Explaining pandemic flu

Understanding pandemic  Epidemic: serious outbreak in a single community, population or region  Pandemic: epidemic spreading around the world affecting hundreds of thousands of people, across many countries

What is a flu pandemic?  Flu pandemics are global epidemics of a newly emerged strain of flu (a new influenza A subtype)  Three pandemics in the last century  Worst killed million worldwide – more lives lost than during the First World War

What causes pandemic flu?  Emergence of a new flu virus  New virus passes easily from person to person  Few, if any, people have any immunity  This allows it to spread widely, easily and to cause more serious illness

Pandemic flu effect on the UK  Impossible to predict when it will begin  Difficult to predict impact with any accuracy  Estimates of scale of illness, death rates and those most likely to have severe illness are uncertain  Will also depend on the availability and effectiveness of antiviral drugs and vaccines

Who is at risk?  Everyone is at risk  Certain groups may be at greater risk of serious illness than others  Until the virus starts circulating we will not know for sure who is at most risk

Is there a vaccine?  Because the virus will be new, there will be no vaccine ready to protect against pandemic flu  A specific vaccine cannot be made until the virus has been identified  Cannot be predicted in same way as ‘ordinary’ seasonal flu  ‘Ordinary’ flu vaccine or past flu jab will not provide protection

 An acute illness resulting from infection by an influenza virus  Highly infectious  Can spread rapidly from person to person  Some strains cause more severe illness than others What is influenza?

Symptoms  Generally of sudden onset  Fever, headache, aching muscles, severe weakness  Respiratory symptoms e.g. cough, sore throat, difficulty breathing

Incubation period of influenza  Estimates vary  The range described is from 1 to 4 days  Most incubation periods are in the range of 2-3 days

How influenza spreads  Easily passed from person to person through coughing and sneezing  Transmitted through –breathing in droplets containing the virus, produced when infected person talks, coughs or sneezes –touching an infected person or surface contaminated with the virus and then touching your own or someone else’s face

Lessons from past pandemics  Occurs unpredictably, not always in winter  Great variations in mortality, severity of illness and pattern of illness or age most severely affected  Rapid surge in number of cases over brief period of time, often measured in weeks  Tend to occur in waves - subsequent waves may be more or less severe, can last for years Key lesson – unpredictability

Impact on business  25% of the UK workforce will take 5-8 working days off over a three-month period  Estimates suggest that during the peak absenteeism will double in the private sector and increase by two-thirds in the public sector

Impact on schools and services  Likely to spread rapidly in schools and other closed communities  Impact on all services including police, fire, the military, fuel supply, food production, distribution and transport, prisons, education and business

Pandemic waves (1) Past experience teaches us that following the emergence of a new pandemic virus:  more than one wave of influenza is likely  the gaps between the waves may be weeks or months  a subsequent wave could be worse than the first

Pandemic waves (2)  The 1918/19 A/H1N1 pandemic occurred in three distinct waves: early spring 1918, autumn 1918 and winter 1919  The second wave was the largest and had the highest case fatality

Pandemic waves (3)  In 1957/58 the second wave was very small in comparison to the first  In contrast, the 1968/69 A/H3N2 pandemic, the second wave in 1969/70 was more severe than the epidemic wave in the winter of 1968/69

Where we are now?  Phase 5: Larger clusters) but human-to- human spread still localised, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk)

Five UK alert levels Alert level 0No cases anywhere in the world 1Cases only outside the UK 2 New virus isolated in the UK 3 Out break(s) in the UK 4 Widespread activity across the UK

SUMMARY  Pandemic flu is different from ‘ordinary’ seasonal flu – more people will become ill, some will die  Specific vaccine cannot be prepared ahead of the pandemic; actions are taking place to speed vaccine production as soon as the pandemic virus is identified  Global surveillance is essential; international co-operation is well established

SUMMARY cont  Antiviral drugs are being stockpiled; when a pandemic arrives they may help slow its progress and reduce severity of illness  Social measures (for example basic hygiene or limiting some population movement) may help slow a pandemic  Advance planning by Government, the NHS, essential services and local communities will help to reduce the impact

Employees of Stewart & Holmes Wholesale Drug Co. Seattle, 1918 Courtesy of Grace Loudon Mc Adam

OH Plan  Comes in from UK level 3  OH Non essential service – routine attendances cancelled  From level 4 – no attendance at OH  Nursing staff may be re-deployed by Government  Essential staff can home work  Admin staff may be redeployed

OH Needs – level 3  Fridge for vaccines & security if vaccines stored at OH  Access to laptops & remote broadband at home for clinical staff  Access to driver/security & fuel if vaccines become available (OH Team to go out to give)  Funding for overtime  Senior OHA to be available for meetings etc

OH Needs cont level 4 +  Gloves, masks & disposable ‘scrubs’ to be available at sites  Thermometers & advice sheets to be available at all sites  Extensive medical kit to be purchased for emergency use if hospitals over run  Extra funding & resources for ‘catch up’ when pandemic over.

More information  NHS Direct  