Transcript Pandemic Influenza - St. Cloud State University

Pandemic Influenza
Renee Frauendienst, RN, PHN, BSN
Division Director
Public Health Division
Stearns County Human Services
Preparing for Pandemic Influenza:
Business will not be as Usual
Recent Pandemics
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1918/1919 Spanish Influenza
– 40/50 million deaths worldwide
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1957 Asian Flu
– 2 million deaths worldwide
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1968 Hong Kong Flu
– 1 million deaths worldwide
1918 Spanish Flu
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Devastating
– “Hospitals filled up and soon became
overwhelmed as doctors and nurses got sick.
Children lost their parents, and people hid in
their homes to avoid a new and mysterious
virus. So many people died that there was no
time to make coffins; many victims had to be
buried in mass graves.”
– “Shops, offices and factories shut down without
enough staff to keep them going, and schools,
hotels and theatres were closed by order of the
government.”
Pandemic Flu Planning
– “strong evidence that the 1918 flu virus
[was] derived wholly from an ancestor
that originally infected birds” Andreas von
Bubnoff (Nature)
– Two subsequent influenza pandemics –
one in 1957 and one in 1968 – have also
been linked to avian flu viruses.
Avian Influenza (“Bird Flu”)
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Viral infection of birds
Believed to be spread by co-mingling
of wild and domestic birds
Controlled by culling infected and
exposed birds (Over 200 million birds
destroyed to date)
Bird to Human Transmission
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Predominantly via contact with feces
from infected birds
Handling infected poultry
Disposing of dead infected poultry
No sustained human to human
transmission to date
Avian Influenza - H5N1
Why do we care?
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238 documented cases, 139 deaths as
of August 14, 2006 (58%)
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Mutating little by little
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Has potential to mutate into a human
strain
Conditions of a Pandemic
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Widely spread without early detection
Novel virus highly infectious to humans, with
no immunity
Virus strain is easily transmissible human to
human
Virus causes serious illness
There is no adequate supply of vaccine
immediately available
Supply of antiviral medication is limited
Could the H5N1 virus cause
the next pandemic?
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Possibly…
So far the virus cannot pass easily from
human to human.
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But…
Eventually, there will be another
pandemic, we just can’t be sure it will
be caused by this H5N1 virus
World Health Organization
Influenza Pandemic Phases
Interpandemic Period
Novel subtypes in animals but not humans
Phase 1
Circulating subtypes in animals posing threat
to humans
Phase 2
Pandemic Alert Period
Novel subtypes in humans, but no
human-to-human transmission
Phase 3
Limited human-to-human
transmission
Phase 4
Localized clusters of human cases
Phase 5
Pandemic Period
Increased and sustained transmission in the
general population on a large scale
Phase 6
Projected Pandemic Impact Based on 2004
U.S. Population Estimate of 294 Million
(0.05% of World Population)
Illness
MODERATE
PANDEMIC
SEVERE
PANDEMIC
90 million
90 million
45 million
45 million
865,000
9,900,000
128,750
1,485,000
64,875
742,500
209,000
1,903,000
(30% of population)
Outpatient Care
(50% of ill)
Hospitalizations
(1% to 11% of ill)
ICU Care
(15% of hospitalized)
Ventilators
(50% of ICU)
Deaths
(0.2% to 2% of ill)
Projected Pandemic Impact Based on 2004
Minnesota Population Estimate of 5.1 Million
(1.75% of U.S. Population)
Illness
MODERATE
PANDEMIC
SEVERE
PANDEMIC
1,544,000
1,544,000
772,000
772,000
15,000
172,000
2,250
25,700
1,120
12,900
3,600
32,900
(30% of population)
Outpatient Care
(50% of ill)
Hospitalizations
(1% to 11% of ill)
ICU Care
(15% of hospitalized)
Ventilators
(50% of ICU)
Deaths
(0.2% to 2% of ill)
Assumptions
Not a matter of if but when
• All countries will be impacted
• Medical supplies and care
may be inadequate
• Impacts will last for weeks to
months
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Assumptions
•Two to three waves of illness
• Pandemics can disproportionately affect
younger people creating workforce
issue
• Potential for high levels of:
- Sickness and death
- Disruption of critical services
- Economic loss
Goals of Pandemic Planning
and Response
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Maintain community infrastructure
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Minimize social disruption
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Reduce morbidity/mortality
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Provide effective public education (before,
during and after)
Public Health Messages
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Off site care facilities
Home care activities
Social distancing
“Snow Days”
Active Surveillance
Isolation and Quarantine
Vaccines and antivirals
Planning Priorities
 Family/Individual
Planning
 Business Continuity
Planning
 Community Planning
Family Emergency
Preparedness Awareness
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Food and water
Change of clothes for each person
Sleeping bags or blankets
First aid kit
Battery powered radio and flashlight with
extra batteries
Social distancing or “snow day” preparations
Key Elements of Preparedness –
From a Business Perspective
• Business Continuity Planning
• Prioritize critical functions
• Identify functions that could be suspended for up
to two months
• Identify positions needed to carry out critical
functions
• Build depth through cross training
• Plan for alternative work schedules
• Explore telecommuting capabilities – large scale
Regional and Local Planning
Considerations
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Integrate non-health entities in planning
and response
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Establish community stockpiles (e.g. of
vaccine and antivirals) & distribution
systems
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Identify spokespersons
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Provide effective public education
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Surveillance systems
Priority Activities for 2006
Review the federal and
state plans
• Plans from other states
• Update local plans
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• Assure response is community based, and
flexible
Planning Priorities
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Community meetings
Education and training staff
Creating messages ahead of time regarding
response
Stockpiles of anti-virals and vaccines
• How to get them distributed-local vs. regional
• Who will get them- essential personnel
• Where to distribute
Planning Priorities
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Coordinated information to public and other
partners
• HAN-health alert network
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Special and vulnerable populations
• Vaccinations/prophylaxis
• Messaging
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Community resources
Community surveillance-early, during,
expanded sites
Mass fatalities
Planning Priorities
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Working with healthcare regarding:
– Continuity of services
– Supply contingency plans
– Surge capacity
– Isolation/Quarantine of compliant/noncompliant
– Protection for workers
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Mortuary Services
Are We Ready?
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More today than yesterday
More tomorrow than today