Post on 21-Jan-2016
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An Overview of Pandemic Influenza Planning in the United States
NAPHSIS Annual MeetingJune 7, 2006
David K. ShayInfluenza Division
Centers for Disease Control and Prevention
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New Viruses Emerge, and Pandemics Happen
H1
H1H3
H2
H7*
H5*
H9*
1918Spanish
Influenza H1N1
1957Asian
Influenza H2N2
1968Hong 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
19992003
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Avian Influenza A(H5N1)Why is Concern High?
• Impact on animals and economy– Lethal to poultry, and mammals infected– Present in waterfowl; shed in feces– Already has had a major economic impact
impact on humans
• Causes severe human disease– Might evolve to become easily transmissible– No H5N1 vaccine commercially available– Limited supplies of expensive antivirals
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Pandemic Planning Must Occur in Many Sectors
• Federal government
• State and local governments
• Healthcare Systems
• Businesses and private sector
• Individuals and families
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National Strategy for Pandemic Influenza
• Issued by President Bush in November 2005
• Guides U.S. preparedness and response by outlining responsibilities– Individuals– Industry– State/local governments– Federal government
• March 2006: Homeland Security Council Implementation Plan
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Goals of the National Strategy
• Stop, slow, or otherwise limit the spread of a pandemic to the United States
• Limit the domestic spread, and mitigate disease, suffering, and death
• Sustain infrastructure and mitigate impact to the economy and functioning of society
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Pillars of the National Strategy
• Pillar 1: Preparedness and Communication– Ensure preparedness– Communicate roles and responsibilities
• Pillar 2: Surveillance and Detection– Systems that provide continuous situational awareness– Ensure earliest warning possible
• Pillar 3: Response and Containment– Limit the spread of the outbreak – Mitigate the health, social and economic impact
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Department of Health and Human Services (HHS)
Pandemic Influenza Plan• Released November 2005• Supports the National Strategy• Outlines key roles of HHS and its
agencies• Doctrine for health sector
preparedness and response• Public health guidance for state and
local partners• HHS Operational Plan will be
released soon
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Planning Assumptions• All will be susceptible to infection with the
pandemic virus due to lack of existing immunity• The clinical attack rate might approach 30%, and
50% of persons who become ill will seek healthcare
• Each wave of infections in a community will last for approximately 6-8 weeks; 2 or 3 waves possible
• Groups at higher risk for severe disease/death cannot be predicted in advance, and may not correspond to those for seasonal influenza (eg, elderly and those with comorbid conditions)
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Moderate (1957-like) Severe (1918-like)
Illness 90 million (30%) 90 million (30%)
Outpatient medical care
45 million (50%) 45 million (50%)
Hospitalization 865,000 9,900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000
• 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
Burden of Pandemic Influenza
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Pandemic Influenza Doctrine:Saving Lives
• A threat anywhere is a threateverywhere
• Quench first outbreaks: detect andcontain where it emerges, if feasible
– International collaborations – Frontline detection and response; rapid laboratory diagnosis – Isolation / quarantine / antiviral prophylaxis / social distancing / animal culling
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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
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HHS Pandemic Influenza Doctrine: Saving Lives
Slow spread, decrease illness and death, buy time
• Antiviral treatment and isolation
• Quarantine for those exposed
• Social distancing
• Vaccination
Weeks
Impact
Prepared
Unprepared
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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
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A Network of Shared Responsibility
• Local - state - federal • Domestic – international• Public – private• Multi-sector• Animal – human• Health protection –
homeland security – economic protection
Healthcare
DeliverySystem
Federal Partners
Education System
Business & Workers
Local /State /Federal Public HealthSystem
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• State and Local• Business• Preschool• Schools (K-12)• Colleges & Universities• Faith-based & Community
Organizations
• Physician Offices and Ambulatory Care
• Home Health• Emergency Medical
Services• Travel Industry• Individuals
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Countermeasures: Vaccines, Antivirals, and
Medical Supplies
Strategic National
Stockpile
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H5N1 Vaccine
• Prototype vaccine developed by the National Institutes of Health
• Based on a H5 strain isolated in Viet Nam last year
• Elicits an antibody response but requires large dose
• 40 million doses (to protect 20 million people) being stockpiled
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Challenges for Pandemic Vaccination
• 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
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Influenza Antivirals
• Goal: treatment courses in the Strategic National Stockpile (SNS) for 25%
• Current status of SNS – 5.1 million Tamiflu (oseltamivir) treatment
courses– 84,000 Relenza (zanamivir) treatment courses
• Additional orders have been placed• Accelerate development of promising new
antiviral candidates
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Health Protection at the Frontline:
Local, County, and State Public Health Departments
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Seasonal Influenza Preparedness
Pandemic Influenza Preparedness
Preparing for a pandemic now means: •Putting into place methods to follow influenza, ie, public health surveillance
•Improving measures to control influenza•Modern seasonal influenza vaccine for all who need it
•New antiviral drugs for prevention and treatment
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Critical Role of Surveillance Data
• Response will require easily interpretable, up-to-date information
• CDC anticipates that at a minimum, the Federal, State, and local responses will require– Mortality rates (overall and pneumonia/influenza) by
state– Hospitalization rates, for some states or large
communities
• Data sufficient to conduct assessments of ‘countermeasures’ in several sites
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Hospitalizations• Current systems
– Emerging Infections Program & New Vaccine Surveillance Network
• Children-only systems at present• Sites in 11 states
• Additional data sources– Expanded EIP: Inclusion of adults, special studies– Vaccine Safety Datalink– BioSense real-time hospitalization data– Hospital capacity
• Exploring use of a HAvBED-like system that accepts bed census data from existing systems
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Mortality
• Current– 122 Cities Mortality Reporting System– Pediatric mortality reporting is a nationally
notifiable condition– NCHS mortality files
• Additional – Exploring timely reporting of all deaths
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Enhancement of Public Health Surveillance Systems
• Highest priority systems– Electronic laboratory data exchange
• Rapid 2-way exchange of patient-level data– Electronic death reporting
• Early use of mortality data submitted by funeral directors
• Benefits– Build public health reporting systems that would have
multiple uses– Use existing electronic data– Allow sub-state level analysis
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Infectious Disease Mortality, United States--20th Century
Armstrong, et al. JAMA 1999;281:61-66.
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Questions?