Pandemic Influenza Planning Update

1
Pandemic Influenza Planning Update

• Your County
• Department of Health
• Spring 2006

2
Overview

• Seasonal Influenza
• Avian Influenza
• Pandemic Influenza
• What we are doing to prepare

3
Influenza
4
Influenza

• Respiratory infection
• Spread through coughing, sneezing
• 1 to 5 days from exposure to onset of symptoms
• Spread 1 day before illness up to 7 days after
• Seasonal influenza traditionally occurs October
  through April

5
Influenza Symptoms

• Rapid onset of
• Fever
• Chills
• Body aches
• Sore throat
• Non-productive cough
• Runny nose
• Headache

6
Seasonal Influenza

• 36,000 deaths nationally every year
  800-1000 in MN
• Vaccine available
• High risk for complications include
• Very young
• Very old
• Fragile immune systems
• Pregnant women

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AVIAN INFLUENZA
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Avian Influenza (Bird Flu)

• Birds of all species thought to be susceptible
• Two forms
• Mild
• Severe
• Signs and Symptoms
• Mild ruffled feathers, reduced egg production
• Severe extremely contagious, rapidly fatal,
  case fatality rate 100

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Avian Influenza - H5N1 Infection in Humans

• Remains an avian flu strain
• Living quarters are close to animals
• Transmission
• Contact with manure
• Handling chickens
• Walking through live poultry markets

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Avian Influenza - H5N1Why do we care?

• Spreading among birds quickly and across
  countries
• Jumping hosts (across animal groups)
• High case fatality rate among people (141
  documented cases, 73 deaths)
  as of
  February 2006
• Mutating little by little
• Has potential to mutate dramatically into a human
  strain

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Pandemic

• Pandemic
• Widespread infection
• No immunity within a population
• Epidemic
• Localized to one population
• Low immunity within the population

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Prerequisites for a Pandemic

• A new virus transmitted to humans (no immunity
  within the community)
• Virus must be able to cause illness in humans
• Virus must be able to pass easily from human to
  human

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(No Transcript)
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Could the H5N1 be the cause of the next flu
pandemic?

• Possibly
• but so far the virus cannot pass
• easily from human to human

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World Health Organization Influenza Pandemic
Phases
Interpandemic Period Interpandemic Period
Novel subtypes in animals but not humans Phase 1
Circulating subtypes in animals posing threat to humans Phase 2
Pandemic Alert Period Pandemic Alert Period
Novel subtypes in humans, but no human-to-human transmission Phase 3
Limited human-to-human transmission Phase 4
Localized clusters of human cases Phase 5
Pandemic Period Pandemic Period
Increased and sustained transmission in the general population on a large scale Phase 6
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Current Pandemic Flu Planning Assumptions
Attack rate (30) 1,544,000 cases in MN
Hospitalization rate (1 to 10 of cases) 15,000 to 172,000 hospital patients in MN
Case-fatality rate (.2 2 of cases) 3,600 to 32,900 deaths in MN
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Local Impact

• Insert local numbers on this slide

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Federal, State, Local Plans
General All Hazards Pandemic Flu
general National Response Plan (NRP) The National Strategy for Pandemic Influenza (White House)
health ESF 8 Public Health and Medical Services HHS Pan Flu Plan
general MEOP HSEMs Pan Flu Plan
health MDH All Hazards Plan MN Public Health Pan Flu Plan
general Local All Hazards Plans Local Pan Flu Plan
health Health component of All Hazards Plans LPH Pan Flu Plan
Federal
State
Local
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Protective Actions

• Governor is state decision maker
• Close schools
• Cancel large gatherings
• Encourage people to limit exposure to others
• Assure continuation of infrastructure
• Make decisions about use of limited resources

20
Goals of MN Planning

• Maintain the elements of the community
  infrastructure necessary to carry out pandemic
  response
• Minimize social disruption and economic loss
• Reduce morbidity
• Minimize mortality
• Stay flexible as the situation unfolds

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Goals of Regional and Local Planning

• Limit the spread of disease
• Create test plans
• Integrate non-health entities in planning
• Establish community stockpiles distribution
  systems
• Identify spokespersons
• Provide effective public education

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Goals of Regional and Local Planning (cont)

• Maintain community infrastructure
• Minimize social disruption
• Reduce morbidity/mortality
• Response is community based, and flexible

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PartnershipsOur health department is working
with

• Homeland Security and Emergency Management
• County and city emergency managers
• Schools
• Law enforcement/military
• Voluntary organizations
• Regional hospital coalition
• Clinics
• Emergency Medical Services
• Media

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Health Medical Planning

• __ County, Tribal and City Public
• Health Agencies
• ___Hospitals ___ Clinics
• Emergency Management
• Emergency
• Medical
• Services
• Other
• Community
• partners
• Insert your
  regional map

25
Local and Regional Public Health Planning

• Education
• Businesses, schools, clinics, community groups
• Community stakeholders
• Trainings
• Infection control education for law enforcement,
  first responders
• Psychological First Aid
• Communication
• Drills/Exercises

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Working with community partners to address

• Disease surveillance
• Clinical issues
• Laboratory
• Infection control
• Health care planning
• Vaccine and antiviral agents

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Working with community partners to address
(cont)

• Community disease control and prevention
• Communications
• Animal health collaboration
• Care of the deceased
• Legal issues
• Ethical issues

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Localize this slide

• Of the following series (29-40) of slides we
  suggest you select 2-3 that are relevant to your
  regional and/or local planning efforts, and are
  reflected in your previous slide.

29
Disease Surveillance

• Tracking influenza
• disease on
• ongoing basis
• Maintain high
• alert for H5N1
• Monitor activity
• in other
• countries

30
Clinical Issues

• Clinicians will question
• travel history and
• poultry exposure on
• influenza-like cases
• Clinicians will report
• critical influenza in
• young, healthy
• individuals
• Developing
• treatment and
• care protocols

31
Laboratory

• Developing capacity for rapid testing
  and confirmation
• Statewide network of clinical laboratories
• Monitoring agricultural testing
• Sharing information quickly
• Connection to CDC

32
Infection Control

• What are effective measures?
• Maintaining stockpiles of supplies
• Reuse, disposal
• Air handling
• Handwashing!!

33
Health Care Planning

• Hospitals in 8 regions working together
• Predicting and managing surge in demand
• Protecting workers and patients
• Off-site care facilities
• Home care
• Minnesota Responds, Medical Reserve Corps

34
Vaccine and Antiviral Agents

• Strategic National Stockpile system
• Mass dispensing clinics
• Vaccine for prevention
• Antivirals potentially for prevention and
  treatment
• Get needed material/supplies to the public
  quickly

35
Community Disease Control and Prevention

• Respiratory hygiene
• Business continuation
• School closing
• Limit interaction of people
• Home care
• Isolation and quarantine

36
Communications

• Need many ways to reach people
• Consistent, understandable, complete
  messages
• Reaching non-English speakers
• Hotlines, web, TV, community organizations
  and many other means

37
Animal Health Collaboration

• Animal health leaders and industry are
  planning for bird outbreak
• Protecting poultry workers
• Disposal of birds
• Economic impact

38
Care of the Deceased

• Manage death certificates
• Mortician collaboration
• Cremations and burials
• Safe, compassionate
• Limit interaction

39
Legal Issues

• Governors authority to manage an
  emergency
• Liability issues
• Being able to move quickly
• Licenses, sharing resources
• Isolation and quarantine

40
Ethical Issues

• What if theres not enough __________? Who
  should get the limited supply?
• Antivirals treatment or prevention?
• Economic impact of closing a business or
  limiting interaction
• Does response change with length of event?
• Reduced types of health care because of
  increased demand

41
Priority Activities for 2006

• Review the federal plan and plans from other
  states
• Update and expand state plans
• Support planning by others
• Education and training
• Public education
• Exercising!

42
Business Planning

• Forecast and allow for absences
• Modify the frequency of face-to-face contact
• Encourage annual flu shots
• Evaluate access to healthcare
• Identify employees and key customers with special
  needs

43
Is Your County Ready?

• More today than yesterday
• More tomorrow than today
• Continuing process
• Requires everyone to participate
• State and local government
• Businesses
• Faith-based and community organizations
• Individuals/families

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Recommended Web Sites

• www.health.state.mn.us
• www.hsem.state.mn.us
• www.ready.gov
• www.pandemicflu.gov
• www.fema.gov/areyouready
• www.ed.gov/emergencyplan
• www.weprevent.org/usa/cover.pdf