Transcript Tennessee Department of Health Pandemic Influenza Planning David Kirschke, MD Medical Epidemiologist Northeast Tennessee Regional Health Office.

Tennessee Department of Health
Pandemic Influenza Planning
David Kirschke, MD
Medical Epidemiologist
Northeast Tennessee Regional
Health Office
Avian Influenza
• All 15 H and 9 N
subtypes circulate
in aquatic birds
Nicholson KG. Lancet. 2003;326:1733-45.
Avian Influenza
• All 15 H and 9 N
subtypes circulate in
aquatic birds
• Only certain types
circulate in humans
• Virus that circulate in
birds but not humans
termed ‘avian’
influenza
• Low / highly
pathogenic
Nicholson KG. Lancet. 2003;326:1733-45.
Origin of Antigenic Shift and
Pandemic Influenza
Phases of a Pandemic
PERIOD
Interpandemic
No human cases
of novel
influenza virus
Pandemic Alert
Human cases with
increasingly
efficient
human-tohuman spread
PHASE
DESCRIPTION
1
No animal influenza viruses
circulating with the potential
to infect humans
2
Animal influenza virus is
circulating with the potential
to infect humans
3 (Current
situation)
Human cases with rare or no
human-to-human spread
4
Small clusters caused by
human-to-human spread
5
Large regional clusters caused
by human-to-human spread
6
Geographically widespread and
efficiently spread from
human-to-human
Pandemic
Worldwide
epidemic
Nations With Confirmed Cases
H5N1 Avian Influenza (16 Oct 2006)
256 cases with 151 (59%) deaths in 10 countries
Assumptions about Disease
Transmission
• No one is immune to pandemic strain; 30% of
population will become ill
• Most will become ill 2 days (range 1-10) after exposure
to the virus
• People may be contagious up to 24 hours before they
know they are sick
• People are most contagious the first 2 days of they are
sick
– Sick children are more contagious than adults
• On average, each ill person can infect 2 or 3 others (if
no precautions are taken)
Assumptions about Disease
Transmission
• Pandemics move through community in waves
• Each wave in a community will last 6-8 weeks
• There will be at least 2 “waves” of pandemic
disease, likely separated by several months
• The entire pandemic period (all waves) will last
about 18 months to 2 years
• Disease may break out in multiple locations
simultaneously, or in isolated pockets
Key Activities to Minimize Impact
of Pandemic Influenza*
• Surveillance for disease activity
• Accurate communication
• Use of social distancing measures
• Distribution and use of all available
medical resources and personnel
* Likely shortage of vaccine, antiviral medication, and advanced medical care
Objectives of Pandemic Planning
•
Primary objective is to minimize
morbidity and mortality from disease
•
Secondary objectives are to preserve
social function and minimize
economic disruption
Planning Assumptions
•
Based upon a pandemic of the
severity of the 1918-1919 influenza
pandemic
– Actual situation / response may vary
•
Local planning is critical
– Federal and state government capacity to
meet the needs of individuals will be
limited
Tennessee Pandemic Influenza
Estimates
Characteristic
Moderate
Severe*
Illness (30%)
1.8 million
1.8 million
Outpatient Care 900,000
900,000
Hospitalization
17,300
198,000
ICU Care
2,575
29,700
Mechanical
Ventilation
Deaths
1,300
14,850
4,180 (0.2%)
38,060 (2%)
*HHS recommends that states plan for severe scenario
Regional Response Plan
• Continuity of
Operations
•
Community
Interventions
•
Business Recommendations
•
Legal Authority
• Laboratory Diagnostics
•
• Healthcare Planning
Pre-Pandemic Case
Management
•
Pre-Kindergarten through
Twelfth Grade and Child Care
•
Colleges and Universities
•
Special Populations
• Disease Surveillance
• Vaccine Distribution
and Use
• Antiviral Drug
Distribution and Use
• Public Health
Communications
•
Workforce and Social
Support
Health Care Planning:
Surge Capacity
• Greatest challenge of pandemic response
• >25% more hospitalized patients than normal
• 40% absenteeism among employees
• Hospitals far short of this degree of surge
capacity
• Non-traditional care locations and altered
standards of care being discussed
Community Disease Control:
Community Wide Measures
• Reduce Social Contact
– School closures, snow days
– Cancellation / discouragement of large public
gatherings, possibly mass transit
• Educate about personal protection
– Hand hygiene and respiratory etiquette
– Avoid sick people if possible
– Stay home when you are sick
– Care for sick household members safely
– Clinical advice hotline
Community Interventions ―
Johnson City, 1918
• “Liberty Parade … called off”
• “Majestic, Edisonia, and Liberty Theaters
closed until further notice.”
• “East Tennessee Fair closed as a precaution
against spread of influenza in Knoxville.”
• “People are urged to stay home when they
have symptoms of influenza.”
• “Collecting in crowds at the railway station
will be prohibited.”
Johnson City Daily Staff, October 1918
Colleges and Universities
• Subject to state policies concerning suspension of
discretionary public gatherings but not by specific school
closure requirements affecting preK-12 schools
• College students are older, have less continuous group contact
than school-aged children, and are not considered a significant
source of influenza spread in a community
• Closing dormitories or suspending classes may be
recommended by regional or state health officers in
collaboration with university officials in light of specific
outbreak conditions
• Colleges and universities are encouraged to develop campus
plans and to collaborate with local and regional pandemic
planning officials for community pandemic plans.
Issues unique to colleges and
universities include:
• Authorizing student trips to affected areas or to international
programs
• How students’ health should be monitored
• Provision of hygiene supplies and education throughout
campus
• Care of ill students on campus
• Classroom attendance policies when influenza is circulating
• Communication with students and families
• Housing of international students and others without other
homes if the facility is closed
• Conditions under which the college or university would cancel
classes
Planning Recommendations
• Each college and university should designate a person or
group to be responsible for monitoring updated information
and preparing for a pandemic;
– One person be designated to liaise with regional and state health
officials
• Pandemic response plans for colleges and universities should
address the unique conditions of their institutions
• Planners should be familiar with policies outlined in federal and
state plans
• Consider how to implement state policies to cancel nonessential public gatherings (Section 7)
• Representatives are encouraged to participate in local
pandemic planning, as appropriate, along with public health
and other community leaders to assure that the needs and
resources of the college or university are considered into local
plans
Resources
• Federal pandemic planning checklist
for colleges and universities
– www.pandemicflu.gov
• State Pandemic Influenza Response
Plan
– http://www.state.tn.us/health/
• Your local health department (see
handout)