1. Pandemic Flu Know the Facts

2. Pandemic Flu Committee Peggy Powell Tony Pescatore Janet Kurzynske Andrea Husband Peggy Riley Kim Henken Ricky Yeargan Deborah Murray

3. Various Types of Flu Seasonal Flu Pandemic Flu Avian Flu

4. Flu Pandemics of the Past Spanish Flu Asian Flu Hong Kong Flu

5. Spanish Flu Pandemic Began September 1918 & Ended April 1919 About 675,000 people died in the United States Rapidly spread and killed those infected

6. Asian Flu Pandemic Began in February 1957 and ended in early 1958 Was quickly identified and vaccine was created About 70,000 people died in the United States

7. Hong Kong Flu Pandemic Began in September 1968 and ended in March 1969 Virus was similar to Asian flu Approximately 34,000 people died in the United States

8. Avian Flu Currently no human cases in the United States Currently excellent screening system for migratory birds Excellent commercial poultry protection No evidence of humans effected by properly cooked poultry Currently no effective vaccine Work is proceeding on vaccine for poultry and humans

9. Avian Flu Health Estimates Should Avian Flu occur as a serious case in the US it is estimated that 90 million people would be effected with 2 million deaths Short term impacts are projected to be 30% of workers sick in most industries with 2.5% expected to die. Average survivors miss 3 weeks of work.

10. Avian Health con’t. In a severe case, it is projected there would be 700,000 hospitalizations, 18-42 million out patient visits Source: Center for Disease Control and Prevention.

11. Projected Avian Flu Economic Impact Severe case applying average worker productivity rates loss to the economy would be $600 billion or 5% of the GNP Huge adverse impact on size of future labor pool Conclusion- Money spent preventing a pandemic will be well spent. Source: Congressional Budge Office

12. Pandemic Flu Website

13. Pandemic Flu Information Home Understanding Flu Preparing for a Pandemic During an Outbreak Materials for County Extension Agents

15. Avian Influenza in the US is NOT the same Virus as “Bird” Flu in Asia

16. Avian Influenza Nomenclature Birds: Influenza A type virus Influenza A is divided into Subtypes based on their surface proteins: Hemagglutin (HA): 15 subtypes Neuraminidase (NA): 9 subtypes H5N1

19. Influenzavirus A Poultry FAD 2005

20. Influenza Virus (Flu) Mammals and birds always have flu viruses circulating in their respective populations Horses, Hogs, Humans, and Birds are just a few of the species that are susceptible to flu viruses Flu viruses generally stay within species There are some exceptions like Swine flu, which resides in hogs but can infect turkeys Flu viruses are always changing, that’s why the human vaccine changes yearly

21. Avian Influenza (AI) North America has always had Avian Influenza strains circulating in waterfowl, wild birds, and live bird markets “Asian Bird Flu”(H5N1) is one of many strains of Avian Influenza Poultry companies are concerned about all avian influenza strains, not just “Asian Bird Flu”

22. Some Perspective on Asian Bird Flu (H5N1) Less than 160 people have died from “Asian Bird Flu” and 265 are known to have gotten sick out of 3.7 Billion people in Asia. Since 2006 48% of the cases and 58% of the deaths have been in Indonesia. It is not contagious between people People afflicted with this disease had very close contact with sick birds (live with them, butchered and ate products from sick birds.) It has been known to be in Asia since 1997 but recently has moved into Africa and Europe

23. Asian Bird Flu (H5N1) infects birds easily but does not infect people easily

24. Factors in Asia that have facilitated H5N1 Infection Eastern Asia has the most poultry and people living in very close proximity Unsanitary conditions Live Bird (Wet) Markets are a primary source for poultry in cities Sick animals are likely to be eaten by impoverished people Consumption of uncooked meat or poultry products (such as raw blood) Cockfighting (highly mobile)

25. Asian Bird Flu(H5N1) This is not a subtle disease in birds It kills birds very quickly and in large numbers (90% plus) With few exceptions, cases have been in live markets, free roaming birds or birds kept in primitive conditions

26. What do you need to know about “Asian Bird Flu”? This disease will not sneak up on the U.S. U.S. commercial poultry are at a lower risk of getting “Asian Bird Flu” than free roaming birds Wild birds, free range poultry, backyard birds, Live bird markets, and gamecocks are at the highest risk of all Avian Flu U.S. Poultry companies understand that this is “not just another AI virus” and are taking precautions

27. How are Poultry Companies responding to the threat? All of the major poultry companies are testing all flocks prior to processing to ensure that poultry products are AI free In the unlikely event of a H5N1 infection in commercial poultry, the flock would not be processed for food. (euthanized on farm) Consumer Education Message: U.S. poultry products will be safe even if Asian Bird flu comes to U.S. (websites, brochures, articles)

28. What is being done in US Voluntary (mandatory) surveillance program. Must test for exports. Mandatory surveillance of live bird markets in NY, NJ and east coast Increase awareness among poultry health officials and state officials USDA increase information to small flocks producers Import ban on poultry from Asia

29. What is being done in Kentucky? Commercial Surveillance Program Poultry Health Advisory Board Emergency Disease Plan Catastrophic Loss Training Creation of an indemnity fund for small flocks ($ 204,000) by commercial industry ($102,000) and Ag Development Fund Match ($102,000)

30. How Poultry Companies are structured to prevent disease Chickens are raised indoors to protect from disease-carrying wild birds A company representative visits the farm weekly to evaluate flock health Producers alert the company immediately to changes in flock health status Biosecurity: Procedures that keep disease away from the flock

31. Poultry Biosecurity Poultry Biosecurity Unauthorized visitors are not permitted on farm Clean coveralls, hairnets, and disposable boots are used when visiting farms Step pans disinfect footwear prior to entering Water systems sanitized (especially lake systems) Producers avoid contact with waterfowl, gamecocks, poultry swap meets, etc.

32. Why aren’t we vaccinating our chickens for Asian Bird Flu? Historically, vaccinating for AI meant that a country was not serious about eradication US Poultry relies heavily on exports: Breast meat stays in domestic markets, Leg quarters go overseas U.S. companies believe that trade barriers would be imposed if U.S. vaccinated for AI Overseas opposition to vaccination may vanish as more countries vaccinate for “Asian Bird Flu”

40. FLUSTOP Flock Observation Observe Flocks Daily Changes in appearance, behavior, drinking and eating behavior Disease symptoms eat less, respiratory signs, lack of coordination, increase death loss Dispose of dead birds properly

41. FLUSTOP Limit Traffic Allow only necessary people and vehicles to enter the farm Post warning signs Log book for visitors Be aware of areas with birds (hunting, farm ponds, pet stores, zoos, parks) Minimum level of security is clean boots

42. FLUSTOP Unwanted Critters Prevent contact with wild birds Clean up grain and feed to control wild birds and rodents Isolate or cull sick birds A chicken is the only animal that should be in a chicken house (keep dogs and cats out) Isolate new or returning poultry from resident birds for at least 30 days

43. FLUSTOP Sanitation Keep pens and buildings neat and clean Prevent wet and damp bedding and eliminate standing water in pens Clean and disinfect all equipment and crates before returning to the farm Establish a wash area away from the poultry buildings Provide clean boots and clothes for workers

44. FLUSTOP Talk to a vet Early detection and reporting are important steps in preventing a disease outbreak If you notice unusual symptoms or increase death contact local vet or the office of the State Veterinarian To report sick wild birds (more than 5 or waterfowl) contact US Fish and Wildlife or the KY Department of Fish and Wildlife

45. FLUSTOP Objects spread disease Diseases spread through direct contact with infected birds Diseases also can be spread by manure, equipment, vehicles, egg flats, eggshells, crates, and boots Avoid visiting other poultry farms Do not share equipment but if you must, wash and disinfect any shared equipment before it is returned to the farm Do not reuse egg cartons, egg flats or packing materials

46. FLUSTOP Prepare food properly Do not eat, drink or use tobacco products when handling poultry Wash hands and surfaces with hot soapy water before and after handling raw poultry or eggs Keep raw poultry and their juices away from other foods Cook poultry to 165 o F

47. Hunter and Taxidermists Limit exposure to feces and bodily fluids from game animals Do not handle or process birds found sick or dead Wear rubber or latex gloves and washable clothing while handling game Dispose of internal organs, feathers, bones skin, and trimmings in a safe manner Do not eat, drink, or use tobacco products while handling game Wash hands with soapy water or alcohol wipes immediately after handling game

48. Hunter and Taxidermists Clean all tools and work surfaces with hot soapy water then disinfect with 10% chlorine bleach or other disinfection Thoroughly cook meat is safe to eat (165 o F) Use caution around water sources and roosting areas were feces from wild birds may accumulate When finished hunting, clean clothing, boots, vehicles as soon as possible Do not bring game birds onto poultry farms

49. http://wildlifedisease.nbii.gov/ai/LPAI-Table.jsp Kentucky 429 Wild bird samples 197 Environmental Samples 626 Total Samples

51. Pandemic Family and Youth Materials

52. Vulnerable Population Groups Death rate for 1918 flu = 2%; death rate for Avian Flu H5N1 = 60% US estimate 2 million deaths Spanish Flu 1918-1919 killed mostly young adults – 675,000 US deaths Asian Flu 1957-1958 school age, young adults, pregnant women most often infected - 70,000 US deaths Hong Kong 1968-1969 highest death rate in 65 and over – 34,000 US deaths

53. Typical At-Risk Populations The very young – Lack of reserves (fluid, fat etc.) The very old – Lack of reserves (fluid, fat, etc.) – More likely to have other health issues making complications (such as pneumonia) more likely

54. Typical At-Risk Populations cont. Pregnant women Health compromised individuals – Lack of reserves – Complications more likely

55. What Happened in 1918? No one had immunity Each individual needed to develop antibodies so that the individual can fight off the virus. Healthy young adults went into immunological overload. Caused unexpected high death rate in young adults.

56. Would Having a Weak Immune Lower the Death Rate in the 1918 Pandemic? There is no evidence that having a weak immune system before the pandemic would have reduced the possibility of having gone into an immune system overload. Having a weak immune system will make an individual more susceptible to the typical complications of a pandemic or flu.

57. Most Vulnerable Population for the Future Pandemic Avian Flu H5N1 presently does not discriminate No way to predict but it might not be the very old and the very young. Everyone should be prepared

58. College of Agriculture Pandemic Website http://www.ca.uky.edu/fcs/pandemicflu/index.h tml

62. Build Your Immune System with Good Nutrition, cont. Describes function of immune system  Stop the disease from entering the body  Kills bacteria or viruses once they enter to body but before they make you sick  Destroys viruses and/or bacteria after they have created disease

63. Good Nutrition cont. What will good nutrition do for you?  Help you develop the best possible immune system  Increase the ability of your body to know a virus has entered it, lowering your chances of getting sick  Increase the ability of your body to attack the virus, helping you fight the pandemic once you get it  Provides reserves that can be used when you are too ill to eat When is it best to start?

64. What is best to eat? Variety 5 fruits and vegetables every day  consume fruits and vegetable of great color – blueberries, cherries, blackberries, broccoli, Brussels sprouts, red bell peppers, etc. 3 servings of low fat dairy each day 6 servings of whole grain breads and cereals to your meals each day 2 servings of protein each day

66. Food for Emergencies – Pandemic Flu Why do we need to store food?  Basic services may be effected  You may not be able to get to the store – illness, quarantine  Why do we need to store food? How much food should you store?  Minimum one week supply of food that does not need to be kept cold, prepared or heated  Look at what you normally eat  Don’t forget the refrigerator  Be creative in storage  Consume less food, but not fluid

68. Check Lists Faith-Based and Community Organizations Pandemic Flu Checklist Faith-Based and Community Organizations Pandemic Flu Checklist Family Emergency Health Information Sheet - Pandemic Flu Family Emergency Health Information Sheet - Pandemic Flu Checklist for Schools - Pandemic Flu Checklist for Preschool and Child Care Facilities - Pandemic Flu Checklist for Preschool and Child Care Facilities - Pandemic Flu

74. Home Nursing Care – Pandemic Flu Taking care of the caregiver  One dedicated caregiver  Sleep, nutrition, exercise, hand washing Taking care of the sick  Fluids, keep them comfortable  Know when needs to get additional medical care What the patient can do  Face mask, wash hands, stay home in small location of house, isolate body fluid General information  Isolate person and body fluids  Family Emergency Health Information  Maintain pandemic medicine kit

75. Pandemic Medicine Kit Fever reducer Anti-nausea and anti-diarrhea medicine Cough, cold, flu medicines Vitamins Prescribed medicine Emergency medicine such as glucose tablets for diabetics Blood pressure monitoring equipment Thermometers Face masks Hand sanitizer Alcohol

81. Pandemic Ready for Businesses http://eden.lsu.edu/LearningOps/Pandemic/

82. Guidance on Preparing Workplaces for an Influenza Pandemic http://www.osha.gov/Publications/influenza_pandemic.html

83. How would taking precautions help?

84. How might a Pandemic Affect my Community? Absenteeism - A pandemic could affect as many as 40 percent of the workforce during periods of peak influenza illness. Employees could be absent because they are sick, must care for sick family members or for children if schools or day care centers are closed, are afraid to come to work, or the employer might not be notified that the employee has died.

85. Change in patterns of commerce - During a pandemic, consumer demand for items related to infection control is likely to increase dramatically, while consumer interest in other goods may decline. Consumers may also change the ways in which they shop as a result of the pandemic. Consumers may try to shop at off-peak hours to reduce contact with other people, show increased interest in home delivery services, or prefer other options, such as drive-through service, to reduce person-to-person contact. How might a Pandemic Affect my Community?

86. Interrupted supply/delivery - Shipments of items from those geographic areas severely affected by the pandemic may be delayed or cancelled. How might a Pandemic Affect my Community?

87. What would your office do?

88. Ask a Pandemic Flu Question Click on question on UK Pandemic website Type in your question Question will go to a person in a centralized dissemination position

89. Links to Other Sites Extension Disaster Education Network PandemicFlu.gov Kentucky Cabinet for Health & Family Services HEEL University of Kentucky Avian Flu Resources

90. Additional Resources Needed

91. QUESTIONS ? Educational programs of the Kentucky Cooperative Extension Service serve all people regardless of race, color, age, sex, religion, disability or national origin. Disabilities accommodated with prior notification.