Pan Avian Flu BusSymp 10 23 06Final erica

Pandemic Influenza Planning in San FranciscoOctober 23, 2006: 

Pandemic Influenza Planning in San Francisco October 23, 2006 Erica Pan, MD, MPH Director, Bioterrorism & Infectious Disease Emergencies Unit

Presentation: 

Presentation Seasonal/Pandemic/Avian Influenza “101” Strategies to prevent or slow spread of disease San Francisco Preparedness Activities Summary

Seasonal/Pandemic/Avian Influenza “101”: 

Seasonal/Pandemic/Avian Influenza “101”

Seasonal Influenza: 

Seasonal Influenza Responsible for the influenza that we see every fall and winter. (There are 3 types: A, B, and C) Influenza A is responsible for most human disease and is the source of all past pandemics The virus changes slightly during the flu season and as it migrates from the northern to southern hemispheres. Because the virus changes so frequently, one vaccine does not give lifelong immunity These changes are monitored and the annual flu vaccine must be designed to try to match these changes.

Seasonal Influenza (cont): 

Seasonal Influenza (cont) Named by H#N#s - these signify proteins on the virus envelope – diff. subtypes Within these subtypes there are different strains Through prior exposure to similar flu virus strains and from the vaccine, many people have partial immunity to the current circulating strain. Annually, the US experiences 30 – 40K deaths from seasonal influenza.

Current Avian Influenza/Bird Flu (H5N1) - Animal Disease: 

Current Avian Influenza/ Bird Flu (H5N1) - Animal Disease Avian Flu is a subtype of Influenza A First detected in Korea in 12/03 in poultry. Wild birds are the reservoir and may be asymptomatic. Wild birds can directly infect domestic poultry, leading to severe morbidity and mortality in domestic poultry. Has now been detected in animals in over 50 countries.

Current Avian Flu (H5N1): Human Disease: 

Current Avian Flu (H5N1): Human Disease Human infections have occurred in 10 countries in East Asia & the Pacific, Europe & Eurasia, and the Near East. There have been a total of 256 confirmed infections and 151 deaths in humans (10/16/06). Virus is not efficiently spread between birds/humans and humans/humans.

Why Are We Worried About Avian Flu?: 

Why Are We Worried About Avian Flu? Rapid spread through poultry flocks in Asia. Although rare, has caused severe disease in humans. Ongoing exposure and infection in humans in rural Asia and Europe (in association with free-ranging poultry flocks). Co-infection with pig or humans infected with influenza could lead to genetic reassortment. Could create new flu type easily transmitted from human-to-human (i.e. create a pandemic).

Slide11: 

Human virus Reassortant virus Non-human virus Mechanisms of Influenza Virus “Shift” Slide courtesy of Janice Louie, CDHS Modified from Ben Schwartx, NVPO

Definitions: 

Definitions Endemic: a disease that exists permanently in a particular region or population. Epidemic: An outbreak of disease that attacks many peoples at about the same time and may spread through one or several communities. Pandemic: When an epidemic spreads throughout the world.

Slide14: 

Definition of a Pandemic Influenza Strain A new Influenza A virus subtype emerges in humans Easily transmitted from person to person Able to cause significant illness and/or death Affects MANY people across the globe http://www.pandemicflu.gov/

Pandemic Influenza: 

Pandemic Influenza In the 20th Century, 3 large pandemics occurred: 1918 (A/H1N1), 1957 (A/H2N2), and 1968 (A/H3N2) Over 10x the expected annual numbers of deaths from influenza during these pandemics Each had origin in avian flu strain

If Pandemic Influenza Emerges..: 

If Pandemic Influenza Emerges.. This is a catastrophic event – we cannot control or stop the arrival of pandemic flu to SF. Infected individuals can spread the disease to others before their symptoms develop. Infection can require as little as 3 particles. The virus can survive on surfaces for many hours. We can’t predict the characteristics of the virus – Will it cause few or many hospitalizations and deaths? What symptoms will it cause? Who will be most susceptible? How will it be spread? How long will sick people be contagious to others?

What Can We Expect in a Pandemic?: 

What Can We Expect in a Pandemic? Potential for illness in a large number of people over many months. This will be a slowly evolving and waxing and waning process. Our hospitals and clinics will be stressed. Variable levels of absenteeism from all sectors of the workforce (anywhere between 5-40%). City Departments and Agencies will implement continuity of operations emergency plans and prioritize essential services. SFDPH, in collaboration with other City Departments and the Mayor’s Office, will institute measures to slow and prevent the spread of disease in SF.

Emergence of Pandemic Flu – Strategies to Prevent Disease: 

Emergence of Pandemic Flu – Strategies to Prevent Disease As with seasonal influenza, pandemic influenza would best be controlled with a vaccine specific to that subtype. If a vaccine became available, SFDPH prepared to set up clinics for “mass prophylaxis” Even in the absence of an available Avian Flu (H5N1) specific vaccine, some evidence suggests seasonal flu vaccine may provide some protection

Flu Vaccines: 

Flu Vaccines Inactivated Intramuscular Induces one type of immunity Approved for >6 mos. of age Brand names: Fluvirin®, Fluarix®, Fluzone® Depending on flu subtypes included in the vaccine and potential pandemic subtype, may provide some protection for pandemic flu Attenuated live virus Intranasal Induces several types of immunity Approved for 5 – 49 yo Brand name: Flumist ® May have broader protection for more types of flu than inactivated

Slide22: 

FLU VACCINE CLINIC: OCTOBER, NOVEMBER, AND DECEMBER. Location: San Francisco Department of Public Health 101 Grove Street, 3rd Floor, Room 300 Cost: $25 Cash, Visa, Mastercard, and ATM cards accepted. AITC cannot accept or bill insurance. A receipt is provided that can be submitted to your insurer. Schedule: Monday, Wednesday, Thursday, and Friday, 9:00 am – 4:00 pm BY APPOINTMENT Appointments can be scheduled online http://www.sfdph.org/aitc/Flu.shtml or by calling (415) 554-2863 Our website also has a list of other public flu clinics: www.sfdph.org/cdcp “Immunization Programs-> Flu Program”

Slide23: 

Emergence of Pandemic Flu – Strategies to Slow Spread of Disease Anti-virals may be effective for prophylaxis and/or treatment. Even for seasonal flu only decrease symptoms by < 1 day Seasonal flu is already resistant to one class of antiviral medicines SFDPH and other public health organizations do NOT support or encourage stockpiling of antiviral medicines by individuals or private organizations Without a vaccine or medication, social distancing and infection control strategies are the only available means to slow the spread of disease.

Social Distancing Strategies: 

Social Distancing Strategies Isolation of sick individuals (hospital, home or other facilities). Quarantine of well individuals exposed to ill persons (home or other facility). Cancel or postpone large gatherings (e.g. sports events). Encourage businesses to implement work at home or other modified strategies. We would NOT “shut down” businesses. Modify school schedules. Delicate balance between school closures and insuring adult workforce can come to work and maintain infrastructure Only as a last resort and only during specific phases of a pandemic if absolutely necessary

Who Has the Authority to Institute Social Distancing Measures?: 

Who Has the Authority to Institute Social Distancing Measures? The local health officer has broad powers to address a pandemic influenza emergency. Under California law, a local health officer who believes a contagious, infectious or communicable disease exists within the territory under his or her jurisdiction “shall take measures as may be necessary to prevent the spread of disease or occurrence of additional cases” and to protect the public’s health (California Health and Safety Code Section 120175).

Infection Control Strategies: 

Infection Control Strategies These will differ for health care settings, for emergency responders, for businesses and for the general public. Avian influenza infection control recommendations for health care settings can be found on our website. Further details and discussion in later presentation.

San Francisco Preparedness Activities: 

San Francisco Preparedness Activities

Role of the Office of Emergency Services in City Wide Planning: 

Role of the Office of Emergency Services in City Wide Planning Coordinates and supports the CCSF response to an emergency event or declared disaster Coordinates local and state Declarations of Disaster Activates Joint Information Center (JIC) for public education, media messaging, "one voice" Coordinates disaster shelter response when needed Activates Policy Group as part of the Emergency Operations Center (EOC) for critical decision making

City Department Preparedness Activities: 

City Department Preparedness Activities City Wide Avian/Pandemic Flu Task Force Representatives from SFDPH, SFPD, SFFD, Sheriff, ECD, DPW, Rec & Park, MTA, Medical Examiner, PUC, DHR, DHS, ACC, Port, SFO, SFUSD, OES. Goal: Provide a format for all City Departments to address their concerns and questions regarding avian and pandemic flu and ensure coordination between City Departments regarding avian influenza planning and response.

City Wide Avian/Pan Flu Task Force: 

City Wide Avian/Pan Flu Task Force SFDPH is developing trainings for City and County staff on pandemic influenza, including PPE (personal protective equipment). Through the coordination activities of OES, each agency will complete a Pandemic Influenza Continuity of Operations Plan.

Pandemic Influenza Continuity of Operations Plan: 

Pandemic Influenza Continuity of Operations Plan Focuses on Planning, Response & Recovery in the areas of: Authority Prioritization of operations and job functions Employee policies Purchasing and procurement of products and services Employee communication Client/constituent communication Infection prevention & control

Department of Public Health Preparedness Activities: 

Department of Public Health Preparedness Activities Development of an operational “Infectious Disease Emergency Response (IDER) Plan” with a pandemic influenza annex Outreach to the clinical community Outreach to the public Outreach to the business community Strengthening public health lab’s ability to test Collaboration with the hospitals: Hospital Infection Control Working Group, and Hospital Pharmacy Working Group, Hospital Council Emergency Preparedness Task Force, Multi-casualty Incident Working Group Surge capacity planning

Outreach to the Clinical Community: 

Outreach to the Clinical Community Infectious Disease Emergency Guide Website: www.sfdph.org/cdcp Presentations at hospitals, medical groups Health Alerts to the clinical community (11/08/05) Providing consultation on possible cases Facilitating testing of possible cases

CDCP Websitewww.sfdph.org/cdcp: 

CDCP Website www.sfdph.org/cdcp

Outreach to the Public: 

Outreach to the Public Website www.sfdph.org/cdcp Fact sheets, FAQs, Weekly updates Avian/Pandemic Influenza Information Line 415-554-2905

Outreach to the Business Community: 

Outreach to the Business Community Active interest from the business community to participate in Pandemic Flu Planning activities. DPH has prepared a “Continuity Plan” for businesses. DPH has sponsored this symposium to promote participation and collaboration in the planning process.

Summary: 

Summary Pandemic Flu preparedness is everyone’s issue: Mayor, Board of Supervisors, City Departments, Hospitals, SF businesses and SF residents. Pandemic Flu Planning is in progress at all levels in our city. As pieces of the planning are completed, SFDPH will make available for the public to review and comment.

Slide38: 

Internet resources for updated information: SF: www.sfdph.org/cdcp the CDC website at http://www.cdc.gov/flu/avian/outbreaks/current.htm; the OIE website at http://www.oie.int/eng/en_index.htm; and/or the WHO website at http://www.who.int/csr/disease/avian_influenza/en/