Pandemic Avian Influenza Preparedness

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Pandemic Avian Influenza Preparedness

• Joe Suyama, MD
• Department of Emergency Medicine
• University of Pittsburgh

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(No Transcript)
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Jernigan J, Clinical Aspects of SARS,
www.cdc.gov, 2003
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Why The Fear?

• Episodic Pandemics Occur
• 10/Last 300 Years
• 1918 20-100 Million Deaths Worldwide
• 1957 -- Mild
• 1968 -- Moderate
• High H5N1 Human Mortality
• 1918 2.2 vs. H5N1 60
• Influenza Virus Biological Destiny

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Reported Infections in Birds and PeopleJanuary
1, 2006
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Reported Infections in Birds and PeopleJune 1,
2006
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January 2008
Country 2006 2007 Total cases deaths cases
deaths cases deaths Azerbaijan 8 5 0 0 8 5 Cambo
dia 2 2 1 1 7 7 China 13 8 5 3 27 17 Djibouti
1 0 0 0 1 0 Egypt 18 10 25 9 43 19 Indonesia
55 45 41 36 116 94 Iraq 3 2 0 0 3 2 Laos 0 0
2 2 2 2 Myanmar 0 0 1 0 1 0 Nigeria 0 0 1 1 1 1
Pakistan 0 0 1 1 1 1 Thailand 3 3 0 0 25 17
Turkey 12 4 0 0 12 4 Viet Nam 0 0 8 5 101 47 To
tal 115 79 85 58 348 216

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• The First Known Highly Pathogenic Avian Influenza
  (HPAI) Panzootic
• 52 Countries
• Rapidly Spreading
• 348 Confirmed Human Cases
• Case Fatality Of 60
• Likely Human To Human Transmissions (Inefficient)
• Recent Family Cluster/Indonesia

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Case Winter 200X

• During high influenza season (hospitals at peak
  capacity) an unusual spike in serious flu cases
  occur high mortality yet clinically
  indistinguishable from Influenza initially
• EDs, hospital floors, and ICUs must deal with
  increasing numbers and severity

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• Media reports spur panic about an Avian Influenza
  outbreak and further strain is placed on
  Hospitals with thousands (sick and not sick)
  inundating the health systems
• Surge capacity is instituted

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Avian Influenza

• Avian influenza is confirmed with high human to
  human transmissibility
• Use of experimental vaccine is instituted

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Chaos

• Quarantine is instituted to the city with poor
  control of the population routine city services
  cease

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Chaos

• Doses of Anti-influenza medications from the
  Strategic National Stockpile arrive
• Quarantined families are running short on food
  and water
• Over ½ of the hospitals in the region have closed
  due to lack of staffing
• Crime has increased in all part of the city

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Potential Health Impact
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Human H5N1- 2007
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Estimated Morbidity And Mortality During An
Influenza Pandemic Within 12-16 Weeks
Require Outpatient Care Hospitalizations Deaths
US 50 Million 2 Million 500,000
PA 1.6 Million 37,800 9,100
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Avian Influenza

• Medical Response
• Public Health
• Surveillance
• Vaccine Dissemination
• Community Preparedness and Planning
• Hospital Preparedness
• Triage/ Resource management
• Economic Impact
• Surge Capacity
• EMS Response

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EMS Pandemic Impact

• 25 Attack Rate First Wave
• 30- 40 Absenteeism
• 2- 3 waves over 18 months
• Disruption of Essential Services
• Utilities
• Transportation
• Public Safety
• Economic Financial Impact
• Food, Medicine Supply Shortages
• Vulnerable Populations

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Medical Management Protocols

• Medical screening and triage
• EOC/911 call screening protocols
• H5N1 treatment protocols
• Expanded scope of practice
• Vaccination
• Antiviral and Antibiotic administration
• Altered standards of care
• Transport /Triage protocols
• Alternate Facilities

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EMS Clinical Recommendations

• For all patients who present with fever and
  respiratory symptoms.
• Screen
• Etiquette
• Protect
• Teach
• Isolate
• Consult

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Screening

• Question the patient about recent travel history
• Recent contact with poultry
• Fever, cough, fatigue, and abrupt onset of
  symptoms are consistent with influenza
• Absence of cough, systemic symptoms, and fatigue
  make diagnosis of influenza unlikely

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Etiquette

• Instruct patients with respiratory symptoms to
• Cover their mouth and nose with a tissue when
  coughing or sneezing.
• Wash their hands after every cough or sneeze
• Discard tissues into trash.

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Protect

• Don personal protective equipment when caring for
  patient
• Gloves
• N-95 Mask
• Gown
• Goggles (Eye Protection)
• Cap
• Barrier protection is necessary but it is time
  consuming and must be changed between patients to
  prevent infection.

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Teach

• Inform family members to stay with the patients
  and offer them masks as well
• Place Airborne and Contact Precaution notice
  outside of rig
• Use single use or single patient equipment when
  possible

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Isolate

• Suspected cases of Influenza should be placed in
  an isolation room on arrival to ED.
• A private room or a multi-patient room in which
  suspected influenza patients are cohorted is an
  alternative.
• If the patient requires movement out of the room
  a mask must be placed on the patient.
• For large numbers of patients an external triage
  area such as a tent may be preferable for
  patients with suspected influenza.

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Consult medic command

• Advise the receiving ED physician and medic
  command.
• The physician contacts an infectious disease
  consultant
• The charge nurse contacts
• Infection Control
• The Nursing Administrator on Duty (AOD)

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Operational Issues

• Staffing of Ambulances
• Vaccination Issues
• Staff
• Patients
• Public
• Surge Capacity Support
• Mutual Aid
• Contingency Planning

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Logistical Planning

• Food and Water
• Housing and alternate facilities
• Supplies
• PPE supplies (re-stocking)
• Fuel, Oil and other vehicular supplies
• Power
• Security

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Logistical Issues

• Implications of the global just-in-time economy
• medical/drug supplies
• food and water
• transportation
• communication
• equipment parts

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Strategic National Stockpile
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Command and Control

• Pandemic Response Stages
• Routine
• Normal Surge
• Supra-normal Surge
• Contingency Response
• Timeline

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Region 13 Planning

• Hospitals
• UPMC
• WPAHS
• ACHD
• Public Safety
• EMS

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Communication

• Primary
• Secondary
• Contingency
• Staffing logs
• Accountability of Staff

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Conclusion

• Planning is key to responding to Pandemic
  Influenza
• Staff protection and accountability paramount to
  continuity of services
• Must understand potential roles and address
  training issues now
• You already have all the skills you need