qualitative study. Journal of Public Health. 32 (1). 26
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REFERENCES U. S. Department of Health and Human Service.
Flu.gov. (2011). Prevention and treatment. Retrieved from
http://pandemicflu.gov/individualfamily/prevention/inde
x.html;http://pandemicflu.gov/individualfamily/preventio
n/index.html
http://pandemicflu.gov/individualfamily/prevention/inde
x.html;http://pandemicflu.gov/individualfamily/preventio
n/index.html U. S. Department of Health and Human Service. Flu.gov.
(2011). Prevention and treatment. Retrieved from
http://pandemicflu.gov/individualfamily/prevention/inde
x.html;http://www.flu.gov/individualfamily/prevention/m
edicine/index.html
http://pandemicflu.gov/individualfamily/prevention/inde
x.html;http://www.flu.gov/individualfamily/prevention/m
edicine/index.html
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REFERENCES World Health Organization. 2011. Global Alert and
Responses. CDC Estimates of 2009 H1N1 Influenza Cases,
Hospitalizations and Deaths in the United States, April 2009 March
13, 2010. Retrieved from http://www.who.int/csr/don/2011_01_20/en/i
ndex.html http://www.who.int/csr/don/2011_01_20/en/i ndex.html