World Health Organisation Viet Nam Avian Influenza / Pandemic Influenza Update April 2006.
Pandemic Influenza Avian Influenza
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Transcript of Pandemic Influenza Avian Influenza
Pandemic Influenza
Avian InfluenzaMaine Department of Health & Human Services
Maine Center for Disease Control & Prevention(formerly Bureau of Health)
Dora Anne Mills, M.D., M.P.H.
1.1. Pandemic Influenza &Pandemic Influenza &Avian Influenza 101Avian Influenza 101
2.2. Preparedness EffortsPreparedness Efforts
1. Pandemic Influenza & Avian Influenza 101
InfluenzaSeasonal influenza
Avian influenza
Pandemic influenza
All Influenza:
RNA viruses
Genetic engines
A: HemagglutininNeuraminidase
Seasonal InfluenzaOctober – April
Influenza Type AH3N2, H1N1
Influenza Type B
Vaccine
Avian Influenza (Bird Flu)Influenza A
Domestic poultry – can be deadlyHigh vs. low pathogenic
Wild birds – carriers
Virus in fecal droppings, saliva/nasal discharge
Recent Avian Influenza Outbreaks Affecting Humans
1997 H5N1 Hong Kong
1999 H9N2 Hong Kong
2003 H7N7 Netherlands
2004 H7N3 Canada
2004 H5N1 Southeast Asia
Pandemic InfluenzaGlobal outbreak
Highly contagious
Deadly
Recent Pandemics1918 Spanish flu (H1N1)
5,000 deaths in Maine500,00 in U.S.40,000,000 worldwide
1957 Asian flu (H2N2)70,000 deaths in U.S.1-2,000,000 worldwide
1968 Hong Kong flu (H3N2)34,000 deaths in U.S.700,000 worldwide
Past Pandemic InfluenzaEstimates for Maine
Moderate (1957/1968)
Severe(1918)
Illness 390,000 390,000Hospitalization 5,000 40,000Deaths 1,100 9,100
H5N1Detected in Asia since 1997
Deadly – 50% mortality in humans
Transmitted birds to mammals and limited human to human
Evolving quickly
H5N1 Activity as of September 29, 2006
253 human cases (thru 10/13/06)
In 58 countries
148 deaths
Mortality rate = 58%
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Humans Infected (Total=253) Human Deaths (Total=148)
Human Infections and Human Deaths by H5N1by Month, October 13, 2006
2. Preparedness EffortsA. Avian Influenza PreparednessB. Pandemic Influenza Preparedness
A. Avian Influenza Preparedness
DetectionTesting in:
Migratory birdsPoultry industry
Preparedness PlanningPoultry workers
Backyard flock owners
Others – bird lovers, hunters
General PublicFood safety
Bird handling
B. Pandemic Influenza Preparedness
“Pan Flu”
Significant Issues forPan Flu Planning
Detection and TrackingCare for Isolated and IllVaccines and AntiviralsFood and Other SupportBasic Services and Economic ImpactCommunicationQuarantine and Isolation
Pandemic AssumptionsAttack rate of 25%-35%
Duration of up to year or more in 2 waves
Each wave lasting 6-8 weeks in community
Healthcare system will be severely taxed, if not overwhelmed
Social Disruption fromPandemic Influenza
Absenteeism in essential sectors
Health, law enforcement, food and fuel supplies, education
Economic impact
Psychological stress
2006 vs 1918Advantages in 2006
Healthier populationBetter medical carePreparedness
Advantages in 1918Smaller populationLess travelMore self-reliance
Federal Preparedness
www.pandemicflu.gov
Components of Federal Plan
SurveillanceLaboratory DiagnosticsHealthcare PlanningInfection ControlClinical GuidelinesVaccineAntiviral Drugs
Community Disease ControlTravel-Related Risks of DiseaseCommunicationsWorkforce Support
Selected Components
Vaccine
Antivirals
Community Disease Control
Vaccines
Assumptions for Vaccination
Two doses will be required
Vaccine unavailable for 3-6 months
Production will be 3-5 million doses (15 µg)per week 10,000 doses per week in Maine
Vaccine Priority Groups
Vaccine and antiviral manufacturersHealth care providers
Those at high risk for severe disease
Public health emergency response workers
Key government leaders
400,000 in Maine
Recommendations for Vaccine and Antivirals may be modified based on:
VirulenceTransmissibilityDrug resistanceGeographic spreadAge-specific attack ratesMorbidity and mortality rates
What You Can Do NowAnnual seasonal influenza vaccination
Pneumococcal vaccination
Antivirals
AntiviralsAdamantanes
AmantadineRimantadine
Neuraminidase inhibitorsOseltamivir (Tamiflu)Zanamivir (Relenza)
Assumptions for Antivirals
Resistance to adamantanes
Neuraminidase inhibitors will be effective in decreasing morbidity and mortality
Current national stockpile = 5 million courses; goal is 80 million courses
? Maine stockpile
Some Antiviral Priority Groups1. Patients admitted to hospital 2. Infected health care workers and EMS
providers3. Infected high-risk patients4. Infected pandemic responders and
government decision-makers5. Exposed health care workers
Equals 40 million courses (150,000 courses for Maine)
Cost of Antiviral Treatment5-Day Course for an Adult
Oseltamivir (Tamiflu) $72.10
Zanamivir (Relenza) $61.80
Personal Stockpiles of Antivirals
Supply
Effectiveness
Resistance
Shelf life
Stockpiles of Antivirals
Institutional
State
Community Disease Control
Challenges to Containment
Short incubation period of 1-5 days
Ability of persons with asymptomatic infection to transmit virus
Early symptoms of illness are likely to be non-specific, delaying recognition
Goal of Community Disease Control
To limit or slow spread of pandemic influenza
Social Distancing
Containment Measures for Ill Individuals
Patient isolation
Management of contactsContact tracingContact monitoringQuarantine
Containment Measures For Groups of Exposed or At-Risk Persons
Quarantine
Containment measures for specific sites or buildings
Containment Measures For Communities
Promotion of community-wide infection control measures
Social distancing (snow days)
Unresolved IssuesRole of airborne transmission
Effectiveness of antivirals
Coordination between states and countries
State of Maine Preparedness
www.maineflu.gov
Overarching Roles of Major State Agencies Involved with Pandemic Influenza Response PlanningGovernor
Incident CommanderMEMA
Coordinator of state’s planning and response to all emergencies
Maine CDCDevelops public health emergency response plansStrategy lead in state’s response to Pandemic InfluenzaSits with Governor during public health emergencies
Maine Department of AgricultureDevelops response plans for zoonosesStrategy lead in state’s response to Avian InfluenzaSits with Governor during animal health emergencies
What Has Maine Been Doing?
1997 – 2001Two statewide Pan Flu ConferencesStatewide PlanTwo exercises
2001 – 2005Post 9/11 Federal Funds
• Early Detection System• Communication Systems• Response System
December, 2005 Pan Flu Conference
Maine’s Planning Efforts 2006
3-part process:
1. Update Maine’s Pandemic Influenza Plan
2. Development of sub-state Pandemic Influenza plans
A. County plansB. Hospital plans
3. Exercise and drills of the plans4. September 20th Summit
- 1,100 attended
Overarching Framework
Early detection
Response systems
Communications
Training
Exercises and drills
•Emergency management
•Healthcare•Many stakeholders
involved•May-August 2006
plans drafted•August 2006-2007
exercise plans•www.maineflu.gov for
contact information
County Preparedness
• 2006 Plans drafted
• 2007 Exercise plans
www.maineflu.gov for contact information
Hospital Preparedness
http://www.fchn.org/healthreform/documents/fchn%5Fpandemicfluplan.pdf
Pandemic PreparednessCan Be Daunting!
Need to:
Keep focused on the known
Be creative
Don’t wait for someone else
School Preparedness
School Preparedness - Maine
200,744 enrolled in Maine elementary and secondary schools
66,000 enrolled in Maine post-secondary schools
Resources for School Pandemic Influenza Preparedness
www.pandemicflu.gov
www.maineflu.gov
Pandemic Flu K-12 Checklist Format
Planning and Coordination
Continuity of Student Learning and Core Operations
Infection Control Policies and Procedures
Communication Planning
http://www.pandemicflu.gov/plan/schoolchecklist.pdf
www.acha.org
Some Highlights of ACHA Guidelines
Planning that allows employees to work from home
Providing for ill students
Addressing health and safety issues
Addressing business continuity
Making contingency plans for completion of courses
Some Highlights of ACHA Guidelines (cont’d)
Testing and rehearsing the plans
Identifying key members of the Pandemic Planning Committee
Identifying appropriate channels of communication and chain of command
Identifying the role of student health services
Compiling a list of supplies that would be needed
Disaster Planning does not equal Public Health Emergency Planning.
Preparedness isEveryone’s Job –
No one ever died of preparedness!