Transcript Intro to Influenza

Pandemic Influenza
Larimer County
Community Leaders
Awareness Meeting
Dec. 6, 2005
Larimer County in 1918
 County
 Fort
population about 27,000
Collins population 8,700
 Loveland
population about 5,000
Social Environment in 1918
Most residents involved in agriculture,
directly or indirectly
 World War I was the major news story
 There was rationing of coal, fuel, food and
other items needed for war effort
 Red Cross was very active in community,
supporting war effort

Outbreak begins in military
training camps
Deaths occurring in
training camps in East
were reported in local
newspapers
 Numerous Larimer
County enlistees/
draftees were among
the fatalities (4 from
Camp Dix, NJ in 1
wk.)

Spreading to Civilians
Larimer County
residents were aware
of growing, alarming
deaths among
civilians in Eastern
cities
 First cases in CO in
Boulder; army
trainees on College
campus. (First cases
in FC at Ag College)

Flu shut down schools and
businesses
Loveland schools
closed on Oct. 8
 Fort Collins closed
schools on Oct. 10

They would not
reopen until
Dec. 30
612
O
ct
13
-1
9
O
ct
20
O
-2
ct
6
27
-N
ov
N
2
ov
3N
N
ov
ov
9
10
-N
N
ov
ov
16
17
-N
ov
N
ov
23
24
-N
ov
D
30
ec
1D
D
ec
ec
7
87
-D
ec
D
ec
14
15
-D
ec
D
ec
21
22
-D
ec
D
29
ec
30
-J
an
Ja
4
n
5Ja
Ja
n
11
n
12
-J
an
Ja
18
n1
9Ja
n2
Ja
5
n
26
-F
eb
Fe
1
b
2Fe
b
8
O
ct
Deaths
Loveland, Oct 1918 - Feb 1919
Flu/Pneumonia Deaths by week
18
2
17
16
14
12
10
8
8
6
5
4
3
5
3
3
2
1
Week
5
4
3
2
2
2
1
1
0
0
1918 Flu killed young adults

Highest number
of deaths were
in the in late
teens through
the mid 30’s
Pneumonia & Influenza Deaths by Age,
Loveland 1917 & 1918 (Sept-Dec)
18
17
16
16
14
Deaths
12
10
8
7
6
6
5
5
4
2
2
1
0
0
1
1
1
0
1
0
0
0
65-74
over 75
0
0-4
5-14
15-24
25-34
35-44
45-54
55-64
Age in years
1917 (Sept-Dec)
1918 (Sept-Dec)
By the end of the outbreak
 Overall,
there were 67 deaths in
Loveland, a town of 5,000 in a 15 week
period.
 This
represented an overall death rate
of 1.3% of the population.
Why are we concerned
today?
“We at WHO believe that
the world is now in the
gravest possible danger
of a pandemic"
Shigeru Omi, World Health Organization , 2005
Pandemic influenza is
the“the most important
threat that we are facing
right now. “
Julie Gerberding, CDC director, 2005
“It will be absolutely essential
that local communities are
well prepared, have a plan,
and have sorted out who will
be responsible for what.”
Michael Leavitt, U.S. HHS director
“Localities should be prepared
to rely on their own resources
to respond.”
U.S. draft pandemic influenza plan, 2005
Influenza
Outbreaks yearly, usually in winter months
 Illness more severe for very young, elderly,
or those with pre-existing health conditions
 Yearly, 5-20% of population get the flu
 Annually causes >200,000 hospitalizations
in US
 36,000 deaths yearly in US

Influenza Prevention
 Yearly
influenza shot
 Avoid those who are ill
 Wash your hands
 Antivirals (in special circumstances)
If you are ill--don’t come to work, cover
coughs and sneezes.
Influenza Virus types
– Type A: Infects humans and other animals
 More severe illness
 Causes regular epidemics; can cause
pandemics
– Type B: Infectious only to humans
 Causes epidemics, but less severe illness
Influenza

Influenza A is
subtyped by surface
proteins
– Hemagglutinin (H)
 16 different types
 Helps virus enter
cells
– Neuraminidase (N)
 9 different types
 Helps virus leave
cell to infect others
Influenza

All known subtypes of Influenza A found in
birds - 144 possible combinations of
H’s and N’s

H5 and H7 cause severe outbreaks in birds

Human disease usually due to H1, H2, H3
and N1 and N2.
Influenza
The flu virus constantly changes

When it does, vaccines will be less
efficient

Immune system may be unable to
recognize new virus
– No immunity in population for new
virus—potential for pandemic
Vaccine Development
Inactivated trivalent vaccine (killed vaccine)
 2 A, 1 B
 Effectiveness of vaccine depends on “match”
between circulating strains and those in vaccine

2005–2006 Influenza Season
A/New Caledonia/20/99-like
A/California/7/2004-like
B/Shanghai/361/2002-like
Influenza—Vaccine Production
 Flu
vaccines first produced in 1940s
 2 manufacturers in US for flu vaccine
 80 million doses produced by late
September
 6-9 months to produce vaccine
Influenza Pandemics

What is a Pandemic?
– Outbreak in wide geographic area
(global)
– Effects large # of people with serious
illness
– Usually a new virus or one which
population has not had exposure in a
long time
– May have rapid spread
– May occur in waves
Seasonal Flu vs Pandemic Flu
Seasonal
 Occurs every year
Occurs during winter
(usually Dec-Mar)
 Most recover in 1-2
weeks without tx
 Very young, very old,
ill most at risk of
serious illness





Pandemic
Occurs infrequently
(3 per century)
Occurs any time of
year
Some may not
recover, even with tx
People of all ages
may be at risk
Pandemic Influenza
 Past
Pandemics:
–1968 Hong Kong Flu (H3N2)
–1957 Asian Flu (H2N2)
–1918 Spanish Flu (H1N1)
1918-1919 influenza pandemic
Worst of past century
Estimated 20-40% of world
population ill
40-50 million people died
worldwide
600,000 or more deaths in US
High mortality in young adults
Why did young people die?
Over-reaction by the immune system
called “cytokine storm”
 Those with the strongest immune systems
affected
 Older people and youngest often die of
bacterial pneumonia complicating flu -treatable now with antibiotics
 Even in 2005, no good treatment for
“cytokine storm.”

There are
severe pandemics and
mild pandemics
Infectious Disease Deaths 1900’s
Deaths per 100,000 per year
1957
1918
1968
Pandemics can last for
months and come in
waves
612
O
ct
13
-1
9
O
ct
20
O
-2
ct
6
27
-N
ov
N
2
ov
3N
N
ov
ov
9
10
-N
N
ov
ov
16
17
-N
ov
N
ov
23
24
-N
ov
D
30
ec
1D
D
ec
ec
7
87
-D
ec
D
ec
14
15
-D
ec
D
ec
21
22
-D
ec
D
29
ec
30
-J
an
Ja
4
n
5Ja
Ja
n
11
n
12
-J
an
Ja
18
n1
9Ja
n2
Ja
5
n
26
-F
eb
Fe
1
b
2Fe
b
8
O
ct
Deaths
Loveland, Oct 1918 - Feb 1919
Flu/Pneumonia Deaths by week
18
2
17
16
14
12
10
8
8
6
5
4
3
5
3
3
2
1
Week
5
4
3
2
2
2
1
1
0
0
H5N1 Avian Influenza

Hong Kong 1997
– 18 human cases, 6 deaths
– 1.4 million birds destroyed

Dec. 2003: Asia
– Ongoing extensive outbreak in poultry
– Limited human to human transmission
– 125 human cases, 64 fatal
July-Aug 2005 Kazakhstan, Russia
 October 2005 Turkey, Romania, Russia

H5N1 Symptoms

Symptoms (human)
– Fever
– Shortness of breath
– Cough
– Pneumonia
– Acute Respiratory Distress
– Diarrhea, sometimes severe
– Life-threatening complications
Transmission of flu virus
Incubation period of 1-4 days for regular
flu - not clear if H5N1 might be longer
 Can be communicable to others 24 hours
before symptoms begin - and up to 5 days
or more after onset (adults) or 10 or more
days (children)
 Usually spread through respiratory
droplets or contaminated objects. May
also be airborne, and perhaps thru feces.

Concern with Avian Influenza
Virus mutates rapidly
 Can acquire genes from viruses infecting
other species
 H5N1 has acquired some of genetic
changes in the 1918 virus associated with
human-human transmission
 Causes severe disease in humans
 High fatality rate

Current H5N1 cases
in Vietnam, Thailand, Cambodia, & Indonesia as of 11/1/05
Date of
Total
Case-fatality
onset
cases
deaths
rate
Dec 2003Mar 2004
35
24
69%
July 2004 October
2004
9
8
89%
Dec 2004
to date
78
30
38%
Total
122
62
51%
Are we more or less at
risk today compared to
1918?
Why at LESS risk in 2005
 Antibiotics
for bacterial pneumonia
complications of influenza
 Some antiviral medicines
 IV fluids, ventilators
 Greater ability to do surveillance,
confirm diagnosis of flu
Why at LESS risk in 2005
 Rapid
means of communications internet, TV, radio, email
 More effective personal protective
equipment
 Fewer people living in each
household and more rooms.
Why at MORE risk in 2005
A
lot more international travel
 10 times more people in Larimer
County, contact with far more people
daily
 Very little surge capacity in health
care today
 Greater reliance on health
professionals
Why at MORE risk in 2005
 More
elderly and immunecompromised people in population
 Much less self-sufficient than in
1918’s (households and businesses)
 Today’s society not used to rationing,
sacrifice, compared to war-time 1918.
Why at MORE risk in 2005
 Far
more manufactured goods and
raw materials come from distant
areas, especially Asia
 “Just-in-time” ordering of needed
supplies instead of warehousing
critical items on site
Overall, are we at more or less
risk?
 Up
to individuals, communities,
states, and nations to decide as they
plan for a possible pandemic
What might happen in a
severe pandemic?
If it happens soon…..
There will be little or no vaccine until
6 - 9 months after the outbreak begins
 There will be very limited supplies of
antiviral medicines for treatment (for 1%
of populations, perhaps less).
 All communities hit a about the same time
 We need a plan for the short-term that
assumes no effective shots or Rx

What might occur
 Health
system could be overwhelmed
 Essential services could be at risk
(fuel, power, water, food, etc.)
 “Just-in-time” supply lines could be
disrupted
 High mortality rates could occur
 Social disruption could occur
Considerations for
preparedness
Can we maintain our utilities?
 Recent
disasters have showed us the
need for water, power, telecommunications, heat in an emergency
 Could they operate with 50% of
staff?
 Do they stockpile materials and parts
to ensure operation for 90-120 days?
Who will provide health care?
 Health
workers will be disproportionately exposed and may become ill
 Some will not show up due to fear
 Some will not be able to leave sick
family members, children out of
school
 Little or no surge capacity; nursing
shortage; future of Medical Reserve
Will transportation/trade
problems impact food supply?
 Typical
household has food on hand
to last 3 days.
 Few families have emergency
reserves for a prolonged period
 Low-income least able to set supplies
aside for an emergency
 Prices may rise quickly in emergency.
Who will help us?
 Little
or no state and federal assistance
 Local government also limited in what it
can do to assist citizens
 Churches, neighbors, friends and
families would need to help each other
 Vulnerable groups would need extra
assistance
 Advance planning and stockpiling of
necessities could help.
What public agencies
and businesses can do
as employers
Maintain Essential Services
 Halt
non-essential activities and redeploy staff to fill vacancies in critical
services.
 Cross
train: Make sure all critical
functions can be done by several
different people.
Maintain Essential Services
 Create
written instructions/
procedures for critical processes that
can be carried out by others
 If
possible, keep essential supplies/
parts stockpiled in advance to
maintain services.
Increase Social Distance
 Determine
how to provide services
with less person-to-person contact
whenever possible
 Increase telecommuting if possible
 Use phone, web, virtual conferences
to replace face-to-face meetings
 Waive non-critical policies if they
force in-person contact
Decrease contact exposures
 Increase
cleaning/sanitizing of locks/
doorknobs, faucet and toilet handles,
shared keyboards, telephones, other
equipment
 Vacuuming/sweeping
infectious particles
may stir up
Decrease contact exposures
 Use/provide
tissues, hand sanitizers,
disposable gloves if available (All
could be scarce during a pandemic)
 Increasing
humidity may reduce virus
Provide Personal Protective
Equipment
 Need
will vary with type business
 Will be difficult to obtain in a
pandemic - need to secure in advance
 Masks (N95 or better) may reduce
exposure, but are difficult to wear for
prolonged time or if employee has
health problems.
Teach protective actions
 Hand
washing without
recontamination
 Covering cough, not using hands
 Avoid putting hands to face, mouth,
nose, eyes.
 Staying home if any signs of illness
Prepare Communications Plan
 How
will key managers communicate
among themselves
 How will information be conveyed to
customers?
 How will information be conveyed to
employees?
 How will employees know who to call
in specific situations?
Prepare for difficult HR issues
 If
offices are closed, will staff be paid?
 If staff are needed, can they refuse to
come to work?
 If required to report, what protective
equipment, if any, will be provided?
 Can employer force someone who may
be ill NOT to work? (Employees without
sick leave may try to work while ill.)
Prepare for difficult HR issues
 If
an employee is required to work
with ill people and becomes ill, is it
a worker’s comp situation?
How Ready Are We?
Used with permission of the Minneapolis Star-Tribune
"Every day a pandemic
doesn't happen
is another day
we have to prepare.”
--Michael Osterholm