1. PANDEMIC FLU
AVIAN FLU
FACTS & FICTION

2. Flu Terms Defined
Seasonal (or common) flu is a viral respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. Linked to about 36,000 deaths/year in the US.
Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available.
Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu. Health officials believe there is a high probability of one occurring in the near future.

3. Flu or Cold

4. How the Flu Spreads

5. Avian Influenza
The H5N1 strain of avian influenza (Bird Flu) is present in birds in Asia, Africa and Europe
Bird flu is not the same as pandemic flu
Pandemic flu would spread easily from one person to another and make people sick all over the world
Bird flu does not do that right now
People who have gotten sick from bird flu had a lot of contact with sick birds
Bird flu is not easy to get
The next type of influenza which you most certainly have heard or read about is the avian flu or bird flu that is occurring outside the United States
Avian flu is bird flu. There are all kinds of bird flu… H5N1 is just one of the many types of bird flu
Go over slide

6. H5N1 Transmission to Humans
Infected birds shed virus in their saliva, nasal secretions, and feces
Fecal - oral transmission
Virus from bird droppings can remain in the environment for several weeks
People who have gotten sick from bird flu had close contact with sick birds and touched them with their bare hands

7. Here we see a woman sleeping with her bird and this shows the cultural differences that reflect the closeness of birds and humans in other cultures

8. Why all the concern?
“Bird flu” (H5N1 avian influenza) may change into a form which is easily transmitted human to human thus leading to a pandemic.
Avian flu may mutate (change) into a form which is easily transmitted human to human leading to a pandemic
Scientists are concerned that “bird flu” (H5N1 avian influenza) could change, causing pandemic influenza.
Statistically we are overdue for a pandemic

9. Types of Flu Viruses
Influenza “A” viruses affect birds and humans/mammals
Can cause more severe illness
H3N2 virus has been most common in past few decades
Letters “H” and “N” refer to molecules on the surface of the virus

10. Avian Flu Concerns about this virus:
Subtype H5N1 is an influenza Type A
(same type as other pandemic flu viruses)
Before 1997 only found in birds and few other animals (more genetic mixing to other species)
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. This is a characteristic of a pandemic flu virus.
Monitoring of birds in the US on-going.
Migratory birds and live bird markets

11. IF / WHEN Bird Flu Arrives in the US…
It does NOT mean that lots of people will get sick
Bird flu is easy for birds to catch, but hard for people to catch
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
Pathogenicity- “Lo-path” vs “hi-path”
use common sense
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

12. WHO Pandemic Phases WHO = World Health Organization
Interpandemic period
Phase 1: No new influenza virus subtypes in human; 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 w/ new subtype, no human-to-human (HTH) spread, or rare spread to close contact
Phase 4: Small clusters w/ limited HTH transmission, highly localized spread, suggesting virus not well adapted to human
Phase 5: Larger clusters, but HTH spread still localized, virus increasingly better adapted to humans, but not yet fully transmissible
Pandemic period
Increased and sustained transmission in general population
WHO = World Health Organization

13. Acchhooo!
Very funny Dave!

14. Influenza Pandemics 20th Century
Credit: US National Museum of Health and Medicine
1918: “Spanish Flu”
1957: “Asian Flu”
1968:
“Hong Kong Flu”
There have been many pandemics throughout history..we have documented records of the last 3 that occurred in the 20th
The most severe was the 1918 Spanish flu with million deaths world wide.
The most severe influenza pandemic occurred in
The reason this particular strain was so severe remains unclear.
The case fatality for people under 65 was over 550/100,000 in the United States (compared with less than 0.5/100,000 during typical seasonal flu epidemics).
Recent research indicates that the 1918 strain was a direct adaptation of an avian to human strain.
A(H1N1)
A(H2N2)
A(H3N2)
20-40 m deaths
675,000 US deaths
1-4 m deaths
70,000 US deaths
1-4 m deaths
34,000 US deaths

15. 1918 Pandemic Flu “Spanish Flu”
In Schenectady (city)
500 deaths (estimated)
15,000 sick
Societal impact:
Widespread restrictions to travel
Closings of schools & businesses
Cancellation of large public gatherings
Spread of Pandemic flu- 1918
1918-About 5 weeks from East to West Coast
With current travel- estimate 5 days
Yes the pandemic has hit locally. Here in Schenectady go over slide
Estimates for Schenectady City:
in 1918 – approximately 500 deaths & 15,000 sick associated with the Spanish flu. .
however it may have been much higher record keeping is different today .

16. 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
1918 numbers extrapolated to today
1.7 million deaths in U. S.
30 – 384 million deaths worldwide
Age projected deaths in U.S.
< 5 years 233,000
15 – 24 years 214,000
25 – 34 years 378,000
35 – 44 years 268,000
> 65 years 426,000
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

17. Pandemic Flu Societal impact Economy Pandemic Flu a Probability
Widespread restrictions to travel
Closings of schools, businesses
Cancellation of large public gatherings
Economy
Potential for severe impact on domestic and world economy
Possible 30-40% workforce out
Impact of $71.3 -$166.5 billion
(CDC Fast Facts )
Pandemic Flu a Probability
Last big one 1918-> statistically overdue for another
Need for preparedness
Planning could reduce impact

18. Impact of Pandemic Flu in NYS (estimated)
If a severe (1918-like) pandemic were to hit, NYS (including NYC) can most likely expect:
6.75 million people to be ill ( 35% of the population)
771,000 hospital admissions (NYS has 40,000 beds now)
15% would require intensive care
7.5% will need ventilators
153,000 deaths
In the peak weeks of the pandemic, health care resources would be stretched beyond capacity.
Influenza patients will most likely utilize:
63% of hospital bed capacity
125% of intensive care capacity
65% of hospital ventilator capacity
(These estimates
were given by NYS DOH)

19. Facts About a Flu Pandemic
Death toll high pandemic flu ,000 US deaths at ALL ages, not just young and old
Essential services Difficult to maintain: COOP
Health systems Overwhelmed
Vaccine Not available early on - not for 6-8 months
Antivirals Limited supply of effective anitvirals

20. Flu Pandemic Timeline Past has shown several waves of illness
Each wave lasts about six to eight weeks
Can be separated by months
Could last for 1-2 years

21. Pandemic Influenza Doctrine: Saving Lives
Objective is to slow spread, decrease illness and death, buy time
Antiviral treatment and isolation for people with illness
Quarantine for exposed
“Social distancing”
Vaccine when available
Local decisions
Weeks
Impact
Prepared
Unprepared

22. Key Public Health Strategies to Reduce Impact
Distribute vaccine as supplies are available
Establish PODs – clinics
Prioritized distribution
Use antivirals effectively
Protect limited asset
Need to be given within 48 hours of onset of symptoms
Effectiveness unknown for new flu strain
Federal CDC guidance
To establish standards for public health actions, consistency

23. Info to Communicate Before Pandemic
Flu facts-
avian vs. seasonal vs. pandemic
Flu vs. cold, other illnesses
Handwashing- 20 seconds
Cough etiquette
disposable tissues
cough into elbow
Social distancing
3 feet rule
no “close talking!”
Flu shots
Emergency supplies- 2 weeks of self-reliance
Water, Food, Medicines
Personal
Protective
Behaviors

24. Individual Infection Control Strategies
Respiratory hygiene/cough etiquette and hand hygiene are effective strategies to stop the spread of germs.
We should make good hygiene a habit.
Our health is in your hands!
NOTE: We all need take preparation into “our own hands.”

25. What can you do right now?
Understand and begin practicing Personal Protective Behavior now
Cover your mouth & nose with a tissue when coughing and sneezing. Throw out tissue in waste basket and wash your hands.
If you don’t have a tissue, don’t cough or sneeze into your hand. Instead, cough or sneeze into the crook of your arm so you won’t get germs on your hands and spread them to others.
Wash your hands often with soap and water. When handwashing is not possible, use antiseptic hand gels that contain alcohol.

26. Respiratory Hygiene / Cough Etiquette
Persons with respiratory symptoms should:
Cover mouth/nose when sneezing or coughing
Use tissues and dispose of appropriately
Perform hand hygiene after contact with respiratory secretions
Distance yourself from others (more than 3 feet)
Wear a surgical/procedural mask in healthcare settings
3 Foot Rule

27. What Schools Can Do Now:
Keep informed; dispel false information and fears- KEY Communications role
Disseminate preventative information – DOH posters can be ordered in quantities or printed from website
Strengthen basic emergency plans with ICS training and practice- NIMS IS-700 course
pandemic planning is an extension of current Safety Plan (SED, DOH) not a whole new plan-NEW School Kit
Make contact with local county public health agencies
Encourage good hand washing (including handling classroom pets) and general flu precautions year-round
Encourage flu shots
New -SED-DOH
Pandemic
Action Kit
for Schools

28. What Schools Can Do Now?
Nurses/Administrators meet your local county public health personnel
District-wide/Building-level Teams review the K-12 Pandemic Influenza Planning Checklist
Per NYSDOH Pandemic Influenza Plan (2/06), during ‘interpandemic and pandemic alert periods’ schools need to:
Develop pandemic plan appendix to Safety Plan that includes COOP -Continuity Of essential Operations and modified operation during “snow days.”
Identify procedures for issues related to employment compensation and job security.
Practice! Do a Tabletop Exercise to “talk through” a flu scenario

29. Pandemic Flu Preparedness Websites
School District (K - 12) Pandemic Influenza Planning Checklist:
NYSDOH pandemic planning guide for schools:
NYSDOH “evolving” Pandemic Influenza Plan:
Capital Region BOCES – other links

30. Individual and Family Preparedness is Crucial!
We might have to take care of ourselves and those around us
Would you be ready?
Were you ready for ice storm?!

32. NYSDOH Posters You can print them from the Website: or order
gov/diseases/communicable/influenza/pandemic/index.htm
or order

33. Roles and Responsibilities of Public Information Officer
Release information regarding the status of the school or District:
Clearly
Concisely
In a timely manner
Responsibilities:
Maintains current knowledge of the emergency plan and staff roles
Provides single point of information for media and parents.
Clears all information through Incident Commander
Represents the school on matters of preparedness to the community

34. General Staff - Function AreasIC
PIO
Safety
Liaison
Planning/
Intelligence
Finance/
Admin.
Operations
Logistics
Report directly to Incident Commander
Oversee a function section

37. NIMS Compliance
School districts that receive federal preparedness funds must require:
Appropriate personnel complete the IS-700 NIMS (National Incident Management System) introductory course by September 30, 2006, in order to receive FY 2007 preparedness grants.
It would also be useful for all faculty and staff likely to be involved in emergency activities, to take the IS-700 NIMS introductory course, including those districts that do not currently receive preparedness funding.
Free on-line course may be accessed at

38. Communications Planning
School District (K-12) Pandemic Flu Planning Checklist - Selected Points
Communications Planning
Develop a dissemination plan for communication with staff, students, families, including lead spokespersons and links to other communications networks.
Develop and test platforms (e.g., hotlines, telephone trees, dedicated websites, and local radio or TV stations) for communicating pandemic status and actions to staff, students, and families.
Disseminate information from public health sources covering routine infection control…
Anticipate the potential fear and anxiety of staff, etc. as a result of rumors and misinformation and plan communications accordingly
Source: Released by HHS on 2/28/2006
Full checklist available at

39. Useful Facts
Flu vs. Cold vs “so-called flu” & symptomatic surveillance
Importance of hygiene practices & what they are
Facts about transmission-
droplet spread, viability on surfaces, shedding
Facts about treatment-
primarily symptoms, anti-virals within 48 hours, vaccine time-line, effectiveness and distribution

40. Sources for Flu Facts
Avian Flu – WHO has info on cases, mortality, updated often, also CDC and Ags & Markets
Pandemic Flu- Health info from CDC, DOH, local PH
SED –
working with DOH on some overall planning policies- “snow days,” guidelines on when to close/re-open.
NEW: Pandemic Action Kit for Schools- has many sample letters, press releases, references
Emergency Management Offices-
Pandemic flu- lead agency would be Health
ICS used uniformly by all response agencies
legal protocols (Article 2-B –authority to use resources)
local first, then state then federal gov’t)

41. Other Facts
When a pandemic occurs, it will not be stopped. The planning and preparation is “Consequence Management”- to reduce the extent and impact- minimizing rate of spread and maximizing use of resources.
A pandemic will last at least a year, probably coming in waves lasting 6-8 weeks. “Snow days” for schools will last months.
All would be susceptible, not just young/old/ill. The Spanish Flu actually seemed to impact the normal “healthy” ones the most.
Isolation & Quarantine will be helpful at first to control spread and new infections.
All medical supplies and operations will be impacted, not just pandemic related. Other health issues still on-going.
Anti-viral and vaccine distribution will be limited and prioritized which will create other problems. Effectiveness of both can only be theorized.

42. Importance of Communications
School Media plans should be part of Safety Plans
Clear, accurate, consistent information disseminated in a timely manner- what you are always trying to do!
Proactive information- infection control (TV ads out now)
keep school community informed as developments occur
Resources for information identified-
County Public Health, State Health Dept.(lead state agency), SED, CDC, WHO, Risk Management
Isolation & Quarantine procedures
“POD” at a school- or used for other needs
communication within and working with health PIO
Proactive Preparation
Have info, website resources available
Possibly have draft letters ready, as in new kit

43. In a severe pandemic... actions of individuals, businesses, and community organizations, as much as those of government, will greatly determine the outcome!

44. Communication strategies
Communications: Before, During, After Pandemic
Messages to minimize panic, maximize effective response