Introduction to Pandemic Influenza Public Health emergencies and international disaster response

Objectives To understand the pattern of infectious disease outbreaks To understand the historical significance and impacts of pandemic influenza outbreaks To learn the WHO protocols and guidelines for combating infectious diseases To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics

World Health Organization Phases of a Pandemic WHO has six phases for a pandemic that are under review following the H1N1 pandemic Each Phase has specific activities recommended to governments Each phase has communication recommendations International Health Regulations of 2005 Novel virus and severity of the virus must be linked in new phase release

How do we identify infected individuals Epidemiology SARS 5 to 7 days 1 to 2 weeks When symptomatic All ill Incubation period about 1 to 4 days 2-3 days for H1N1, 2-8 days for H5N1 Infective for about 5 to 7 days up to 2 weeks in high-risk individuals Infectious up to 24 hours BEFORE symptoms May be asymptomatic (30 - 50%) How do we identify infected individuals Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg

Clinical Features Fever (3 - 7 days) Dry cough Sore throat Weakness Muscle aches Runny nose Loss of appetite Headache Blocked nose Lethargy (2 weeks) Pneumonia

High Risk Populations Schools Military facilities Incarcerated Children have longer viral shedding period Greater opportunities for spread Military facilities Close living quarters Field hygiene Incarcerated Prisons Mental facilities Elderly care facilities

Who is a “close contact”? People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.

Picture: http://www. molecularlab

Droplet Precautions Prevent infection by large droplets from Examples Sneezing Coughing Talking Examples Neisseria meningitidis Pertussis Influenza Avian influenza (probable)

Rapid Response Strong Surveillance systems will provide the opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS Logistical support and trained personnel A Risk Communication Plan and support from the local authorities Plan for 6 weeks of support for 10,000 people

Rapid Containment Cannot Be “Business as Usual” Start containment Country and WHO involved Results from WHO lab “When is it too late to contain?” Specimen to WHO lab Results from national lab Specimen to national lab Initial investigation Detection of Index Cluster Report to local office Start of Index Cluster Onset of first case

Societal Impacts School closures Air transportation and general movement of goods Potential Border Closures (Tourism decline) Economic slow down Health system overload from flu patients Care for normal sick is reduced Supplies and staff become over burdened

Sustaining Essential Services Planning estimates are that 40% of the work forces will be affected Essential services will deteriorate slowly Health services (patient care and Public Health) Water and Sanitation Food and agriculture production Power (fuel and power grids) Communications Banking and finance Transportation Rule of law (police, courts, prisons, and national security

Non-Pharmaceutical Interventions Infection controls Voluntary isolation of sick people Voluntary quarantine of healthy contacts School closures Social distancing Travel restrictions Mask use Hand washing

Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months Enough eggs? Strain selection? Adjuvants? Repeat doses? Expiration?

Potential Strategies to Decrease the Impact of a Pandemic Prevent or delay introduction, slow spread Decrease illness and death Vaccine when available Antiviral treatment and isolation for people with illness Non-pharmaceutical interventions Weeks Impact Prepared Unprepared

Summary Combating a Pandemic; the three keys to success Knowledge of the virus is critical Mutations and movement Laboratory testing capabilities (Field and Lab testing) Vaccines (6-9 months) Development Manufacturing Distribution Non-Pharmaceutical interventions Population compliance or non-compliance