Pandemic Influenza Pandemic Influenza PreparednessPreparedness

KentuckyKentucky

Department for Public Department for Public HealthHealth

DEFINITIONDEFINITION

An influenza pandemic (or global An influenza pandemic (or global epidemic) occurs when a new virus epidemic) occurs when a new virus

subtype appears, against which no one subtype appears, against which no one is immune. This may result in several is immune. This may result in several simultaneous epidemics worldwide simultaneous epidemics worldwide

with high numbers of cases and with high numbers of cases and deaths. With the increase in global deaths. With the increase in global

transport and urbanization, epidemics transport and urbanization, epidemics caused by the new influenza virus are caused by the new influenza virus are

likely to occur rapidly around the likely to occur rapidly around the world. world.

Impact of Past Impact of Past Influenza PandemicsInfluenza Pandemics

1968-69 Hong Kong Flu (H3N2)1968-69 Hong Kong Flu (H3N2)34,000 deaths US34,000 deaths US

1957-58 Asian Flu (H2N2)1957-58 Asian Flu (H2N2)70,000 deaths US70,000 deaths US

1918-19 Spanish Flu (H1N1)1918-19 Spanish Flu (H1N1)>500,000 deaths US>500,000 deaths US20-50 million worldwide20-50 million worldwide

NOT IF, BUT WHEN…NOT IF, BUT WHEN…

Are you prepared to prevent or Are you prepared to prevent or minimize the human morbidity minimize the human morbidity

and mortality, the social and mortality, the social disruption and the economic disruption and the economic consequences caused by an consequences caused by an

influenza pandemic?influenza pandemic?

Catastrophic EventsCatastrophic Events

1994 Northridge, CA = 51 deaths 1994 Northridge, CA = 51 deaths 2004 hurricanes = 152 US deaths 2004 hurricanes = 152 US deaths 1995 Oklahoma City = 168 deaths1995 Oklahoma City = 168 deaths 1974 tornadoes = 330 deaths1974 tornadoes = 330 deaths 2001 Terror = 2,992 deaths2001 Terror = 2,992 deaths 1916 polio epidemic = 7,000 deaths1916 polio epidemic = 7,000 deaths 2004 Tsunami = est. 300,000 deaths2004 Tsunami = est. 300,000 deaths

Estimated Impact of a Future Influenza Estimated Impact of a Future Influenza Pandemic in the U.S.*Pandemic in the U.S.*

Deaths: 89,000 - 207,000Deaths: 89,000 - 207,000

Hospitalizations: 314,000 - 734,000Hospitalizations: 314,000 - 734,000

Outpatient visits: 18 - 42 million Outpatient visits: 18 - 42 million

Additional illnesses: 20 - 47 millionAdditional illnesses: 20 - 47 million

Economic impact: $71.3 - 166.5 billionEconomic impact: $71.3 - 166.5 billion

* Model assumes attack rates of 15-35 % and is based on the 1968 pandemic, and a US population of 290 million persons. Meltzer M, et al. Emerging Infectious Diseases 1999;5:659-671.

Why Prepare?Why Prepare?

Planning may help to reduce Planning may help to reduce transmission of the pandemic transmission of the pandemic

virus strain, to decrease cases, virus strain, to decrease cases, hospitalizations and deaths, to hospitalizations and deaths, to maintain essential services and maintain essential services and

to reduce the economic and to reduce the economic and social impact of a pandemic.social impact of a pandemic.

Estimated Time Frame?Estimated Time Frame?

It would be unrealistic for any It would be unrealistic for any state to consider that it could state to consider that it could

prepare and implement a prepare and implement a detailed and comprehensive detailed and comprehensive

pandemic plan in weeks, or even pandemic plan in weeks, or even months.months.

Pandemic PhasesPandemic Phases(World Health Organization)(World Health Organization)

Interpandemic (phases 1-2): No new Interpandemic (phases 1-2): No new influenza virus subtypes in humans influenza virus subtypes in humans

Pandemic alert (phases 3-5):Pandemic alert (phases 3-5):– Phase 3: human infection with new Phase 3: human infection with new

subtype, no h-t-h* spreadsubtype, no h-t-h* spread– Phase 4: small clusters, limited h-t-h Phase 4: small clusters, limited h-t-h

transmission, localized spreadtransmission, localized spread– Phase 5: h-t-h spread still localized, Phase 5: h-t-h spread still localized,

larger clusterslarger clusters Pandemic (phase 6): sustained transmission Pandemic (phase 6): sustained transmission

in general populationin general population

*h-t-h: human to human spread

A Multisectoral ApproachA Multisectoral Approach

A multisectoral approach means the A multisectoral approach means the involvement of many levels of involvement of many levels of

government, and of people with government, and of people with various specialties including policy various specialties including policy

development, legislative review and development, legislative review and drafting, animal health, public health, drafting, animal health, public health,

patient care, laboratory diagnosis, patient care, laboratory diagnosis, laboratory test development, laboratory test development,

communication expertise and disaster communication expertise and disaster management.management.

Community InvolvementCommunity Involvement

Community involvement means Community involvement means making optimal use of local making optimal use of local

knowledge, expertise, resources knowledge, expertise, resources and networks. It is a powerful and networks. It is a powerful way to engage people and to way to engage people and to build the commitment needed build the commitment needed

for policy decisions.for policy decisions.

Vaccines to Protect Against Vaccines to Protect Against Pandemic Influenza VirusesPandemic Influenza Viruses

A vaccine probably would not be A vaccine probably would not be available in the early stages of a available in the early stages of a

pandemic. Once a potential pandemic. Once a potential pandemic strain of influenza pandemic strain of influenza virus is identified, it takes virus is identified, it takes

several months before a vaccine several months before a vaccine will be widely available. will be widely available.

Vaccine AvailabilityVaccine Availability

Start of Influenza PandemicStart of Influenza Pandemic No Vaccine AvailableNo Vaccine Available

6 Months6 Months Initial Introduction of Influenza Initial Introduction of Influenza VaccineVaccine

1 Year into Pandemic1 Year into Pandemic Adequate Amounts Produced Adequate Amounts Produced to Vaccinate U.S. Population to Vaccinate U.S. Population with 1 Dose with 1 Dose

2 Years into Pandemic2 Years into Pandemic Adequate Amounts Produced Adequate Amounts Produced to Vaccinate U.S. Population to Vaccinate U.S. Population with 2 Doses with 2 Doses

•2 Doses will be necessary for adequate immunity

•Best Case Scenario

Pandemic Influenza UniquenessPandemic Influenza Uniqueness

The pandemic will last much longer than The pandemic will last much longer than most other emergency events and may most other emergency events and may include “waves” of influenza activity include “waves” of influenza activity separated by monthsseparated by months

The numbers of health-care workers and The numbers of health-care workers and first responders available to work can be first responders available to work can be expected to be reduced expected to be reduced

Because of how widespread an influenza Because of how widespread an influenza pandemic would be, resources in many pandemic would be, resources in many locations could be limitedlocations could be limited

No Time to Waste…No Time to Waste…