Pandemic Planning: A Nation Prepared

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Pandemic PlanningA Nation Prepared

• U.S. Department of Health and Human Services
• Mike Leavitt, Secretary

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HHS Pandemic Influenza Preparedness Planning
ADM John O. Agwunobi Assistant Secretary for
Health
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The Burden of Influenza

• Seasonal Influenza
• Globally 250,000 to 500,000 deaths each year
• In the United States each year
• 36,000 deaths
• gt200,000 hospitalizations
• 37.5 billion in economic costs from influenza
  and pneumonia
• Pandemic Influenza
• An ever-present threat

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• Seasonal Influenza Preparedness

Pandemic Influenza Preparedness
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Pandemics Do Happen!
H9
1998
1999
H5
2003
1997
2003-2006
H7
1980
1996
2002
2003 2004
H1
H3
H2
H1
1977
1915
1925
1935
1945
1955
1965
1975
1985
1995
2005
1918 Spanish Influenza H1N1
1957 Asian Influenza H2N2
1968 Hong Kong Influenza H3N2
Avian Flu
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H5N1 Influenza Severe Pneumonia - Vietnam 2004
DAY 5 DAY 7
DAY 10
Hien TT et al., New England J Med
20043501179-1188
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Planning Assumptions Health Care

• 50 or more of those who become ill will seek
  medical care
• Number of hospitalizations and deaths will depend
  on the virulence of the pandemic virus

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Pandemic Strain Emergence Reassortment of
Influenza A Viruses
Human virus
Avian virus
Avian Reservoir
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Pandemic Strain Emergence Direct Infection
Avian virus
Avian Reservoir
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Addressing Local Practices
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Situation Report Avian Influenza

• Widespread and spreading prevalence in migratory
  birds broad host range
• Continued outbreaks among domestic poultry
• Mammalian infection (cats, pigs, etc.) lethal
• Virus is evolving
• Sporadic human cases (184 reports to date)
• Most in young and healthy
• Case-fatality gt50 (103 deaths)
• Rare person-to-person transmission
• Sustained and rapid person-to-person transmission

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Nations With Confirmed Cases H5N1 Avian Influenza
(March 21, 2006)
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Phases of a Pandemic Where We Are Now
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HHS Pandemic Influenza Plan

• Support the National Strategy for Pandemic
  Influenza
• Outlines planning assumptions and doctrine for
  health sector pandemic preparedness and response
• Public Health Guidance for State and Local
  Partners
• 11 Supplements with detailed guidance

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HHS Pandemic Influenza DoctrineSaving Lives

• A threat anywhere is a threateverywhere!
• Quench first outbreaks detect andcontain where
  it emerges, if feasible
• International collaborations
• Frontline detection and response rapid
  laboratory diagnosis
• Isolation / quarantine / antiviral prophylaxis /
  social distancing / animal culling

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HHS Pandemic Influenza Doctrine Saving Lives

• Prevent or at least delay introduction into the
  United States
• May involve travel advisories, exit or entry
  screening
• For first cases, may involve isolation /
  short-term quarantine of arriving passengers

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HHS Pandemic Influenza Doctrine Saving Lives

• Slow spread, decrease illness and death, buy time
• Antiviral treatment and isolation for people with
  illness
• Quarantine for those exposed
• Social distancing
• Vaccine when available
• Local decisions

Unprepared
Impact
Prepared
Weeks
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HHS Pandemic Influenza Doctrine Saving Lives

• Clearly communicate to the public
• Prepare people with information
• Encourage action steps to prepare now
• Provide updates when new information emerges
• Use trusted messengers
• Coordinate to ensure consistent messages
• Address rumors and inaccuracies

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Our Health Protection Preparedness SystemA
NETWORK of Shared Responsibility!

• Local - tribal - state - federal
• Domestic international
• Public private
• Multi-sector
• Non-partisan
• Animal human
• Health protection homeland security economic
  protection

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Countermeasures Vaccines, Antivirals,
andMedical Supplies
Strategic National Stockpile
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Challenges in Pandemic Vaccine Preparedness

• Expand production of current (egg-based) vaccine
• Evaluate dose-sparing technology (adjuvants,
  intramuscular vs. intradermal route)
• Accelerate development of modern (non-egg)
  vaccines
• Target new antigens

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Vaccine Production and Use U.S Seasonal Influenza
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Avian Influenza Vaccine Production

• Working with the National Institutes of Health
• Current H5N1 Vaccine 40 million doses being
  produced
• Second Clade 2 Avian Influenza vaccine

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Antivirals and Medical Supplies Influenza
Treatments

• Stockpile
• Tamiflu 5 million treatment courses in
  Strategic National Stockpile (SNS) with 12.4
  million treatment courses ordered
• Tamiflu oral suspension 97,000 courses in SNS
  with an additional 260,000 on order (arrival date
  to be determined)
• Relenza 84,000 courses in SNS with 1.75 million
  treatment courses ordered
• Strategy
• Procure 81 million courses of antivirals
• 6 million courses to be used to contain an
  initial U.S. outbreak
• 75 million courses to treat 25 percent of U.S.
  population
• Accelerate development of promising new antiviral
  candidates

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Antivirals and Medical Supplies Influenza
Treatments

• 350 million appropriated in FY 2006 to upgrade
  state and local response capacity for pandemic
  influenza
• 100 million of the funding is scheduled to be
  awarded to all 50 states 7 territories Puerto
  Rico Washington, D.C. New York City Chicago
  and Los Angeles County and allocated according to
  a base population formula
• 250 million will be awarded later this year.
  Application for funding is supplemental to
  current cooperative agreements

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State and Local Pandemic Influenza Planning
Checklist

• Community Leadership and Networking
• Surveillance
• Health System Partnerships
• Infection Control and Clinical Care
• Vaccine Distribution and Use
• Antiviral Drug Distribution and Use
• Community Disease Control and Prevention
• Communications
• Workforce Support

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Pandemic Influenza Checklists

• State and Local
• Business
• Preschool
• Schools (K-12)
• Colleges Universities
• Faith-based Community Organizations

• Physician Offices and Ambulatory Care
• Home Health
• Emergency Medical Services
• Travel Industry

www.pandemicflu.gov
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Health Protection at the Frontline Local,
County, and State Public Health Departments and
the Indian Health Service

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• Seasonal Influenza Preparedness

Pandemic Influenza Preparedness

• Preparing for a pandemic now will mean
• Lives saved during seasonal influenza
• Modern seasonal influenza vaccine for all who
  need it
• New antiviral drugs for prevention and treatment
• Community health protection from other threats
• Peace of mind

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Complacency is the enemy of health protection!
www.pandemicflu.gov
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Avian Influenza (AI) Preparedness and Response
Veterinary Services March, 2006
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Topics Covered

• Avian Influenza Overview
• USDAs AI Interventions
• Targeted surveillance
• Border protection
• Trade restrictions OIE guidelines
• Outreach education
• Preparedness response

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Avian Influenza Overview

• Avian influenza (AI) - identified in the early
  1900s
• High pathogenic avian influenza (HPAI) causes
  contagious illness, death in birds Low
  pathogenic (LPAI) causes mild to no illness
• Vast majority of AI viruses found in birds do not
  represent a public health concern

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Avian Influenza Overview (cont.)

• Virus is characterized by H and N type (surface
  proteins).
• 144 different characterizations of the virus,
  based on 16 H types and 9 N types
• AI viruses mutate easily only H5 and H7 viruses
  have the potential to mutate from an LPAI to an
  HPAI form.
• AI viruses vary widely in pathogenicity from
  strain to strain. Therefore not all H5N1 viruses
  are infectious for people or pathogenic to
  poultry.

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Species Affected
Genetic Reservoirs
H3, H7
H1, H2, H3
Intermixing
H5N1
Commercial, LBMs Others
H10
H1-12 H14-15
H1-2, 4-7, H9-13, 15-16
Other Aquatic Birds?
H1, H3, H4, H7, H13
H1, H3
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How is the virus spread among birds?

• Direct contact between healthy and infected birds
  
• Infected fecal matter
• Can be found on surface of unwashed egg shells
  from infected birds

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Three HPAI Findings in U.S.

• 1924 Fowl Plague affected live bird markets
  in the Northeastern U.S.
• 1983 destruction of 17 million birds in PA
• 2004 quickly contained and eradicated in TX

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AI Surveillance

• APHIS and States conduct surveillance through
• National Poultry Improvement Plan (NPIP)
• State and University laboratories
• Export testing at slaughter
• State movement requirements

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AI Surveillance (cont.)

• APHIS safeguarding system encompasses
• Targeted surveillance
• Cooperative efforts with States and Industry
• Outreach and education
• Trade restrictions
• Anti-smuggling programs

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LPAI Surveillance and Control Plan

• Federally-coordinated and State-assisted LPAI
  H5/H7 LPAI Control Program
• Commercial poultry
• Live bird marketing system
• Since 1986, APHIS and States have monitored live
  bird markets (LBMs) in Northeast U.S.

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Surveillance NPIP

• Establishes standards for evaluation of poultry
  breeding stock and hatchery products
• Avian influenza free certification for
  commercial companies
• New LPAI program that will provide for H5 and H7
  AI monitoring

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Surveillance NPIP (cont.)

• New LPAI program that will provide for H5 and H7
  AI monitoring
• Program components AI monitored program,
  surveillance specifications, and State LPAI
  response and containment plans

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LBMs Surveillance

• Uniform Standards published in 2004 provide
  guidelines for markets, dealers and producers
• Licensing requirements and education
• Bird testing and recordkeeping
• Sanitation and biosecurity
• Surveillance and inspections
• LPAI positive facilities

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LBMs Surveillance (cont.)

• States enforce LPAI program standards
• Federal indemnification provided for
  participating States with positive diagnosis of
  H5 or H7 LPAI
• APHIS initiated cooperative agreements with 21
  States

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LPAI Surveillance National Animal Health
Laboratory Network (NAHLN)

• 37 States participate in the network. NAHLN labs
• Provide laboratory services nationwide
• Provide laboratory data for reporting
• Respond to foreign animal disease outbreaks
• Focus on animal diseases

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Border Protection Risk of Introduction of Asian
Strain of H5N1

• USDA works closely with DHS to prevent smuggling
  of illegal poultry and poultry products.
• USDAs Smuggling Interdiction and Trade
  Compliance unit and DHS Customs and Border
  Patrol actively monitor U.S. ports.
• Legally imported birds from other countries are
  tested for AI.

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Border Protection Risk of Introduction of H5N1
Asian Strain of H5N1
Migratory Birds Overlap of summer breeding
grounds in Alaska, Northeast Canada

• Genetic separation of H5 AI viruses between New
  Old World
• Asian birds rarely get off course and go to N.
  America
• Risk from wild birds is low

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Trade Restrictions

• USDA maintains trade restrictions on countries
  affected by H5N1
• Albania, Azerbaijain, Cambodia, Cameroon,
  Peoples Republic of China, Egypt, France (VS
  defined restricted zone only), India, Indonesia,
  Iraq, Iran, Italy, Japan, Kazakhstan, Korea,
  Malaysia, Mongolia, Myanmar, Niger, Nigeria,
  Poland, Romania, Russia, Slovakia, Slovenia,
  Switzerland, South Korea, Taiperi China,
  Thailand, Turkey, Ukraine and Vietnam
• Poultry and poultry products from those countries
  are strictly prohibited.
• USDA works with trading partners and the World
  Organization for Animal Health (OIE) to maintain
  safe trade.

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World Organization for Animal Health (OIE)
Reporting and Guidelines

• OIE guidelines state that
• HPAI and all H5/7 LPAI must be reported to the
  OIE.
• Poultry meat and table eggs do not transmit LPAI
• Trade in poultry and poultry products can
  continue despite a finding of LPAI
• Recommends certain health measures for the trade
  in poultry and poultry products based on risk and
  AI status
• Compartmentalization allows countries to document
  separation based on biosecurity

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Outreach Education

• USDAs Biosecurity for the Birds Campaign is an
  extensive and far-reaching outreach initiative
  designed to
• Educate non-commercial poultry owners about the
  signs of AI other poultry diseases
• Promote the importance of practicing biosecurity
• Encourage rapid reporting of clinical signs of
  disease and/or unexpected deaths

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USDA AI Web Sitewww.usda.gov/birdflu

• Information about Biosecurity for the Birds
  program
• Links to other Federal entities working on AI
• Fact Sheets and other information resources
• QA on AI
• News Releases
• Technical Briefings

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Preparedness in the Event of an Outbreak

• Key is early detection and rapid response
• USDA maintains a comprehensive emergency response
  structure
• Partnerships with local, State, and Federal
  organizations
• Integration with the National Response Plan
• Continual collaboration with HHS, DHS and other
  Federal entities
• Diagnostic capabilities

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Response to an Outbreak in Poultry

• Guidelines
• Stamping out
• National Response Plan
• First responders
• Vaccines

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Response for AI in Wild Birds

• Manage wildlife threats
• Assess risk wildlife poses to susceptible
  livestock and poultry
• Containment, survey and surveillance, and
  population management

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Questions?
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Convention Center Floor Plan 2 Exhibit Hall and
Ballrooms
BREAK OUT SESSIONS ROOM
LOCATIONS Community/Volunteer Groups
E 21B Private Sector/Business E
21C Schools K-12 E 21 A
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Convention Center Floor Plan 1 Exhibit Hall and
Break out Sessions
LUNCH Exhibit Hall B
BREAK OUT SESSIONS -- ROOM LOCATIONS Assisted
Living/Long Term Care E 10C Colleges and
Universities E 10D Community/Volunteer Groups E
21B (see floor plan 2) Fire/EMS E
11A Healthcare E 10 AB Law Enforcement/Judiciary
E 11C Local Government E 11B Private
Sector/Business E 21C (see floor plan 2) Schools
K-12 E 21 A (see floor plan 2)
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