Influenza: Facing New Global Challenges Howard Steinberg, Health Officer

1. Influenza: Facing New Global Challenges Howard Steinberg, Health Officer Morris County Office of Health Management

2. Overview • Interim Pandemic Planning • Seasonal, Avian and Pan Flu • Infection Control • Surveillance • Planning • Public Information

6. Community Mitigation Strategy by Pandemic Severity

9. Seasonal Flu Influenza Pandemic Avian Influenza

10. Characteristics of Seasonal Influenza • Occurs annually – October through April • More than 36,000 deaths and 200,000 hospitalizations annually in US • Elderly, immunocompromised and young children most vulnerable • Largely preventable through vaccine

11. Influenza Viruses • Three types (A,B,C) • Type A • Can infect humans and a variety of animals (birds, pigs, horses) • Wild birds are the natural reservoir • Divided into subtypes (HA and NA) • Greatest risk for epidemic/pandemic

12. Influenza Viruses • Type B • Humans – only known reservoir • Not classified into subtypes • Can cause epidemics but not pandemics • Type C • Humans and swine– known reservoirs • Mild illness in humans without seasonality • Not classified into subtypes • Does not cause epidemics/pandemics

13. Influenza A H # N # 1-9 1-16

14. Antigenic Shift and Drift Shift (Type A only) Major changes new subtype Exchange of gene segments May cause pandemic Example: H3N2 replaced H2N2 in 1968 Occurs infrequently Drift (Types A and B) Minor change, within subtype Gradual accumulation of amino acid changes in HA and/or NA May cause epidemic Example: drifted A/H3N2/Fujian circulated A/H3N2/Panama (vaccine strain 2003/4) Occurs continuously Cox NJ, Subbarao K. Lancet 1999;354:1277-82.

15. Characteristics of Avian Flu • Bird flu (H5N1) • Migratory waterfowl are carriers • Virus passed to domestic poultry flocks

16. Transmission to humans • Person-to-person transmission not confirmed • High death rate

18. Characteristics of Pandemic Influenza • Needs to meet 3 criteria • New strain of virus • Ability to cause serious disease and death in humans • Easy person-to-person spread

19. Pandemic Impact

20. Pandemics • 1918 Spanish Flu H1N1 500,000 US • 1957 Asian Flu H2N2 70,000 US • 1968 Hong Kong H3N2 34,000 US

21. Challenges • Health Care • Social • Personal

22. Health Care Challenges • Don’t know which people the virus will affect the most • Vaccines will not be available in the early stages of pandemic • Health care workforce will be sick along with everyone else • Health care system will be overwhelmed

23. Societal Challenges • Maintaining essential community services and business • Distributing limited amounts of medications and vaccines • Maintaining civil order

24. Personal Challenges • Protecting self and family • Attending school/work • Obtaining goods, services and necessities • Maintaining daily life activities • Obtaining medical care • Traveling • Obtaining reliable information

26. Pandemic Influenza Preparedness

27. Worldwide Watch • Animal Health • World Organization for Animal Health (OIE) • United Nations Food and Agriculture Organization (UNFAO) • Human Health • World Health Organization (WHO) • Centers for Disease Control & Prevention (CDC)

28. Governmental Preparedness FEDERAL LEVEL: • CDC assisting with monitoring efforts worldwide • Federal strategic plan and pandemic influenza plan developed • CDC recommending that each state develop its own plan

29. Governmental Preparedness STATE LEVEL: • Continually updating and expanding our influenza pandemic plan • Continually developing public information materials • Developing guidelines for NJ hospitals • Regularly updating DHSS website • Exercising plans • Surveillance

30. Governmental Preparedness LOCAL LEVEL: • Pandemic plans part of local emergency preparedness plans • LINCS agencies (county and city based) coordinate local preparedness efforts • NJ Medical Reserve Corps

31. Healthcare System Preparedness • Developing preparedness plans • Enhancing infection control procedures • Stockpiling supplies • Cross training staff • Conducting exercises

32. School Preparedness • Schools Open • Schools Closed

33. What can you do? • Prepare now – “Ready Together NJ” Emergency Pocket Guide: Morris County • Know where to get reliable information as the incident unfolds • Follow instructions provided by governmental public health authorities

34. Infection Control • Measures practiced by healthcare personnel to decrease transmission and acquisition of infectious agents.

35. Background • Each year nearly 22 million school days are lost to the common cold alone. • Research shows that when students practice health habits, they miss fewer days of school.

36. Planning Considerations • Spread will likely be rapid and unpredictable • Each wave of the virus may last 6-8 weeks each • 40% of all children will be sick

37. What can you do to prevent the spread of influenza? • Cover your mouth and nose when you cough or sneeze • Avoid touching your face • Stay home if you are sick • Wash your hands frequently

38. Wash Your Hands! • Use warm water and soap • Rub hands vigorously for 20 seconds • Wash palms, backs, wrists, under fingernails and between fingers • Rinse off all soap • Dry hands with paper towel • Use the paper towel to turn off the faucet • Use the paper towel to open the bathroom door

39. When should I wash my hands? • When visibly soiled • When contaminated with blood or bodily fluids • After removing gloves

40. When should I wash, continued • Before eating • Before feeding others • Prior to handling food • After personal functions such as using the bathroom or blowing your nose

41. When to use antibacterial gels • When hand hygiene is required and hands are not visibly soiled • Between contacts with students • After touching objects that have been in contact with sick people • When you can’t wash your hands with soap and water

42. Use of antibacterial gels • Apply to palm of one hand • Rub hands together making sure to cover all surfaces of hands and fingers • Rub until hands are dry

43. Germs Are Everywhere • Age appropriate discussion of germs • Invisible • Present even though not seen

45. Investigative Questions • How can disrupting the environmental conditions stop the spread of infectious disease? • How can thorough hand washing limit the spread of infectious diseases?

46. Investigative Questions • Are plans in place to send sick children home safely? • What will be done if parents send sick children to school? • How will you monitor how many children are sick? • Is there a policy to isolate sick children?

47. Implications for Schools • Children expected to have high rates of infection • Schools may face closures or release of students • Schools may be used as emergency facilities

48. Policy and Logistical Challenges • School feeding • Continuation of learning • Need for comprehensive approach

49. Start Planning Now…Preparedness • Evaluate supply policies and order supplies if needed (tissues, soap, antibacterial hand gel) • Train teachers and staff on the risks and implications of a pandemic

50. Preparedness, Continued • Create a surveillance system to help track student and staff absences • Consider different mechanisms for delivering educational content if schools are closed for extended periods of time • Test your plans and conduct tabletop exercises