Pandemic Influenza

1. Pandemic Influenza • Current status • Potential scenarios • Role of PAHO • Disaster preparedness/response and communicable diseases addressing the pandemic

2. Pandemic Influenza • Annual Influenza • Avian Influenza • Pandemic Influenza H1-16 N1-9

3. Influenza epidemics and pandemics

4. Requirements for emergence of a pandemic influenza strain • Total lack of immunity in world population • Be able to cause disease in humans • Efficient person-to-person transmission of the virus

5. Avian Influenza

10. H5N1 Wild Bird Flu OutbreaksFebruary 2006

11. H5N1 Wild Bird Flu OutbreaksFebruary 2006

12. Avian Influenza H5N1

17. Cameroon (13/MAR/2006) Afghanistan (10/MAR/2006) Pakistan (03/MAR/2006) Serbia & Montenegro (02/MAR/2006) Hungary (01/MAR/2006) Niger (28/FEB/2006) Azerbaijan (27/FEB/2006) Switzerland (26/FEB/2006) Slovakia (24/FEB/2006) Malaysia (23/FEB/2006) Bosnia & Herzegovina (20/FEB/2006) Egypt (19/FEB/206) India (18/FEB/2006) France (17/FEB/2006) Germany (06/FEB/2006) Iran (14/FEB/2006) Greece (13/FEB/2006) Bulgaria (12/FEB/2006) Slovenia (12/MAR/2006) Italy (11/FEB/2006) Nigeria (08/FEB/2006) Iraq (02/FEB/2006) Included Human Cases Worldwide occurrence of newly infected countries with H5N1 in 2006(including date of 1st official notification to OIE)

21. Human cases of Avian Influenza

22. Cumulative Numbers of Confirmed Human Cases of Avian Influenza A/H5N1 A (H5N1) Reported to WHO*March 10, 2006 * WHO reports only laboratory-confirmed cases.

23. Status of “National” Influenza Pandemic Preparedness Plans in the Americas Finalized Draft In progress

24. Potential scenarios

25. Expected deaths in LAC due to pandemic influenza 8-week outbreak; scenario 1968

26. Expected deaths in LAC due to pandemic influenza8-week outbreak; scenario 1918.

28. Avian Influenza Economic implications Major Global poultry exporters, 2004 Source: USDA, JM Ovalle

29. Potential Impact of Avian Influenza in LAC • Population at risk • 600 million people in LAC • 194 million people living in rural areas • 5 billion domestic birds in LAC • Economy • Poultry production (around US$ 18,5 billion dollars). • Egg production (around US$ 5 billion dollars). • Imposition of barriers to commerce. • Food Safety • Poultry comprises 40% of the animal protein consumed in the Region. • Employment in poultry production chain • Environment (carcass disposal) • Tourism • The tourism sector in the Caribbean contributes to 31% for the Gross Domestic Product and employs 500,000 people.

31. Start of a Pandemic

32. Start of a pandemic • Once the first cases of pandemic flu are reported, countries will probably declare public health alert or emergency • Countries with validated and rehearsed pandemic plans will be in best position to make decisions and take actions rapidly.

33. Spread • It may not be possible to stop a pandemic once it begins • The pandemic virus can spread rapidly causing outbreaks around the world affecting up to 30% of the population. • Better hygiene, nutritional status, and drugs can mitigate some of the impact but international spread could be more rapid than previous pandemics.

34. Pandemic scenario • Lack of vaccines in the first several months. • Health services overwhelmed by public seeking medical assistance if they present typical influenza like symptoms and other severe and life-threatening complications. • Many countries will need to convert health services, including emergency and intensive care units for increased demand. • There may be a need to temporarily close schools, grocery stores and other public gathering places and facilities. • Reduced capacity in essential services as health-care, law enforcement, transportation due absenteeism. • Not enough antiviral drugs to protect all citizens. Drug delivery may create conflicts.

35. PAHO´s actions • PAHO Director established an inter-programmatic and multidisciplinary Task Force on Epidemic Alert and Response • Advise, Enable, Coordinate, and Monitor: • PAHO activities for influenza pandemic preparedness and response • Implementation of the International Health Regulations in the Region • Responsible for drafting the PAHO Strategic and Operational Plan for responding to pandemic influenza

36. Task Force on Epidemic Alert & Response

37. National Influenza Centers (NICs) in the Americas 25 NICs in the Region Countries with multiple NICs Labs that are not NICs but send samples to CDC Source: Flunet *

38. Strengthening Epidemiologic Surveillance Capacities • Active involvement of the Influenza related WHO Collaborating Centers and National Influenza Centers in the Global Influenza Network • Training in surveillance and diagnosis of influenza viruses • Support NICs for viral characterization • Supply of reagents for Influenza virus diagnosis

39. Strengthening national capacity • Increase national, subregional and regional awareness on pandemic influenza and other health related emergencies and disasters. • Meetings and workshops on pandemic influenza for health sector network of epidemiologists, disaster coordinators, health services, veterinary health and others. • Development of pandemic influenza table top simulation exercises including health and other key roles as agriculture, civil protection, tourism, transportation, foreign affairs, Red Cross, etc.

40. Regional and national emergency response Key activities • Execute the PAHO Contingency Plan • Activate EOC at PAHO HQ and in Country Offices. • Mobilize multisectoral capacity for quick readiness and response. • Mobilize Emergency Response Teams. • Mobilization of financial resources for pandemic response. • Implement emergency logistic procedures and mechanisms.

41. Pandemic Influenza Challenge and Opportunity