PANDEMIC INFLUENZA

BACKGROUND AND GUIDANCE FOR SCHOOLS

Influenza

• Respiratory infection• Transmission: contact with respiratory secretions

from an infected person who is coughing and sneezing

• 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

Common Influenza Symptoms

• Rapid onset of:– Fever– Chills– Body aches– Sore throat– Non-productive cough– Runny nose– Headache

Influenza is a serious illness

• Annual deaths: 36,000• Annual hospitalizations: >200,000• Total economic costs: $37.5B

• Who is at greatest risk for serious complications?– persons 65 and older– persons with chronic diseases– infants– pregnant women– nursing home residents

Definitions• Epidemic: An increase in disease above what is

normally expected• Pandemic: A worldwide epidemic

How Do Influenza Pandemics Arise?

• Wild water fowl are natural reservoirs of influenza

• They can spread the virus to domestic birds

How Do Influenza Pandemics Arise?

• When avian flu viruses experience sudden changes in genetic structure

and

• Are capable of infecting humansand

• Can reproduce and spread from person to person efficiently

Why Be Concerned About Pandemic Influenza?

• Influenza pandemics are inevitable: naturally recur at more-or-less cyclical intervals

• Can cause:– High levels of sickness and death– Drastic disruption of critical services– Severe economic losses

• There will be little warning time between the onset of spread of a pandemic and its arrival in the U.S. Outbreaks occur simultaneously in many areas

• Impacts will last for weeks to months and likely to occur in successive waves

• Pandemics can disproportionately affect younger, working-age people

• Current avian influenza outbreak in Asia

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

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

Planning Assumptions: Health Care

Moderate (1957-like) Severe (1918-like)

Illness 90 million (30%) 90 million (30%)

Outpatient medical care 45 million (50%) 45 million (50%)

Hospitalization 865,000 9, 900,000

ICU care 128,750 1,485,000

Mechanical ventilation 64,875 745,500

Deaths 209,000 1,903,000

• 50% or more of those who become ill will seek medical care• Number of hospitalizations and deaths will depend on the virulence

of the pandemic virus

The 1918 Influenza Pandemic

Chicken Little and the Sky is Fallingor The Next Major Disaster?

Which is it?

Current Outbreak: Avian Influenza (H5N1)

• Began in fall, 2003. • At least 252 confirmed human cases in

Asia, Africa and Europe 148 deaths in Asia and Africa

(World Health Organization, 10/06)• Mammalian infection (cat, pig)• No efficient person-to-person

transmission• Isolated Human disease• Case-fatality rate > 50%• Outbreak spreading, not controlled

Current Avian Outbreaks

Clinical illness with H5N1 compared with typical human influenza illness

• More severe illness in younger persons• Primary viral pneumonia appears to be

more common and with rapid onset• Incubation period may be longer 1-4+ days

(up to 14 days?)• Duration of infectious period likely longer,

particularly in adults 1d. prior to 7d. after

Adapted from Guillermo Herrera, CDC, 2005

(in adults; children ~longer)

Pandemic Effects: Strain on Resources

• Health care shortages– Vaccine / Antivirals– Hospital beds / equipment– Masks

• Personnel shortages

• Disruption of essential society functions

• Panic

Vaccines, Antivirals, andMedical Supplies

Pandemic Influenza Vaccine Questions

• When will it be available?

• How much will there be?

• Who will own it?

• Who should get it?

• How should it be delivered?

Treatment and Prevention: Vaccine

• Vaccines takes 6-8 months to produce following the emergence of a new virus

• Supplies will be limited, if available at all– 2nd dose after 30 days will likely be required– New vaccine safety and efficacy has

“unknowns”

Treatment & Prevention: Antiviral Drugs

• Antiviral agents

– Effective in preventing illness

– Can prevent severe complications

– May not be effective against pandemic virus

• Supplies will be limited

– Treatment over prevention

Nassau County Department of Health Pandemic Influenza Preparedness Strategies

• Distribution Planning– First Responder Prophylaxis– Municipality operated PODs– Employer operated PODs (regional)– DOH operated PODs– School operated PODs through municipalities

Points of Distribution• Community based sites used to distribute

vaccines or medications to healthy citizens

• Would the schools be used?

• Municipalities will coordinate POD planning within their communities.

Individual and Family Preparedness

– We will have to take care of ourselves and those around us.

– During a pandemic, public health will maximize resources for the greatest impact on the population as a whole.

– Schools should communicate with local/ state public health agencies and/or emergency responders about the assets/services the districts could contribute to the community.

Influenza Prevention: What Can We Do?

Specific Recommendations for Infection Control in Schools and Workplaces:

Pandemic preparedness planning Distribution of educational messages and infection control guidance Social distancing: people stay home when ill Promotion of respiratory etiquette Provision of materials for respiratory hygiene/etiquette: tissues and disposal receptacles

ISSUES FOR SCHOOL DISTRICTS TO THINK ABOUT

• Absenteeism among children AND staff• Resources limited: vendors, buses• Role of school nurses• Communication with parents and staff and community• Advantages and disadvantages to closing schools

(amount of closure time)• Working with local municipalities• Implications with State aide• Policies sending sick children home (isolation within the

school, masks, etc)• Policies for allowing previously sick children to return to

schools

RESOURCES FOR SCHOOLS

Nassau County Health Department, with direction from the New York State Health and Education Departments, will provide guidance to schools districts

• To create plans• To create communication materials for students,

staff and parents• To provide guidance for closing schools

Key Step for District Preparedness

• Incorporate the pandemic influenza plan as an annex in the school district’s all hazards plan.

• Develop strong relationships with your school communities– Build confidence that information will be

distributed accurately and quickly

- Consider community meetings that describe current plans in place

COMMUNICATIONBefore a Pandemic Hits

• School Websites

• Lunch Menus

• PTAs

• Letters to the Community

• BOE Meetings

• Marquis

• Proactive

COMMUNICATIONBefore a Pandemic Hits

COMMUNICATIONBefore a Pandemic Hits

• Establish relationship with Public Health Officials early on

• Review/update procedures for communicable disease reporting

Pandemic Influenza

“Don’t worry about it, it’s probably just a head cold.”

Acknowledgments

Presentation compiled and adapted from multiple slide sets from the:

Centers for Disease Control and Prevention HHS National Vaccine Program Office New York State Department of Health Connecticut Department of Health Kansas Department of Health Department of Defense Washington Department of Health