Presented by Kelly Keenan, MPH

Jefferson County Public Health

October 2014

Basic Pandemic Preparedness for Healthcare Facilities

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Introduction to Pandemics & Epidemics

Seasonal Influenza

Overview of Pandemic Planning

OVERVIEW

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Introduction to Pandemics & Epidemics

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Outbreak – An increase, often sudden, in the number of cases of a disease above what is normally expected in that population in that area.

Can be a single case, depending on the disease

Endemic - The constant presence and/or usual prevalence of a disease or infectious agent in a population within a geographic area.

E.g. Malaria is endemic in Africa, Seasonal influenza in United States

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What Are We Talking About?

Naval Aircraft Factory, Philadelphia, Pennsylvania, on 19 October 1918

Epidemic – Commonly used synonymously with outbreak. An outbreak (sudden, unexpected) that impacts a large number of people.

E.g. 2014 Ebola, Colorado Pertussis

Side note – some argue that the “obesity epidemic” is not actually an epidemic because the increase in obesity cases was not sudden or unexpected.

Pandemic –An epidemic that has spread over several countries or continents, usually affecting a large number of people.

E.g. 2003 SARS, 2009 H1N1

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What Are We Talking About?

Paramedics in protective suits move Ebola-infected missionary Miguel Pajares at Carlos III Hospital in Madrid on Thursday, August 7. The gentleman died five days later.

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Pandemic vs. Epidemic at the Local Level

In St. Louis, where members of the American Red Cross removed victims of the 1918 Spanish flu from a house.

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Pandemic History

Ancient History

430 B.C. Plague of Athens (Typhoid Fever)

¼ of the population died over 4 years, weakened Athenian troops and the dominance of Athens

165 -200 The Antonine Plague (Smallpox)

5 million people died. At one point 2,000 died each day

541 The Plague of Justinian (Bubonic Plague)

25 million people died. At one point 5,000 died each day

1347 -1351 Black Death (Bubonic Plague)

75-200 million people died worldwide

World population was 450 million

½ of Europe's population died in a span of four years

Plague doctor in Rome wearing a protective suit and a mask (1656).

Pandemic History

United States Pandemic History

1633-1634 Smallpox Epidemic in New England

Killed off 70% of the Native Americans

1855-1959 The Third Pandemic (Bubonic Plague)

10 million people died

Plague arrived in San Francisco , isolated cases remain

in the United States today

1918-1919 Spanish Flu Pandemic (H1N1 Influenza)

20% to 40% of the worldwide population became ill

50 million people died

675,000 people died in the United States

1952 Polio Epidemic

In the United States, 58,000 cases were reported, including:

3,145 deaths

21,269 were left with mild to disabling paralysis

Smallpox Eradication (1967)

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Pandemic History

United States Pandemic History

1957 – 1958 Asian Flu Pandemic (H2N2 Influenza) 69,800 people in the United States died

1968 – 1969 Hong Kong Virus Pandemic (H3N2 Influenza) 33,800 people in the United States died

1980s – Present HIV Pandemic 35 million people are living with HIV

2.1 million people were infected in 2013

39 million people have died from AIDs-related causes 1.5 million people died in 2013

2009 – 2010 H1N1 Influenza Pandemic 60.8 million cases in the United States, with:

274,304 hospitalizations

12,469 deaths

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Group Discussion: Types of Pandemics

Take a few minutes and brainstorm the pandemic diseases that you are aware of!

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Types of Pandemics, WHO

Influenza (seasonal, pandemic & avian)

Cholera

Emerging diseases (nodding disease)

Hendra virus infection

Leptospirosis

Meningitis

Nipah virus infection

Plague

Rift Valley fever

SARS and coronavirus infections

Smallpox and human monkeypox

Tularaemia

Viral haemorrhagic fevers (ebola)

Viral hepatitis (A, B, C, E)

Yellow fever

Cholera, Hati

Current Known Pandemic Threats

Avian Influenza*

H5N1

H7N9

Coronaviruses

SARS

MERS

Chikungunya July 17, 2014 - 1st acquired case in the

United States

Ebola Virus

Emerging & evolving diseases

*Bird Flu: A Virus of Our Own Hatching by Michael Greger (bit outdated from 2006, however covers one theory of “why is this happening, especially in China” very well).

A burial team in Monrovia, Liberia: Ebola (2014)

WHO’s Pandemic Phases (2013)

WHO Interim Guidance on Pandemic Influenza Risk Management (2013)

*New* WHO Pandemic Influenza Phases

Interpandemic Phase

Alert Phase

Pandemic Phase

Transition Phase

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Predicted Consequences of a Pandemic & Epidemic

Hard to predict impact

Properties of the virus

Modes of transmission

Incubation period

Symptom development

Clinical attack rate

Population vulnerability

Subsequent waves of spread

Capacity to respond

FEMA Influenza Pandemic Planning Assumptions

30% of the community will become ill (~160,000 in Jefferson County)

½ of the ill will seek care (~80,000 in Jefferson County)

Absenteeism will be 40%

Fun fact from Carl Zimmer that is probably completely made up.

Predicted Consequences of a Pandemic & Epidemic

Estimated Reproductive Number

BREAK

Tree House in Atlanta, Georgia

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Pandemic & Epidemic Response

Surveillance

Mass Prophylaxis

Community Containment

Medical Surge

Continuity of Operations

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Response: Surveillance

Maintain surveillance systems to identify potential outbreaks

Reportable diseases

During a suspected outbreak

Establish case definition.

Collect and analyze available data to evaluate the virological, epidemiological and clinical characteristics.

Document the evolving epidemic including population susceptibility, changes in epidemiological and clinical features, geographical spread, trends and impact.

Monitor and assess impact using criteria such as workplace and school absenteeism, regions affected, groups most affected and essential worker availability.

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Response: Mass Prophylaxis

If prophylaxis is effective against the agent

If effective prophylaxis is available

If support resources are available (e.g. staff)

If the benefits of prophylaxis outweigh the exposure risk

Vaccine clinics during H1N1 Pandemic (2009)

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Response: Community Containment

Good hygiene practices Hand washing, personal protective

equipment

Isolation Keep sick away from well

Quarantine Keep exposed away from the

non-exposed

Social Distancing “Snow days”

Community Quarantine Closure of public gatherings

including schools, events and churches

In true extremes, curfews and community lockdowns

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Response: Medical Surge

Limited resources available (e.g. staff)

Reduced treatment options

Crisis Standards of Care or Alternated Standards of Care

BLU-MED Response Systems will happily sell you one of these surge tents.

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Response: Continuity of Operations

Addresses internal agency operations

Elements of COOP Framework

Essential Functions

Orders of Succession

Delegation of Authority

Continuity Facilities

Continuity Communications

Vital Records Management

Human capital

Test, Training, and Exercise Program

Devolution of Control and Direction

Reconstitution of Operations

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Questions About Pandemics & Epidemics?

Seasonal Influenza

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~5-20% of U.S. residents get the flu annually

+200,000 people are hospitalized for flu-related complications

Everyone 6 months of age and older should get the flu vaccine

Seasonal flu vaccines have a very good safety track record

Get Your Flu Shot!!

President Obama during H1N1 Pandemic, 2009

Seasonal Vaccine Benefits

90% of pediatric influenza deaths occurred in children who had not received a flu vaccination in the 2012-2013 season (CDC)

71% reduction in flu-related hospitalizations among adults of all ages (CDC)

77% reduction in flu-related hospitalizations for adults 50 years and older (CDC)

Giving flu vaccine to pregnant women was 92% effective in preventing hospitalization of infants for flu (CDC)

Get Your Flu Shot!!

A footnote of caution… 6 studies found that receiving the trivalent inactivated influenza vaccine put

individuals at an increased risk of contracting H1N1 during the 2009 pandemic.

More research on the impact of seasonal vaccine in a pandemic is needed.

Seasonal Vaccine & Pandemics

Seasonal Vaccine & Pandemics

So, should I be more worried about an Influenza Pandemic or the Seasonal Influenza?

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Comparing United States Seasonal Influenza Annual Fatalities to Annual Equivalent Pandemic Influenza Fatalities

Seasonal Influenza

Pandemic Influenza

And a bit of generalized perspective…

Seasonal vs. Pandemic Fatalities, Annual Equivalent Comparison

CDC High annual estimate from 1967-2007

CDC Low annual estimate from 1967-2007

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High Estimate Low Estimate

Comparing United States Seasonal Influenza Annual Fatalities to Annual Equivalent Pandemic Influenza Fatalities

Seasonal Influenza

Pandemic Influenza

And a bit of generalized perspective…

Seasonal vs. Pandemic Fatalities, Annual Equivalent Comparison

Includes the 1918 Spanish Flu. All deaths from 1918-2010, divided by 92 years

Does not include the 1918 Spanish Flu. All deaths from 1920 - 2010, divided by 90 years.

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20000

30000

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50000

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High Estimate Low Estimate

Comparing United States Seasonal Influenza Annual Fatalities to Annual Equivalent Pandemic Influenza Fatalities

Seasonal Influenza

Pandemic Influenza

And a bit of generalized perspective…

Seasonal vs. Pandemic Fatalities, Annual Equivalent Comparison

Includes the 1918 Spanish Flu, 1918-2010

Does not include the 1918 Spanish Flu, 1920-2010

High estimate from 1967-2007

Low estimate from 1967-2007

And a bit of perspective…

Seasonal Influenza

United States

Annually between 3,000 and 49,000 people die from seasonal influenza.

Worldwide

Annually between 250,000 and 500,000 people die from seasonal influenza.

Influenza Pandemics

United States

1918-2010: 790,000 deaths from pandemic influenza

Equivalent to ~8,500 deaths per year

1920-2010: 120,00 deaths from pandemic influenza

Equivalent to ~1,200 deaths per year

Worldwide

1918-2010: ~52,284,000 deaths from pandemic influenza

Equivalent to ~570,000 deaths annually

1920-2010: ~6,284,000 deaths from pandemic influenza

Equivalent to ~70,00 0 deaths annually

Seasonal vs. Pandemic Fatalities, Annual Equivalent Comparison

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Overview of Pandemic Preparedness

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Business Pandemic Planning

DHHS & flu.gov’s Business Pandemic Influenza Planning Checklist Plan for the impact of a pandemic on your business

Increase or decrease in business

Plan for the impact of a pandemic on your employees and customers Increase or decrease in customers Decrease in employees

Establish policies to be implemented during a pandemic Sick leave & flexible worksite, including mandatory Hygiene (hand washing, cover your couch) Geographic travel restrictions

Allocate resources to protect your employees and customers during a pandemic Infection control supplies Resources for telecommuting and remote employee access

Communicate to and educate your employees JCPH can help you with this, just ask us!

Coordinate with external organizations and help your community Including your health department and healthcare coalition

CDPHE’s Pandemic Plan Template

***Coming Soon*** Release date was extended to October 15th – we will share this with everyone once we get it .

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JCPH’s Recommendations

JCPH Recommends Planning for: Complete the business checklist

Also address: Surveillance

How will you track the impact internally?

Remember: JCPH does county-wide surveillance

Mass Prophylaxis Work with JCPH

Community Containment How will you address ill or exposed staff and clients?

Medical Surge Would medical surge impact your facility?

Continuity of Operations This one should impact everyone

Many of these can (and should) be incorporated into daily operations

Pandemic Planning

Great starting point:

http://www.flu.gov/planning-preparedness/business

http://www.flu.gov/planning-preparedness/business/businesschecklist.pdf

CDPHE PanFlu Template: ***Coming Soon***

Business Continuity and Continuity of Operations Planning

Ready.gov: http://www.ready.gov/business-continuity-planning-suite

FEMA: http://www.fema.gov/continuity-operations

FHCC meetings in 2015

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Resources

Kelly Keenan, Emergency Response Planner

Jefferson County Public Health

kkeenan@jeffco.us 303-271-8391

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