1. Low Pathogenic Strains vs. Highly Pathogenic Strains

2. H5N1 Infection in Cats Study looked at 500 blood samples taken from stray cats taken from poultry markets in Java. Of these cats, 20% had antibodies to H5N1. Unusually high numbers of dead cats have been found near many of the outbreaks. Unlike humans, cats shed virus in high titers and pass it to each other.

3. Human H5N1 Cases Human Cases: Summary of Current Situation Since January, 2004 WHO has reported human cases of avian influenza A (H5N1) in the following countries: East Asia and the Pacific: Cambodia China Indonesia Thailand Vietnam Europe & Eurasia: Azerbaijan Turkey Near East: Egypt Iraq For additional information about these reports, visit the World Health Organization Web Site. Updated January 2007 World Health Organization Web Site

8. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO March 14, 2007 Country 20032004200520062007Total casesdeathscasesdeathscasesdeathscasesdeathscasesdeathscasesdeaths Azerbaijan0000008500 85 Cambodia0000442200 66 China11008513800 2314 Djibouti0000001000 10 Egypt000000181011 2413 Indonesia00001912564676 8365 Iraq0000003200 32 Nigeria0000000011 11 Thailand001712523300 2517 Turkey00000012400 4 Viet Nam33292061190000 9342 Total 44463297421168087280170

9. Responding to the Avian Influenza Pandemic Threat Recommended Strategic Actions World Health Organization 2005

10. WHO Proposals 1. Reduce opportunities for human infection - education 2. Strengthen the early warning system 3. Contain or delay spread at source - drugs, quarantine 4. Reduce morbidity, mortality and social disruption 5. Conduct research to guide response measures

11. Problems With Early Warning Systems most outbreaks are occurring in poor countries no funds to pay farmers for culled flocks (10 billion $$ to date) no funds for information systems or labs home slaughter of sick chickens poor or no health care services

13. New WHO Pandemic Phases Interpandemic Period Phase 1 – No new influenza subtypes in humans, 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 with new subtype, no human-to-human (HTH) spread Phase 4 – Small clusters with limited HTH transmission, highly localized spread, suggesting the virus is not well adapted to humans Phase 5 – Larger clusters, but HTH spread is still localized, virus is increasingly better adapted to humans, but not yet fully transmissible Pandemic Period – Increased and sustained transmission in general population

14. Current WHO phase of pandemic alert

16. Pandemic Vaccine Supply Assumptions Imported vaccine will not be available Two doses will be needed for protection 4-8 months until first vaccine doses are available U.S Manufacturing Capacity Only Sanofi has a completely domestic supply chain Estimated production sufficient to deliver 5 million monovalent doses per week Implication – less than 1% of the population may be protected per week

17. Health Care and Emergency Response Address hospital surge capacity issues Address roles of triage centers, volunteers, home care Develop hospital employee health guidance Develop infection control guidelines Address mass mortality issues Develop system for tracking hospital resources

18. CDC PANDEMIC RANKING February 1, 2007 Category 1 Pandemic90,000 additional deaths Isolate the sick at home, reduce visitors Category 3 Pandemic90,000 – 450,000 additional deaths consider closing schools for no more than a month Category 5 Pandemic>900,000 additional deaths Close schools (including universities) for up to 3 months, avoid gatherings and encourage people to work from home

19. What we all learned from Katrina is that sometimes we have to think very clearly about the unthinkable, because the unthinkable often happens. Michael Leavitt Health and Human Services Secretary

20. http://pandemicflu.gov

24. http://www.pandemicflu.state.pa.us

25. http://pandemicflu.gov/plan/pdf/CIKRpandemicInfluenzaGuide.pdf

26. http://www.pandemicflu.gov

29. HMC PANDEMIC PLAN

30. http://emergencyhomepreparation.org /

31. http://www.influenzareport.com/influenzareport2006.pdf

32. Birdflubook.com

33. Were all holding our breaths. H5N1 is the most important threat the world is facing. People who fail to prepare for a flu pandemic are going to be tragically mistaken. Julie Gerberding, Head of the CDC