Update Pandemic Influenza Avian Influenza Seasonal Influenza

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UpdatePandemic InfluenzaAvian
InfluenzaSeasonal Influenza

• Kevin G. Pearce, MPA
• Peninsula Health District
• Virginia Department of Health
• August 2006

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Why the concern?

• Pandemic ( worldwide) epidemic of a new
  influenza virus
• New virus ? Most people will have no immunity
• Higher disease attack rates higher death rates
  than seasonal or normal influenza

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Past influenza pandemics

• Pandemic flu is unpredictable, like the flu virus
  itself
• 1968-69 Hong Kong flu
• 34,000 deaths in US
• 1957-58 Asian flu
• 70,000 deaths in US
• 1918-1919 Spanish flu
• gt500,000 deaths in US
• Worst case scenario

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Why the concern?

• Pandemic ? rapid spread around world in repeating
  waves
• 1918 waves circled globe in 6-9 months

United Kingdom experience Jordan E, American
Medical Association, 1927
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High death rate among young adults

• Influenza pneumonia mortality per 100,000
  person, by age group

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Why the concern?

• Extremely disruptive
• Worker absenteeism
• Lost productivity
• Unable to get/transport supplies raw materials
• Uncertain infrastructure
• Fuel utilities telecom info technology
• Public safety personnel public services
• Food medicine suppliers
• Increased demands on health care infrastructure
  workforce
• Reduced tourism, travel, entertaining, hotels
• No help from other areastheyre affected

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What if

• On the Peninsulawe saw a 35 attack rate over 2
  months (approx. 163,000 ill)

Estimates using CDCs FluAid 2.0
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Influenza on the Peninsula
Total cases 163,000 35 of population
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• Does
• H5N1
• avian influenza

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Pandemic influenza

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H5N1 avian influenza

• H5N1current epidemic avian flu strain
• Highly pathogenic avian influenza (HPAI)
• Continuous circulation in Asia since 2003
• Historically unprecedented avian pandemic
• Magnitude duration of pandemic in birds
• Virus is changing

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H5N1 avian influenza(Nations with confirmed
cases July 7, 2006)
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H5N1 avian influenza

• Before 1997, H5 influenza virus never infected
  humans
• Now
• Human cases from close exposure to ill birds
• No sustained human-to-human transmission
• Few cases, but high fatality (gt50)
• 229 cases 131 deaths, World Health
  Organization, July 4, 2006
• Treatment primarily supportive
• Antivirals (Tamiflu Relenza)

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Is H5N1 a pandemic virus?

• 3 requirements
• v Novel strain - new H /or N subtype
• v Causes significant disease in humans
• NO Consistent human-to-human transmission
• Avian H5N1 influenza virus is not a pandemic
  virus - but it might become one

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H5N1 on WHOPandemic Risk Scale
3
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PreparednessPlanning

• National Strategy for Pandemic Influenza,
  November 1, 2005
• HHS Pandemic Influenza Plan, November 2005
• www.pandemicflu.gov
• Virginia Department of Health Emergency
  Operations Plan Pandemic Influenza Attachment,
  Updated March 2006
• www.vdh.virginia.gov/PandemicFlu/index.asp

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PreparednessWhere do we stand?

• No ready-to-use H5N1 vaccine
• Antivirals
• Limited supply of Tamiflu
• Production in next 10 years will treat only 20
  of world population
• Unclear if Tamiflu will work for treatment
• Not enough available to use for prevention

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Preparedness strategies

• Heightened surveillance
• Immediate response at 1st sign of an outbreak
• Respond to limit and confine outbreak
• Buy time to make vaccine and take other actions
• Applies to both humans and birds

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Control strategies

• Isolation quarantine
• Non-pharmaceutical approaches
• Cough hand hygiene
• Travel restrictions
• Social distancing
• Eliminate mass gatherings
• Close schools, theaters, etc.
• General public wears masks

www.pbs.org/wgbh/amex/influenza/
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What should you be doing?Prepare your family

• Store a two week supply of food.
• Have nonprescription drugs and other health
  supplies on hand.
• Teach your children and model the behavior
• To wash hands frequently with soap and water
• To cover coughs and sneezes with tissues
• To stay away from others as much as possible if
  they are sick
• To stay home from work and school if sick.
• Talk with family members and loved ones about how
  they would be cared for if they got sick, or what
  will be needed to care for them in their home.

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Why?

• A strong network of prepared people, families,
  and organizations is vital to a communitys
  successful response to pandemic influenza.

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What else should you do?

• Get flu shots every year to your entire staff.
• Develop adequate stockpiles in case of supply
  chain disruption.
• Plan for personnel decreases and novel ways to
  accomplish your objectives.