Pandemic Planning: A Nation Prepared: Pandemic Planning: A Nation Prepared U.S. Department of Health and Human Services
Mike Leavitt, Secretary
Slide4: HHS Pandemic Influenza Preparedness Planning ADM John O. Agwunobi
Assistant Secretary for Health
Slide7: Pandemics Do Happen! H1 H1 H3 H2 H7* H5* H9* 1918
Spanish
Influenza
H1N1 1957
Asian
Influenza
H2N2 1968
Hong Kong
Influenza H3N2 1980 1997 1915 *Avian Flu 2003 2004 1977 1996 2002 1925 1935 1945 1955 1965 1975 1985 1995 2005 2003-2006 1998 1999 2003
Slide9: 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
Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006) : Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006)
Phases of a Pandemic: Where We Are Now: Phases of a Pandemic: Where We Are Now
HHS Pandemic Influenza Plan: HHS Pandemic Influenza Plan Support the National Strategy for Pandemic Influenza
Outlines planning assumptions and doctrine for health sector pandemic preparedness and response
Public Health Guidance for State and Local Partners
11 Supplements with detailed guidance
HHS Pandemic Influenza Doctrine: Saving Lives: HHS Pandemic Influenza Doctrine: Saving Lives Prevent or at least delay introduction into the United States
May involve travel advisories, exit or entry screening
For first cases, may involve isolation / short-term quarantine of arriving passengers
HHS Pandemic Influenza Doctrine: Saving Lives: HHS Pandemic Influenza Doctrine: Saving Lives Clearly communicate to the public
Prepare people with information
Encourage action steps to prepare now
Provide updates when new information emerges
Use trusted messengers
Coordinate to ensure consistent messages
Address rumors and inaccuracies
Challenges in Pandemic Vaccine Preparedness: Challenges in Pandemic Vaccine Preparedness Expand production of current (egg-based) vaccine
Evaluate dose-sparing technology (adjuvants, intramuscular vs. intradermal route)
Accelerate development of modern (non-egg) vaccines
Target new antigens
Avian Influenza Vaccine Production : Avian Influenza Vaccine Production Working with the National Institutes of Health
Current H5N1 Vaccine – 40 million doses being produced
Second Clade 2 Avian Influenza vaccine
Antivirals and Medical Supplies: Influenza Treatments: Antivirals and Medical Supplies: Influenza Treatments Stockpile
Tamiflu: 5+ million treatment courses in Strategic National Stockpile (SNS) with 12.4 million treatment courses ordered
Tamiflu oral suspension: 97,000 courses in SNS with an additional 260,000 on order (arrival date to be determined)
Relenza: 84,000 courses in SNS with 1.75 million treatment courses ordered
Strategy
Procure 81 million courses of antivirals
6 million courses to be used to contain an initial U.S. outbreak
75 million courses to treat 25 percent of U.S. population
Accelerate development of promising new antiviral candidates
Antivirals and Medical Supplies: Influenza Treatments: Antivirals and Medical Supplies: Influenza Treatments $350 million appropriated in FY 2006 to upgrade state and local response capacity for pandemic influenza
$100 million of the funding is scheduled to be awarded to all 50 states; 7 territories; Puerto Rico; Washington, D.C.; New York City; Chicago; and Los Angeles County and allocated according to a base + population formula
$250 million will be awarded later this year. Application for funding is supplemental to current cooperative agreements
State and Local Pandemic Influenza Planning Checklist: State and Local Pandemic Influenza Planning Checklist Community Leadership and Networking
Surveillance
Health System Partnerships
Infection Control and Clinical Care
Vaccine Distribution and Use
Antiviral Drug Distribution and Use
Community Disease Control and Prevention
Communications
Workforce Support
Complacency is the enemy of health protection!:
www.pandemicflu.gov Complacency is the enemy of health protection!
Avian Influenza (AI) Preparedness and Response : Avian Influenza (AI) Preparedness and Response Veterinary Services
March, 2006
Topics Covered: Topics Covered Avian Influenza Overview
USDA’s AI Interventions
Targeted surveillance
Border protection
Trade restrictions & OIE guidelines
Outreach & education
Preparedness & response
Avian Influenza Overview: Avian Influenza Overview Avian influenza (AI) - identified in the early 1900s
High pathogenic avian influenza (HPAI) – causes contagious illness, death in birds; Low pathogenic (LPAI) causes mild to no illness
Vast majority of AI viruses found in birds do not represent a public health concern
Avian Influenza Overview (cont.): Avian Influenza Overview (cont.) Virus is characterized by H and N type (surface proteins).
144 different characterizations of the virus, based on 16 H types and 9 N types
AI viruses mutate easily; only H5 and H7 viruses have the potential to mutate from an LPAI to an HPAI form.
AI viruses vary widely in pathogenicity from strain to strain. Therefore not all H5N1 viruses are infectious for people or pathogenic to poultry.
Slide38: Species Affected Genetic Reservoirs Intermixing H1, H3 H1, H2, H3 H3, H7 Commercial,
LBMs
Others H1-12
H14-15 H1-2, 4-7,
H9-13, 15-16 H10 H1, H3, H4, H7,
H13 Other Aquatic
Birds? H5N1
How is the virus spread among birds?: How is the virus spread among birds? Direct contact between healthy and infected birds
Infected fecal matter
Can be found on surface of unwashed egg shells from infected birds
Three HPAI Findings in U.S.: Three HPAI Findings in U.S.
1924 – “Fowl Plague” affected live bird markets in the Northeastern U.S.
1983 – destruction of 17 million birds in PA
2004 – quickly contained and eradicated in TX
AI Surveillance: AI Surveillance APHIS and States conduct surveillance through:
National Poultry Improvement Plan (NPIP)
State and University laboratories
Export testing at slaughter
State movement requirements
AI Surveillance (cont.): AI Surveillance (cont.) APHIS’ safeguarding system encompasses:
Targeted surveillance
Cooperative efforts with States and Industry
Outreach and education
Trade restrictions
Anti-smuggling programs
LPAI Surveillance and Control Plan: LPAI Surveillance and Control Plan Federally-coordinated and State-assisted LPAI H5/H7 LPAI Control Program
Commercial poultry
Live bird marketing system
Since 1986, APHIS and States have monitored live bird markets (LBMs) in Northeast U.S.
Surveillance: NPIP: Surveillance: NPIP
Establishes standards for evaluation of poultry breeding stock and hatchery products
“Avian influenza free” certification for commercial companies
New LPAI program that will provide for H5 and H7 AI monitoring
Surveillance: NPIP (cont.): Surveillance: NPIP (cont.) New LPAI program that will provide for H5 and H7 AI monitoring
Program components: “AI monitored” program, surveillance specifications, and State LPAI response and containment plans
LBMs – Surveillance: LBMs – Surveillance Uniform Standards published in 2004 provide guidelines for markets, dealers and producers:
Licensing requirements and education
Bird testing and recordkeeping
Sanitation and biosecurity
Surveillance and inspections
LPAI positive facilities
LBMs – Surveillance (cont.): LBMs – Surveillance (cont.) States enforce LPAI program standards
Federal indemnification provided for participating States with positive diagnosis of H5 or H7 LPAI
APHIS initiated cooperative agreements with 21 States
LPAI Surveillance – National Animal Health Laboratory Network (NAHLN): LPAI Surveillance – National Animal Health Laboratory Network (NAHLN) 37 States participate in the network. NAHLN labs:
Provide laboratory services nationwide
Provide laboratory data for reporting
Respond to foreign animal disease outbreaks
Focus on animal diseases
Border Protection & Risk of Introduction of Asian Strain of H5N1: Border Protection & Risk of Introduction of Asian Strain of H5N1 USDA works closely with DHS to prevent smuggling of illegal poultry and poultry products.
USDA’s Smuggling Interdiction and Trade Compliance unit and DHS’ Customs and Border Patrol actively monitor U.S. ports.
Legally imported birds from other countries are tested for AI.
Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1: Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1 Genetic separation of H5 AI viruses between New & Old World
Asian birds rarely get off course and go to N. America
Risk from wild birds is low Migratory Birds – Overlap of summer breeding grounds in Alaska, Northeast Canada
Trade Restrictions: Trade Restrictions USDA maintains trade restrictions on countries affected by H5N1:
Albania, Azerbaijain, Cambodia, Cameroon, People’s Republic of China, Egypt, France (VS defined restricted zone only), India, Indonesia, Iraq, Iran, Italy, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Myanmar, Niger, Nigeria, Poland, Romania, Russia, Slovakia, Slovenia, Switzerland, South Korea, Taiperi China, Thailand, Turkey, Ukraine and Vietnam
Poultry and poultry products from those countries are strictly prohibited.
USDA works with trading partners and the World Organization for Animal Health (OIE) to maintain safe trade.
World Organization for Animal Health (OIE) – Reporting and Guidelines: World Organization for Animal Health (OIE) – Reporting and Guidelines OIE guidelines state that:
HPAI and all H5/7 LPAI must be reported to the OIE.
Poultry meat and table eggs do not transmit LPAI
Trade in poultry and poultry products can continue despite a finding of LPAI
Recommends certain health measures for the trade in poultry and poultry products based on risk and AI status
Compartmentalization allows countries to document separation based on biosecurity
Outreach & Education: Outreach & Education USDA’s Biosecurity for the Birds Campaign is an extensive and far-reaching outreach initiative designed to:
Educate non-commercial poultry owners about the signs of AI & other poultry diseases
Promote the importance of practicing biosecurity
Encourage rapid reporting of clinical signs of disease and/or unexpected deaths
USDA AI Web Site www.usda.gov/birdflu: USDA AI Web Site www.usda.gov/birdflu Information about “Biosecurity for the Birds” program
Links to other Federal entities working on AI
Fact Sheets and other information resources
Q&A on AI
News Releases
Technical Briefings
Preparedness in the Event of an Outbreak: Preparedness in the Event of an Outbreak Key is early detection and rapid response
USDA maintains a comprehensive emergency response structure:
Partnerships with local, State, and Federal organizations
Integration with the National Response Plan
Continual collaboration with HHS, DHS and other Federal entities
Diagnostic capabilities
Response to an Outbreak in Poultry: Response to an Outbreak in Poultry Guidelines
Stamping out
National Response Plan
First responders
Vaccines
Response for AI in Wild Birds: Response for AI in Wild Birds Manage wildlife threats
Assess risk wildlife poses to susceptible livestock and poultry
Containment, survey and surveillance, and population management
Questions?: Questions?
Slide60: Convention Center Floor Plan 2 – Exhibit Hall and Ballrooms BREAK OUT SESSIONS ROOM LOCATIONS
Community/Volunteer Groups E 21B
Private Sector/Business E 21C
Schools K-12 E 21 A
Slide61: Convention Center Floor Plan 1 – Exhibit Hall and Break out Sessions BREAK OUT SESSIONS -- ROOM LOCATIONS
Assisted Living/Long Term Care E 10C
Colleges and Universities E 10D
Community/Volunteer Groups E 21B (see floor plan 2)
Fire/EMS E 11A
Healthcare E 10 A&B
Law Enforcement/Judiciary E 11C
Local Government E 11B
Private Sector/Business E 21C (see floor plan 2)
Schools K-12 E 21 A (see floor plan 2) LUNCH Exhibit Hall B