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Pandemic Influenza Planning

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Pandemic Influenza Planning . Frank J. Welch, MD, MSPH Medical Director Department of Health and Hospitals Office of Public Health . - PowerPoint PPT Presentation
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Pandemic Influenza Planning Frank J. Welch, MD, MSPH Medical Director Department of Health and Hospitals Office of Public Health
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Page 1: Pandemic Influenza Planning

Pandemic Influenza Planning

Frank J. Welch, MD, MSPHMedical Director

Department of Health and HospitalsOffice of Public Health

Page 2: Pandemic Influenza Planning

“We don’t know the timing of the next pandemic, how severe it will be. We don’t know what drugs will work. We don’t have a vaccine. Yet we are telling everyone to prepare for a pandemic. It’s tricky…This is scary and we don’t know… That’s the message.”

Dick ThompsonWorld Health OrganizationDecember 2005

Page 3: Pandemic Influenza Planning

Discussion Topics

• Influenza overview • 20th century pandemics• Current threat• Role of Public Health in preparedness and

response• Unique preparedness issues for a

pandemic

Page 4: Pandemic Influenza Planning

In Louisiana We Know How to Prepare for This:

Page 5: Pandemic Influenza Planning

How do we prepare for this?

Animation Courtesy of Mathematica Visualizations – Jeff Bryant

Page 6: Pandemic Influenza Planning

http://worldvid.cit.nih.gov/flu/flu.wmv

http://worldvid.cit.nih.gov/flu/flu.rm

Proceedings of the National Academy of Science, April 11, 2006Vol. 103, No. 15: 5935 – 5940.

Page 7: Pandemic Influenza Planning

Flu terms• Seasonal (or common) flu

– Respiratory illness that can be transmitted person to person. Most people have some immunity; vaccine available. What is left over from previous pandemics.

• Avian (or bird) flu– Caused by influenza viruses that occur naturally

among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. No human immunity and no vaccine.

• Pandemic flu– A virulent human flu (often from mutation of an avian

flu) that causes a global outbreak (pandemic) of serious illness. Since little natural immunity, the disease can spread easily from person to person. Currently no pandemic flu.

Page 8: Pandemic Influenza Planning

How does influenza spread?

• Breathing in droplets – Produced when infected

person talks/coughs/ sneezes• Touching an infected

person or surface – Contaminated with the virus

and then touching your own or someone else’s face

• Incubation period = time from exposure to virus to development of symptoms– Varies, but usually 1-4 days

Page 9: Pandemic Influenza Planning

Flu Preventive Steps

• Vaccination• Stay home when sick, 1 week from onset of

symptoms• Cover your cough• Hand hygiene

– Wash with soap and water regularly– Alcohol-based sanitizer if no water available

• Avoid touching eyes, nose and mouth• Avoid close contact with people who are sick

Page 10: Pandemic Influenza Planning

Seasonal and Pandemic FluSeasonal Flu

• Average U.S. deaths ~36,000/yr200,000 hospitalizations

• Symptoms (sudden onset): fever, cough, runny nose, muscle pain; death often caused by complications like pneumonia

• Generally causes modest societal impact

• Manageable impact on domestic and world economy

Pandemic Flu• Number of deaths could

be quite high (1918 death toll ~ 500,000)

• Symptoms may be more severe and complications more frequent

• May cause major impact on society

• Potential for severe impact on domestic and world economy

Page 11: Pandemic Influenza Planning

Seasonal and Pandemic Flu, cont

Seasonal Flu• Outbreaks follow

predictable patterns; annual; usually in winter

• Usually some immunity from previous exposure

• Complication risks- young, elderly and underlying health conditions

• Health systems usually meet needs

• Vaccine and antivirals usually available

Pandemic Flu• Unable to predict when;

Occurs rarely (three times in 20th century – last 1968)

• No previous exposure; little or no pre-existing immunity

• Healthy people may be at increased risk

• Health systems may be overwhelmed

• Vaccine not available in early stages and antivirals may be in limited supply

Page 12: Pandemic Influenza Planning

20th Century Flu Pandemics• 1918 – Spanish Flu

– Worldwide 20-50 million deaths – 500,000 deaths in US

• 1957-1958 – Asian Flu– Worldwide 1-2 million deaths – 70,000 deaths in US

• 1968-1969 – Hong Kong Flu– Worldwide 700,000 deaths – 34,000 deaths in US

Typical Influenza Season– 36,000 deaths in US

Page 13: Pandemic Influenza Planning

Avian (Bird) Influenza• Occurs naturally among birds

– Wild birds worldwide carry the virus – usually no illness

– Domesticated birds - can become ill and die• Humans

– Can become infected -- severe illness and death– Most cases from close contact with infected poultry– May have rarely spread from one person to another– Cases/deaths since 2003 = 270/164 (60% mortality)

Page 14: Pandemic Influenza Planning

Will H5N1 cause the next pandemic?

• Avian Flu not yet Pandemic Flu– Current outbreaks of H5N1 Avian Flu in poultry and

birds are the largest ever documented

• Impossible to predict next pandemic flu event

• If not H5N1, then another

Page 15: Pandemic Influenza Planning

Lessons from Past Pandemics

• Occur unpredictably, not always in winter • Variations in mortality, severity of illness and

pattern of illness• Rapid surge in number of cases over brief period

of time, often measured in weeks• Tend to occur in waves

– Each wave lasts about 2-3 months– Subsequent waves may be more or less severe– Generally occur 3-12 months after previous wave

Page 17: Pandemic Influenza Planning

Estimated Louisiana Pandemic Influenza Impact

• 3 million infected• 600,000 – 1.4 million clinically ill• 300,000 – 700,000 requiring outpatient care• 10,000 – 22,500 hospitalized• 3,000 – 6,000 deaths

Page 18: Pandemic Influenza Planning

Estimated Pandemic Influenza

Impact in the US• 200 million persons infected• 38-89 million clinically ill• 18-42 million requiring outpatient care• 314,000 – 733,000 hospitalized• 89,000 – 207,000 deaths

Page 19: Pandemic Influenza Planning

Interpandemic

Larger clusters, localized

Limited spread among humans

Pandemic

Pandemic Flu: Current Status

WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

Pandemic alert

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

New virus in

humans

Little/no spread among humans

Small clusters, localized

Limited spread among humans

Increased and

sustained spread in general human

population

No new virus in humans

Animal viruses low risk

to humans

No new virus in humans

Animal viruses low risk

to humans

Current H5N1 status

Page 20: Pandemic Influenza Planning

Requirements for Pandemic Flu

• For pandemic flu to occur, three conditions must be met: – A new influenza A virus appears or “emerges” in

the human population – The new virus causes serious illness in people – The new virus spreads easily from person to

person worldwide

Page 21: Pandemic Influenza Planning

Antiviral Medicines• Used for treatment of ill individuals, and rarely prophylaxis of contacts of

an ill person.

• Expensive, scarce, have side effects, and inappropriate use can cause viral resistance.

•• Antivirals from the SNS will be distributed to hospitals for patients ill with

the PanFlu virus.

• The SHO and the Office of Public Health will also provide guidelines on appropriate use of antivirals that are distributed. Public education will be very important given the scarcity of this resource.

• Prioritizing within priority groups will be necessary given the limited supply. As with vaccine, it will be critical to clearly communicate with the public about the rational for priority groups.

Page 22: Pandemic Influenza Planning

Vaccines• Vaccine will likely not be available when the novel virus first affects

communities. • Current manufacturing procedures require six to eight months before

large amounts of vaccine are available for distribution.

• Once a vaccine becomes available, it will be distributed through the Strategic National Stockpile system:

• The target population will be the entire Louisiana population. • Demand for vaccine will be greater than the supply early in the course

of the pandemic. • Once vaccine is available, it will need to be distributed as quickly as

possible through Point of Dispensing (POD) sites.• Immunologic responses is poor to unknown. It is likely that a second

(booster) dose of vaccine two to four weeks after the first dose is given will be required.

• Like antivirals, early in distribution, vaccines will need to be prioritized.

Page 23: Pandemic Influenza Planning
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Pandemic Flu Preparedness and Response Planning

…must move beyond traditional notions of continuity of operations, as a pandemic promises to test the limits of current contingency plans.

Pandemic Influenza – Preparedness,Response, and RecoveryGuide for Critical Infrastructure and Key ResourcesPublication Date: 9-19-2006

Page 26: Pandemic Influenza Planning

How do we plan?• Understand roles

– Federal, State, Local– Hospitals and Clinics– Business and Industry– Schools and Universities– Faith-Based and Community organizations– Individuals/families

• Education• Collaboration

Page 27: Pandemic Influenza Planning
Page 28: Pandemic Influenza Planning
Page 29: Pandemic Influenza Planning

Federal Checklists

• Federal planning• State and local planning• Individual planning• Business planning• Community and faith-

based organizations planning

• School planning– Child Care and Preschool– School District (K – 12)– Colleges and Universities

• Health Care planning– Emergency Medical

Services and non-emergent medical transport

– Medical offices and clinics– Home Health Care– Long-Term care– Hospitals

Page 30: Pandemic Influenza Planning

Selective recommendations from the Business, Community and School Planning

Checklists

Plan for up to 40% employee absenteeism for up to 2 months

Page 31: Pandemic Influenza Planning

Summary• Influenza pandemics are naturally recurring

events – come in waves• Experts think the world may be on the brink of

another pandemic • All countries will be affected; illness will be

widespread; mortality rate will be high• Healthcare systems will be overwhelmed• Economic and social disruption will be great• Risk minimized through preventive steps• No vaccine initially• Plan beyond “traditional notions of continuity of

operations”• Everyone needs to be prepared

Page 32: Pandemic Influenza Planning

When you do not know all the variables, but the risk is extreme, the lesson becomes: Plan for it all.

Pandemic Influenza – Preparedness,Response, and RecoveryGuide for Critical Infrastructure and Key ResourcesPublication Date: 9-19-2006

Page 33: Pandemic Influenza Planning

References• State Pandemic Resources

– http://www.dhh.louisiana.gov/offices/?ID=295• Family Readiness Guide

– http://www.dhh.state.la.us/offices/publications/• Official Pandemic Flu Web Site

– http://www.pandemicflu.gov/• Pandemic Influenza Preparedness, Response,

and Recovery Guide for Critical Infrastructure and Key Resources– http://www.pandemicflu.gov/plan/

pdf.CIKRpandemicInfluenzaGuide.pdf


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