Pandemic Influenza Planning

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Pandemic Influenza Planning
Frank J. Welch, MD, MSPH Medical Director
Department of Health and Hospitals Office of
Public Health
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We dont know the timing of the next pandemic,
how severe it will be. We dont know what drugs
will work. We dont have a vaccine. Yet we are
telling everyone to prepare for a pandemic. Its
trickyThis is scary and we dont know Thats
the message. Dick Thompson World
Health Organization December 2005
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Discussion Topics

• Influenza overview
• 20th century pandemics
• Current threat
• Role of Public Health in preparedness and
  response
• Unique preparedness issues for a pandemic

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In Louisiana We Know How to Prepare for This
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How do we prepare for this?
Animation Courtesy of Mathematica Visualizations
Jeff Bryant
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http//worldvid.cit.nih.gov/flu/flu.wmvhttp//wo
rldvid.cit.nih.gov/flu/flu.rm
Proceedings of the National Academy of Science,
April 11, 2006 Vol. 103, No. 15 5935 5940.
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Flu terms

• Seasonal (or common) flu
• Respiratory illness that can be transmitted
  person to person. Most people have some immunity
  vaccine available. What is left over from
  previous pandemics.
• Avian (or bird) flu
• 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. No human immunity and no vaccine.
• Pandemic flu
• A virulent human flu (often from mutation of an
  avian flu) that causes a global outbreak
  (pandemic) of serious illness. Since little
  natural immunity, the disease can spread easily
  from person to person. Currently no pandemic
  flu.

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How does influenza spread?

• Breathing in droplets
• Produced when infected person talks/coughs/
  sneezes
• Touching an infected person or surface
• Contaminated with the virus and then touching
  your own or someone elses face
• Incubation period time from exposure to virus
  to development of symptoms
• Varies, but usually 1-4 days

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Flu Preventive Steps

• Vaccination
• Stay home when sick, 1 week from onset of
  symptoms
• Cover your cough
• Hand hygiene
• Wash with soap and water regularly
• Alcohol-based sanitizer if no water available
• Avoid touching eyes, nose and mouth
• Avoid close contact with people who are sick

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Seasonal and Pandemic Flu

• Seasonal Flu
• Average U.S. deaths 36,000/yr
• 200,000 hospitalizations
• Symptoms (sudden onset) fever, cough, runny
  nose, muscle pain death often caused by
  complications like pneumonia
• Generally causes modest societal impact
• Manageable impact on domestic and world economy

• Pandemic Flu
• Number of deaths could be quite high (1918 death
  toll 500,000)
• Symptoms may be more severe and complications
  more frequent
• May cause major impact on society
• Potential for severe impact on domestic and world
  economy

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Seasonal and Pandemic Flu, cont

• Seasonal Flu
• Outbreaks follow predictable patterns annual
  usually in winter
• Usually some immunity from previous exposure
• Complication risks- young, elderly and underlying
  health conditions
• Health systems usually meet needs
• Vaccine and antivirals usually available

• Pandemic Flu
• Unable to predict when Occurs rarely (three
  times in 20th century last 1968)
• No previous exposure little or no pre-existing
  immunity
• Healthy people may be at increased risk
• Health systems may be overwhelmed
• Vaccine not available in early stages and
  antivirals may be in limited supply

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20th Century Flu Pandemics

• 1918 Spanish Flu
• Worldwide 20-50 million deaths
• 500,000 deaths in US
• 1957-1958 Asian Flu
• Worldwide 1-2 million deaths
• 70,000 deaths in US
• 1968-1969 Hong Kong Flu
• Worldwide 700,000 deaths
• 34,000 deaths in US

• Typical Influenza Season
• 36,000 deaths in US

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Avian (Bird) Influenza

• Occurs naturally among birds
• Wild birds worldwide carry the virus usually no
  illness
• Domesticated birds - can become ill and die
• Humans
• Can become infected -- severe illness and death
• Most cases from close contact with infected
  poultry
• May have rarely spread from one person to another
• Cases/deaths since 2003 270/164 (60 mortality)

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Will H5N1 cause the next pandemic?

• Avian Flu not yet Pandemic Flu
• Current outbreaks of H5N1 Avian Flu in poultry
  and birds are the largest ever documented
• Impossible to predict next pandemic flu event
• If not H5N1, then another

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Lessons from Past Pandemics

• Occur unpredictably, not always in winter
• Variations in mortality, severity of illness and
  pattern of illness
• Rapid surge in number of cases over brief period
  of time, often measured in weeks
• Tend to occur in waves
• Each wave lasts about 2-3 months
• Subsequent waves may be more or less severe
• Generally occur 3-12 months after previous wave

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http//www.pbs.org/wgbh/amex/influenza/maps/index.
html
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Estimated Louisiana Pandemic Influenza Impact

• 3 million infected
• 600,000 1.4 million clinically ill
• 300,000 700,000 requiring outpatient care
• 10,000 22,500 hospitalized
• 3,000 6,000 deaths

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Estimated Pandemic InfluenzaImpact in the US

• 200 million persons infected
• 38-89 million clinically ill
• 18-42 million requiring outpatient care
• 314,000 733,000 hospitalized
• 89,000 207,000 deaths

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Pandemic Flu Current Status
Interpandemic
Pandemic
Pandemic alert
Phase 4
Larger clusters, localized Limited spread
among humans
Phase 1
Phase 2
Phase 3
Phase 5
Phase 6
No new virus in humans Animal viruses low risk to
humans
No new virus in humans Animal viruses low risk to
humans
New virus in humans Little/no spread among humans
Small clusters, localized Limited spread among
humans
Increased and sustained spread in general human
population
Current H5N1 status
WHO Global Influenza Preparedness Plan, 2005.
Available at http//www.who.int/csr/resources/pub
lications/influenza/GIP_2005_5Eweb.pdf
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Requirements for Pandemic Flu

• For pandemic flu to occur, three conditions must
  be met
• A new influenza A virus appears or emerges in
  the human population ?
• The new virus causes serious illness in people ?
• The new virus spreads easily from person to
  person worldwide

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Antiviral Medicines

• Used for treatment of ill individuals, and rarely
  prophylaxis of contacts of an ill person.
• Expensive, scarce, have side effects, and
  inappropriate use can cause viral resistance.
• Antivirals from the SNS will be distributed to
  hospitals for patients ill with the PanFlu virus.
  
• The SHO and the Office of Public Health will also
  provide guidelines on appropriate use of
  antivirals that are distributed. Public
  education will be very important given the
  scarcity of this resource.
• Prioritizing within priority groups will be
  necessary given the limited supply. As with
  vaccine, it will be critical to clearly
  communicate with the public about the rational
  for priority groups.

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Vaccines

• Vaccine will likely not be available when the
  novel virus first affects communities.
• Current manufacturing procedures require six to
  eight months before large amounts of vaccine are
  available for distribution.
• Once a vaccine becomes available, it will be
  distributed through the Strategic National
  Stockpile system
• The target population will be the entire
  Louisiana population.
• Demand for vaccine will be greater than the
  supply early in the course of the pandemic.
• Once vaccine is available, it will need to be
  distributed as quickly as possible through Point
  of Dispensing (POD) sites.
• Immunologic responses is poor to unknown. It is
  likely that a second (booster) dose of vaccine
  two to four weeks after the first dose is given
  will be required.
• Like antivirals, early in distribution, vaccines
  will need to be prioritized.

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Pandemic Flu Preparedness and Response Planning

• must move beyond traditional notions of
  continuity of operations, as a pandemic promises
  to test the limits of current contingency plans.
• Pandemic Influenza
• Preparedness,Response, and Recovery
• Guide for Critical Infrastructure and Key
  Resources
• Publication Date 9-19-2006

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How do we plan?

• Understand roles
• Federal, State, Local
• Hospitals and Clinics
• Business and Industry
• Schools and Universities
• Faith-Based and Community organizations
• Individuals/families
• Education
• Collaboration

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Federal Checklists

• Federal planning
• State and local planning
• Individual planning
• Business planning
• Community and faith-based organizations planning

• School planning
• Child Care and Preschool
• School District (K 12)
• Colleges and Universities
• Health Care planning
• Emergency Medical Services and non-emergent
  medical transport
• Medical offices and clinics
• Home Health Care
• Long-Term care
• Hospitals

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Selective recommendations from the Business,
Community and School Planning Checklists
Plan for up to 40 employee absenteeism for
up to 2 months
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Summary

• Influenza pandemics are naturally recurring
  events come in waves
• Experts think the world may be on the brink of
  another pandemic
• All countries will be affected illness will be
  widespread mortality rate will be high
• Healthcare systems will be overwhelmed
• Economic and social disruption will be great
• Risk minimized through preventive steps
• No vaccine initially
• Plan beyond traditional notions of continuity of
  operations
• Everyone needs to be prepared

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When you do not know all the variables, but the
risk is extreme, the lesson becomes Plan for it
all. Pandemic Influenza Preparedness,Respon
se, and Recovery Guide for Critical
Infrastructure and Key Resources Publication
Date 9-19-2006
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References

• State Pandemic Resources
• http//www.dhh.louisiana.gov/offices/?ID295
• Family Readiness Guide
• http//www.dhh.state.la.us/offices/publications/
• Official Pandemic Flu Web Site
• http//www.pandemicflu.gov/
• Pandemic Influenza Preparedness, Response, and
  Recovery Guide for Critical Infrastructure and
  Key Resources
• http//www.pandemicflu.gov/plan/pdf.CIKRpandemicIn
  fluenzaGuide.pdf