Transcript Introduction to Indiana’s Pandemic Influenza Preparedness Plan

Introduction to Indiana’s
Pandemic Influenza
Preparedness Plan
Mary L. Hill, RN, Esq.
Deputy State Health Commissioner
Indiana State Department of Health
Indiana’s Pandemic Influenza
Preparedness Plan
• Overview of pandemic influenza
• Overview of the Indiana Pan Flu Preparedness Plan
• Overview of the Indiana Pan Flu Operations Plan
• Ethical Issues
ISDH – It’s not just a job…it’s an adventure
Seasonal Flu v. Pan Flu
Seasonal Flu – Annual US data:
• Causes of 200,000 hospitalizations
• Results in the death of 36,000 people
Pandemic Flu - Potential US impact:
• Virulent human flu causing a global outbreak
• Little immunity, spread easily person to person
• Could cause 9.9 million hospitalizations
• Could result in 1.9 million deaths (2% of population) if similar in
scope to 1918 pandemic flu
Pandemic Influenza of 1918
– At least 40 million deaths worldwide
– More fatalities than occurred in WWI
– Half of those dying were in their 20s and 30s, representing
as many as 8 to 10% of all young adults
– More died in 24 weeks than AIDS has killed in 24 years
Health System Implications
– Widespread illness and death
– Overwhelmed hospitals and clinics
– Inadequate medical resources
– Many people with chronic conditions or emergency needs
may not be treated
Importance of personal preparedness stockpile (don’t forget the
pet supplies)!
Other Implications
– Disruption of business –
• SARS 2003: Cases – 8400, Deaths – 916
• Resulted in loss of $12 - $30 billion to Asia
• Canada – 50% reduction in international travel
– School closures – Feeding children and families who rely on
school meals.
– Community events – Colts, Pacers, Black Expo, church,
social, etc.
Indiana’s Pandemic Influenza
Preparedness Plan
• Pandemic Influenza Plan
• Developed in 2005, updated in 2006
• Available at www.isdh.in.gov
Indiana’s Pandemic Influenza
Preparedness Plan Contents
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Strategies and Policies
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Planning, Coordination, and Command Structure
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Surveillance and Investigation
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Laboratory Testing
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Health Care Planning
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Infection Control
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Clinical Guidelines
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Vaccine and Antiviral Distribution and Use
Indiana’s Pandemic Influenza
Preparedness Plan Contents
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Community Disease Control and Prevention (Community Containment)
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Managing Travel-related Risks
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Public Health Communication and Education
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Workforce Support: Psychosocial Considerations and Info Needs
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Checklists for medical offices, clinics, health depts., hospitals
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Ethical Considerations
Planning includes Engagement of
Community and Stakeholders
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Community Advisory Groups
– Community containment
– Antiviral and vaccine prioritization
– Mental health issues
– Altered standards of care
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Strategic and Policy Considerations
– Community Containment
– Special Populations
– Vaccine and Antiviral Medication
– Continuity of Operations Plan (COOP)
– Volunteers
Mary Meets Her Idol, Sergeant Harvey Walden
VH 1 Celebrity Fit Club
ISDH Responsibility
“prepare for and execute an effective response to
pandemic influenza that assures promotion of health
and protection from harm for Indiana citizens.”
“Execution Trumps Strategy”
“Git ‘er done!” Larry the Cable Guy
ISDH Responsibilities:
– Department Operations Center (DOC)
– Technical Advisory Group (TAG)
– Incident Command Structure (ICS)
– Communication During the Pandemic
Recent flood response activities provided opportunity for ISDH
to implement and evaluate these functions
State Surveillance Activities
– Influenza Sentinel Providers Surveillance Network
– Reporting to CDC via State and Territorial Epidemiologists
– Influenza-associated mortality
– Public Health Emergency Surveillance System (PHESS)
– Hospital Bed Tracking System
Laboratory Testing
The Indiana State Department of Health (ISDH) Laboratory
A hospitalized patient may be tested for H5 infection if:
a.
Severe respiratory illness for which an alternative diagnosis has
not been established; and
b.
Travel within 10 days to a country with documented infections
Laboratory Testing
If the patient is hospitalized or ambulatory and has:
a. Temperature >100.4°F (>38°C); and
b. Cough, sore throat, or shortness of breath; and either:
c. Contact within 10 days prior to symptoms with:
i. Poultry or domestic birds or
ii. A patient with known or suspected influenza A (H5) infection.
Specimens require prior approval from a member of the ISDH Epidemiology
Resource Center Surveillance Team (ERC ST)
Health Care Planning
• Planning for mass care
• Alternate care sites
• Altered standards of care
• Mass fatalities
• Protection of the health care workforce
“Old Fashioned” Infection Control Practices
• Droplet precautions
• Isolation
• Social distancing
• Frequent hand washing
Why do we continue to shake hands?
Clinical Guidelines
• Epidemiologic criteria
• Clinical criteria
Vaccine Distribution and Use
• Manufacturing Vaccine Requires 6 months
• Pre-Pandemic Vaccine – 13 million doses stockpiled
• Priority Group Recommendations
• Large-scale Vaccination
– Requires public-private partnerships
– Shared responsibility
Antiviral Distribution and Use
• Classes of Antiviral medications
– Amantadine derivatives (Symmetrel, Flumadine)
– Neuraminidase inhibitors (Tamiflu, Relenza)
• Treatment of ill patients
• High Priority Groups for Treatment
• Stockpiling Antiviral Medication
• Delivery of Public Stockpiles of Antivirals
Containment
• Isolation
• Quarantine
• Social distancing
• Limitations on public gatherings
Managing Travel Related Risks
• The CDC provides current information on
outbreaks
– Travel notices
– Traveler’s Health section of the CDC Web
site at www.cdc.gov/travel/outbreaks.htm
– Indiana Health Alert Network (IHAN)
messages
Managing Travel Related Risks
• Four different categories of travel notices
– Disease transmission,
– Containment measures,
– Quality of surveillance, and
– Quality and accessibility to medical care.
Managing Travel Related Risks
• Protocols for management of suspect pandemic
influenza passengers on flights landing in
Indianapolis are under development
• Collaboration between MCHD and ISDH
Recent suspected XDR TB case and international travel
Communication and Education
• Crisis Communication Plan
• Identified vehicles of dissemination
• Education and engagement
“The media is to public health as the scalpel is to the
surgeon.”
Workforce Support
• A pandemic poses personal and emotional challenges
• Stress levels may reach varying degrees of severity
• Family and Social Services Administration, Division of Mental
Health and Addiction (FSSA/DMHA), has developed guidelines for
mental health support during a pandemic
Workforce Support
• Early mental health interventions important
– Should support reducing mortality and morbidity, offering
psychological first aid, and identifying serious mental illness
– It will be necessary for primary care providers to be enlisted to
assist in the provision of these support services.
National Requirement for State
Pandemic Influenza Operations Plans
– Strategic Goals
• Ensure Continuity of Operations for State Agencies
• Ensure Continuity of State Government
• Protect Citizens
• Sustain and support Critical Infrastructure and Key
Resource Sectors
Critical Infrastructure and
Key Resource Sectors
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Agriculture and Food
Banking and Finance
Chemical
Commercial Facilities
Commercial Nuclear Reactors, Materials,
and Waste
Dams
Defense Industrial Base
Drinking Water and Water Treatment
Emergency Services
Critical Infrastructure and
Key Resource Sectors
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Energy
Government Facilities
Information Technology
National Monuments and Icons
Postal and Shipping
Public Health and Health Care
Telecommunications
Transportation Systems
Indiana’s Pandemic Influenza
Preparedness Plan
Ethical Issues
Ethical Considerations
• An influenza pandemic will create a shortage of medical personnel
and resources
– Vaccines, antiviral medications, mechanical ventilators, and
hospital bed space
– Decisions must be made regarding which persons should
receive the scarce resources available.
• Community containment, isolation, and quarantine
– Involve considerations such as civil liberties
Ethical Considerations
• Processes and policies on a variety of similar issues should be
carefully considered and fairly implemented.
• The ISDH is working with CAGs, the Indiana University Center for
Bioethics, community leaders, and the ISDH Office of Legal Affairs
(OLA) in developing these approaches.
Indiana’s Pandemic Influenza
Preparedness Plan
• Resource allocation - Antivirals, vaccine, human resources
• Triage - Access to care, ICU beds, mechanical ventilation
• Altered standards of care
– Change in priorities and expectations for delivery of care
• Workforce management - Obligations of health care workers
• Restriction on liberty - Quarantine and isolation