1. Pandemic Flu and You

2. Topics of Discussion  Seasonal Influenza  Avian Flu  Pandemic Flu  Impact & Planning  Public Health Role  Your Role  Resources

3. Topics of Discussion  Seasonal Influenza (Flu)  Avian Flu  Pandemic Flu  Your Role  Resources

4.  Illness caused by the influenza virus  Extremely contagious and spreads quickly to others.  Symptoms vary from person to person  Occurs every year, usually in the fall and winter killing 36,000 people in U.S. What is Seasonal influenza (flu)?

5. Symptoms of Seasonal Flu  Sudden onset of:  Respiratory symptoms= cough, sore throat, difficulty breathing  Fever, headache, aching muscles, weakness

6. Common Complications of Seasonal Flu  Pneumonia  Primary viral  Secondary bacterial  Mixed viral and bacterial  Exacerbation of existing disease  Chronic pulmonary disease  Cardiac conditions

7. Less Common Complications  Ecephalopathy  Myocarditis  Pericarditis  Myositis  Transverse myelitis  Reye’s syndrome

8. The Flu Virus as a Contagion Incubation Symptomatic (Sick) Recovering Work, etc.Work/Home/HospitalBack to work, etc Day 0Day 11Day 4Day 15 DANGER OF INFECTION Day 2 Infectious (Shedding Virus)

9. Home Treatment of the Flu Home Treatment of the Flu  Bed rest  Hydration-with eight ounces of fluid every hour  Acetaminophen, ibuprofen, naproxen  Avoid aspirin when dealing with children

10. Seeking Medical Treatment for the Flu  Persistent fever  Productive cough  Increasing difficulty breathing  Improvement, followed by relapse

11. Influenza Prevention  Protecting Yourself:  Yearly vaccinations  Wash your hands regularly  Avoid touching eyes, nose and mouth  Avoid close contact with sick people  Protecting Others:  Stay at home when sick  Cover your cough  Everything that we have covered

12. Prevention Here are Some Things You can Do  Yearly vaccinations  Wash your hands regularly  Avoid touching eyes, nose and mouth  Avoid close contact with sick people  Stay at home when sick  Cover your cough Protects Yourself Protects Others

13. Avian (Bird) Influenza  An infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus)  Birds  Wild birds worldwide carry the virus – usually without illness  Domesticated birds - can become ill and die  Humans  Can become infected. Most cases from close contact with infected poultry  There have been a total of 32 isolated local clusters with human-to-human transmission  2007- Total cases of human infection=348 resulting in 216 deaths (50+% case fatality rate)

14. Avian (Bird) Flu  What is it?  An infection occurring naturally among birds (example: HSN1)  Wild birds are natural carriers- Sometimes without illness  Can infect domesticated birds- often resulting in illness, culling, and death.  Humans can become infected. Most cases due to close contact.

15. Will H5N1 become the next pandemic?  Avian Flu not yet Pandemic Flu  current outbreaks of H5N1 Avian Flu in poultry and birds are the largest ever documented  Issue of concern- some cases of H5N1 virus in other kinds of animals, such as pigs and tigers  Some human cases of contraction  Impossible to predict next pandemic flu event If not H5N1,then another Plan now! Practice Prevention NOW!

16. What is a Pandemic Flu?  Epidemic: serious outbreak in a single community, population or region  Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries  Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to

17. What is a Pandemic Flu?  Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries  Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to

18. Putting Pandemic Flu into Perspective  2001 terrorist attack with anthrax  killed five people  2002 outbreak of West Nile Virus  killed 284 people nationally in six months  2003 SARS outbreak  killed over 800 people world wide  froze Asian economies  frightened millions of people into wearing masks on the streets

19. Pandemic Spanish Flu- H1N1- The most devastating flu pandemic in recent History, killing 40 to 80 million world wide Pandemic Asian Flu- H2N2- First identified in China- Caused roughly 70,000 deaths in the U.S. Pandemic Hong Kong Flu- H3N2- First detected in Hong Kong, this virus caused roughly 34,000 deaths in the U.S. Appearance of a new influenza strain in humans- Russian Flu-H1N1 Appearance of a new influenza strain in humans-H5N1 Appearance of a new influenza strain in humans- H9N2 Appearance of a new influenza strain in humans- H7N2- Evidence of infection in one person following a poultry outbreak in Virginia H5N1- caused illness in 47 people in Thailand and Vietnam, 34 of whom died H7N3- is reported for the first time in humans. The strain caused illness in two poultry workers in Canada. H10N7 - is reported for the first time in humans. It caused illness in two infants in Egypt. One child’s father is a poultry merchant. H7N1- 89 people in the Netherlands, most of whom were poultry workers, became infected with eye infections or flu-like symptoms. A veterinarian who visited one of the affected poultry farms died. H9N2- Caused illness in one child in Hong Kong **Seasonal Influenza results in 36,000 deaths in the U.S. every year

20. Three Pandemics  1968-Hong Kong Flu  Caused 34,000 deaths in the United States  1957-Asian Flu  70,000 deaths in the United States  1918-Spanish Flu  Over 600,000 deaths in the United States. Up to 100 million world wide Tent Hospitals-1918

21. More History about Spanish Flu of 1918  8-10% of all young adults may have been killed.  From September 1918-December 1918-Killed more people than the Black Death in the Middle Ages killed in 100 years  Killed more people in 24 weeks than AIDS has killed in 24 years

22. Compare 2008 to 1918  2008  Modern travel  Many areas more densely populated  Population exceeds 6 billion  1918  World War I (civilian and military overcrowding)  Public information withheld  Population approximately 1.8 billion

23. Lessons from Past Pandemics  Occurs unpredictably, not always in winter  Variations in:  Case fatality rates (number of people diagnosed with a disease that die from that disease)  Severity of illness  Pattern of illness (ages most severely affected)  Rapid surge in number of cases over brief period of time  Tend to occur in waves- May only be one wave

24. Becoming a Pandemic Becoming a Pandemic  For pandemic influenza to occur, three conditions must be met: A new virus which humans are not immune emerges A new virus which humans are not immune emerges The virus causes severe human illness or death in humans The virus causes severe human illness or death in humans  The virus spreads easily from person to person worldwide  H5N1 has two of the three today. H5N1 Virus

25. Possibility versus Probability  World Health Organization assures us that there will be another influenza pandemic.  Unknown when it will occur/how severe the next pandemic will be  Unknown what the organism will be World Health Organization

26. Interpandemic Larger clusters, localized Limited spread among humans Pandemic Current Status WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf Pandemic alert Phase 1Phase 2Phase 3 Phase 4 Phase 5Phase 6 New virus in humans Little/no spread among humans Small clusters, localized Limited spread among humans Increased and sustained spread in general human population No new virus in humans Animal viruses low risk to humans No new virus in humans Animal viruses low risk to humans Current H5N1 status

27. Antigenic Drift vs. Shift  Antigenic drift: small changes in the virus that happen continually over time.  New virus strains are produced and our immune system has greater difficulty recognizing them  Antigenic shift: radical changes in the influenza A viruses-happens only occasionally  our immune system can’t recognize them at all Happens Every Year Current issue of Concern

28. Would there be a vaccine?  Because the virus will be new, there will be no vaccine ready to protect against pandemic flu  A specific vaccine cannot be made until the virus has been identified  Seasonal flu vaccine or past flu immunization will not provide protection

29. Medications During Pandemic Flu  Antiviral Medications  can prevent complications if taken within first 48 hours of illness  may not be effective against a pandemic flu virus  extremely limited supply now  would be prioritized  initial use probably only for treatment, not prophylaxis Antiviral Medications Amatadine (Symmetrel) Rimantadine (Flumadine) Zanamivir (Relenza) Oseltamivir (Tamiflu)

30. Anitiviral and Vaccine Conclusions  Antiviral medications will be limited during a pandemic  Efficacy is unproven, but expected to help individuals  Vaccines should work well, but require time for production  Treatment and prophylaxis guidelines will evolve as situation develops

31. Pandemic Influenza Impacts  Estimated Impact in Louisiana  3 Million infected  Between 600,000-1.4 million clinically ill  Between 300K-700K requiring outpatient care  Between 10,000 – 22,500 hospitalized  Between 3,000 – 6,000 deaths

32. Health Care, Business, Communities, Government, Schools  Significant disruption of infrastructure  Transportation  Schools  Businesses  Medical care  Utilities  Police and fire protection  Communications  Limited to no assistance from State and Federal Governments due to nation-wide impact

33. Infection Control - Our Basic Protection  Hand Hygiene  Wash hands regularly with soap & water  If no water available: 60%-95% alcohol-based sanitizer  Cover your cough strategy  Environmental cleaning  1:10 bleach solution  EPA registered disinfectant  Gloves & surgical masks

34. Personal/Family Planning  Stockpiling up to 30 days of water, food, supplies, medicines  Social distancing  Practice all the same behaviors to prevent seasonal flu  Stay at Home Toolkits.

35. Community Goals in Pandemic Flu  Limit death and illness  Moving beyond a dependence on state and national support  Preserve continuity of essential government and business functions  Minimize social disruption  Minimize economic losses

36. Public Health Role in Pandemic  Facilitate planning  Disease tracking & control  Communication about public health issues  Coordinate mass antiviral medication and vaccination clinics  Issue isolation and quarantine orders

37. Please Remember Even though local, state and federal agencies have plans to protect the public, you are responsible for your own safety, even in an emergency!

38. What Can You Do Now? BE: Safe-Prepared-Healthy-Aware-A Volunteer www.oph.dhh.louisiana.gov

39. What Can You Do Now?  P repare your community – become involved in disaster training & volunteerism.  R emember to get enough sleep.  E xercise regularly.  P revent the spread of infection – wash hands regularly, cough/sneeze into tissue, keep your hands away from your nose/mouth.  P ut out cigarettes.  A nnual flu shots.  N utritious eating.  F amily plan and kit.  L ook for information about pandemic flu.  U tensils, food and beverages should not be shared.

40. Stay Informed. Be Prepared.  Family Readiness Guide  http://www.dhh.louisiana.gov/offices/publications/pubs -1/Family%20Readiness%20Guide.pdf http://www.dhh.louisiana.gov/offices/publications/pubs -1/Family%20Readiness%20Guide.pdf http://www.dhh.louisiana.gov/offices/publications/pubs -1/Family%20Readiness%20Guide.pdf  Official Pandemic Flu Web Site  http://www.pandemicflu.gov/ http://www.pandemicflu.gov/  Centers for Disease Control and Prevention  http://www.cdc.gov/flu/pandemicflu /

41. Contact Information