Andrew Pelletier, MD, MPH Maine Department of Health and Human Services June 26, 2006 Pandemic Influenza

Oh my goodness! The sky is falling! I must go and tell the king. Chicken Little

Influenza Seasonal influenza Avian influenza –H5N1 Pandemic influenza

Characteristics of Pandemics Novel virus Severe illness in humans Efficiently transmitted

Recent Pandemics 1918 –500,000 deaths in U.S –70,000 deaths in U.S –34,000 deaths in U.S.

Pandemic Assumptions Attack rate of 25%-35% Duration of a year or more in 2 waves –Each wave lasting 6-8 weeks in community Healthcare system will be severely taxed if not overwhelmed

Pandemic Influenza Projections for Maine Moderate (1957/1968) Severe (1918) Illness380,000 Outpatient care190,000 Hospitalization4,70048,500 Deaths1,1009,000

Social Disruption from Pandemic Influenza Absenteeism in essential sectors Economic impact Psychological stress

H5N1 In Asia since 1997 –Initially in poultry Avian disease now in 50 countries –Asia, Europe and Africa Current focus of pandemic preparedness

Influenza Control Vaccination Antiviral drugs Infection control/community containment

Assumptions for Vaccination Two doses will be required Vaccine will not be available for 3-6 months after start of pandemic Production will be ~4 million doses per week

Assumptions for Antivirals Tamiflu and Relenza will be effective in decreasing morbidity and mortality Expected domestic production for Tamiflu is 1.25 million courses/month Goal is stockpile of 80 million courses –Current stockpile is 26 million courses

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

Summary Unknown when pandemic will occur or how severe it will be Progression of H5N1 is worrisome Current ability to respond to a pandemic is limited Taking basic steps to prepare is important

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