2. OBJECTIVES Pandemic Influenza Then and Now Public Health Pandemic Influenza Planning –What to expect –What not to expect Individual/Employee Pandemic Planning

3. WHAT IS PANDEMIC INFLUENZA? A global influenza outbreak –Caused by a change in a flu virus –Most severe occur with big changes in the virus Because it is a drastically changed virus, few or no people would be immune Many people would get sick in every part of the world Asia is the source of many outbreaks because swine, birds and humans live under the same roof, providing opportunity for viral mixing

4. HOW DOES INFLUENZA VIRUS CHANGE? Antigenic Drift: –Small changes in virus over time –New strains appear and replace older strains –May not be recognized by antibodies to older strains Antigenic Shift: –Abrupt, major change (reassortment) –Results in novel strain or new subtype –Can cause pandemic influenza

5. PANDEMIC INFLUENZA CYCLE Recognized global outbreaks of influenza since the 1500’s Historical cycles of 10 to 40 years Rapid transmission worldwide. High attack rate for all age groups. High mortality rates, esp. for young adults.

6. 1918: Spanish Flu A(H1N1) 20-40 m deaths 675,000 US deaths 1957:AsianFlu A(H2N2) 1-4 m deaths 70,000 US deaths 1968: Hong Kong Flu A(H3N2) 1-4 m deaths 34,000 US deaths Influenza Pandemics 20th Century

7. GLOBAL STATUS OF CURRENT PANDEMIC THREAT World Health Organization (WHO) defines 3 major periods (broken into 6 phases) of increasing human infection with new flu virus: –Interpandemic (no human infection) –Pandemic Alert (limited human infection) –Pandemic (widespread human infection) We are at Pandemic Alert Isolated human infections with a novel influenza strain [H5N1] with no (or rare) person-to-person transmission.

8. Country 200320042005200620072008Total cases death s cases death s cases death s cases death s cases death s cases death s cases death s Azerbaijan00000085000085 Cambodia00004422110077 China11008513853002717 Djibouti00000010000010 Egypt0000001810259004319 Indonesia 000020135545423798126103 Iraq00000032000032 Lao People's Democratic Republic 00000000220022 Myanmar00000000100010 Nigeria00000000110011 Pakistan00000000110011 Thailand001712523300002517 Turkey0000001240000 4 Viet Nam332920611900851110248 Total4446329843115798659109359226 Source World Health Organization

9. WILL H5N1 BE THE NEXT PANDEMIC? Impossible to know if or when If not H5N1, then another will come The prudent time to plan is now

10. AVIAN FLU OCCURS REGULARLY IN AVIAN SPECIES SOMETIMES SPREADS TO OTHER SPECIES PANDEMIC FLU OCCURS PERIODICALLY IN HUMANS CAN BE CAUSED BY ANY STRAIN OF INFLUENZA VIRUS

11. PLANNING ASSUMPTIONS: DISEASE TRANSMISSION No one immune to virus; 30% of population will become ill People may be contagious up to 24 hours before they know they are sick People are most contagious the first 2 days of illness –Sick children are more contagious than adults On average, each ill person can infect 2 or 3 others (if no precautions are taken)

12. Medical Burden in Knox County Based on 2006 Knox County population estimate of 399,254

13. HEALTH AND HUMAN SERVICES PLANNING OBJECTIVES Primary objective: –Minimize sickness and death Secondary objectives: –Preserve functional society –Minimize economic disruption

14. INFLUENZA CONTAINMENT STRATEGIES Routine Activities –Surveillance 911 calls ER visits Sentinel physicians –Public information and education –Promote “respiratory hygiene” and hand washing Unique Activities –Measures to increase social distancing –Change how we perform our day-to-day business to protect our staff and patients who still need our services

15. INFLUENZA CONTAINMENT Very early isolation and quarantine Reduce social contact –Stay home if you are sick –Canceling large gatherings, mass transit, schools Decision based on location of flu activity: –Outbreak not local: gatherings >10,000 cancelled –Outbreak in local/neighboring county: >100 School closings determined by State Commissioner of Health/Board of Education. Heavy reliance on personal measures

16. INFLUENZA CONTAIMENT, PERSONAL MEASURES Hand Hygiene –Frequent washing –60%-95% alcohol-based sanitizer Respiratory Hygiene –Cover your cough Environmental cleaning –1:10 bleach solution –EPA registered disinfectant Gloves & surgical masks for direct contact with ill person These apply at home and at work

17. Flu Vaccine Production minimum 6 month process:(growing 93 million eggs) HHS priority groups –Military and vaccine manufacturers –Healthcare workers with direct patient care –Persons at highest risk for complications Two doses needed for protection Tamiflu Anti-viral agent Could be used to contain first human outbreak Resistance described Should be used within 48 of infection HHS priority groups: military and hospitalized patients Tamiflu ≠ Preparedness

18. Guidance for Families Plan for childcare in the event schools close Arrangements made for eldercare, pet care Discuss/develop plan with employer how you might work at home

19. Guidance for Families Personal protection: –Hand hygiene and respiratory etiquette –Surgical masks: proven effective for droplet precautions –Pneumococcal vaccination of those for whom it is recommended Stockpiling: One to three week essential water, food, supplies, medicines

20. RESOURCES PandemicFlu.gov CDC.gov/flu/avian www.nyhealth.gov Knoxcounty.org/health Knoxpanflu@knoxcounty.org