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Pandemic Influenza Avian Influenza

Pandemic Influenza Avian Influenza. Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M.D., M.P.H. Pandemic Influenza & Avian Influenza 101 Preparedness Efforts College and University Preparedness.

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Pandemic Influenza Avian Influenza

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  1. Pandemic InfluenzaAvian Influenza Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M.D., M.P.H.

  2. Pandemic Influenza &Avian Influenza 101 • Preparedness Efforts • College and University Preparedness

  3. 1. Pandemic Influenza & Avian Influenza 101

  4. Influenza • Seasonal influenza • Avian influenza • Pandemic influenza

  5. Seasonal Influenza • October – April • Influenza Type A • H3N2, H1N1 • Influenza Type B • Vaccine

  6. Avian Influenza (Bird Flu) • Influenza A • Domestic poultry – can be deadly • High vs. low pathogenic • Wild birds – carriers • Virus in fecal droppings, saliva/nasal discharge

  7. Recent Avian Influenza Outbreaks Affecting Humans • 1997 H5N1 Hong Kong • 1999 H9N2 Hong Kong • 2003 H7N7 Netherlands • 2004 H7N3 Canada • 2004 H5N1 Southeast Asia

  8. Pandemic Influenza • Global outbreak • Highly contagious • Deadly

  9. Recent Pandemics • 1918 Spanish flu (H1N1) • 5,000 deaths in Maine • 500,00 in U.S. • 40,000,000 worldwide • 1957 Asian flu (H2N2) • 70,000 deaths in U.S. • 1-2,000,000 worldwide • 1968 Hong Kong flu (H3N2) • 34,000 deaths in U.S. • 700,000 worldwide

  10. Past Pandemic InfluenzaEstimates for Maine

  11. H5N1 • Detected in Asia since 1997 • Deadly – 50% mortality in humans • Transmitted birds to mammals and limited human to human • Evolving quickly

  12. H5N1 activity as of May 19, 2006 • 217 human cases • In 58 countries • 123 deaths • Mortality rate = 57%

  13. Human Infections and Human Deaths by H5N1 by Month, May 19, 2006 Source: World Health Organization Chart created by the Office of Public Health Emergency Preparedness

  14. 2. Preparedness Efforts • Avian Influenza Preparedness • Pandemic Influenza Preparedness

  15. A. Avian Influenza Preparedness

  16. Detection Testing in: • Migratory birds • Poultry industry

  17. Preparedness Planning • Poultry workers • Backyard flock owners • Others – bird lovers, hunters

  18. General Public • Food safety • Bird handling

  19. B. Pandemic Influenza Preparedness • “Pan Flu”

  20. Significant Issues forPan Flu Planning • Mass Casualty Management • Vaccines Antivirals • Detection and Tracking • Home Care • Hospital Care • Food and Other Support • Transportation of the Critically Ill • Self –Support • Basic Services and Economic Impact • Communication • Quarantine and Isolation

  21. Pandemic Assumptions • Attack rate of 25%-35% • Duration of up to year or more in 2 waves • Each wave lasting 6-8 weeks in community • Healthcare system will be severely taxed if not overwhelmed

  22. Social Disruption fromPandemic Influenza • Absenteeism in essential sectors • Health, law enforcement, food and fuel supplies, education • Economic impact • Psychological stress

  23. 2006 vs 1918 Advantages in 1918 • Smaller population • Less travel • More self-reliance Advantages in 2006 • Healthier population • Better medical care • Preparedness

  24. Federal Preparedness

  25. www.pandemicflu.gov

  26. Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Antiviral Drugs Community Disease Control Travel-Related Risks of Disease Communications Workforce Support Components of Federal Plan

  27. Vaccine Antivirals Community Disease Control Selected Components

  28. Vaccines

  29. Assumptions for Vaccination • Two doses will be required • Vaccine will not be available for 3-6 months after start of pandemic • Production will be 3-5 million doses (15 µg)per week

  30. Vaccine Priority Groups • Vaccine and antiviral manufacturers • Health care providers • Persons >65 with >1 high risk conditions • Persons 6 mo to 64 yr with >2 conditions • Persons >6 months with history of hospitalization for pneumonia or influenza • Pregnant women • Household contacts of immunocompromised persons and children <6 months • Public health emergency response workers • Key government leaders

  31. Vaccine Priority Groups (cont) • Healthy people >65 • 6 months to 64 years with 1 high risk condition • Healthy 6-23 months old • Other public health emergency workers • Public safety workers • Utility workers • Transportation workers • Telecommunications workers • Government health decision-makers • Funeral directors • Healthy persons 2-64 years not included above (180 million)

  32. Recommendations for Vaccine and Antivirals may be modified based on: • Virulence • Transmissibility • Drug resistance • Geographic spread • Age-specific attack rates • Morbidity and mortality rates

  33. What You Can Do Now • Annual seasonal influenza vaccination • Pneumococcal vaccination

  34. Antivirals

  35. Antivirals • Adamantanes • Amantadine • Rimantadine • Neuraminidase inhibitors • Oseltamivir (Tamiflu) • Zanamivir (Relenza)

  36. Assumptions for Antivirals • Resistance to adamantanes • Neuraminidase inhibitors will be effective in decreasing morbidity and mortality • Expected domestic capacity for oseltamivir is 1.25 million courses per month • Goal is stockpile of 80 million courses • Current stockpile is 5 million courses

  37. Antiviral Priority Groups • Patients admitted to hospital (T) • Health care workers and EMS providers (T) • Immunocompromised persons and pregnant women (T) • Pandemic health responders and government decision makers (T) • Young children 12-23 months old, persons >65 years old, and persons with underlying medical conditions (T) • Outbreak response in nursing homes (PEP) • 7 Health care workers in ED, ICU, dialysis centers and EMS providers (P)

  38. Antiviral Priority Groups (cont) • Pandemic societal responders and health care workers without direct patient contact (T) • Other outpatients (T) • Highest risk outpatients (P) • Other health care workers with direct patient contact (P) Top 7 groups = 40 million courses

  39. Cost of Antiviral Treatment5-Day Course for an Adult • Amantadine $ 9.50 • Rimantadine $16.10 • Oseltamivir (Tamiflu) $72.10 • Zanamivir (Relenza) $61.80

  40. Personal Stockpiles of Antivirals • Supply • Effectiveness • Resistance • Equity • Shelf life

  41. Stockpiles of Antivirals • Institutional • State

  42. Community Disease Control

  43. Challenges to Containment • Short incubation period • Ability of persons with asymptomatic infection to transmit virus • Early symptoms of illness are likely to be non-specific, delaying recognition

  44. Goal of Community Disease Control • To limit or slow spread of pandemic influenza • Social Distancing

  45. Containment Measures for Ill Individuals • Patient isolation • Management of contacts • Contact tracing • Contact monitoring • Quarantine

  46. Containment Measures For Communities • Promotion of community-wide infection control measures • Snow days and self-shielding • Closure of office buildings, shopping buildings, and public transportation • Widespread community containment (cordon sanitaire)

  47. Containment Measures For Groups of Exposed or At-Risk Persons • Quarantine • Containment measures for specific sites or buildings

  48. Unresolved Issues • Role of airborne transmission • Effectiveness of antivirals • Coordination between states and countries

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