Influenza – What in the world do YOU need to know?

Kristine A. Smith, M.A.

Flu Facts

What is Influenza? Acute, febrile respiratory

illness affecting nose, throat, bronchial tubes and lungs

Epidemics caused by influenza viruses A and B(Type C uncommon in people; no epidemics)

Occurs worldwide, causing considerable morbidity (illness) and mortality (death) each year

Symptoms appear rapidly

Symptoms

Fever, dry cough, sore throat, muscle aches/pain, headache, lack of energy, possibly runny nose

Fever and body aches for 3-5 days

Cough and lack of energy - 2 weeks

Symptoms similar to other upper respiratory diseases such as adenovirus, rhinovirus, parainfluenza, legionellosis, etc.

How You Get the Flu?

Typical incubation: 2 days

Range: 1-4 days Viral shedding

Can begin 1 day before symptom onset

Peak shedding first 3 days of illness

Correlates with temperature

Subsides after 5 days in adults, can be 10+ days in children

Transmission is Transmission is predominately droplet predominately droplet spreadspread

The Burden of Seasonal Influenza

Globally: 250,000 to 500,000 deaths each year

In the United States each year: 36,000 deaths >200,000 hospitalizations $37.5 billion in economic costs from influenza

and pneumonia

How Influenza Viruses 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

What is an Influenza Pandemic ?

A global influenza outbreak Caused by a brand new (novel) flu virus Most severe occur with changes in both surface proteins Viruses can be isolated at any time of year

Because it is a new 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

Influenza Pandemics 20th Century

A(H1N1) A(H2N2) A(H3N2)1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”

20-40 m deaths

675,000 US deaths

1-4 m deaths

70,000 US deaths

1-4 m deaths

34,000 US deaths

Credit: US National Museum of Health and Medicine

Timeline of Emergence of Timeline of Emergence of Influenza A Viruses in HumansInfluenza A Viruses in Humans

1918 1957 1968 1977 19971998/9

2003

H1

H1

H3H2

H7H5H5

H9

SpanishInfluenza

AsianInfluenza

RussianInfluenza

AvianInfluenza

Hong KongInfluenza

If a Pandemic Happens: What to expect…

At the peak of a moderate pandemic influenza outbreak (i.e. 35% attack rate, 6 week duration), New York State (excluding New York City) can expect: 14,916 influenza-related hospital admissions per week 3,728 influenza-related deaths per week

2,609 deaths in the hospital

Influenza patients will most likely utilize: 63% of hospital bed capacity 125% of intensive care capacity 65% of hospital ventilator capacity

Will Avian Flu Cause the Next Pandemic?

No one knows!

The H5N1 virus could change to spread more easily among humans-but it might not.

It could “swap genes” with another animal virus, or with a human flu virus

Avian Influenza

The H5N1 strain of avian influenza (bird flu) is present in birds in many countries across several continents. Bird flu is NOT the same as pandemic flu

Some human cases of avian influenza have also occurred Cases occurred after close contact with infected birds No sustained person to person transmission

Human death rate is high >57%

Nations With Confirmed Cases H5N1 Avian Influenza (July 21, 2006)

H5N1 Outbreak: December 2003 –July 20, 2006 Laboratory confirmed human cases:

231 human cases

133 human deaths

Case fatality rate 57 percent

Cases occurred in countries with endemic infection of poultry

Nearly all human cases had poultry/bird exposure

No sustained person-to-person transmission identified

No influenza A viruses with human and avian genes detected yet

Source: World Health Organization

Situation Report: Avian Influenza

Widespread prevalence in migratory birds; broad host range

Continued outbreaks among domestic poultry

Mammalian infection (cats, pigs, etc.) - lethal

Virus is evolving

Sporadic human cases (>190 reports to date)• Most in young and healthy, Case-fatality 57%• Rare person-to-person transmission

Sustained and rapid person-to-person transmission

What is New York State doing to prepare?

WHO Pandemic Phases

Interpandemic Interpandemic periodperiod

Phase 1: Phase 1: No new influenza virus subtypes in No new influenza virus subtypes in human; subtype that has caused human human; subtype that has caused human infection may be present in animalsinfection may be present in animals

Phase 2: Phase 2: As above, but circulating animal As above, but circulating animal subtype poses substantial risk of human subtype poses substantial risk of human diseasedisease

Pandemic Pandemic alert periodalert period

Phase 3: Phase 3: Human infection w/ new subtype, no Human infection w/ new subtype, no human-to-human (HTH) spread, or rare spread human-to-human (HTH) spread, or rare spread to close contactto close contact

Phase 4: Phase 4: Small clusters w/ limited HTH Small clusters w/ limited HTH transmission, highly localized spread, transmission, highly localized spread, suggesting virus not well adapted to humansuggesting virus not well adapted to human

Phase 5: Phase 5: Larger clusters, but HTH spread still Larger clusters, but HTH spread still localized, virus increasingly better adapted to localized, virus increasingly better adapted to humans, but not yet fully transmissiblehumans, but not yet fully transmissible

Pandemic Pandemic periodperiod

Increased and sustained transmission in Increased and sustained transmission in general populationgeneral population

NYSDOH Planning Process

Original plan drafted using internal DOH workgroups – August 2004

Based on federal DHHS August 2004 pandemic plan

NYSDOH revised plan and incorporated recent guidance issued in the updated DHHS November 2005 plan

Additional workgroup members added from:

Local health departments

Hospitals and hospital associations

NYSDOH plan: www.health.state.ny.us

Federal plan: www.pandemicflu.gov

Current Status of NYS Planning

With the Disaster Preparedness Commission (DPC) agencies, SEMO is coordinating development of a State pandemic plan that will become an annex of the State’s Comprehensive Emergency Management (“All Hazards”) plan

Local Health Departments are developing county-specific plans—due date August 30, 2006

Hospitals and Regional Resource Centers are planning for surge capacity

Pandemic preparedness town meetings, regional partner meetings, regional media forums are being held

Extensive Training is Underway

NIMS training for emergency responders

Point of Dispensing (POD) training for Local Health Departments

Laboratory specimen collection and submission training

Informatics training for key partners using HIN, HPN, HERDS

Multiple tabletop and functional exercises held: ProtEX NY state POD

exercise, November 2005 2006 versions Nov. 9 in

NYC, Syracuse

CDEx full functional exercise, June 2006 (more than 200 agencies participated)

Public Health Emergency Preparedness -

A Shared Responsibility! Local – state – federal Domestic –

international Public – private Multi-sector Animal – human Health protection –

homeland security – economic protection

Healthcare

DeliverySystem

Federal Partners

Education System

Businesses & Workers

Local/State/Federal Public HealthSystem

Businesses, school systems, community infrastructure providers, and other employers should develop plans for continuity of essential operations and modified operation with a significantly reduced workforce

25 to 30% of persons may become ill during a 6 to 8 week outbreak An additional 10% of the workforce may be absent due to illness of a

family member Others may stay home due to a fear of becoming infected

What can YOU do to prepare?

General Infection Control Assumptions in a Pandemic

Core prevention and control measures (e.g., vaccination and antivirals) will not be available or will be limited

We must prepare for that!

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 now

What is Respiratory Hygiene/Cough Etiquette?

Cover mouth/nose when sneezing or coughing If no tissue, use elbow instead of hands

Use tissues and dispose of appropriatelyPerform hand hygiene after contact with

respiratory secretionsDistance yourself from others

(more than 3 feet)

What is Hand Hygiene?

Traditional hand washing Soap and hot water Minimum of 20 seconds

(the time it takes to sing “Happy Birthday” twice)

Alcohol based hand rubs Acceptable means to disinfect/sanitize EXCEPT

when hands are visibly soiled

Did You Ask About Masks?

Recommended for: Health care workers with

direct patient contact

Those at high risk for complications of influenza

Symptomatic persons

Contacts of ill persons

More About Masks

Benefit of wearing masks by well persons in public settings has not been established Persons may choose to wear a mask as part of an

individual protection strategy that includes respiratory hygiene/cough etiquette, hand hygiene, and social distancing

If you wear a mask, keep your hands away from your face!

Clean your hands each time you touch your mask!

Isolation and quarantine: reduces influenza transmission by separating infected persons from uninfected persons, and exposed persons from non-exposed persons

Isolation of ill persons will be valuable during all phases of pandemic influenza

Quarantine of those exposed to ill persons is justified when there are a limited number of cases

Individual or GroupInfection Control Strategies

Work or School Based Infection Control Strategies

Respiratory hygiene/cough etiquette, hand hygiene Stay away if ill (staff stay home, students do not go

to classes) Encourage self-reporting of illness that develops Active screening for

illness in staff/students Send staff/students home

(with mask) if ill

Community-Based Infection Control Strategies

Social distancing Snow days, voluntary self-

shielding Cancellation of public events

concerts, sports events, movies, plays

Closure of schools and workplaces office buildings, shopping malls

Closure of recreational facilities community swimming pools, youth

clubs, gymnasiums

Individual and Family Preparedness is Crucial!

We might have to take care of ourselves and those around us

How many would be ready?

Family Preparedness Checklist

To plan for a pandemic Store a supply of food

and water Have non-prescription

drugs and other health supplies on hand

Get involved in your community

Start now to limit the spread of germs and prevent infection Hand hygiene Respiratory hygiene Stay home if sick

Parents need to model behavior!

Questions

Contact Information:

(518) 486-1642

kas10@health.state.ny.us

Additional Resources: Contact your local health department Websites – www.nyhealth.gov or www.pandemicflu.gov