Influenza Preparedness Plan for Oshkosh, WI

1
Influenza Preparedness Plan for Oshkosh,
WI
T. Zehms
Tabitha T. Zehms Department of Biology and
Microbiology University of Wisconsin-Oshkosh 800
Algoma Blvd. USA Oshkosh, WI 54901 E-mail
zehmst30_at_uwosh.edu
Department of Biology and Microbiology 800 Algoma
Boulevard Oshkosh, WI 54901 USA
AVIAN FLU The H5N1 strain of avian influenza has
spread over half the world and as it progresses,
more and more countries are scrambling to prepare
pandemic plans. Avian flu is a concern for
humans because it mutates at a rapid rate. The
more changes it makes, the possibility of
becoming capable to infect human beings grows.
The virus is carried by wild birds without
symptoms but kills domestic birds rapidly.
People who come in close contact with poultry or
property with poultry secretions/waste on a
regular basis have, on rare occasions, contracted
a strain of the virus that was able to infect
them. Should the virus mutate into a strain that
successfully can pass from human to human without
an interaction with domestic birds, a pandemic
could break out. Because this would be a new
strain of human influenza, there is no vaccine
and no one has any immunity to it.1The following
sections describe what can be done to prevent
infection, to treat cases, and to stay informed
both on the individual/family level and the
community level.
Quarantine The World Health Organization
recommends implementing a quarantine after six or
more people become infected in the same
neighborhood. Quarantined areas can start at the
neighborhood level and increase to the entire
city, as deemed appropriate by the Winnebago
County Public Health Department. Quarantines
might be accompanied by forbidding travel outside
the city or county, except for the transportation
of food and other critical supplies such as
medicine and hospital needs. Establishing a
curfew would ease the security demands of the
city police, who will already be guarding and
monitoring the shipment of important supplies
like antiviral shipments. Consistent street
patrol would be required as well when businesses
and schools are temporarily closed. Police,
firefighters, other first responders, and health
care workers would still be required to attend
work, as well as any public works or wastewater
treatment workers that need to keep vital
processes in the city running. In addition to
closing work places and schools, mass gatherings
might be restricted, for such occurrences allow
the virus to be exposed to many individuals at
once. This may include churches, public
libraries, theatres, coffee shops, bars, and
other areas of socializing. The best way to
prevent spreading the virus is to keep people
(and their germs) away from each other.

• Potential Risks
• Pharmacies depend largely on imported
  pharmaceuticals. If their suppliers are deemed
  non-essential, shipments of medicine might not
  come in, resulting in a shortage of important
  drugs. If medicines are unavailable for an
  unknown amount of time, physicians should be
  stationed at each pharmacy and decide who should
  continue to receive drugs and who should not.
  Whatever antivirals are available should be
  reserved for health care workers and those who
  are sick and come in contact with the extremely
  sick. Many of Oshkoshs citizens have special
  needs and depend on the pharmacy for daily
  living. These individuals should talk to their
  doctors about the shelf-lives of their drugs and
  possible stockpiling potential. This includes
  those with the following chronic diseases
• Diabetes
• HIV/AIDS
• Cancer
• Fibromyalgia
• Arthritis
• Hypertension
• Heart disease/high cholesterol
• Anyone that depends on medicine to prevent organ
  failure/rejection.

Fig. 4. A woman in critical condition with a bird
flu-like respiratory illness in Hanoi, Vietnam.
Courtesy of U.S. World News World Report.
Fig. 1 An example of close poultry-to-human
contact at a market in Cambodia. Courtesy of CNN
Online Bird Flu Photo Gallery.
Antiviral Medication It is not known how the
H5N1 strain of avian flu will react to antiviral
treatment. Countries are stockpiling Tamiflu, a
medication that might work. While demand is high
and supply is low, Winnebago County should still
seek to create its own stockpile of antiviral
drugs. This would allow the county to treat its
health care workers and other necessary personnel
in a prophylactic manner, thus preventing the
spread of the virus. Antiviral medication should
also be used to treat an area in the city that
has seen six or more cases of avian flu. Again
the idea would be to prevent the illness from
developing in individuals that are not yet sick.
Victims of avian flu should also be on an
antiviral treatment. Caution should be taken,
however with prophylactic treatment. If the use
of the medicine will not prevent the outbreak
from spreading successfully, then the medication
should not be used. In order to prevent such an
uncontrolled outbreak, it is vital that health
care workers receive vaccines or regular cycles
of prophylactic treatment with antiviral drugs.
Stockpile extractions should be authorized by a
public health professional and a physician. This
would allow the county to prevent overuse and
improper use of the drug that could lead to the
virus developing resistance to it.

• STAY INFORMED
• In the past, Oshkosh has formed and operated an
  Emergency
• Operations Center (EOC). It is recommended in
  the State
• Influenza Preparedness Plan2 to also establish a
  Joint
• Information Center (JIC), a place where the media
  and officials
• can meet to exchange important information.
• Oshkosh citizens could look to OCAT (Oshkosh
  Community
• Access Television) and WOCT (101.9fm) for
  necessary
• information about what is happening here in our
  city
• Number of cases and deaths
• Decisions made by the EOC
• Death tolls
• Fire/Police/Health Department mandates to
  citizens
• Notices of food and supply shipments and pick-up
  locations
• School closings
• Public event bans

• AS AN INDIVIDUAL A FAMILY

Long-term care facilities house many elderly
citizens with weaker immune systems, making them
particularly vulnerable to becoming infected.
The H5N1 strain of avian flu is actually more
virulent in those with young and healthy immune
systems, especially those between the ages of
20-45. The more the immune system attacks the
invader, the more cells are available for the
virus to take over and multiply. Despite this,
residents of long-term care facilities can still
catch a harmful influenza strain and should take
special precautions to prevent spreading the
disease to all their neighbors. Employees should
be vaccinated and/or treated with antivirals to
prevent bringing the disease into the
environment. Elderly citizens living
independently and alone should report any
respiratory infection symptoms to their doctor
and a public health official immediately.

• Flu Care Kit
• Pain and Fever Reducer
• Decongestant (Pseudoephedrine)
• Cough medicine
• Thermometer
• Tea or juice
• Chicken soup and a non-electric can opener
• Throat lozenges (adults and older children only)
• Tissues
• Blankets
• Nitrile gloves
• Respirator masks (ex. 3Ms N95)

Fig. 3. NCP 1603 - Emergency hospital during an
influenza epidemic, Camp Funston, Kansas.
Courtesy of the National Museum of Health and
Medicine.
Vaccines If a vaccine is developed tomorrow, it
will be in such great demand that even if a
pandemic did not occur for several years, there
still might not be enough to go around. This
requires health departments around the world to
develop a list of who should be vaccinated first.
The following compilation is a guideline
provided by the States Pandemic Plan1, based on
positions essential to the citys protection and
maintenance
FIND OUT MORE! The best protection you can
provide for yourself and your family is to stay
informed and updated on the progression of avian
flu. The following sites are in-depth resources
on avian flu and what to do in case of a
pandemic CDC's Pandemic Influenza Worldwide
Preparednesshttp//www.cdc.gov/flu/pandemic Worl
d Health Organization Pandemic Preparedness http/
/www.who.int/csr/disease/influenza/pandemic/en/ C
hica-Canada Influenza and Pandemic
Influenzahttp//www.chica.org/flu.html U.S.
Government PandemicFlu.Orghttp//www.pandemicflu.
gov/plan/tab1.html Homeland Security Pandemic
Fluhttp//www.whitehouse.gov/infocus/pandemicflu/

• TREATMENT
• Hospitals
• Aurora Medical Center 84 beds 8 respirators
• Mercy Medical Center 157 beds, with 8 respirators
• special unit 172
• Whether or not the hospitals in Oshkosh will be
  able to handle all of the flu patients depends
  largely on how well and how quickly the city
  responds to the presence of avian flu when it is
  first discovered. Based on the simple fact that
  no one has immunity to the virus, it is quite
  likely that we will overfill our hospitals and
  will require alternative Isolation Hospitals.
  Staff for these make-shift hospitals would have
  to consist of any available doctors/nurses/CNAs,
  etc., that could be spared from local hospitals
  and clinics. Nursing and medical students could
  volunteer.
• Here are some examples of Isolation Hospitals
• Gruenhagen Conference Center
• Park Plaza Hotel and Conference Center
• Kolf Sports Center, UWO
• High school gymnasiums

• Emergency Kit
• Medical supplies and First Aid manual
• Hygiene supplies
• Portable radio, flashlights and extra batteries
• Shovel and other useful tools
• Money and matches in a waterproof container
• Fire extinguisher
• Blanket and extra clothing
• Infant and small childrens needs (if
  appropriate)
• Pet food and supplies
• Disinfectants
• Cash and credit cards
• Sturdy shoes or work boots
• Candles
• Fluids with electrolytes
• Alcohol-based hand sterilizer

• Licensed healthcare workers (physicians,
  physician assistants, nurses, mental health
  professionals
• State public health officials
• First responders (Fire, Police, EMTs)
• Medical laboratory workers
• Emergency management personnel
• National Guard members that have been called into
  service by the governor
• Long term care facility staff (nursing homes,
  assisted-living homes, etc.)
• Utility field workers (gas, electric, water,
  sewer, etc.)
• Communications personnel
• Fuel suppliers
• Food suppliers
• Waste management workers (general and medical)
• Public transportation drivers
• Air travel personnel (pilots, air traffic
  controllers, etc.)
• Corrections workers
• Morticians/Coroners/Medical Examiners
• Pharmacists
• Red Cross field workers
• U.S. Postal Service Workers

Fig. 2. TEM of Avian influenza A H5N1 viruses
(tan) in MDCK cells (green). PHIL 1841
AS A COMMUNITY If there is an outbreak of Avian
Flu in the Oshkosh community, there are two
models of handling casesisolation and
quarantine. Isolation Best if there are fewer
than six cases localized in a specific
neighborhood/region of the city3. People with
suspected symptoms or those who are caring for
them should report the illness to their doctor
and, when instructed, bring the patient in to a
clinic or hospital. The patient would then
remain in the hospital until symptoms had ceased
and physicians declared it okay for them to
return home, or in the worst case,
death. Relatives and friends of the family who
had recently been in contact with the admitted
patient are encouraged to voluntarily isolate
themselves for up to a week. This would allow
time for symptoms to develop if they did contract
the virus without bringing it out into the
community (to the workplace, school, etc.).
Contact with your primary doctor and local health
department is critical during this time.

• Food Water
• Manual can opener
• Canned/jarred baby food and formula
• Canned juices
• Dried fruit
• Dry, crisp crackers
• Potatoes
• Canned meat, fruits, and vegetables
• Read-to-eat cereals
• Peanut butter
• Jelly
• Hard candy, chocolate bars, and canned nuts
• Energy bars
• Bottled water, or enough stored water to have 1
  gallon/person/day for two weeks. Make sure the
  water is properly chlorinated, either by adding
  two drops of chlorine/quart of water or with
  purchased chlorine purification tablets. These
  are available at camping and sporting goods
  stores.

• REFERENCES
• 1. Pandemic Flu.Gov. Accessed April 2006. Last
  Updated Nov. 2005. http//www.pandemicflu.gov/gene
  ral/
• Department of Health and Family Services.
  Accessed April 2006.Last Updated February 2006.
  http//www.dhfs.state.wi.us/preparedness/pdf_files
  /WIPandemicInfluenzaPlan.pdf
• World Health Organization. Advice on the Use of
  Oseltamivir. Last Updated March 2006. Accessed
  March 2006
• http//www.who.int/csr/disease/avian_influenza/gu
  idelines/useofoseltamivir2006_03_17A.pdf