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
3. College and University Preparedness

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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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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
Outpatient care 195,000 195,000
Hospitalization 3,500 40,000
ICU care 500 6,000
Mechanical ventilation 250 3,000
Deaths 850 7,500
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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 May 19, 2006

• 217 human cases
• In 58 countries
• 123 deaths
• Mortality rate 57

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Human Infections and Human Deaths by H5N1 by
Month, May 19, 2006  
Source World Health Organization Chart created
by the Office of Public Health Emergency
Preparedness
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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

• Mass Casualty Management
• Vaccines Antivirals
• Detection and Tracking
• Home Care
• Hospital Care
• Food and Other Support
• Transportation of the Critically Ill
• Self 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 will not be available for 3-6 months
  after start of pandemic
• Production will be 3-5 million doses (15 µg)per
  week

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Vaccine Priority Groups

• Vaccine and antiviral manufacturers
• Health care providers
• Persons gt65 with gt1 high risk conditions
• Persons 6 mo to 64 yr with gt2 conditions
• Persons gt6 months with history of hospitalization
  for pneumonia or influenza
• Pregnant women
• Household contacts of immunocompromised persons
  and children lt6 months
• Public health emergency response workers
• Key government leaders

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Vaccine Priority Groups (cont)

• Healthy people gt65
• 6 months to 64 years with 1 high risk condition
• Healthy 6-23 months old
• Other public health emergency workers
• Public safety workers
• Utility workers
• Transportation workers
• Telecommunications workers
• Government health decision-makers
• Funeral directors
• Healthy persons 2-64 years not included above
  (180 million)

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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
• Expected domestic capacity for oseltamivir is
  1.25 million courses per month
• Goal is stockpile of 80 million courses
• Current stockpile is 5 million courses

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Antiviral Priority Groups

1. Patients admitted to hospital (T)
2. Health care workers and EMS providers (T)
3. Immunocompromised persons and pregnant women (T)
4. Pandemic health responders and government
   decision makers (T)
5. Young children 12-23 months old, persons gt65
   years old, and persons with underlying medical
   conditions (T)
6. Outbreak response in nursing homes (PEP)
7. 7 Health care workers in ED, ICU, dialysis
   centers and EMS providers (P)

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Antiviral Priority Groups (cont)

• Pandemic societal responders and health care
  workers without direct patient contact (T)
• Other outpatients (T)
• Highest risk outpatients (P)
• Other health care workers with direct patient
  contact (P)
• Top 7 groups 40 million courses

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Cost of Antiviral Treatment5-Day Course for an
Adult

• Amantadine 9.50
• Rimantadine 16.10
• Oseltamivir (Tamiflu) 72.10
• Zanamivir (Relenza) 61.80

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Personal Stockpiles of Antivirals

• Supply
• Effectiveness
• Resistance
• Equity
• 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
• 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 Communities

• Promotion of community-wide infection control
  measures
• Snow days and self-shielding
• Closure of office buildings, shopping buildings,
  and public transportation
• Widespread community containment (cordon
  sanitaire)

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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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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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Overarching Roles of Major State Agencies
Involved with Pandemic Influenza Response
Planning (cont)

• The Maine CDC is responsible for protecting the
  publics health, including detecting and
  controlling the introduction and spread of
  contagious diseases among Maine people, and with
  developing public health emergency response plans
• The Maine Department of Agriculture is
  responsible for controlling the introduction and
  spread of contagious diseases among livestock and
  poultry, and with developing emergency animal
  disease response plans

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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
• Response System

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Maines Planning Efforts 2006

• 3-part process
• Update Maines Pandemic Influenza Plan
• Development of sub-state Pandemic Influenza plans
• Exercise and drills of the plans

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Overarching Framework

• Early detection
• Response systems
• Communications
• Training

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County Preparedness
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• 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
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• Hospitals and Regional Resource Centers
• 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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http//www.fchn.org/healthreform/documents/fchn5F
pandemicfluplan.pdf
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College and University Preparedness
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College University Preparedness - Maine

• 66,000 enrolled in Maine post-secondary schools
• 82 public and private post-secondary
  institutions
• 1,400 foreign students

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Resources for College and University Pandemic
Influenza Preparedness
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www.maineflu.gov
www.pandemicflu.gov
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http//www.cshema.org/resource/pandemic0306.htmco
llege
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http//www.pandemicflu.gov/plan/collegeschecklist.
html
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Blueprint for Pandemic Flu Preparedness Planning
for Colleges and Universities
Developed with support from Arthur J. Gallagher
Risk Management Services, Inc.
http//www.ajg.com/portal/search/ajgpwrres.asp?Use
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This document has been excerpted and revised with
permission by the World Health Organization from
their document titled, WHO checklist for
influenza pandemic preparedness planning.
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The University Emergency Preparedness Task Force
has an Emergency Response Plan to cover most
emergencies, including pandemics.
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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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