Low Pathogenic Strains vs. Highly Pathogenic Strains

H5N1 Infection in Cats Study looked at 500 blood samples taken from stray cats taken from poultry markets in Java. Of these cats, 20% had antibodies to H5N1. Unusually high numbers of dead cats have been found near many of the outbreaks. Unlike humans, cats shed virus in high titers and pass it to each other.

Human H5N1 Cases Human Cases: Summary of Current Situation Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: East Asia and the Pacific: Cambodia China Indonesia Thailand Vietnam Europe & Eurasia: Azerbaijan Turkey Near East: Egypt Iraq For additional information about these reports, visit the World Health Organization Web Site. Updated January 2007 World Health Organization Web Site

Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO March 14, 2007 Country Total casesdeathscasesdeathscasesdeathscasesdeathscasesdeathscasesdeaths Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Nigeria Thailand Turkey Viet Nam Total

Responding to the Avian Influenza Pandemic Threat Recommended Strategic Actions World Health Organization 2005

WHO Proposals 1. Reduce opportunities for human infection - education 2. Strengthen the early warning system 3. Contain or delay spread at source - drugs, quarantine 4. Reduce morbidity, mortality and social disruption 5. Conduct research to guide response measures

Problems With Early Warning Systems most outbreaks are occurring in poor countries no funds to pay farmers for culled flocks (10 billion $$ to date) no funds for information systems or labs home slaughter of sick chickens poor or no health care services

New WHO Pandemic Phases Interpandemic Period Phase 1 – No new influenza subtypes in humans, subtype that has caused human infection may be present in animals Phase 2 – As above, but circulating animal subtype poses substantial risk of human disease Pandemic Alert Period Phase 3 – Human infection with new subtype, no human-to-human (HTH) spread Phase 4 – Small clusters with limited HTH transmission, highly localized spread, suggesting the virus is not well adapted to humans Phase 5 – Larger clusters, but HTH spread is still localized, virus is increasingly better adapted to humans, but not yet fully transmissible Pandemic Period – Increased and sustained transmission in general population

Current WHO phase of pandemic alert

Pandemic Vaccine Supply Assumptions Imported vaccine will not be available Two doses will be needed for protection 4-8 months until first vaccine doses are available U.S Manufacturing Capacity Only Sanofi has a completely domestic supply chain Estimated production sufficient to deliver 5 million monovalent doses per week Implication – less than 1% of the population may be protected per week

Health Care and Emergency Response Address hospital surge capacity issues Address roles of triage centers, volunteers, home care Develop hospital employee health guidance Develop infection control guidelines Address mass mortality issues Develop system for tracking hospital resources

CDC PANDEMIC RANKING February 1, 2007 Category 1 Pandemic90,000 additional deaths Isolate the sick at home, reduce visitors Category 3 Pandemic90,000 – 450,000 additional deaths consider closing schools for no more than a month Category 5 Pandemic>900,000 additional deaths Close schools (including universities) for up to 3 months, avoid gatherings and encourage people to work from home

What we all learned from Katrina is that sometimes we have to think very clearly about the unthinkable, because the unthinkable often happens. Michael Leavitt Health and Human Services Secretary

HMC PANDEMIC PLAN

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Were all holding our breaths. H5N1 is the most important threat the world is facing. People who fail to prepare for a flu pandemic are going to be tragically mistaken. Julie Gerberding, Head of the CDC