Facilitating An Effective Public Health Response To Pandemic Flu
Pandemic Flu and You JJ Naponick, MD MPH Administrator/Medical Director Department of Health &...
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Transcript of Pandemic Flu and You JJ Naponick, MD MPH Administrator/Medical Director Department of Health &...
Pandemic Flu and You
JJ Naponick, MD MPHAdministrator/Medical Director
Department of Health & HospitalsOffice of Public Health
Region 6
Topics of DiscussionInfluenza Avian FluPandemic FluImpact & PlanningPublic Health RoleYour RoleResources
mild to severe respiratory illness of sudden onset caused by an influenza virus
highly infectious spread rapidly from person to person
some strains more severe than others
occurs every year killing 36,000 people in U.S.
What is influenza (flu)?
Symptoms of Influenza
sudden onset of symptoms
fever, headache, aching muscles, weakness
respiratory symptoms cough, sore throat, difficulty breathing
incubation period = time from exposure to virus to development of symptoms
varies for influenza , but generally 1 to 4 days
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
Influenza PreventionVaccinationStay at home when sickCover your coughWash hands regularlyAvoid touching eyes, nose and mouthAvoid close contact with people who are sick
Avian (Bird) InfluenzaAn infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus)
Birdswild birds worldwide carry the virus – usually no illnessdomesticated birds - can become ill and die
Humans can become infected with avian influenza -> severe illness and deathmost cases from close contact with infected poultry very rarely may have spread from one person to anothercases/deaths since 2003 = 258/153
• 2003: 4/4• 2004: 46/32• 2005: 97/42• 2006: 111/75
Will H5N1 become the next pandemic?
Avian Flu not yet Pandemic Flucurrent 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
Plan now
Understanding Pandemic Flu
Epidemic: serious outbreak in a single community, population or region
Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries
Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to
Influenza A Virus
Hemagglutinin (H)–16 subtypes(attachment, penetration)
Neuraminidase (NA)–9 subtypes(release)
8 viral genes(assembly, replication)
M2 protein(penetration)
Hemagglutinin (H)–16 subtypes(attachment, penetration)
Antigenic Drift vs. Shift
Antigenic drift: major changes in the form of one or both of the two principle antigens on the viral surface
our immune system has greater difficulty recognizing them
Antigenic shift: radical changes in the form of the one or both of the two principle antigens on the viral surface
our immune system can’t recognize them at all
Putting Pandemic Flu into Perspective
2001 terrorist attack with anthraxkilled five people
2002 outbreak of West Nile Viruskilled 284 people nationally in six months
2003 SARS outbreakkilled over 800 people world widefroze Asian economiesfrightened millions of people into wearing masks on the streets
History of Pandemic Influenza1968-1969
Worldwide 700,000 deaths (34,000 in US)
1957-1958Worldwide 1.5 million deaths (70,000 in US)
1918 Worldwide 40-50 million deaths (500,000–650,000 in US)
Typical Influenza Season36,000 deaths in US
Lessons from Past PandemicsOccurs 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 - subsequent waves may be more or less severe
Pandemic Flu: Current Status and Requirements
Currently no pandemic influenza in the world
For pandemic influenza to occur, three conditions must be met:
a new influenza A virus appears or “emerges” in the human populationit causes serious illness in people it spreads easily from person to person worldwide
Interpandemic
Larger clusters, localized
Limited spread among humans
Pandemic
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
Current status of
H5N1
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
Would there be a vaccine?Because the virus will be new, there will be no vaccine ready to protect against pandemic flu
A specific vaccine cannot be made until the virus has been identified
Seasonal flu vaccine or past flu immunization will not provide protection
Medications During Pandemic FluAntiviral Medications
can prevent complications if taken within first 48 hours of illnessmay not be effective against a pandemic flu virusextremely limited supply nowwould be prioritized initial use probably only for treatment, not prophylaxis
Antiviral Medications
Amatadine (Symmetrel)
Rimantadine (Flumadine)
Zanamivir (Relenza)
Oseltamivir (Tamiflu)
Isolation and Quarantineisolate ill individuals with certain contagious diseases
quarantine contacts (those exposed to such contagious diseases) play a role in the early stages of the pandemiclegal measures possible
probably would rely on voluntary cooperation
once beyond initial cases“stay home when you are sick”
Influenza Containment Strategy: Community
ResponseBasic ActivitiesSurveillance and quarantine of early casesPublic information and educationPromote “respiratory hygiene” and hand washing
Enhanced ActivitiesFocused measures to increase social distanceCommunity-wide measures to increase social distance
Community Wide Measures
Reduce Social Contact by canceling large gatherings, mass transit, schoolDecision based on location of flu activity:
Outbreak not local: large gatherings cancelledOutbreak in local/neighboring county: small gatherings cancelled
School closings determined by State Department of Health & Hospitals Department of Education Local School Boards.
Pandemic Influenza Impacts
Estimated Impact in Louisiana
3 Million infectedBetween 600,000-1.4 million clinically illBetween 300K-700K requiring outpatient careBetween 10,000 – 22,500 hospitalizedBetween 3,000 – 6,000 deaths
Impact on Infrastructure
Significant disruption of transportation, commerce, utilities, public safety and communications Limited to no assistance from State and Federal governments due to nation-wide impact
Impact on Health CareIllness rates will soar
Many people will require some medical care
Health care facilities will be overwhelmed
Symptoms may be severe
Complications: may be more frequent healthy people may be at increased risk
Impact on Business
Impact on Business Owners
Up to 40% employee absenteeismPossible increase/decrease in demand for products or servicesDisruption of communication & supply chainsFewer employees and customers
Issues to AddressModification of:
• customer/employee interaction
• sick leave & work location
Communication/education Collaboration Infection Control
Workforce Support
Psychological and physical strain on personnel responding in emergency situation
Psychological stress for families
Plan for staff to have adequateSleepFoodAccess to psychological and spiritual support
Guidance Personal/Family Planning
Personal protection: Hand hygiene and respiratory etiquetteSurgical masks: proven effective for droplet precautions Pneumococcal vaccination per recommended guidelines
Stockpiling: One to three week essential water, food, supplies, medicines
Guidance School Planning
Develop alternative procedures for learning in event of school closures
Develop plan for essential office functions
payroll, communication with students, families, and staff
Infection Control educate & practice
Guidance for Faith-based Planning
Develop alternative procedures for worship in event of social distancing
Develop plan for essential office functionspayroll, communication with members and staff
Infection Controleducate & practice
Infection Control - Our Basic Protection
Hand HygieneWash hands regularly with soap & waterIf no water available: 60%-95% alcohol-based sanitizer
Cover your cough strategy
Environmental cleaning1:10 bleach solutionEPA registered disinfectant
Gloves & surgical masks
Community Goals in Pandemic Flu
Limit death and illness
Preserve continuity of essential government and business functions
Minimize social disruption
Minimize economic losses
Public Health Role in Pandemic
Facilitate planningDisease tracking & controlCommunication about public health issuesCoordinate mass antiviral medication and vaccination clinicsIssue isolation and quarantine orders
What Can You Do Now?Prepare your community – become involved in disaster training & volunteerism.
Remember to get enough sleep.
Exercise regularly.
Prevent the spread of infection – wash hands regularly, cough/sneeze into tissue, keep your hands away from your nose/mouth.
Put out cigarettes.
Annual flu shots.
Nutritious eating.
Family plan and kit.
Look for information about pandemic flu.
Utensils, food and beverages should not be shared.
Get Informed. Be Prepared.State Draft Pandemic Flu Plan
http://www.dhh.state.la.us/offices/publications/pubs-145/Pandemic%20Influenza%20Plan_100906.pdf
Family Readiness Guidehttp://www.dhh.state.la.us/offices/publications/
Official Pandemic Flu Web Sitehttp://www.pandemicflu.gov/
Centers for Disease Control and Preventionhttp://www.cdc.gov/flu/pandemicflu/
Even though local, state and federal agencies have plans to protect the public, you are responsible for your own safety,
even in an emergency!
Remember, things will eventually get better!