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بسم الله الرحمن الرحيم

بسم الله الرحمن الرحيم. Pandemic Influenza School of Health ShahidBeheshti University of Medical Sciences By: Hatami H. MD. MPH 2008. Clinical Epidemiology of Avian flu. Definition and public health importance Etiologic agents. مقايسه. Incubation period Natural course

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بسم الله الرحمن الرحيم

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  1. بسم الله الرحمن الرحيم Pandemic Influenza School of Health ShahidBeheshti University of Medical Sciences By: Hatami H. MD. MPH 2008

  2. Clinical Epidemiology of Avian flu • Definition and public health importance • Etiologic agents مقايسه • Incubation period • Natural course • Geographical distribution • Timeline trend • Age, Gender, Occupation, Social situation • Predisposing factors • Susceptibility & Resistance • Secondary attack rate • Modes of transmission, period of communicability OCCURRENCE • Prevention : primary, secondary, tertiary

  3. اوّلين موارد آنفلوآنزاي پرندگان در انسان 18 + 387 = 405 6 + 245 = 251 هنگ كنگ 1997

  4. دلايل اهميت ويروس H5N1 • آسيب زايي و حدّت • ميزان مرگ • وسعت انتشار • راه‌هاي انتقال • احتمال تغييرات ژنتيك • احتمال وقوع جهانگيري انساني

  5. Definitions • An epidemic - is an increase in disease above what you what would normally expect • A pandemic - is a worldwide epidemic

  6. How Do Influenza Pandemics Arise? • Wild birds are natural reservoirs of flu viruses, including those that infect people • Flu viruses undergo slight changes each year (“Drift”), requiring us to update our vaccines Epidemic influenza • Periodically, avian flu viruses will undergo major genetic changes (“shift”) Pandemic influenza

  7. How Do Influenza Pandemics Arise? • When avian influenza viruses experience sudden changes in genetic structure And • Are capable of infecting humans And • Can reproduce and spread from person to person….a pandemic occurs

  8. وضعيت فعلي پاندمي

  9. Phases of a Pandemic World Health Organization Preparedness Response مراحل = Phases Phase I Phase 2 Phase 3 Phase 4 Phase 5 Phase 6 Interpandemic Pandemic Alert Pandemic دوره ها = Periods جايگاه فعلي پاندمي Declared globally by the World Health Organization Declared nationally by the Department of Health and Human Services

  10. World Health Organization Phases of a Pandemic • Inter-pandemic period • Pandemic Alert period • Pandemic Period • Post Pandemic Period

  11. World Health Organization Phases of a Pandemic • Inter-pandemic period • Phase 1 – No new virus subtypes in humans • Phase 2 – Animal subtype poses a risk of human disease • Pandemic Alert Phase • Pandemic Period • Post Pandemic Period

  12. World Health Organization Phases of a Pandemic • Inter-pandemic period • Pandemic Alert period • Phase 3 – Human infection, no human to human spread • Phase 4 – Small localized clusters of human to human spread • Phase 5 – Larger clusters, still localized, virus adapting to humans • Pandemic Period • Post Pandemic Period

  13. World Health Organization Phases of a Pandemic • Inter-pandemic period • Pandemic Alert Phase • Pandemic Period • Phase 6 – Increased and sustained transmission in the general population. Waves of 8-12 weeks. • Post Pandemic Period

  14. World Health Organization Phases of a Pandemic • Inter-pandemic period • Pandemic Alert Phase • Pandemic Period • Post Pandemic Period

  15. Phases of a Pandemic World Health Organization Preparedness Response مراحل = Phases Phase I Phase 2 Phase 3 Phase 4 Phase 5 Phase 6 Interpandemic Pandemic Alert Pandemic دوره ها = Periods جايگاه فعلي پاندمي Declared globally by the World Health Organization Declared nationally by the Department of Health and Human Services

  16. ويروس عامل پاندمي ؟؟ H5N1 ?? H1N1 ?? HxNy ??

  17. موارد گزارش شده آنفلوآنزاي پرندگان در سطح جهان تا28/3/1386

  18. نوپديدي آنفلوآنزاي H5N1 در انسان تا 19/9/1387 1382 1383 1384 1385 1386 تعداد موارد موارد مرگ كل موارد = 389 موارد مرگ = 246 (63%) 18 مورد بيماري و 6 مورد مرگ 1376

  19. موارد آنفلوآنزاي H5N1 در انسان تا 20/7/1387 تا 8/4/1386

  20. اثرات مخرب پاندمي تاثير بر كليه جوانب و شئون زندگي اجتماعي

  21. اثرات مخرب پاندمي كاهش پرسنل به ميزان تقريبي 30% در كل سيستم مديريت چه اموري قائم به فرد مي‌باشد؟؟

  22. تخمين ميزان مرتاليتي و مربيديتي Estimated numbers of Illness, Hospitalization, and Deaths Moderate and Severe Pandemic Scenarios - US and King County

  23. اثرات مخرب پاندمي • كاهش پرسنل به ميزان تقريبي 30% در كل سيستم • كاهش توان مراكز خدمات بهداشتي ـ درماني • كاهش تواننيروهاي امدادي • كاهش نيروهاي امنيتي • محدوديت منابع و امكانات

  24. اثرات مخرب پاندمي محدوديت منابع و امكانات : • اختلال در امر حمل و نقل • اختلال در امر ارتباطات • مشكل برق • مشكل آب • مشكل سوخت • . . .

  25. اثرات مخرب پاندمي گشوده شدن زندان‌ها • ناامني اجتماعي • . . .

  26. اثرات مخرب پاندمي تاثير بر كليه جوانب و شئونات زندگي اجتماعي

  27. همكاري • هماهنگي • ارتباط

  28. ساماندهي اثرات مخرب پاندمي مسئول تامين، حفظ و ارتقاء سلامتي جسمي، رواني، اجتماعي ؟؟؟؟؟

  29. ستاد بحران نيروهاي مردمي ارگان‌هاي دولتي وزارت كشور استانداري‌ها بسيج جامعه پزشكي وزارت بهداشت معاونت سلامت محور اصلي NGOها

  30. برنامه كلي ساماندهي 1 ـ كاهش ميزان بيماري و مرگ و مير 2 ـ به حداقل رساندن ازهم پاشيدگي اجتماعي 3 ـ به حداقل رساندن زيان‌هاي اجتماعي 4 ـ حفظ كيان حكومتي

  31. پيش‌بيني و پيشگيري • كاهش توان مراكز خدمات بهداشتي ـ درماني • كاهش تواننيروهاي امدادي • محدوديت منابع و امكانات

  32. پيش‌بيني و پيشگيري محدوديت منابع و امكانات : • اختلال در امر حمل و نقل • اختلال در امر ارتباطات • مشكل برق • مشكل آب • مشكل سوخت • . . . نياز به اجراي مانور مشترك

  33. پيش‌بيني و پيشگيري محدوديت منابع و امكانات : • اختلال در امر حمل و نقل حمل زودرس برخي از كالاها (دارو، غلات، مواد سوختي . . . )حمل و نقل زودرس مواد اوليه،

  34. پيش‌بيني و پيشگيري محدوديت منابع و امكانات : • اختلال در امر ارتباطات تهيه راديوهاي كوچك . . .

  35. پيش‌بيني و پيشگيري محدوديت منابع و امكانات : • مشكل برق آموزش پرسنل ذخيره، تهيه يخچال‌هاي بدون برق در مراكز بهداشتي نياز به اجراي مانور مشترك

  36. پيش‌بيني و پيشگيري محدوديت منابع و امكانات : • مشكل آب حفر چاه‌هاي اضطراري، . . .

  37. Public Health Preparedness Public Health Objectives • Maintain and expand functions critical to pandemic response • Maintain critical day-to-day operations • All Department resources may be needed to address the consequences of a pandemic • Some Department functions may be suspended • Business continuity planning and “response team” development are underway

  38. Direction and Control • PHSKC will direct the countywide health and medical response with health care system partners • Local Health Officer will issue countywide directives when needed (i.e. school closings, health and medical response) • PHSKC response actions will emphasize surveillance, social distancing and communications • All local jurisdictions will activate emergency operations plans as needed • Local Elected Officials will issue directives to ensure continuity of government

  39. Antiviral Medications • CDC is stockpiling anitivirals in the SNS • KC developing a local stockpile of antivirals • Vaccines and antivirals will be prioritized for predefined target groups • Local Health Officer will direct (via PH Order) how these medications will be used

  40. Social Distancing / Isolation and Quarantine • Isolation of patients will occur throughout the event • (mainly at home) • Quarantine of close contacts may occur only in the early phases • Decisions regarding closings and reopening will be based on current epidemiological data

  41. Social Distancing / Isolation and Quarantine • Schools, large child care centers and libraries may be closed early by the LHO • Stadiums, theaters, churches may be closed by the LHO and KC Executive

  42. Health Care Coalition • Comprised of representatives from a broad base of health care organizations • Coordinating body and information clearinghouse for the medical system during major emergencies • Health care system response will resemble Unified Command

  43. Health Care Coalition Participants • Hospitals • Large medical groups • Safety net healthcare organizations • Professional associations • Home health and long term care providers • Key stakeholders, e.g. EMS, Puget Sound Blood Center, Red Cross

  44. Health Care Coalition Responsibilities • Develop all-hazard preparedness plans • Develop an Executive Advisory Body: • Review plans and agreements • Advise the LHO on health issues during disasters • Develop a Regional Medical Resource Center • Information Management • Resource Management • Communication

  45. Regional Responsibilities • Emergency Management • Public Works • First Responders • Human Services • General Government • Private Sector

  46. Pandemic Preparedness Responsibilities of All Partners • Educate and Inform: • Department / Business Leaders • Supervisors • Staff • Families

  47. Pandemic Preparedness Responsibilities of All Partners • Influenza Prevention • Stay home when sick • Cover your cough • Wash hands regularly and use alcohol hand gel • Avoid touching eyes, nose, mouth

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