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Texas Pandemic Influenza Preparedness

Texas Pandemic Influenza Preparedness. Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant. Agenda. Everything you wanted to know about pandemic influenza but couldn’t find anyone to ask What you can do to prepare your family

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Texas Pandemic Influenza Preparedness

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  1. Texas Pandemic Influenza Preparedness Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant

  2. Agenda • Everything you wanted to know about pandemic influenza but couldn’t find anyone to ask • What you can do to prepare your family • What you can do to prepare your school • What you can do to prepare your students & their families

  3. Everything you wanted to know. . . • Definitions • Examine reasons pandemics occur • Look at the progress of Avian H5N1 Influenza • Discuss why we are concerned • Review current prevention efforts • Consider the state of the science

  4. Avian vs Pandemic Influenza ?

  5. Epidemiology of Avian flu in humans • Avian (Bird) Flu is a disease of birds • All Avian Flu viruses are endemic in waterfowl & do not harm them • Wild birds mix with domestic chickens in back yard farms • Domestic chicken flocks mix in live poultry markets • People mix with sick or dead chickens • People catch Avian Flu

  6. Seasonal Annually Known virus Vaccine available (usually) High mortality young & old esp. w/ health problems Pandemic Irregular intervals Novel virus No or mismatched vaccine High mortality in 20-50 year olds; mortality in young similar to seasonal flu Seasonal vs Pandemic Flu

  7. Pandemics of the 20th Century

  8. Composition of Seasonal Vaccines • 2004 – 2005 • A / New Caledonia / 99 / H1N1 • A / Fugian / 02 / H3N2 • 2005 – 2006 • A / New Caledonia / 99 / H1N1 • A / California / 03 / H3N2 • 2006 – 2007 (recommended) • A / New Caledonia / 99 / H1N1 • A / Wisconsin / 05 / H3N2

  9. Pandemics of the 20th Century

  10. Antigenic change • Antigenic ‘drift’ occurs in HA and NA • Associated with seasonal epidemics • Continual development of new strains secondary to genetic mutations • Antigenic ‘shift’ occurs in HA and NA • Associated with pandemics • Appearance of novel influenza A viruses bearing new HA or both HA & NA

  11. Mechanisms of Antigenic Shift Reassortment in humans Direct Infection Non-human virus Human virus Indirect Infection Reassorted virus

  12. Countries with H5N1 Influenza in animals & humans Countries with H5N1 influenza in animals Countries with H5N1 influenza in humans 51 18 11 10 5 2 2 1 2005 2006 2004 2003 Through June 15, 2006

  13. Bird and Human Cases H5N1 June 13, 2006 Bird Cases Human Cases

  14. The H5N1 Flu Threat to Humans • A new virus to which humans have no immunity - Yes • The virus causes significant human illness or death - Yes • The virus spreads easily from person-to-person – NO The Avian Flu (H5N1) virus has 2 out of 3 of these today…

  15. Why the Concern with H5N1? • 1918 (H1N1) flu and H5N1 avian flu are the only “kissing cousins” among the 169 known avian flu viruses.

  16. 1918 Influenza Pandemic • 20-40 million persons died worldwide, possibly more • Death rate 25 times higher than previous epidemics • 500-650,000 deaths in the U.S.: Ten times as many Americans died of flu than died in WW I • The epidemic preferentially affected and killed younger, healthy persons • The epidemic was so severe that the average life span in the U.S. was depressed by 10 years

  17. MOST FATAL EVENTIN THE LAST 300 YRS U.S. LIFE EXPECTANCY AT BIRTH

  18. 1918 H5N1 Incident rate (0-75) 55 15

  19. Case fatality rate comparison (0-75) 15 55

  20. Case fatality rate comparison

  21. Cytokine Storm • Has been suggested as an explanation for the devastating nature of the 1918 flu • Is an over reactive immune response that causes multiple organ system failure • Evidence indicates H5N1 deaths are caused by this

  22. Worst Case Scenario

  23. Pandemic wave mortality

  24. Animal intervention

  25. Society during a pandemic • Healthcare system • Work • School • Travel • Supplies • Services

  26. Prevention & Containment – Nonpharmaceutical • Public Health population focused measures • Personal protective measures • Business contingency planning • Care of sick at home

  27. Potential Community Measures to Decrease Transmission • Travel advisories/limit travel to affected areas • Screening travelers from affected areas* • Limit large public gatherings; close schools • Encourage telecommuting • Limit availability of public transportation • Hand hygiene, respiratory hygiene/cough etiquette • Quarantine of exposed persons* • Education to allow early identification and isolation of cases* * Note: Some measures may be most useful early in outbreak and with strains that are not efficiently transmitted

  28. Evidence for use of masks • Limited evidence available on benefits of masks in preventing healthcare or community influenza transmission • Use prudent at least in healthcare settings • SARS studies have shown clear benefit mask use in healthcare setting

  29. Influenza Antiviral Drug Questions • How much supply will there be? • Will feds or state have control over distribution decisions? • How should it be used? • Who should get it? • How can it be delivered? • Where does the $$ come from?

  30. 12/07?? 50 million courses

  31. Influenza Antiviral Drug Questions • How much supply will there be? • Will feds or state have control over distribution decisions? • Where do the $$ come from? • How should it be used? • Who should get it? • How can it be delivered?

  32. Influenza Vaccine Questions • When will it be available? • How much will there be? • How effective will it be? • Who will own it? • How should it be delivered? • Who should get it? • Who will pay for it?

  33. Current method • 1950’s technology • Depends on eggs and chicks • Shortages often due to problems here • Requires 4-6 months for vaccine production

  34. Pandemic wave mortality

  35. New method • Cell cultures • Less room • More dependable • Requires 4-6 weeks for vaccine production

  36. Vaccine Consumption - 2000 Source: WHO Global Influenza Program

  37. Vaccine Production Capacity

  38. Texas Plan Challenges InHealth Systems Response • Assuring essential workers are prophylaxed and/or vaccinated • Surge Capacity • Emergency Systems for Advance Registration of Volunteer Health Professionals Program (ESAR-VHP) • Availability of PPE • Disaster Mental Health • Dead bodies

  39. Texas Plan Challenges InCommunication • Risk Communication • Pre-event message preparation for the public • Educating decision makers • Communication technology • Interoperability

  40. How can you prepare? • Visit the DSHS website at: www.dshs/state/tx/us • Follow the Pandemic Influenza link to the state’s plan. • Appendix F “Personal Protective Strategies

  41. How can you prepare? • Get seasonal flu vaccine • Stay informed • Stockpile supplies, food, & some $$ • Talk to MD and RPh about extra routine meds • Don’t forget pets • Have a family plan • Know your business’ continuity plan

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