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88 Years of Influenza Pandemics in 15 Minutes

Bureau of Emergency Preparedness and Response. Pandemic Influenza: history and background. Peter C. Kelly, M.D., FACPArizona Dept. of Health Services. Bureau of Emergency Preparedness and Response. Drivers for Pan Flu Preparedness. WHO Influenza PreparednessSARS and TorontoHurricane Katrina and

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88 Years of Influenza Pandemics in 15 Minutes

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    1. Bureau of Emergency Preparedness and Response 88 Years of Influenza Pandemics in 15 Minutes Peter C. Kelly, M.D. Arizona Dept. of Health Services

    2. Bureau of Emergency Preparedness and Response Pandemic Influenza: history and background Peter C. Kelly, M.D., FACP Arizona Dept. of Health Services

    3. Bureau of Emergency Preparedness and Response Drivers for Pan Flu Preparedness WHO Influenza Preparedness SARS and Toronto Hurricane Katrina and New Orleans

    4. Bureau of Emergency Preparedness and Response It’s all about the virus

    5. Bureau of Emergency Preparedness and Response Influenza Virus RNA, 8 segments Unstable,mutates frequently Surface proteins Hemagglutinin Neuraminidase Niche in nature is birds

    6. Bureau of Emergency Preparedness and Response Drift and Shift Both refer to genetic changes Drift: Minor changes in H and N antigens; occur annually or every few years Shift: Major change (30% or more) in H and/or N antigens; “new” virus. Important for starting pandemics

    7. Bureau of Emergency Preparedness and Response Influenza is Global

    8. Bureau of Emergency Preparedness and Response Surface Glycoproteins Used to classify virus; H1, H2 etc Important in disease HA attaches virus to respiratory epithelial cells NA facilitates release of virus from infected cell Immunity/vaccines

    9. Bureau of Emergency Preparedness and Response Influenza Virus and Birds Migratory waterfowl Often not diseased Transmit to domestic birds and other animals 15 H types, 9 N types Only 3 H,2 N in humans Pathogenicity varies

    10. Bureau of Emergency Preparedness and Response How does the virus get to humans?

    11. Bureau of Emergency Preparedness and Response How does the virus get from person to person?

    12. Bureau of Emergency Preparedness and Response How does the virus cause disease? Attaches to respiratory epithelium Enters the cell and reproduces Causes cell death Primary target is bronchial tissue

    13. Bureau of Emergency Preparedness and Response Pandemics

    14. Bureau of Emergency Preparedness and Response Required for Influenza Pandemic “New” virus (antigenic shift) Susceptible population Transmitted from animals to humans Cause disease in humans Efficient person to person transmission

    15. Bureau of Emergency Preparedness and Response Influenza Pandemics Have occurred for centuries Occur 11 to 42 years apart Unpredictable but not random Attack rates of 10 to 40% Excess mortality But humanity survives

    16. Bureau of Emergency Preparedness and Response 20th Century

    17. Bureau of Emergency Preparedness and Response Current Model of Pandemics

    18. Bureau of Emergency Preparedness and Response 1918-19 Pandemic aka Spanish Flu H1N1 virus, Genetics: “avian like” First cases in USA Global spread ~1 yr Mortality 20-50 million USA 500,000

    19. Bureau of Emergency Preparedness and Response Impact High mortality Social disruption Burial Public services Events cancelled Spread along troop transport routes Poor public health response

    20. Bureau of Emergency Preparedness and Response Mortality and “Waves” Taubenberger, Morens. EID. 2006;12: 15-22.

    21. Bureau of Emergency Preparedness and Response “the Mother of All Pandemics” Taubenberger, Morens.EID.2006;12:15-22 H1N1 1918 virus is the ancestor of current influenza viruses Human and porcine lineage have some H1N1 genes H3N2 virus retains some H1N1 genes None of these as virulent as original

    22. Bureau of Emergency Preparedness and Response 20th Century

    23. Bureau of Emergency Preparedness and Response 1957-58 Influenza Pandemic Asian Influenza H2N2 virus: 3 new genes (H,N, PB1); 5 genes from 1918 H1N1 First cases in China Spread around world in 6 months 1st wave: Fall’57 school age 2nd wave: Jan’58 adults 80,000 deaths in USA Very young and elderly

    24. Bureau of Emergency Preparedness and Response 20th Century

    25. Bureau of Emergency Preparedness and Response 1968-69 Influenza Pandemic Hong Kong Influenza H3N2 Virus, 2 new genes(H, PB1), 5 retained from 1918. N2 from Asian Only 1 antigen shifted Population has some immunity to N2

    26. Bureau of Emergency Preparedness and Response H3N2 Influenza Lowest mortality of 20th cent. pandemics 34,000 deaths in USA U shaped mortality curve

    27. Bureau of Emergency Preparedness and Response Wave Phenomenon

    28. Bureau of Emergency Preparedness and Response Where are we now? H3N2 era. Seasonal influenza. Antigenic drift. Annual vaccine. Mortality ~36,000 SURPRISE 2003 H5 N1 avian virus Highly pathogenic in birds, especially chickens Almost world wide spread (asia,africa,and europe)

    29. Bureau of Emergency Preparedness and Response

    30. Bureau of Emergency Preparedness and Response

    31. Bureau of Emergency Preparedness and Response

    32. Bureau of Emergency Preparedness and Response Humans and H5N1 HPAI Few cases in close contact with chickens As of 7/14/06; 230 cases and 132 deaths No efficient human to human transmission

    33. Bureau of Emergency Preparedness and Response Required for Influenza Pandemic “New” virus (antigenic shift) Susceptible population Transmitted from animals to humans Cause disease in humans Efficient person to person transmission

    34. Bureau of Emergency Preparedness and Response WHO Alert

    35. Bureau of Emergency Preparedness and Response International Preparedness Control in birds Global Influenza Surveillance Vaccine development Antiviral drugs, oseltamivir National preparedness plans

    36. Bureau of Emergency Preparedness and Response Be an optimist! Power of scientific inquiry WHO global surveillance is good and getting better Communication and cooperation among nations is better since SARS Vaccine development and production methods are on a fast track

    37. Bureau of Emergency Preparedness and Response What about state and local PH?

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