The Potential Threat of Influenza

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The Potential Threat of Influenza
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Flu Terms Defined

• Seasonal (or common) flu is a respiratory illness
  transmitted person-to-person. Most have some
  immunity, and a vaccine is usually available.
• Pandemic flu is virulent human flu that causes a
  global outbreak of serious illness. There is
  little natural immunity, and spreads easily from
  person-to -person. There is no vaccine
  available.
• Avian (or bird) flu is caused by influenza
  viruses that occur naturally among wild birds.
  The H5N1 variant is deadly to domestic fowl and
  can be transmitted from birds to humans. There is
  no human immunity, and no vaccine is available.

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Disaster vs Pandemic
Thailand Tsunami 2004 Khao Beach
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Disasters vs Pandemics

• Widespread geographic impact
• Occur in multiple waves over one year
• Invisible evidence
• Human casualties predominate
• State/federal response may be very limited
• Widespread economic crisis

• Limited in scope to a certain area
• Limited in time from minutes to days
• Visible evidence
• Material casualties predominate
• Can count on local material aid and state/federal
  response
• Localized economic impact

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Seasonal Influenza Overview

• Respiratory infection
• Transmission contact with respiratory secretions
  from an infected person who is coughing and
  sneezing
• Incubation period 1 to 5 days from exposure to
  onset of symptoms
• Communicability Maximum 1 to 2 days before to 4
  to 5 days after onset of symptoms
• Timing Peak usually occurs December through
  March in North America

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Influenza Symptoms

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

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Impact of Human InfluenzaSeasonal Epidemics in
United States
Deaths 36,000
Hospitalizations 200,000
Physician visits 25 million
Infections and illnesses 50 - 60 million
Thompson WW et al. JAMA. 2003289179-86. Couch
RB. Ann Intern Med. 2000133992-8. Patriarca PA.
JAMA. 199928275-7. ACIP. MMWR.
200453(RR06)1-40.
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Seasonal vs Pandemic Flu

• Seasonal Flu
• Annually fall
• Known virus
• Vaccine available (usually)
• High mortality young old esp. w/ health problems

• Pandemic Flu
• Irregular intervals anytime of year
• Novel virus
• No or mismatched vaccine
• High attack rate and mortality in 1550 year
  olds mortality in young similar to seasonal flu

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Influenza Types

• Type A
• Epidemics and pandemics
• Animals and humans
• All ages
• Type B
• Milder epidemics
• Humans only
• Primarily affects children

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Influenza Virus Composition
Type of nuclear material
Neuraminidase
Hemagglutinin
A/Beijing/32/92 (H3N2)
Virus type
Geographic origin
Strain number
Year of Isolation
Virus subtype
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Influenza Antigenic Changes

• Structure of hemagglutinin (H) and neuraminidase
  (N) periodically change
• Drift Minor change, same subtype
• In 1997, A/Wuhan/359/95 (H3N2) virus was dominant
• A/Sydney/5/97 (H3N2) appeared in late 1997 and
  became the dominant virus in 1998
• Shift Major change, new subtype
• H2N2 circulated in 1957-67
• H3N2 appeared in 1968 and replaced H2N2
• Pandemic potential

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Mechanisms of Antigenic Shift
Reassortment in humans
Direct Infection
Avian virus
Indirect Infection
Human virus
Reassortment In pigs
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Drugs Available for Treatment and
Chemoprophylaxis
Drug Trade Name Virus Type Treatment age
Amantadine Symmetrel A gt1 year
Rimantadine Flumadine A Adults
Zanamavir Relenza A and B gt7 years
Oseltamivir Tamiflu A and B gt1 year
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Avian Influenza
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http//www.pandemicflu.gov/
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Countries with H5N1 Influenza in Animals Humans
Countries with H5N1 influenza in animals
Countries with H5N1 influenza in humans
Through December 28, 2006
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The H5N1 Flu Threat to Humans

• A new virus to which humans have no immunity
  Yes
• The virus causes significant human illness or
  death Yes
• The virus spreads easily from person-to-person
  NO
• The Avian Flu (H5N1) virus has 2 out of 3 of
  these today

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Human Pandemic Influenza
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Recorded Influenza Pandemics
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Influenza Pandemics of the 20th Century
Name Year Virus Subtype Deaths Worldwide United States Deaths Worldwide United States
Spanish flu 191819 H1N1 4050 Million 550,000
Asian flu 195758 H2N2 2 Million 76,000
Hong Kong flu 196869 H3N2 1 Million 34,000
http//www.who.int/csr/disease/avian_influenza/en/
index.html
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Pandemics of the 20th Century
Year Name Strain Actual Deaths 2006 Deaths
1918 Spanish H1N1 675,000 1,959,000
1957 Asian H2N2 76,000 137,639
1968 Hong Kong H3N2 34,000 50,760
1969-2006 Seasonal Influenza H1N1 H3N2 34,000-40,000/ year 1,224,000-1,440,000 since last pandemic
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Pandemic Flu Waves

• Flu waves last 2-12 weeks
• Waves fade then reoccur multiple times
• Peak of waves lasts 1-3 weeks
• Some locations hit when others are not
• Secondary waves are usually the worst

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Pandemic flu - 1918

• Healthcare system overwhelmed
• Churches and schools shut down
• Hysteria and panic reigned
• Telecommunication and transportation failed
• Police protection failed
• Deathcare system overwhelmed

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Scared, Sick and Dying Personnel

• Up to 30-50 could be infected over a 12-15 month
  period.
• Some staff members will die.
• Up to 50 of a workforce can be absent at the
  peak of a wave either ill, caring for sick
  family members, lacking transportation or scared.

US Army Hospital Aix-Lex-Bains, France 1918
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Estimated Episodes of Illness, Healthcare
Utilization and Death for Texas

Characteristic Moderate (1958/68like) Severe (1918like)
Illness 7 mil (30) 7 mil (30)
Outpatient medical care 3.5 mil (50) 3.5 mil (50)
Hospitalization 67,300 770,000
ICU care 10,000 115,500
Mechanical ventilation 5,125 58,200
Deaths 16,260 186,000
Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics. Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics. Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics.
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Key Steps for Government Business Continuity
Planning

• 1. Prioritize critical functions
• Life, Health, Safety (Police, Fire, EMS, Public
  Health, Hospitals)
• Identify functions that support life, health and
  safety actions (Communications, data management,
  facility operation, payroll)
• Identify functions that are critical to the
  mission of an agency

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Key Steps for Government Business Continuity
Planning

1. Identify staff needed to carry out critical
   functions
2. Identify functions that could be suspended
3. Build depth through cross training
4. Plan for alternative work schedules
5. Explore telecommuting capabilities large scale

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Pandemic Influenza PreparednessKey Steps for
Government Agencies

• Engage businesses, agencies and organizations
  that depend on your services or on whom you
  depend
• Involve leadership - identify actions they may
  take in response to a pandemic event

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Pandemic Influenza PreparednessKey Steps for
Government Agencies

• Determine an incident command structure for
  agency leadership with at least 2 levels of
  back-up
• Educate employees as to plans
• Encourage personal preparedness

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Pandemic Influenza Response Plan - Next Steps

• Develop agency standard operating procedures to
  fulfill roles assigned by the State Pandemic
  Influenza Response Plan
• Brief leaders
• Conduct training and exercises over and over
  internally as well as opportunities for external
  exercise participation

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Thank You
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Pandemic Influenza ProjectionsAustin area 1.3
million people

• No. of casualties 1st wave 2nd wave
• Illnesses 326,657 65,332
• Hospitalizations 13,067 2,614
• Deaths 5,553 1,111

Source Austin Travis County Health Department
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Number of Confirmed Human Cases of Avian
Influenza A/(H5N1) Worldwide (by 22 January
2007)
Country   2003 2003 2004 2004 2005 2005 2006 2006 2007 2007 Total Total
Country   cases deaths cases deaths cases deaths cases deaths cases deaths cases deaths
Azerbaijan 0 0 0 0 0 0 8 5 0 0 8 5
Cambodia 0 0 0 0 4 4 2 2 0 0 6 6
China 1 1 0 0 8 5 13 8 0 0 19 12
Djibouti 0 0 0 0 0 0 1 0 0 0 1 0
Egypt 0 0 0 0 0 0 18 10 1 1 14 6
Indonesia 0 0 0 0 19 12 56 46 5 4 54 42
Iraq 0 0 0 0 0 0 3 2 0 0 2 2
Thailand 0 0 17 12 5 2 3 3 24 16
Turkey 0 0 0 0 0 0 12 4 0 0 12 4
Viet Nam 3 3 29 20 61 19 0 0 0 0 93 42
Total 4 4 46 32 97 42 116 80 6 5 269 163

Total number of cases includes number of
deathsWHO reports only laboratory-confirmed cases