Transcript Influenza A

Influenza
What’s New and What’s Relevant in 2005-2006?
Jeffrey S. Duchin, M.D.
Chief, Communicable Disease Control,
Epidemiology and Immunization Section,
Public Health - Seattle & King County
Division of Allergy and Infectious Diseases,
University of Washington
Outbreak of Avian Influenza A (H5N1)
WHO: H5N1 poses a considerable
human public health risk
– Widespread, outbreak not controlled
– Mutates rapidly, propensity to acquire
new genes
– Increasing host range
– Directly infects humans
Since December 2003
– At least 122 human cases
– 62 deaths from Vietnam, Thailand, Cambodia
and Indonesia
WHO Pandemic Alert: Stage 3 (of 6)
The influenza pandemic of 1918-19
The influenza
pandemic of
1918-19 killed
more humans
than any other
disease in a
period of similar
duration in the
history of the
world.*
*Alfred W. Crosby; America’s Forgotten Pandemic: The Influenza of 1918, Cambridge
University Press, 1989
Deaths from the influenza pandemic of 1918-19
Population: 1,761,371
Total deaths: 15,785
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Deaths By Week due to Pneumonia & Influenza
October 1918 through March 1919 - Philadelphia, PA
Poll
What portion of the recently released
national pandemic influenza plan have
you read?
A.
B.
C.
D.
All
Most
Some
None
Pandemic Influenza Planning
Potential Impact of Pandemic Influenza in the U.S.
 Little warning between onset of pandemic and
arrival in U.S.
 Attack rate 30%: 90 million persons clinically ill
 45 million persons require outpatient medical care
 865,000–9.9 million persons hospitalized
 128,750-1,485,000 persons require ICU care
 64,875-742,500 require mechanical ventilation
 209,000-1.9 million deaths
 Economic cost estimate: $181 billion for moderate
pandemic
Pandemic Influenza Planning
Potential Impact of Pandemic Influenza in the U.S.
Vaccine and antiviral drugs
will be in short supply.
Expect 6-8 month lag-time
for vaccine availability.
Healthcare workers and other first
responders will be at higher risk
of exposure and illness than the
general population.
Risk of sudden shortages of key
personnel in critical community
services
– Healthcare, police, fire, utilities,
transportation workers, air
traffic controllers, etc.
Role of Local Public Health
 Surveillance
– Early detection, characterize epidemiology,
monitor impact
 Distribution of antiviral drug stocks and vaccine
 Provide guidance on clinical management &
infection control
 Implement community containment strategies
– Assure legal preparedness
 Communication to public
 Facilitate healthcare system planning and response
 Psychological and social support to emergency
responders
Surveillance: Pandemic Alert Period
Clinical Criteria for Influenza-Like Illness (ILI)
Temperature of >38°C
(>100.4°F)
plus
Cough or
Sore throat or
Shortness of breath
>100.4°F
>38°C
Surveillance: Pandemic Alert Period
Who to Identify and Test
Hospitalized patients with severe ILI
(including pneumonia) AND who meet
epidemiologic criteria
Non-hospitalized patients with ILI with strong
epidemiologic suspicion of exposure
– e.g., direct contact with ill poultry
in an affected area, or close contact
with a known or suspected human
case of novel influenza
Surveillance: Pandemic Alert Period
Epidemiologic Criteria
 Travel or occupational risks within 10 days of
symptom onset
 Travel risks
– Visited or lived in an area affected by highly
pathogenic avian influenza A outbreaks in domestic
poultry or where a human case of novel influenza
has been confirmed
and either
– had direct contact with poultry
OR
– had close contact with a person with confirmed or
suspected novel influenza or severe unexplained
respiratory illness
Useful websites to stay current: OIE (www.oie.int/eng/en_index.htm),
WHO (www.who.int/en/), and CDC (www.cdc.gov/flu/)
Surveillance: Pandemic Alert Period
Epidemiologic Criteria (cont.)
 Direct contact with poultry is defined as:
– touching birds (well-appearing, sick, or dead)
or
– touching poultry feces or surfaces
contaminated with feces
or
– consuming uncooked poultry products
(including blood) in an affected area
 Close contact with a person from an infected
area with confirmed or suspected novel
influenza is defined as:
– being within 3 feet (1 meter) of that person
during their illness
Surveillance: Pandemic Alert Period
Epidemiologic Criteria (cont.)
Occupational risks
– persons who work on farms or live
poultry markets
– Persons who process or handle poultry
infected with known or suspected
avian influenza viruses
– workers in laboratories that contain
live animal or novel influenza viruses
– healthcare workers in direct contact
with a suspected or confirmed novel
influenza case
Pandemic Influenza
Vaccination
Vaccine delivery - central
preventive strategy
A second dose after 30 days
will likely be required
Short time frame for vaccine
delivery, distribution, and
administration
Severe or moderate shortage
will likely exist
Security issues
Pandemic Influenza
Vaccination Strategies
Define priority groups for early vaccination*
Increase pneumococcal vaccine coverage
before pandemic
*NOTE: detailed outline groups are available in complete slide set on
NWCPHP website
Antiviral Agents
 May help decrease transmission in specific settings
– Most useful before vaccine available
 Prevention of infection (prophylaxis): 70-90% effective
 Treatment: neuraminidase inhibitors may reduce
severe complications of influenza
– Start within 48 hours of symptom onset
– Emergence of resistance
 Supply will be severely limited so define priority
– Cumulative number in priority groups 1-5: 33.9
million persons
– Cumulative number in priority groups 1-10: 132.7
million persons
– Treatment versus prophylaxis (6-8 week course)
Healthcare System Emergency Preparedness
Severe pandemic = prolonged mass casualty
event
Extreme stress on healthcare system
– Will last for weeks to months
– Up to 1/3 of workforce may be out: staff shortages
– Shortages of ICU beds,
ventilators, critical care needs
– Shortages of drugs and other supplies
– Mass fatality situation
– Disruption of critical infrastructure
& essential services
Healthcare System Emergency Preparedness
Hospitals should work with other local
hospitals, community organizations
(e.g., social service groups), and the
local health department to coordinate
healthcare activities in the community.
HHS plan available at:
http://pandemicflu.gov/
From: HHS Pandemic Influenza Plan: Healthcare Planning
Poll
As we prepare for pandemic influenza,
my jurisdiction has worked least with the
following group:
A.
B.
C.
D.
Hospitals
Schools
Businesses
Law Enforcement
King County Healthcare System
Pandemic Influenza Taskforce
Public Health sponsored half-day meeting in
March 2005 with healthcare system stakeholders
to discuss pandemic influenza
Broad participation from hospitals, outpatient
care organizations, community clinics, specialty
professional organizations, emergency managers
Discussed existing preparedness plans for
pandemic influenza and identified healthcare
system gaps
King County Healthcare System
Pandemic Influenza Taskforce Recommendations
Standardized, cooperative, integrated
healthcare system approach is essential
Need to identify healthcare system executives
with whom public health leadership can consult
rapidly to address priority emergency response
issues of relevance to the healthcare system
King County Healthcare System
Pandemic Influenza Taskforce Recommendations
 Need efficient, coordinated communication
– Coordinate mass casualty response
– Facilitate optimal resource management
– Assess and monitor impact on healthcare
facilities
– Provide unified medical system interface with
EOC/Incident management system
– Communicate information related to clinical
management, vaccine, antiviral drugs,
community containment measures
King County Healthcare System
Pandemic Influenza Taskforce Recommendations
 Technical experts must plan for specific
priority needs including critical care and
clinical management
 Need mass fatality management plans
 Need to include participation by non-hospital
(community-based) healthcare assets
–
–
–
–
–
Home healthcare organizations
Healthcare for the Homeless
Association of Occupational Health Practitioners
Jail Health
Representative from long term care facilities
King County Healthcare System
Pandemic Influenza Taskforce Recommendations
 Priority areas:
– Critical care surge capacity
– Community pandemic planning and
surge capacity
 Vulnerable populations
– Regulatory, licensing, and legal issues
– Financial impact and implications
– EMS response
– Mass fatality planning
Poll
My jurisdiction is better prepared for
pandemic influenza than what is being
portrayed in the media.
A. True
B. False
Gaps in Healthcare System Response
to Emergencies
The healthcare system is fragmented.
Planning by individual facilities is
necessary but not sufficient for robust
community emergency response.
Community-wide healthcare emergency
response structures and plans are not
sufficiently comprehensive to respond to
major disasters.
Gaps in Healthcare System Response
to Emergencies (cont.)
There is no forum for public officials and
healthcare leaders to discuss policy issues.
In an emergency, there is no operational
mechanism in place to coordinate response
activities across healthcare organizations.
The linkages between the overall healthcare
system and the emergency incident command
structure need to be strengthened.
Emergency preparedness planning has
focused primarily on hospitals.
Healthcare System Emergency Preparedness
Healthcare Coalition
Strengthen the healthcare system’s
emergency preparedness and response
to all hazards
Increase medical surge capacity
Improve coordination and communication
during emergency response
Healthcare Coalition (cont.)
Expand the health system’s emergency
response capacity through regional
agreements and plans
Coordinate the emergency response of
health care organizations through effective
communications
Integrate the health system’s response
into the larger emergency response
Advise public officials on health policy
matters during emergencies
Healthcare Coalition (cont.)
Coordinated action is more effective than
multiple individual organizational efforts.
Cooperative agreements and plans promote
the most effective use of resources.
Leadership and operational management
must come from within the healthcare
community.
Healthcare Coalition: Assumptions
Elected officials and the Health Officer
have emergency powers to preserve the
public health.
The use of emergency health powers, if
necessary, will be more effective with
advance planning and in timely
consultation with healthcare leaders.
Healthcare Coalition: Assumptions (cont.)
Public health’s primary role in this context
is to support and facilitate the healthcare
system’s emergency preparedness planning
and response.
Healthcare Coalition
Coalition model consistent with the HHS Medical
Surge Capacity and Capability Handbook
– (http://www.hhs.gov/ophep/mscc_handbook.html)
Consistent with the requirements of the National
Incident Management System (NIMS)
Similar coalitions have been formed and
effectively used in emergency situations in other
communities, including Minnesota, Washington
DC, and Northern Virginia
Healthcare Coalition (cont.)
Hospitals
Large medical groups
Safety net healthcare organizations
Professional associations
Home health and long term care providers
Key stakeholders, e.g., EMS, Puget Sound
Blood Center, Red Cross
Emergency Mgmt Response - Maintenance
of Critical Services
Maintain essential services in both the
health and non-health sectors
Impact of widespread absenteeism on
human infrastructure responsible for critical
community services
Identify essential services that, if
interrupted, would pose a serious threat to
public safety or significantly interfere with
the ongoing response to the pandemic
Develop contingency plans to provide backup of such services and/or replacement
personnel
Pandemic Influenza
Communication
 Good communication can guide the public,
media, and health care providers in
responding appropriately and complying
with exposure-control measures.
 Provide accurate, consistent, and
comprehensive information.
 Address rumors, inaccuracies, and
misperceptions promptly.
 Coordinate messages.
 Guide community members on actions to protect
themselves, family members, and colleagues.
 Contradictions and confusion can undermine public
trust and impede control measures.
Healthcare System Emergency Preparedness
Routine Circumstances
Hospitals
Clinics
Public health
Healthcare system
Community
health centers
Outpatient facilities
Healthcare System Emergency Preparedness
Outbreaks & Public Health Emergencies:
Paradigm Shift
Public health
Emergency response
Healthcare system