1. WWU Broad View Pandemic Influenza Fall 2006

2. Appreciation Materials in this program were modified from March 2006 information from the City of Bellingham, courtesy of Fire Chief Bill Boyd Some materials were excerpted from a June 23, 2006 National Safety Council presentation by the Centers for Disease Control

3. Information Provided Influenza characteristics, symptoms and transmission Pandemic influenza characteristics and current status Impacts and historical evidence from previous pandemics Control and prevention for individuals, households and at WWU How WWU is preparing

4. Influenza Contagious disease caused by RNA virus Primarily affects the respiratory tract Can cause severe illness and lead to life- threatening complications Global infectious disease threat Annual public health problem

5. Transmission: How Influenza Spreads Contact with respiratory secretions from an infected person via –Coughing or Sneezing –Touching respiratory droplets on: – Self, another person or object **** THEN ***** Touching one’s mucous membranes –Eyes, mouth, nose –Without washing hands

6. Seasonal Influenza Information Incubation period: 1 to 5 days from exposure to onset of symptoms Communicability: Maximum 1-2 days before to 4-5 days after onset of symptoms Timing: Peak usually occurs December through March in North America

7. Influenza Symptoms Rapid onset of: –Fever –Chills –Body aches –Sore throat –Non-productive cough –Runny nose –Headache

8. Average Influenza Impact in U.S. Over 200,000 hospitalizations per year About 36,000 deaths per year Substantial economic impact –Lost work and school days –Estimated $37.5 billion in costs (CDC information from National Safety Council)

9. Seasonal Influenza is a Serious Illness Who is at greatest risk for serious complications? –Persons 65 and older –Persons with chronic diseases –Infants –Pregnant women –Nursing home residents

10. Comparison of Pandemic and Seasonal Influenza Seasonal caused by subtypes of influenza viruses to which people have been previously exposed Pandemics caused by subtypes to which –People have never been previously exposed OR –People have not been exposed for a very long time

11. Defining Pandemic Influenza Global outbreak with: –Novel virus - all or most people susceptible –Readily transmissible from person to person –Wide geographic spread

12. Influenza Viruses Subtype based on surface glyco-proteins –16 different hemaglutinins (H) – 9 different neuraminidases (N) Human types: H1N1, H3N2 Current avian: H5N1 RNA viruses mutate very vigorously

13. Impact of Past Influenza Pandemics PandemicExcess Mortality Populations Affected 1918-19 (A/H1N1) 500,000Persons <65 years 1957-58 (A/H2N2) 70,000Infants, elderly 1968-69 (A/H3N2) 36,000Infants, elderly 1977-78 (A/H1N1) 8,300Young (persons <20)

14. Severe vs Moderate Moderate 1957-like Severe 1918-like Illness90 million (30%) Outpatient medical care 45 million (50%) Hospitalization865,000 (1%)9,900,000 (11%) ICU Care128,750 (0.1%)1,485,000 (1.7%) Mechanical Ventilation 64,875 (0.07%)745,500 (0.8%) Deaths209,000 (0.2%)1,903,000 (2.1%)

15. Pandemic Influenza: 2 nd waves 1957: second wave began 3 months after peak of the first wave 1968: second wave began 12 months after peak of the first wave

16. Close Calls: Avian Influenza Transmitted to Humans 1997: H5N1 in Hong Kong 18 hospitalizations and 6 deaths 1999: H9N2 in Hong Kong 2 hospitalizations 2003: H5N1 in China 2 hospitalizations, 1 death H7N7 in the Netherlands 80 cases, 1 death (eye infections, some respiratory symptoms)

17. Avian Influenza Poultry Outbreaks, Asia, 2003-04

18. Human Cases as of March 2006

19. H5N1 Poultry Influenza Current Outbreaks (as of Feb 2006) Africa: Niger Nigeria East Asia & the Pacific: Cambodia, China, Hong Kong, (SARPRC), Indonesia, Japan, Laos, Malaysia, Mongolia, Thailand, Vietnam Europe & Eurasia: Austria, Azerbaijan, Bosnia & Herzegovina (H5), Bulgaria,Croatia, France, Germany, Greece, Italy, Romania, Russia, Slovak Republic, Slovenia, Switzerland (H5), Turkey, Ukraine Near East: Egypt, Iraq, (H5) Iran South Asia: India

20. Location of Human cases – H5N1 East Asia and the Pacific: –Cambodia –China –Indonesia –Thailand –Vietnam Europe & Eurasia: –Turkey Near East: –Iraq

21. Avian Influenza High Concerns Has caused severe disease in humans who have been infected Limited human-human transmission has occurred in Asia Could evolve to be readily transmissible between humans No vaccine for humans is available Limited supply of expensive antiviral medicines

22. “The pandemic clock is ticking, we just don’t know what time it is” E. Marcuse

23. Historical Review of Pandemic 1918-19 is selected because –Severity of disease –Enormous impact on society

24. The 1918 Influenza Pandemic

25. America’s Forgotten Pandemic by Alfred Crosby “The social and medical importance of the 1918- 1919 influenza pandemic cannot be overemphasized. It is generally believed that about half of the 2 billion people living on earth in 1918 became infected. At least 20 million people died. In the Unites states, 20 million flu cases were counted and about half a million people died. It is impossible to imagine the social misery and dislocation implicit in these dry statistics.”

26. America’s deaths from influenza were greater than the number of U.S. servicemen killed in any war Civil WWI 1918-19 WWII Korean Vietnam War Influenza War War Thousands

34. Influenza Control Measures Vaccines Anti-viral medicines Preventing transmission –Infection control Preventing contact –Social distancing

35. Preventing Transmission Infection Control Hand hygiene Face masks for symptomatic persons Isolation of ill people and quarantine of those exposed

36. Preventing Contact Social Distancing School closures Cancellation of public gatherings Deferring travel to involved areas Providing alternatives to face-to-face contacts at work and in other venues Increasing distances between people over 3 feet Decreasing contact between people

37. Influenza Control: Quarantine Challenges –short incubation period for influenza –a large proportion of infections are asymptomatic –clinical illness from influenza infection is non specific Not used during annual epidemics Could potentially slow onset of a pandemic before sustained person-to-person transmission has been established

38. Medical Care during an Influenza Pandemic Surge capacity of the hospital system is limited Challenges: –Magnitude and duration –Staff shortages –Limited ability to call in external resources

39. U.S. HHS Doctrine: Save Lives U.S. Health & Human Services Department: Slow spread, decrease illness and death, buy time Lowers the peak burden on medical infrastructure Diminishes overall cases & impacts No Intervention Intervention

40. Despite... –Expanded global and national surveillance –Better healthcare, medicines, diagnostics –Greater vaccine manufacturing capacity New risks: –Increased global travel and commerce –Greater population density –More elderly and immunosuppressed –More daycare and nursing homes Pandemic Flu Today

41. On-line resources www.pandemicflu.gov www.cdc.gov/business www.doh.wa.gov/panflu/ www.dhhs.gov/nvpo/pandemics/ www.wwu.edu/depts/ehs/pandemic.shtml

42. How WWU is Preparing Pandemic Policy approved Pandemic response plan being developed Web page available Exercise conducted August 2006