Transcript PANDEMIC INFLUENZA - Center for Infectious Disease

Influenza – What in the world
do YOU need to know?
Kristine A. Smith, M.A.
Flu Facts
What is Influenza?
 Acute, febrile respiratory
illness affecting nose,
throat, bronchial tubes
and lungs
 Epidemics caused by
influenza viruses A and B
(Type C uncommon in
people; no epidemics)
 Occurs worldwide,
causing considerable
morbidity (illness) and
mortality (death) each
year
 Symptoms appear rapidly
Symptoms
 Fever, dry cough, sore throat, muscle aches/pain,
headache, lack of energy, possibly runny nose
 Fever and body aches for 3-5 days
 Cough and lack of energy - 2 weeks
 Symptoms similar to other upper respiratory diseases
such as adenovirus, rhinovirus, parainfluenza,
legionellosis, etc.
How You Get the Flu?
 Typical incubation: 2 days
Range: 1-4 days
 Viral shedding
 Can begin 1 day before
symptom onset
 Peak shedding first 3
days of illness
 Correlates with
temperature
 Subsides after 5 days in
adults, can be 10+ days
in children
Transmission is
predominately droplet spread
The Burden of Seasonal Influenza
 Globally: 250,000 to 500,000 deaths each year
 In the United States each year:
36,000 deaths
>200,000 hospitalizations
$37.5 billion in economic costs from influenza
and pneumonia
How Influenza Viruses Change?
 Antigenic Drift:
Small changes in virus over time
New strains appear and replace older strains
May not be recognized by antibodies to older strains
 Antigenic Shift:
Abrupt, major change (reassortment)
Results in novel strain or new subtype
Can cause pandemic influenza
What is an Influenza Pandemic ?
 A global influenza outbreak
 Caused by a brand new (novel) flu virus
 Most severe occur with changes in both surface proteins
 Viruses can be isolated at any time of year
 Because it is a new virus, few or no people would be
immune
 Many people would get sick in every part of the world
 Asia is the source of many outbreaks because swine,
birds and humans live under the same roof, providing
opportunity for viral mixing
Influenza Pandemics 20th Century
Credit: US National Museum of Health and
Medicine
1918: “Spanish Flu”
A(H1N1)
1957: “Asian Flu”
A(H2N2)
1968: “Hong Kong Flu”
A(H3N2)
20-40 m deaths
1-4 m deaths
1-4 m deaths
675,000 US deaths
70,000 US deaths
34,000 US deaths
Timeline of Emergence of
Influenza A Viruses in Humans
Avian
Influenza
Spanish
Influenza
H1
1918
Hong Kong
Influenza
Asian
Influenza
Russian
Influenza
H9
H5
H7
H5
H1
H3
H2
1957 1968 1977
1997
2003
1998/9
If a Pandemic Happens:
What to expect…
 At the peak of a moderate pandemic influenza outbreak
(i.e. 35% attack rate, 6 week duration), New York State
(excluding New York City) can expect:
 14,916 influenza-related hospital admissions per week
 3,728 influenza-related deaths per week

2,609 deaths in the hospital
 Influenza patients will most likely utilize:
 63% of hospital bed capacity
 125% of intensive care capacity
 65% of hospital ventilator capacity
Will Avian Flu Cause the Next
Pandemic?
No one knows!
The H5N1 virus could change to spread
more easily among humans-but it might
not.
It could “swap genes” with another animal
virus, or with a human flu virus
Avian Influenza
 The H5N1 strain of avian influenza (bird flu) is present in
birds in many countries across several continents.
 Bird flu is NOT the same as pandemic flu
 Some human cases of avian influenza have also
occurred
Cases occurred after close contact with infected birds
No sustained person to person transmission
 Human death rate is high >57%
Nations With Confirmed Cases
H5N1 Avian Influenza (July 21, 2006)
H5N1 Outbreak:
December 2003 –July 20, 2006
 Laboratory confirmed human cases:
231 human cases
133 human deaths
 Case fatality rate 57 percent
 Cases occurred in countries with endemic infection of
poultry
 Nearly all human cases had poultry/bird exposure
 No sustained person-to-person transmission identified
 No influenza A viruses with human and avian
genes detected yet
Source: World Health Organization
Situation Report: Avian Influenza
 Widespread prevalence in migratory birds; broad host
range
 Continued outbreaks among domestic poultry
 Mammalian infection (cats, pigs, etc.) - lethal
 Virus is evolving
 Sporadic human cases (>190 reports to date)
• Most in young and healthy, Case-fatality 57%
• Rare person-to-person transmission
Sustained and rapid person-to-person transmission
What is New York State
doing to prepare?
WHO Pandemic Phases
Interpandemic Phase 1: No new influenza virus subtypes in
human; subtype that has caused human
period
infection may be present in animals
Phase 2: As above, but circulating animal
subtype poses substantial risk of human
disease
Pandemic
alert period
Phase 3: Human infection w/ new subtype, no
human-to-human (HTH) spread, or rare spread
to close contact
Phase 4: Small clusters w/ limited HTH
transmission, highly localized spread,
suggesting virus not well adapted to human
Phase 5: Larger clusters, but HTH spread still
localized, virus increasingly better adapted to
humans, but not yet fully transmissible
Pandemic
period
Increased and sustained transmission in
general population
NYSDOH Planning Process
 Original plan drafted using internal DOH workgroups –
August 2004
 Based on federal DHHS August 2004 pandemic plan
 NYSDOH revised plan and incorporated recent guidance
issued in the updated DHHS November 2005 plan
 Additional workgroup members added from:
 Local health departments
 Hospitals and hospital associations
 NYSDOH plan: www.health.state.ny.us
 Federal plan: www.pandemicflu.gov
Current Status of NYS Planning
 With the Disaster Preparedness Commission (DPC)
agencies, SEMO is coordinating development of a
State pandemic plan that will become an annex of the
State’s Comprehensive Emergency Management
(“All Hazards”) plan
 Local Health Departments are developing countyspecific plans—due date August 30, 2006
 Hospitals and Regional Resource Centers are
planning for surge capacity
 Pandemic preparedness town meetings, regional
partner meetings, regional media forums are being
held
Extensive Training is Underway
 NIMS training for
emergency responders
 Point of Dispensing
(POD) training for Local
Health Departments
 Laboratory specimen
collection and submission
training
 Informatics training for
key partners using HIN,
HPN, HERDS
 Multiple tabletop and
functional exercises held:
 ProtEX NY state POD
exercise, November 2005
 2006 versions Nov. 9 in
NYC,
Syracuse
 CDEx full functional
exercise, June 2006
(more than 200 agencies
participated)
Public Health Emergency Preparedness A Shared Responsibility!
 Local – state – federal
 Domestic –
international
 Public – private
 Multi-sector
 Animal – human
 Health protection –
homeland security –
economic protection
Healthcare
Delivery
System
Federal
Partners
Local/State/
Federal Public
Health
System
Businesses
& Workers
Education
System

Businesses, school systems,
community infrastructure providers, and
other employers should develop plans for
continuity of essential operations and
modified operation with a significantly
reduced workforce
25 to 30% of persons may become ill during a 6 to 8 week
outbreak
An additional 10% of the workforce may be absent due to
illness of a family member
Others may stay home due to a fear of becoming infected
What can YOU do to
prepare?
General Infection Control
Assumptions in a Pandemic
 Core prevention and control
measures (e.g., vaccination
and antivirals) will not be
available or will be limited
 We must prepare for that!
Individual Infection Control Strategies
Respiratory hygiene/cough etiquette and
hand hygiene are effective strategies to
stop the spread of germs
We should
make good
hygiene a
habit now
What is Respiratory Hygiene/
Cough Etiquette?
Cover mouth/nose when sneezing or
coughing
If no tissue, use elbow instead of hands
Use tissues and dispose of appropriately
Perform hand hygiene after contact with
respiratory secretions
Distance yourself from others
(more than 3 feet)
What is Hand Hygiene?
Traditional hand washing
Soap and hot water
Minimum of 20 seconds
(the time it takes to sing
“Happy Birthday” twice)
Alcohol based hand rubs
Acceptable means to disinfect/sanitize EXCEPT
when hands are visibly soiled
Did You Ask About Masks?
 Recommended for:
Health care workers with
direct patient contact
Those at high risk for
complications of influenza
Symptomatic persons
Contacts of ill persons
More About Masks
 Benefit of wearing masks by well persons in
public settings has not been established
Persons may choose to wear a mask as part of an
individual protection strategy that includes respiratory
hygiene/cough etiquette, hand hygiene, and social
distancing
 If you wear a mask,
keep your hands away
from your face!
 Clean your hands
each time you touch
your mask!
Individual or Group
Infection Control Strategies
 Isolation and quarantine: reduces influenza transmission
by separating infected persons from uninfected persons,
and exposed persons from non-exposed persons
Isolation of ill persons will be valuable during all phases
of pandemic influenza
Quarantine of those exposed to ill persons is justified
when there are a limited number of cases
Work or School Based
Infection Control Strategies
 Respiratory hygiene/cough etiquette, hand hygiene
 Stay away if ill (staff stay home, students do not go
to classes)
 Encourage self-reporting of illness that develops
 Active screening for
illness in staff/students
 Send staff/students home
(with mask) if ill
Community-Based
Infection Control Strategies
 Social distancing
Snow days, voluntary self-shielding
 Cancellation of public events
concerts, sports events, movies,
plays
 Closure of schools and
workplaces
office buildings, shopping malls
 Closure of recreational facilities
community swimming pools, youth
clubs, gymnasiums
Individual and Family Preparedness
is Crucial!
We might have to take care of ourselves and
those around us
How many would be ready?
Family Preparedness Checklist
 To plan for a pandemic
Store a supply of food
and water
Have non-prescription
drugs and other health
supplies on hand
Get involved in your
community
 Start now to limit the
spread of germs and
prevent infection
Hand hygiene
Respiratory hygiene
Stay home if sick
Parents need to
model behavior!
Questions
Contact Information:
(518) 486-1642
[email protected]
Additional Resources:
 Contact your local health department
 Websites – www.nyhealth.gov or www.pandemicflu.gov