1. Are We Ready? Influenza Pandemic Summit June 20, 2006 Sponsored by: Nuclear, Biological, Chemical (NBC) Public Health Workgroup Funded by: New York State Department of Health

2. Influenza 101 What do WE need to know? Paula Calkins Lacombe, B.S. M.S. Director of Public Health Clinton County Health Department June 20, 2006

4. Outline   Describe Seasonal Influenza Avian Influenza Pandemic Influenza   Differences between cold and flu   Factors In Emergence of Flu Pandemic   Strategies to Reduce Impact Public Health

5. Flu – What it is and is NOT   The actual term for flu is influenza   It is respiratory infection   It is not a GI illness with vomiting, diarrhea   It is not a cold

6. Flu or Cold

7. Flu Viruses   Three types of flu virus A,B,C ( A & B cause the most serious illness)   Type A Many subtypes that cause most serious disease in humans Can cause human epidemics and pandemics Can sicken many other birds and mammals. chickens, ducks, geese, pigs, and horses

8. Mutation   Viruses routinely mutate Antigenic drift - small changes in the viruses Antigenic shift – occurs when rare, abrupt and major change in a type A virus that results in new subtype not previously found in humans (Novel virus) If this new virus has the ability to spread easily to humans can lead to pandemic

9. How is Flu Spread   Close contact – spread by exposure to large respiratory droplets, direct contact, or near-range exposure to aerosols, within 3 feet.   Little evidence of airborne transmission over long distances or prolonged periods of time (as is seen with M. tuberculosis).

10. Influenza Infection Timeline British Columbia Ministry of Health

11. Types of Influenza/Flu   Seasonal Flu: Contagious respiratory illness caused by influenza viruses occurs every year Seasonal Flu:   Avian Flu: Bird flu is caused by avian influenza viruses; occurs naturally among birds. Avian Flu:   Pandemic Flu: Currently none. A flu pandemic is a global outbreak with a new influenza A virus that causes serious human illness and that spreads easily from person to person. Pandemic Flu:

12. Seasonal Influenza   Seasonal influenza Outbreaks are predictable - seasonal patterns Occur annually- usually in winter People usually build up some immunity from previous exposure Most healthy adults – no serious complications Highest risk of complications – elderly and very young Vaccines are usually available

13. Seasonal Influenza   Average deaths in US per year 36,000   Modest impact on society Influenza A Virus

14. AVIAN INFLUENZA

15. Avian Flu   Why all the concern? Subtype H5N1 is an influenza Type A Before 1997 only found in birds and few other animals Bird influenza viruses can mutate into a form which is easily transmitted human to human. This will represent a dramatic antigenic shift. Humans have no immunity to this virus thus the risk.

16. Avian Flu   Reassortment Avian viruses & human viruses may also “reassort” in another animal and create a new virus   Mixing vessels Humans – with those who survive H5N1 Pigs get avian and human influenza   If virus changes (New/Novel virus) and develops ability to spread human to human an influenza pandemic can begin

18. Country 200420052006Total casesdeathscasesdeathscasesdeathscasesdeaths Azerbaijan00008585 Cambodia00442266 China00851071812 Djibouti00001010 Egypt0000146 6 Indonesia00171132264937 Iraq00002222 Thailand171252002214 Turkey0000124 4 Viet Nam29206119009342 Total463295418152 225128 June 6 – WHO (World Health Organization)

19. Why It is Spreading in Asia   Large, dense population of people, poultry, and animals in close quarters   Lifestyle   Additional mammals involved Housecats in Netherlands Tigers in Thailand Pigs in China

24. Avian Influenza   Avian influenza (Bird Flu) is not the same as pandemic flu   No one knows if this current avian virus (H5N1) will cause the next pandemic IF Bird Flu Arrives in the US…   It does NOT mean that lots of people will get sick   People who have gotten sick from bird flu had a lot of contact with sick birds and touched them with their bare hands   Bird flu is easy for birds to catch, but hard for people to catch

25. Bird Handling Advice   Even in the absence of bird flu, you should not handle wild birds   Many healthy birds can carry germs that can make people sick   Wear gloves if you have to touch a wild bird, and wash your hands afterward

26. PANDEMIC INFLUENZA Could it Happen, and What if it Does?

27. What is a Pandemic Flu?   A global influenza outbreak caused by a brand new (novel) flu virus

28. Facts About a Flu Pandemic   No immunity no previous exposure   Occurs rarely 3x in 20 th century not since 1968   Complications More severe symptoms With more frequent complications Can effect young and healthy people

29. Facts About a Flu Pandemic   Death toll high In US,1918 pandemic 675,000   Health systems Overwhelmed   Vaccine Not available early on, not for 6-8 months   Antivirals Limited supply of effective anitvirals

30. Pandemic Flu   Societal impact Widespread restrictions to travel Closings of schools, businesses Cancellation of large public gatherings   Economy Potential for severe impact on domestic and world economy

31. Assumptions Vaccine Will not be available Takes 6 – 8 months to produce May need two doses Decreased Workforce Plan 25 – 50% unavailable to work Time is our friend

32. Timeline of Human Flu Pandemics Major pandemic The appearance of a new influenza strain in the human population

33. Influenza Pandemics 20 th Century A(H1N1)A(H2N2)A(H3N2) 1918: “Spanish Flu”1957: “Asian Flu”1968: “Hong Kong Flu” 20 - 40 million deaths 675,000 US deaths 1 - 4 million deaths 70,000 US deaths 1 - 4 million deaths 34,000 US deaths Credit: US National Museum of Health and Medicine

35. Deja Flu - Similarities in 1918   Originated in birds   The avian influenza virus we are seeing in Southeast Asia attacks humans similar to 1918; those with healthiest immune system are most susceptible

36. 1918 Influenza Pandemic

37. This May 29, 1919 photograph showed rows of tents that had been set up on a lawn at Emery Hill in Lawrence, Massachusetts where victims of the 1918 influenza pandemic were treated.

38. Deja Flu - Similarities in 1918   1918 numbers extrapolated to today 1.7 million deaths in U. S. 30 – 384 million deaths worldwide   Age projected deaths in U.S. < 5 years233,000 15 – 24 years214,000 25 – 34 years378,000 35 – 44 years268,000 > 65 years426,000 From APIC News -Vol. 24 Issue 2- Preparing for the Next Pandemic by Michaie Osterholm, PHD, MPH, Director, Center for Infectious Disease Research and Policy

39. Flu Pandemic Timeline Past shown several waves of illness Each wave lasts about six to eight weeks Can be separated by 3 - 9 months

40. Factors in Emergence of Flu Pandemic   Microbial adaptation and change   Host susceptibility to infection   Climate and weather   Changing ecosystems

41. Factors in Emergence   Economic development and land use   Human demographics and behavior   Technology and industry   International travel and commerce

42. Factors in Emergence   Poverty and social inequality   War and famine   Lack of political will   Breakdown of public health measures

43. What Can We Do About It? Share Responsibility! Healthcare Delivery System Individual Education, Law Enforcement, Emergency Services Business Government & Workers Local /State / Federal Public Health System Faith Communities

44. Planning Will Make A Difference Weeks Impact Prepared Unprepared

45. Key Public Health Strategies to Reduce Impact   Surveillance Monitor disease activity   CoordinationLocal, state, and federal planning, systems and resources

46. Key Public Health Strategies to Reduce Impact   Utilize Isolation and Quarantine Limit exposure of cases (sick) Limit exposure of contacts to others   Social Distancing Closing schools Reduce crowds and places where people gather Work from home

47. Key Public Health Strategies to Reduce Impact   An informed and responsive public Develop public education and communications to keep the public informed. Essential to minimizing the health effects

48. Key Public Health Strategies to Reduce Impact   Reduce stress on health care system Care for people at home or other facilities Protect limited assets – use effectively Empower people to do so Ethics – Discuss NOW! Hot lines, support services   Keep people healthy Back to basics Respiratory Etiquette and Hand Hygiene

49. Key Public Health Strategies to Reduce Impact   Distribute vaccine rapidly when available Establish PODs – clinics   Use antivirals effectively Protect limited asset

50. Messages to Take Home   Understand the facts about Influenza and a Pandemic   Communicate what you have learned   Integrate the messages and apply them to your setting   Make plans   Communicate, Cooperate, and Collaborate

51. References   References Animal Health Diagnostic Center   Center for Infectious Disease Research and Policy   Michigan State University’s College of Veterinary Medicine   National Center for Food Protection and Defense   Townsends, Inc.   Wildlife Conservation Society   WHO Global Influenza Preparedness Plan   APIC News -Vol. 24 Issue 2 -Preparing for Pandemic Flu: Is Time Running Out   British Columbia Ministry of Health Plans   CDC and NYSDOH   Presentations Speaker 1: Alfonso Torres Executive Director, Animal Health Diagnostic Center; and Associate Dean of Veterinary Public Policy, College of Veterinary Medicine, Cornell University Speaker 2: William Karesh Director, Field Veterinary Program, Wildlife Conservation Society Speaker 3: Spangler "Buzz" Klopp Corporate Veterinarian, Townsends, Inc. Speaker 4: Michael Osterholm Director, Center for Infectious Disease Research and Policy and Associate Director, National Center for Food Protection and Defense, University of Minnesota Speaker 5: Lonnie King Dean, College of Veterinary Medicine, Michigan State University