Pandemic Influenza Readiness Update Linda Johnson, MSN, RN, CIC

Pandemic Influenza Viruses Year Subtype 1889H2N? 1899 H3N8 1918H1N1 “swine” 1957H2N2 “Asian” 1968H3N2 “Hong Kong” 1977H1N1 “Russian” ?H5N1 Avian

Influenza Single-stranded, helcally shaped, RNA virus Basic antigen types A, B, and C Subtypes on type A are determined by surfaces antigens hemagglutinin (H) has a role in virus attachment to cells neuraminidase (N), has a role in virus penetration into cells

8 RNA strands Membrane Hemagglutinin Neuraminidase INFLUENZA VIRION

Influenza A Causes moderate to severe illness affects all age groups can infect some animals such as pigs and birds continually undergoing antigenic changes

Influenza Incubation period is 1-5 days (2) abrupt onset of fever sore throat and nonproductive cough, headache, myalgias. Severity of illness depends on prior exposure with clinically related variants case-fatality per 1000 cases

Influenza Transmission is by droplet spread may also be spread by direct contact respiratory secretions shed virus for days viremia does not occur

What are the symptoms of the Flu vs. a common cold? Symptoms of flu Fever (usually high) Headache (prominent) Extreme tiredness Dry cough Sore throat-sometimes Runny or stuffy nose- sometimes Muscle aches-usual and often severe Nausea, vomiting or diarrhea (more common in children ) Symptoms of a cold Fever is rare or low grade Headache rare Extreme tiredness-not usual Cough- mild hacking Sore throat- common Congestion-common Muscle aches-slight Sneezing-usual Nausea and vomiting-rare

Complications of the flu Bacterial pneumonia Dehydration Worsening of chronic medical condition like diabetes or congestive heart failure Sinus or ear infections

H5N1 November, 2005

The Next Flu Pandemic? Exact timing impossible to occur Often do follow major antigenic shifts in flu virus Could be this flu season or several years away Ongoing preparation is key to readiness

Response to Influenza Pandemic Normal routines will be disrupted by a true pandemic. Health care system, campus and entire community affected –Influx of patients with acute health care needs –Elective medical care postponed –Schools likely would close –Daycares likely close Need for information management to prevent panic

UM Health Care Preparations Education Equipment Vaccine Anti-viral medication Bed Capacity Staffing Coordination of response

Education of UMHC Personnel Respiratory hygiene -clinic and front line staff Masks available for persons who come in coughing Tissues, hand sanitizer, and germicidal wipes available in all clinics Hand hygiene!!! Do not allow staff to work sick

Equipment N-95 disposable respirators. –In event of pandemic it is very unlikely to be able to get any additional masks. –Requires fit testing. Ventilators –University Hospital- 74 ventilators – 30 in use on average day –CRH 23 vents mostly infant –Cache of 400 disposable vents

Bed Capacity Convert outpatient areas to inpatient wards (i.e. 7 West) If very high capacity needed, may need to convert non-medical buildings to inpatient care areas Tier 1 funding for bioterrorism - 2 trailers with supplies for 75 bed tent hospital each. Question of heat, water, oxygen, staff

Flu Vaccine Ample supply this year Encourage all staff to receive flu vaccine Unlikely to be effective against avian influenza Experimental avian flu vaccine may be effective If new strain, unlikely to have a vaccine for several months after start of pandemic using traditional vaccine manufacturing methods Work on developing new methods which will allow vaccine to be produced on 4-6 weeks

Treatment Tamiflu may be effective against avian influenza. Drug made in Europe. Production plant being built in USA – Operational 2008?Not yet! Pharmaceutical stockpile- National stockpiles are in place- Missouri has some state and local stockpiles in limited quantities

Staffing Issues Many staff may be ill Staff afraid to come to work May need to temporarily reassign professional staff from non-patient care areas to patient care duties Emergency day care for children of staff All other hospitals struggling with similar issues - no temporary staff available

Coordination of Response Emergency Preparedness coordinator Works with campus and community resources –Prepare for wide variety of possible disaster scenarios –Assist in coordinating response of UMHC to actual disaster

Pandemic Influenza plan UMHC’s plan updated last in Aug 2008 Follows DHSS’s national plan Part of the emergency operations plan Gives prioritization of antivirals and vaccine

Drills Oct 28, 2008 Alternate care site drill