Pandemic Influenza: When, Where, and What Then?: Pandemic Influenza: When, Where, and What Then? An Informational Forum Presented by the Wood County Pandemic Influenza Task Force


Wood County Pandemic Influenza Planning Group: Wood County Pandemic Influenza Planning Group Wood County Health Department Wood County Hospital Wood County Emergency Management Agency Red Cross, Wood County Branch BGSU Wood County Sheriff Wood County ADAMHS Veterinarians WC Net Wood County Ag Society Others


Planning Process: Planning Process Develop Emergency Response Plans Exercise plans Revise the plans


Today’s Presentation: Today’s Presentation Differences in seasonal, pandemic and avian influenza Why there is concern about H5N1”Bird Flu” National, Ohio and Wood County’s pandemic influenza preparedness activities What can families and individuals do to prepare? Questions and Answers


DEFINITIONS: DEFINITIONS Epidemic local or regional outbreak of a disease Pandemic worldwide outbreak of a disease


DEFINITIONS: DEFINITIONS Seasonal Influenza Influenza viruses that already exist in people and cause illness usually in the fall and winter


DEFINITIONS: DEFINITIONS Pandemic Influenza A widespread outbreak of flu that occurs… when a new influenza A virus appears in the human population… causes serious illness and then… spreads easily from person to person worldwide


DEFINITIONS: DEFINITIONS Avian Influenza Influenza virus in birds caused by type A strains


Seasonal Influenza: Seasonal Influenza A respiratory infection acquired by… Contact with an infected person who is coughing and sneezing Incubation period: 1 to 3 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


Typical Seasonal Influenza Symptoms: Typical Seasonal Influenza Symptoms Rapid onset of: Fever Chills Body aches Fatigue Sore throat Non-productive cough Runny nose Headache


Seasonal Influenza is a Serious Illness: Seasonal Influenza is a Serious Illness Annual Cases in the US 35-50 million 10-20% of Americans Hospitalizations: more than 200,000* Annual deaths: 36,000* Average economic Cost $1-3 billion dollars per year Average annual estimates during the 1990s Source: CDC


Most at Risk for Serious Complications from Seasonal Flu: Most at Risk for Serious Complications from Seasonal Flu people 65 and older people with chronic diseases infants pregnant women nursing home residents


Vaccination for Seasonal Flu: Vaccination for Seasonal Flu Cornerstone of prevention for seasonal influenza Especially important for all health care workers Scientists study and identify viruses that are causing illness this year to then develop the vaccine for the following year Annual production cycle ensures availability by late summer/early fall


Slide14: So what is PANDEMIC INFLUENZA?


Pandemic Influenza: Pandemic Influenza A widespread outbreak of flu that occurs… when a new influenza A virus appears in the human population… causes serious illness and then… spreads easily from person to person worldwide


Phases of a Pandemic : Phases of a Pandemic Inter-pandemic Pandemic Alert Pandemic


Stages of Pandemic: Stages of Pandemic Source: World Health Organization


Pandemic Flu in Humans: Pandemic Flu in Humans


Pandemic Flu in Humans: Pandemic Flu in Humans


How does a virus cause a pandemic?: How does a virus cause a pandemic? Pandemic Requirements: Novel “New” Virus to humans Virus causes severe illness and deaths Sustained human-to-human transmission H5N1, “bird flu”, has achieved the first 2 of the 3 requirements


How the virus changes: How the virus changes Some mammals such as pigs can carry avian, human, and swine influenza viruses at the same time. This has happened in people, too. The viruses share genes to produce a new virus. The new virus could infect humans and spread from person to person.


How the virus changes: How the virus changes Human virus New virus Non-human virus DIRECT INDIRECT


Impact of Past Pandemics: Impact of Past Pandemics Year Name Global deaths 1918-19 Spanish flu 20-40 million 1957-58 Asian flu 1-2 million 1968-69 Hong Kong flu 1 million There were 3 influenza pandemics in the 20th century that caused significant death and illness.


Ohio Impact of the 1918 Influenza Pandemic: Ohio Impact of the 1918 Influenza Pandemic


What is Bird Flu?: What is Bird Flu? Bird flu is the flu in birds Occurs naturally among birds Bird flu usually only passes between birds Can cause severe illness and death especially in domesticated birds (including chickens, ducks, and turkeys).


How is bird flu spread?: How is bird flu spread? Infected birds pass the virus in saliva, nasal secretions, and feces. Birds may become infected when they have contact with contaminated excretions or surfaces. Migratory birds can be carriers without becoming ill.


Bird Migrations: Bird Migrations


How do people get the bird flu?: How do people get the bird flu? Bird flu viruses DO NOT usually infect humans Most cases of infection in humans have resulted from close and prolonged contact with infected poultry or contaminated surfaces. The ongoing spread from person-to-person has not occurred.


Where is Bird Flu Occurring?: Where is Bird Flu Occurring? The H5N1 virus has not yet been found in the U.S. The H5N1 virus was originally found in birds in Southeast Asia Recently, the H5N1 virus has been detected in birds in other Western European countries and in Egypt and India.


Current locations of bird fu in humans: Current locations of bird fu in humans As of April 27, 2006, Source: World Health Organization


Where is Avian Flu H5N1 Now?: Where is Avian Flu H5N1 Now? As of…April 28, 2006 See Source 1


Since there isn’t an H5N1 pandemic right now, why are we so concerned?: Since there isn’t an H5N1 pandemic right now, why are we so concerned? H5N1 disease has increased in severity in mammals Can infect pigs (raising concerns about reassortment of viruses) *Note: Properly cooked pork and poultry is not infectious. Occurs naturally in wild birds Current human mortality rate is around 50% Illnesses have predominantly affected healthy children and young adults (? similar to 1918)


Our preparedness today compared to 1918: Our preparedness today compared to 1918 Expanded global and national surveillance Better healthcare, medicines, diagnostics Greater vaccine manufacturing capacity


Today’s New Risks: Today’s New Risks Increased global travel and commerce Greater population density More elderly and people with weakened immunity More daycare and nursing homes


Ways to minimize spread: Ways to minimize spread Community Strategies Isolation: Separating someone who has disease from the general population. Quarantine: Placing persons who have been (or may have been) exposed to disease in a place where they will not expose others. Sheltering: Healthy people (not exposed) stay at home or ‘where they are’ to keep from being exposed to disease


Ways to minimize spread: Ways to minimize spread Community Strategies Canceling public gatherings Closing schools Working from home Distance learning


Other Control Measures: Other Control Measures Education to help with self-diagnosis and self-care Public health information Risks and risk avoidance Avoiding crowds Hand washing “Cover your Cough” Masks may offer some protection


Vaccine Issues: Vaccine Issues Current vaccine production process time 6-9 months There will likely be shortages initially People will be vaccinated in stages Two doses will likely be necessary for immunity


Vaccination stages: Vaccination stages Health care workers involved in direct patient contact and essential support; Highest risk group. Household contacts of children <6 months and severely immunocompromised; pregnant women. Key government leaders and critical public health pandemic responders. Rest of high risk.


Vaccination stages: Vaccination stages Most critical infrastructure and other public health emergency responders Other key government health decision makers and mortuary services Healthy 2-64 year olds not in other groups


Antiviral treatments: Antiviral treatments Therapy to reduce severity of disease Prophylaxis to try to prevent the disease Currently available medications may or may not be effective


Ohio Dept. of Health Preparedness Activities: Ohio Dept. of Health Preparedness Activities Developing a response plan Plan will be linked to the state’s Emergency Operations Plan Exercises (tabletops and regional functional exercises)


Regional Planning: Regional Planning NW Ohio Hospital Council planning for hospital “surge” (Increase in number of patients presenting to hospital) Planning for alternate care facilities for influenza patients Regional public health coordination Plans are constantly changing and evolving as the situation develops


What can schools and businesses expect in a pandemic?: What can schools and businesses expect in a pandemic? Possible disruption of the usual way of operating Usual services may not be available High worker absenteeism (40%) Schools may be closed Transportation services may not be available


How do Schools and Businesses Plan?: How do Schools and Businesses Plan? Plan for the impact: Identify a planning team Identify critical/essential services and staff needed to keep operations going Train and prepare ancillary workforce to fill in Develop a plan for increased or decreased demand for your products/services Assess the potential financial impact Keep reliable up to date information Establish an emergency communications plan and test it periodically


Plan for the impact on your customers and staff…: Plan for the impact on your customers and staff… Estimate employee absences Identify ways to reduce or eliminate face to face contact—telecommuting or distance learning Encourage seasonal flu vaccinations Evaluate access to health care services, including social and mental health services Identify employees/students with special needs Plan for the impact on student learning and extra-curricular activities Develop a continuity of operations plans for essential services


Establish policies to be implemented during a pandemic…: Establish policies to be implemented during a pandemic… Compensation and sick-leave policies that may be unique to pandemic Flexible work site and hours, telecommuting and staggered work hours Promote respiratory hygiene Establish policies for employees/students who have been exposed to influenza, are suspected of being ill or become ill at work or school Policies for restricted travel How to activate emergency response plan


Resources that can protect your staff, customers and students…: Resources that can protect your staff, customers and students… Infection control supplies: Hand hygiene products Tissues Enhanced communications equipment to support telecommuting and distance learning On-site or available medical consultation and advice Establish policies for transporting ill students or employees


Communicate and Educate…: Communicate and Educate… Provide printed materials and programs for employees and students Anticipate fear and anxiety and plan on how to respond Talk to employees and students about your plan Provide information for employees and students on how to care for ill family members Develop methods for getting information out quickly to students/employees during a pandemic Identify community sources for information and find out how local emergency response will occur


Coordinate with outside agencies…: Coordinate with outside agencies… Collaborate with insurers, health plans local health care facilities Participate in local planning processes Report high worker/student absenteeism rates to the health department Communicate with local response organizations on how your business or school can help in planning Share your “best practices” with other businesses and schools


Resources on the internet…: Resources on the internet… Centers for Disease Control and Prevention www.CDC.gov www.pandemicflu.gov World Health Organization www.who.int Ohio Department of Health www.odh.state.oh.us Wood County Health Department www.co.wood.oh.us/healthdepartment Wood County Emergency Management Agency www.co.wood.oh.us/ema US Department of Agriculture www.usda.gov American Veterinary Medical Association www.avma.org


Sources: Sources Source 1: Avian flu cases worldwide http://www.who.int/csr/disease/avian_influenza/en/index.html Source 2: Timeline of Influenza A viruses in humans http://www.hhs.gov/nvpo/pandemics/annotatedSlide.ppt Source 3: Infectious disease mortality in the U.S. in the 20th century Armstrong, et al. JAMA 1999;281:61-66. Source 4: Potential impact of next influenza pandemic Meltzer, CDC, unpublished data Source 5: Estimates of hospitalizations & deaths due to pandemic influenza Meltzer et al. EID 1999;5:659-71 Source 6: U.S. vaccine and medical stockpile spending http://www.cidrap.umn.edu/cidrap/content/influenza/panflu/news/sep1505hhs.html Source 7: Antiviral Drug Therapy Kaiser, Arch Intern Med 2003