PANDEMIC INFLUENZA PLANNING: WHAT SCHOOLS NEED TO KNOW

1. PANDEMIC INFLUENZA PLANNING: WHAT SCHOOLS NEED TO KNOW

2. EVERYONE IS WORRYING ABOUT INFLUENZA (KIDS, PARENTS, TEACHERS...)

3. THINKING ABOUTPANDEMIC INFLUENZA ● INTRO & BACKGROUND ● WHAT IS PANDEMIC INFLUENZA? ● WHAT IS AVIAN INFLUENZA? ● WHAT IS OUR STATE OF KNOWLEDGE? ● WHAT SHOULD WE DO TO PREPARE? Mitigation & Prevention Response Preparedness Recovery

4. WHAT IS A PANDEMIC?AN EPIDEMIC IS A DISEASE THAT OCCURS WITH GREATER FREQUENCY THAN EXPECTED A PANDEMIC IS AN EPIDEMIC THAT SPREADS ALL OVER THE WORLD, OR A MAJOR REGION OF THE WORLD (E.G., A CONTINENT)EPIDEMICS AND PANDEMICS EPI = UPON; DEMIC = "THE PEOPLE"PAN = "ALL OVER"; DEMIC = "THE PEOPLE"WELL-KNOWN PANDEMICS INCLUDE AIDS, TB, MALARIA (IN ALL TROPICAL REGIONS) AND THE "BLACK DEATH" OF THE 14TH CENTURY (BUBONIC/PNEUMONIC PLAGUE)

5. PANDEMICS OF INFLUENZAINFLUENZA PANDEMICS OCCUR PERIODICALLY WHEN A NEW INFLUENZA VIRUS APPEARS; THEY ARE ALWAYS UNPREDICTABLEOVER THE PAST 300 YEARS, THERE HAVE BEEN 11 INFLUENZA PANDEMICS OCCURING AT INTERVALS OF AS LITTLE AS 8 AND AS MANY AS 65 YEARSPANDEMIC VIRUSES APPEAR, CAUSE PANDEMICS, AND THEN KEEP REAPPEARING TO CAUSE ANNUAL MILDER WINTER EPIDEMICSTHE LAST 4 INFLUENZA PANDEMICS WERE IN 1889, 1918, 1957 AND 1968THE 1918 PANDEMIC WAS THE MOST FATAL EVENT IN HUMAN HISTORY, KILLING AN ESTIMATED 50-100 MILLION PEOPLETHE 1918 INFLUENZA VIRUS CAME BACK ANNUALLY UNTIL 1957, WHEN IT WAS REPLACED BY AN OFFSPRING VIRUS THAT HAD "PICKED UP" NEW BIRD INFLUENZA GENES; THE 1968 PANDEMIC WAS CAUSED BY A FURTHER DESCENDANT OF THE 1957 VIRUS

6. MOST FATAL EVENTIN HUMAN HISTORYWORLDWIDE FATALITIES:50-100 MILLION US FATALITIES:675,000 U.S. LIFE EXPECTANCY AT BIRTH

8. ILLUSTRATION BY W. THORNTON SHIELLS, MOH, GREAT BRITAIN, 1919 "HELIOTROPE CYANOSIS", PRECEDING DEATH

9. 1918 influenza lung pathology (Case 2): Primary influenza pneumonia with acute massive pulmonary edema and bronchopneumonia A/New York/1/18 SLIDE COURTESY OF JK TAUBENBERGER, AFIP

12. WHAT IS "BIRD FLU"?"BIRD FLU" IS A SLANG TERM FOR AVIAN INFLUENZAIT IS NOT A GOOD TERM BECAUSE:1) THERE IS NO SUCH DISEASE AS "FLU", A COLLOQUIAL TERM FOR A VARIETY OF DIFFERENT STOMACH AND RESPIRATORY UPSETS2) ALL HUMAN INFLUENZA A VIRUSES ARE DESCENDANTS OF AVIAN INFLUENZA VIRUSES, BUT DIFFER FROM THEM IN HAVING LEARNED THE TRICK OF JUMPING INTO HUMANS3) ALL AVIAN INFLUENZA VIRUSES ARE ADAPTED TO THEIR HOSTS - WILD WATERFOWL (DUCKS AND GEESE), AND DO NOT HARM THEMH5N1 IS ONE OF MANY TYPES OF AVIAN INFLUENZA (E.G., H7N7, H5N2) BUT IS OF INTEREST BECAUSE IT HAS BEEN SPREADING RAPIDLY AND KILLING CHICKENS. SOME EXPERTS FEAR IT WILL TURN INTO A PANDEMIC BY JUMPING FROM CHICKENS TO HUMANS. BUT OTHER EXPERTS DOUBT THIS WILL HAPPEN.

13. HOW DO AVIAN VIRUSES OF DUCKS & GEESE BECOME HUMANIZED?

14. Sequence analysis predicted the importance of the change at residues 190 & 225 for human adaptation • The 1918 HA receptor-binding site shows that the Glu190Asp mutation leads to a slight increase in the pocket size that increases affinity for a(2,6) linkages • This has been tested experimentally SLIDE COURTESY OF JK TAUBENBERGER, AFIP

15. UPDATE

17. HUMAN H5N1 CASES ( ) & DEATHS ( ) CUMULATIVE , GLOBAL TOTAL, WHO-CONFIRMED

18. WHAT IS THE CURRENT STATE OF KNOWLEDGEABOUT AVIAN INFLUENZA? ● EVOLVING "STORY", CHANGES DAILY ● NO PRECEDENT FOR THIS ● HOW INFLUENZA SWITCHES TO HUMANS IS COMPLETELY UNKNOWN ● THE EXPERTS ARE UNSURE AND DO NOT AGREE ON KEY POINTS ● NO GOOD DATA ON WHAT WILL WORK TO PREVENT OR MITIGATE A PANDEMIC

23. SCHOOLS FACE TOUGH PANDEMIC QUESTIONS

24. SCHOOL PANDEMIC PLANNINGTHINGS TO THINK ABOUT▶THE ROLES OF SCHOOLS IN THE COMMUNITY▶COMMUNICATING WITH PUBLIC HEALTH AND GOVERNMENT OFFICIALS▶UPDATING SCHOOL CRISIS PLANS▶LEARNING ABOUT PREVENTING INFECTIONS▶EDUCATING PARENTS, KIDS, STAFF▶INFORMING/COUNTERING DISINFORMATION▶MAINTAINING THE LEARNING ENVIRONMENT

25. PANDEMIC PLANNINGSTATEWIDEFEDERAL LOCAL

26. FRAMEWORK FOR PANDEMIC PLANNING▶LOCAL SCHOOL/DISTRICT & COMMUNITY CRISIS PLANNING▶STATE PANDEMIC PLANNING ACTIVITIES▶FEDERAL PLANNING AND GUIDANCEDepartment of Homeland SecurityDepartment of Health & Human ServicesDepartment of Educationmany other federal agencies▶Planning must be broad/interactive/cross-cutting:government executive, civil agencies, health departments, medical providers, businesses, schools, private/voluntary/faith based organizations

30. BEFORE THE PANDEMICMITIGATION & PREVENTION►Liaison with state/local health officials►Roles/responsibilities of staff►Roles of school nurses & school physicians►Assign key roles►Review health needs of students►Improve health activities

31. BEFORE THE PANDEMICPANDEMIC PREPAREDNESS►Update crisis plans►Educating staff, students & parents►Procedures to Account for Students/Staff►Crisis Communication/Authority Delegation

32. DURING THE PANDEMICPANDEMIC RESPONSE►Maintaining operations & the learning environment►Triage of ill students; Isolation►Hygiene, sanitation/disinfection, good health practices►Disease prevention (masks, hand washing)►Communications & countering misinformation►School closure►Role of schools in disseminating community informationUse of schools as clinics, hospitals, morgues, vaccination sites or vaccine storage sites►Dealing with fears, losses

33. AFTER THE PANDEMICPANDEMIC RECOVERY► Allocate time for recovery► Involve kids & parents► Counseling► Debriefings/lessons learned► Plan anniversaries► Facility remediation

34. ACKNOWLEDGEMENTSTHANKS TO THE MANY WONDERFUL FOLKS AT THE US DEPARTMENT OF EDUCATION, INCLUDING BILL MODZELESKI, DANA CARR, DEBBIE PRICE, CAMILLE WELLBORN, AND A CAST OF (LITERALLY) THOUSANDS...

35. HOMEWORK ASSIGNMENT IDENTIFY AND CALL YOUR KEY LOCAL PUBLIC HEALTH OFFICIAL

36. END OF TALK

37. UNUSUAL FEATURES OF THE1918 INFLUENZA PANDEMIC ◙3 successive waves within ∼ 9 months ◙ Unexpectedly high mortality at all ages ◙Paradoxical mortality: low in wave 1, high in waves 2 & 3 ↑in young/healthy, ↓in elderly ◙ Severe bronchopneumonia; cyanotic collapse ◙Caused by a novel H1N1 virus

38. Q5: WHAT KILLED INFLUENZA VICTIMS?

39. U. S. Army training camp and other military outbreaks were deadly but well studied medically/epidemiologically

40. SCHOOL HOUSES WERE TURNED INTO TEMPORARY HOSPITALS DURING THE 1918 INFLUENZA PANDEMIC

41. SCHOOL CLASS, 1918

44. EXTENSIVE PUBLIC HEALTH EXPERIENCE WITH TB CONTROL HEAVILY INFLUENCED INFLUENZA PREVENTION EFFORTS IN THE U. S.

47. INDOOR CHURCH SERVICES WERE BANNED BY HEALTH DEPARTMENTS