Pandemic Influenza Avian Influenza

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Pandemic InfluenzaAvian Influenza

• Maine Department of Health Human Services
• Maine Center for Disease Control Prevention
• (formerly Bureau of Health)
• Dora Anne Mills, M.D., M.P.H.

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1. Pandemic Influenza Avian Influenza 101
2. Preparedness Efforts

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1. Pandemic Influenza Avian Influenza 101
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Influenza

• Seasonal influenza
• Avian influenza
• Pandemic influenza

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All Influenza

• RNA viruses
• Genetic engines
• A HemagglutininNeuraminidase

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Seasonal Influenza

• October April
• Influenza Type A
• H3N2, H1N1
• Influenza Type B
• Vaccine

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Avian Influenza (Bird Flu)

• Influenza A
• Domestic poultry can be deadly
• High vs. low pathogenic
• Wild birds carriers
• Virus in fecal droppings, saliva/nasal discharge

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Recent Avian Influenza Outbreaks Affecting Humans

• 1997 H5N1 Hong Kong
• 1999 H9N2 Hong Kong
• 2003 H7N7 Netherlands
• 2004 H7N3 Canada
• 2004 H5N1 Southeast Asia

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Pandemic Influenza

• Global outbreak
• Highly contagious
• Deadly

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Recent Pandemics

• 1918 Spanish flu (H1N1)
• 5,000 deaths in Maine
• 500,00 in U.S.
• 40,000,000 worldwide
• 1957 Asian flu (H2N2)
• 70,000 deaths in U.S.
• 1-2,000,000 worldwide
• 1968 Hong Kong flu (H3N2)
• 34,000 deaths in U.S.
• 700,000 worldwide

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Past Pandemic InfluenzaEstimates for Maine
Moderate (1957/1968) Severe(1918)
Illness 390,000 390,000
Hospitalization 5,000 40,000
Deaths 1,100 9,100
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H5N1

• Detected in Asia since 1997
• Deadly 50 mortality in humans
• Transmitted birds to mammals and limited human to
  human
• Evolving quickly

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H5N1 Activity as of September 29, 2006

• 253 human cases (thru 10/13/06)
• In 58 countries
• 148 deaths
• Mortality rate 58

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Human Infections and Human Deaths by H5N1by
Month, October 13, 2006
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2. Preparedness Efforts

1. Avian Influenza Preparedness
2. Pandemic Influenza Preparedness

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A. Avian Influenza Preparedness
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Detection

• Testing in
• Migratory birds
• Poultry industry

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Preparedness Planning

• Poultry workers
• Backyard flock owners
• Others bird lovers, hunters

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General Public

• Food safety
• Bird handling

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B. Pandemic Influenza Preparedness

• Pan Flu

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Significant Issues forPan Flu Planning

• Detection and Tracking
• Care for Isolated and Ill
• Vaccines and Antivirals
• Food and Other Support
• Basic Services and Economic Impact
• Communication
• Quarantine and Isolation

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Pandemic Assumptions

• Attack rate of 25-35
• Duration of up to year or more in 2 waves
• Each wave lasting 6-8 weeks in community
• Healthcare system will be severely taxed, if not
  overwhelmed

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Social Disruption fromPandemic Influenza

• Absenteeism in essential sectors
• Health, law enforcement, food
• and fuel supplies, education
• Economic impact
• Psychological stress

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2006 vs 1918

• Advantages in 1918
• Smaller population
• Less travel
• More self-reliance

• Advantages in 2006
• Healthier population
• Better medical care
• Preparedness

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Federal Preparedness
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www.pandemicflu.gov
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Components of Federal Plan

• Community Disease Control
• Travel-Related Risks of Disease
• Communications
• Workforce Support

• Surveillance
• Laboratory Diagnostics
• Healthcare Planning
• Infection Control
• Clinical Guidelines
• Vaccine
• Antiviral Drugs

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Selected Components

• Vaccine
• Antivirals
• Community Disease Control

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Vaccines
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Assumptions for Vaccination

• Two doses will be required
• Vaccine unavailable for 3-6 months
• Production will be 3-5 million doses (15 µg)per
  week ? 10,000 doses per week in Maine

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Vaccine Priority Groups

• Vaccine and antiviral manufacturers
• Health care providers
• Those at high risk for severe disease
• Public health emergency response workers
• Key government leaders
• 400,000 in Maine

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Recommendations for Vaccine and Antivirals may be
modified based on

• Virulence
• Transmissibility
• Drug resistance
• Geographic spread
• Age-specific attack rates
• Morbidity and mortality rates

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What You Can Do Now

• Annual seasonal influenza vaccination
• Pneumococcal vaccination

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Antivirals

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Antivirals

• Adamantanes
• Amantadine
• Rimantadine
• Neuraminidase inhibitors
• Oseltamivir (Tamiflu)
• Zanamivir (Relenza)

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Assumptions for Antivirals

• Resistance to adamantanes
• Neuraminidase inhibitors will be effective in
  decreasing morbidity and mortality
• Current national stockpile 5 million courses
  goal is 80 million courses
• ? Maine stockpile

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Some Antiviral Priority Groups

• Patients admitted to hospital
• Infected health care workers and EMS providers
• Infected high-risk patients
• Infected pandemic responders and government
  decision-makers
• Exposed health care workers
• Equals 40 million courses
• (150,000 courses for Maine)

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Cost of Antiviral Treatment5-Day Course for an
Adult

• Oseltamivir (Tamiflu) 72.10
• Zanamivir (Relenza) 61.80

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Personal Stockpiles of Antivirals

• Supply
• Effectiveness
• Resistance
• Shelf life

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Stockpiles of Antivirals

• Institutional
• State

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Community Disease Control

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Challenges to Containment

• Short incubation period of 1-5 days
• Ability of persons with asymptomatic infection to
  transmit virus
• Early symptoms of illness are likely to be
  non-specific, delaying recognition

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Goal of Community Disease Control

• To limit or slow spread of pandemic influenza
• Social Distancing

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Containment Measures for Ill Individuals

• Patient isolation
• Management of contacts
• Contact tracing
• Contact monitoring
• Quarantine

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Containment Measures For Groups of Exposed or
At-Risk Persons

• Quarantine
• Containment measures for specific sites or
  buildings

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Containment Measures For Communities

• Promotion of community-wide infection control
  measures
• Social distancing (snow days)

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Unresolved Issues

• Role of airborne transmission
• Effectiveness of antivirals
• Coordination between states and countries

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State of Maine Preparedness
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www.maineflu.gov
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Overarching Roles of Major State Agencies
Involved with Pandemic Influenza Response Planning

• Governor
• Incident Commander
• MEMA
• Coordinator of states planning and response to
  all emergencies
• Maine CDC
• Develops public health emergency response plans
• Strategy lead in states response to Pandemic
  Influenza
• Sits with Governor during public health
  emergencies
• Maine Department of Agriculture
• Develops response plans for zoonoses
• Strategy lead in states response to Avian
  Influenza
• Sits with Governor during animal health
  emergencies

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What Has Maine Been Doing?

• 1997 2001
• Two statewide Pan Flu Conferences
• Statewide Plan
• Two exercises
• 2001 2005
• Post 9/11 Federal Funds
• Early Detection System
• Communication Systems
• Response System
• December, 2005 Pan Flu Conference

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Maines Planning Efforts 2006

• 3-part process
• Update Maines Pandemic Influenza Plan
• Development of sub-state Pandemic Influenza
  plans
• County plans
• Hospital plans
• Exercise and drills of the plans
• September 20th Summit - 1,100 attended

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Overarching Framework

• Early detection
• Response systems
• Communications
• Training
• Exercises and drills

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County Preparedness

• Emergency management
• Healthcare
• Many stakeholders involved
• May-August 2006 plans drafted
• August 2006-2007 exercise plans
• www.maineflu.gov for contact information

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Hospital Preparedness

• 2006 Plans drafted
• 2007 Exercise plans
• www.maineflu.gov for contact information

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http//www.fchn.org/healthreform/documents/fchn5F
pandemicfluplan.pdf
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Pandemic PreparednessCan Be Daunting!

• Need to
• Keep focused on the known
• Be creative
• Dont wait for someone else

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School Preparedness
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School Preparedness - Maine

• 200,744 enrolled in Maine elementary and
  secondary schools
• 66,000 enrolled in Maine post-secondary schools

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Resources for School Pandemic Influenza
Preparedness
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www.maineflu.gov
www.pandemicflu.gov
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Pandemic Flu K-12 Checklist Format

• Planning and Coordination
• Continuity of Student Learning and Core
  Operations
• Infection Control Policies and Procedures
• Communication Planning

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http//www.pandemicflu.gov/plan/schoolchecklist.pd
f
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www.acha.org
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Some Highlights of ACHA Guidelines

• Planning that allows employees to work from home
• Providing for ill students
• Addressing health and safety issues
• Addressing business continuity
• Making contingency plans for completion of
  courses

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Some Highlights of ACHA Guidelines (contd)

• Testing and rehearsing the plans
• Identifying key members of the Pandemic Planning
  Committee
• Identifying appropriate channels of communication
  and chain of command
• Identifying the role of student health services
• Compiling a list of supplies that would be needed

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Disaster Planning does not equal Public Health
Emergency Planning.
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Preparedness isEveryones Job No one ever died
of preparedness!
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