Preparing for a Possible Pandemic Avian Influenza H5N1

1
Preparing for a Possible Pandemic Avian
Influenza H5N1

• Dane Dickson MD
• Madison Memorial Hospital
• District 7 Health Department

2
Influenza PandemicBackground

• Influenza A
• Species Specific
• Multiple Strains per species
• Usually do not cross from one animal to another

3
Anatomy of Influenza A
Surface Proteins (H and N)
Transmission Genes
Disease Genes
4
Severity of an Influenza Virus

• Degree of immunity existing in the population
• Ability of the virus to cause disease
• Ease of transmission
• Severity of disease

5
Yearly Flu and Immunity in the Population
H3N2 Panama
H3N2 Moscow
H3N2 Fujian
H3N2 Californian
6
Immunity in the Population and Antigenic Shift
H3N2 Panama
H3N2 Moscow
H5N1 ?
7
Setting the Stage for a Pandemic

• Virus with the following characteristics
• Novel surface protein (no immunity in the human
  population)
• Rapid transmission
• Severe disease

8
Pandemics of the 1900s
9
1918 Spanish Flu SpreadApproximate Starting
Date of Influenza by Location In 1918
(http//www.pbs.org/wgbh/amex/influenza/maps/index
.html)
10
1918 Spanish Flu Ability to Cause Disease

• These men start with what appears to be an
  attack of . . . influenza, and when brought to
  the hospital they very rapidly develop the most
  viscous type of pneumonia that has ever been
  seen. Two hours after admission they have . . .
  spots over the cheek bones, and a few hours later
  you can begin to see the cyanosis extending from
  their ears and spreading all over the face, until
  it is hard to distinguish the coloured men from
  the white. It is only a matter of a few hours
  then until death comes, and it is simply a
  struggle for air until they suffocate. It is
  horrible. One can stand it to see one, two or
  twenty men die, but to see these poor devils
  dropping like flies sort of gets on your nerves.
  We have been averaging about 100 deaths per day,
  and still keeping it up.

"Courtesy of the National Museum of Health and
Medicine, Armed Forces Institute of Pathology,
Washington, D.C."
Physician Letter Camp Devens, Massachusetts in
1918. (http//www.pbs.org/wgbh/amex/influenza/sfe
ature/devens.html
11
1918 Spanish Flu

• Unusual Distribution of death
• Spared the elderly
• ? Some immunity in the elderly that spared them

Ages 0 10 20 30 40 50 60
70
12
Pandemic Flu - Beginnings
Avian Influenza A (HPAI)
Human Influenza A
Normal Disease
Severe Disease
Human Spread
Bird Spread
Mixing
Severe Disease
Human Spread
Pandemic - Human Influenza A
13
Avian Influenza H5N1

• Avian influenza virus
• Rapid spread throughout much of the world
• Highly infectious TO BIRDS
• Very Lethal
• Over 200 people infected with BIRD virus
• All had very close contact with birds
• 50 mortality

14
(No Transcript)
15
Avian Influenza H5N1 (cont.)

• Marked similarity to the 1918 Influenza Virus
• World-wide public health risk
• Not if, but when will acquire the genes needed to
  effectively transmit through humans
• May be a revisit of 1918 Pandemic

16
Impact of Pandemic

• Depends on Severity of Virus
• May result in intermittent shut down of all areas
  of society
• May overwhelm medical and ancillary services
• Likely to last for months (3-6)

17
Modern Pandemic Possible Impact
18
Ending of Pandemic

• Immunity is Achieved
• Vaccines
• Exposures

19
Preparation for Pandemic

• National Strategy for Pandemic Flu
• States and Localities
• Our communities are on the front lines of a
  pandemic and will face many challenges in
  maintaining continuity of society in the face of
  widespread illness and increased demand on most
  essential government services. State and local
  responsibilities include the following
• Ensuring that all reasonable measures are taken
  to limit the spread of an outbreak within and
  beyond the communitys borders
• Integrating non-health entities in the planning
  for a pandemic, including law enforcement,
  utilities, city services and political
  leadership.

20
Preparation for Pandemic

• National Strategy for Pandemic Flu
• Individuals and Families
• The critical role of individuals and families in
  controlling a pandemic cannot be overstated.
  Modeling of the transmission of influenza vividly
  illustrates the impact of one individuals
  behavior on the spread of disease, by showing
  that an infection carried by one person can be
  transmitted to tens or hundreds of others. For
  this reason, individual action is perhaps the
  most important element of pandemic preparedness
  and response.
• Education on pandemic preparedness for the
  population should begin before a pandemic, should
  be provided by all levels of government and the
  private sector

21
Transmission of Influenza
How? Large droplets and contact.
When? Even before symptoms start!
22
Self Imposed Reverse Quarantine (SIRQ) Plan

• Goals
• Protecting individuals and families from being
  infected with pandemic flu
• Keeping society functioning through maintaining
  infrastructure

23
SIRQ

• Overview
• Keeping individuals/families isolated from each
  other yet allowing people to continue to function
  in society.
• Individuals that must break reverse quarantine
  need to be trained how to keep themselves safe.
• Implementation
• Unified message - Across all sectors of society
• Grass roots dissemination

24
SIRQ

• Absolutely Crucial
• EVERYONE MUST IMPLEMENT AND PROPIGATE THE PLAN

25
SIRQDetailed Overview and Implementation
Time
Hand Washing
Distance
Tissues
Education and Dissemination
Surgical Mask
26
SIRQDetailed Overview and Implementation

• FORM A PROTECTED CELL
• DO EVERYTHING IN YOUR POWER TO PROTECT
• Do not allow anyone into this group (may have the
  virus).
• Do not allow any member of this group bring an
  infection home to the others.
• THOSE WHO MUST LEAVE THIS CELL MUST PROTECT
  THEMSELVES.

Distance (Reverse Quarantine)
27
SIRQDetailed Overview and Implementation

• MUST IMPLEMENT THE PROTECTED CELL IN A TIMELY
  FASHION
• First case of flu in the United States
• Must continue until given vaccine or threat is
  past and the all clear is given.
• Must listen to approved sources for messages
  about the implementation of the plan.

TIME
28
SIRQDetailed Overview and Implementation
Surgical Mask

Hand Washing
Protection (All those that leave RQ)
Tissues
29
SIRQDetailed Overview and Implementation

• RATIONAL
• TYPE OF MASK?
• N95 or Respirator
• Surgical Mask (Tie)
• Procedure Mask (ear loops)
• RECOMMEND
• Tie Surgical Mask
• (Easier to breath, doesnt need fit testing,
  easier to stock pile, very adequate for droplets)

Protection Surgical Mask
30
SIRQDetailed Overview and Implementation

• RATIONAL
• TYPES OF SOAP
• Alcohol-based hand cleansers
• Anti-microbial soap
• Twinkle-Twinkle Little Star
• RECOMMENDATION
• Alcohol-based hand cleanser or soap

Protection Hand Washing
31
SIRQDetailed Overview and Implementation

• RATIONAL
• RECOMMENDATION
• Everyone cover their mouth when they sneeze or
  cough

Protection Tissues
32
SIRQDetailed Overview and Implementation

• EVERYONE MUST BE EDUCATED
• THIS PLAN IS REGIONAL and UNIVERSAL
• Grass roots goal of 100 Education and Protection
• THE GREATER THE IMPLEMTATION THE GREATER THE
  PROTECTION.

Educate and Disseminate