U.S. Pandemic Influenza Preparedness and Response: Planning and Activities “The pandemic influenza clock is ticking. We just don’t know what time it is.” “This is the one health threat we’re preparing for that we know will happen”

H5N1 Avian Influenza Infection in domestic poultry in 9 Asian countries 14 documented human cases and 11 deaths No documented person-to-person transmission Some ongoing circulation of H3N2 influenza Control measures and ongoing activities Culling infected flocks Case investigations Enhanced surveillance Vaccine development

Goals of Pandemic Influenza Response Decrease the burden of disease Minimize social disruption Reduce economic impacts

Pandemic Influenza Preparedness Preparedness & response plan State planning Antiviral supply & use Intl. coord. Infect. control Research Vaccine issues

Time Provide quality medical care Infection control in medical & long term care settings Antiviral treatment & prophylaxis Impact Pandemic influenza disease Pandemic Response Components Vaccination Interventions to decrease transmission Maintain essential community services/emergency response activities

Recent Developments Affecting Pandemic Influenza Planning Increased focus on influenza & other threats Avian influenza outbreaks (1997, 1999, 2003, 2004) Global spread of SARS Improved infrastructures and technologies Improved vaccine development technologies New antiviral medications New communications systems Experience from influenza season Other emergency preparedness activities

The U.S. Pandemic Influenza Preparedness and Response Plan Core Plan Describes National coordination and decision-making Provides an overview of key preparedness issues Outlines response actions at national, state, & local levels Guides (2) Guidance for State/local Health Departments planning Guidance for health care system planning Annexes (10) More detailed and technical information on key preparedness and response issues

Vaccine and Vaccination Preparedness Goals Assure surge production capacity Shorten timelines to availability Ensure effective distribution & administration to achieve pandemic response goals

Improving Vaccine Preparedness Assure year-round egg supply Increase U.S. manufacturing capacity Develop and test vaccine pilot lots for strains with pandemic potential Conduct research to improve ability to rapidly develop reference strains that grow well in production systems

Antiviral Drug Issues Chemoprophylaxis and therapy can have major health impacts Drug availability & manufacturing capacity limited Small oseltamivir stockpile in SNS Key preparedness issues Develop antiviral use strategies and estimate impacts Assess availability and consider stockpile options Work with health departments to develop strategies for effective distribution and use

Interventions to Decrease Disease Spread in an Influenza Pandemic Health care system interventions Infection control and isolation of patients in hospitals Vaccination/antiviral prophylaxis of HCWs and in LCTF Community interventions Travel advisories and precautions Screening travelers from areas with disease Quarantine of exposed persons …based on the epidemiology & transmission of infection

State & Local Preparedness State and local health departments Pandemic/BT/other preparedness planning HRSA grants to coordinate medical care and enhance capacity CDC support for surveillance and public health laboratories Tabletop and field exercises Health care system Need for planning and education

International Coordination: GHSI and APEC Global Health Security Initiative G7 countries & Mexico Foci - vaccine development & supply; antiviral strategies Asia-Pacific Economic Cooperation 19 Pacific rim economies Foci – enhance national planning; surveillance; potential interventions in absence of vaccine/antivirals

Influenza Pandemic Preparedness: Next Steps Finalize national plan Promote and support planning at State/local levels with testing of plans in tabletop and field exercises Address key issues to enhance preparedness improving response capacity Monitor progress and revise plan