1. Summit on Avian Influenza Presented by: NJ Department of Health & Senior Services August 31, 2006

3. Overview FLU FACTS: To understand the difference between the terms seasonal, avian and pandemic influenza, and the impact of a pandemicFLU FACTS: To understand the difference between the terms seasonal, avian and pandemic influenza, and the impact of a pandemic FLU PREP: To identify ways that NJ is preparing for an influenza pandemicFLU PREP: To identify ways that NJ is preparing for an influenza pandemic FLU & YOU: To identify steps people can take to protect themselvesFLU & YOU: To identify steps people can take to protect themselves

4. What is Influenza? Primarily infection of upper respiratory tractPrimarily infection of upper respiratory tract Incubation period: 1-3 daysIncubation period: 1-3 days Infectious period:Infectious period: 24 hours before symptom onset and up to 5 days after symptom onset

5. What causes Influenza? Three types of influenza viruses: A, B & C Type A Type A  Can infect humans and other animals  144 potential strains (H-16; N-9)  Wild birds are the natural reservoir  Most likely to cause epidemics and pandemics (cont.)

6. Types of Influenza Type B Type B  Humans only  No subtypes  Can cause epidemics, not pandemics Type C Type C  Humans and swine  No subtypes  Mild illness; does not cause epidemics

7. Seasonal Influenza in the US Occurs annually – October through April Occurs annually – October through April More than 36,000 deaths More than 36,000 deaths More than 200,000 hospitalizations More than 200,000 hospitalizations Elderly, young children and people with certain health conditions are most vulnerable Elderly, young children and people with certain health conditions are most vulnerable Largely preventable through vaccine Largely preventable through vaccine

8. Prevention & Treatment Prevention Prevention Annual flu vaccinationAnnual flu vaccination Respiratory hygieneRespiratory hygiene Social distancingSocial distancing Treatment Treatment Fluids, fever reducing medication, bed restFluids, fever reducing medication, bed rest Antiviral medication – not a cure!Antiviral medication – not a cure!

9. Why a flu shot each year? Shift (Type A only) Shift (Type A only) Major changes new subtypeMajor changes new subtype Exchange of gene segmentsExchange of gene segments May cause pandemicMay cause pandemic Example: H3N2 replaced H2N2 in 1968Example: H3N2 replaced H2N2 in 1968 Occurs infrequently Occurs infrequently Drift (Types A and B) Drift (Types A and B) Minor change, within subtypeMinor change, within subtype Gradual accumulation of amino acid changes in HA and/or NAGradual accumulation of amino acid changes in HA and/or NA May cause epidemicMay cause epidemic Example: drifted A/H3N2/Fujian circulated A/H3N2/Panama (vaccine strain 2003/4)Example: drifted A/H3N2/Fujian circulated A/H3N2/Panama (vaccine strain 2003/4) Occurs continuously Cox NJ, Subbarao K. Lancet 1999;354:1277-82

10. What about Avian Influenza? AKA: Bird Flu AKA: Bird Flu Type A, H5N1Type A, H5N1 Carried by migratory waterfowlCarried by migratory waterfowl Virus passed to domestic poultryVirus passed to domestic poultry Direct transmissionDirect transmission to humans from poultry to humans from poultry High death rateHigh death rate

11. What is a pandemic? Epidemic = community or regional outbreak of an infectious disease Epidemic = community or regional outbreak of an infectious disease Pandemic = global epidemic Pandemic = global epidemic

12. What causes a Flu Pandemic? New strain of virus New strain of virus Ability to cause serious disease and death in humans Ability to cause serious disease and death in humans Easy person-to-person spread Easy person-to-person spread

13. Pandemic Impact

14. Challenges Health Care Health Care Social Social Personal Personal

15. Health Care Challenges Don’t know which people the virus will affect the most Don’t know which people the virus will affect the most Vaccines will not be available in the early stages of pandemic Vaccines will not be available in the early stages of pandemic Antivirals, if available, may be ineffective Antivirals, if available, may be ineffective Health care workforce will be sick along with everyone else Health care workforce will be sick along with everyone else Health care system will be overwhelmed Health care system will be overwhelmed

16. Societal Challenges Maintaining essential government Maintaining essential government services and business services and business Implementing Implementing social distancing social distancing Distributing limited Distributing limited amounts of medications amounts of medications and vaccines and vaccines Maintaining civil order Maintaining civil order

17. Personal Challenges Protecting self and family Protecting self and family Attending school/work Attending school/work Obtaining goods, services and necessities Obtaining goods, services and necessities Maintaining daily life activities Maintaining daily life activities Obtaining medical care Obtaining medical care Traveling Traveling Obtaining reliable information Obtaining reliable information

18. Worldwide Watch

19. Governmental Preparedness The Centers for Disease Control & Prevention and the US Dept. of Human Services The Centers for Disease Control & Prevention and the US Dept. of Human Services NJ Dept. of Health & Senior Services and the Office of Homeland Security & Preparedness NJ Dept. of Health & Senior Services and the Office of Homeland Security & Preparedness Local and regional health depts. Local and regional health depts. www.njmrc.nj.govwww.njmrc.nj.gov

20. Healthcare System Preparedness Developing preparedness plans Developing preparedness plans Enhancing infection control procedures Enhancing infection control procedures Stockpiling supplies Stockpiling supplies Cross training staff Cross training staff Conducting exercises Conducting exercises

21. Personal Preparedness Keep a supply of food, water and medical supplies Keep a supply of food, water and medical supplies Start now to develop healthy habits Start now to develop healthy habits Respiratory hygieneRespiratory hygiene Hand hygieneHand hygiene Stay home if sickStay home if sick Know where to get reliable health information Know where to get reliable health information Follow instructions provided by governmental public health authorities Follow instructions provided by governmental public health authorities

22. Summary Flu pandemics are unpredictable Flu pandemics are unpredictable We don’t know if the avian H5N1 virus will cause the next flu pandemic We don’t know if the avian H5N1 virus will cause the next flu pandemic Flu pandemics can have serious impact on us, society, businesses and the health care system Flu pandemics can have serious impact on us, society, businesses and the health care system NJ governmental agencies are preparing for a potential flu pandemic NJ governmental agencies are preparing for a potential flu pandemic

23. Resources NJ Dept. of Health & Senior Services NJ Dept. of Health & Senior Services www.nj.gov/health/fluwww.nj.gov/health/fluwww.nj.gov/health/flu Ready Together NJReady Together NJ US Centers for Disease Control US Centers for Disease Control www.cdc.gov/fluwww.cdc.gov/fluwww.cdc.gov/flu www.pandemicflu.govwww.pandemicflu.govwww.pandemicflu.gov Planning Checklists: http://www.pandemicflu.gov/plan/checklists.htmlPlanning Checklists: http://www.pandemicflu.gov/plan/checklists.html

24. Contact Information Contact Information Sylvia H. Bookbinder, MPH, CHES Sylvia H. Bookbinder, MPH, CHES Infectious & Zoonotic Disease Program Infectious & Zoonotic Disease Program New Jersey Department of New Jersey Department of Health & Senior Services Health & Senior Services 609-588-7500 609-588-7500 Sylvia.Bookbinder@doh.state.nj.us Sylvia.Bookbinder@doh.state.nj.us