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Preparing for a Influenza Pandemic in Utah

Preparing for a Influenza Pandemic in Utah. Robert T. Rolfs, MD, MPH Utah Department of Health December 4, 2006. About Influenza. Viral illness - Influenza A, B, C Abrupt onset fever, chills, muscle aches, headache, followed by cough, sore throat, nasal congestion

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Preparing for a Influenza Pandemic in Utah

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  1. Preparing for a Influenza Pandemic in Utah Robert T. Rolfs, MD, MPH Utah Department of Health December 4, 2006

  2. About Influenza • Viral illness - Influenza A, B, C • Abrupt onset fever, chills, muscle aches, headache, followed by cough, sore throat, nasal congestion • 5-6 days restricted activity, 3 days lost from school or work • Transmission – person to person • Respiratory droplets, contaminated hands/surfaces, aerosol • Infectious – 1 day before to 5 days after illness onset • Short time from infection to transmission leads to rapid spread in community

  3. Spread of an Infectious DiseaseGeneration Time SARS - Generation time = 8-10 days Influenza - Generation time = 2-4 days Days

  4. What is Seasonal Influenza? • “Annual” seasonal epidemics • Attack rates average 5-20% • 20-40,000 deaths in U.S. annually • Greatest effect on very young and older adults • Result of antigenic “drift” • Ongoing changes of influenza viruses that allow people to be infected more than once

  5. Percentage of Visits for Influenza-like illness (ILI) Reported by Sentinel ProvidersUtah 2003-4, 2004-5 and 2005-06 seasons

  6. Influenza-associated Hospitalizations Utah 2005-2006* • Date as of March 1, 2006

  7. Student Absenteeism Rates2005-2006 Influenza Season

  8. Avian Influenza • Many varieties of influenza occur in birds • Primarily affects wild aquatic birds • Serious illness is unusual in wild birds • Illness more severe in domestic poultry, classified based on severity • Most avian influenza viruses don’t infect humans • Highly pathogenic avian influenza is not found in Utah at this time

  9. What is an Influenza Pandemic? • Global outbreak of influenza • Appearance of new type of influenza A virus to which people have no immunity • Can cause serious illness and spread rapidly from person to person worldwide. • Past pandemics have caused high levels of illness, death, social disruption and economic loss.

  10. Influenza Pandemics in the 20th Century

  11. Influenza pandemics – death rates by age

  12. 1918 Influenza PandemicDeath rates - United Kingdom, 1918-19 Tauberberger JK, Morens DM. 1918 Influenza: the Mother of All Pandemics. EID 206;12(1). http://www.cdc.gov/ncidod/eid/vol12no01/05-0979.htm#Figure1

  13. Iowa State gymnasium, converted into hospital, 1918 flu epidemic

  14. Spread of H2N2 in 1957

  15. 1968 Pandemic – peak by state Sharrar RG. National influenza experience in the US, 1968-1969. Bull. WHO 1969;41:361-66.

  16. Avian Influenza H5N1 • 1997 – Hong Kong outbreak • 18 persons hospitalized & 6 deaths • Live bird markets, controlled by destruction of poultry (>1.5 million) • 2003 Re-emerged in China, Vietnam, Thailand, Korea • Poultry outbreaks and human cases • 2005 – 2006 • Ongoing poultry outbreaks & human infections • 1st human-to-human transmission • Wild birds, other mammals found infected • Spread to Eurasia, Africa, and Europe

  17. Avian Influenza (H5N1) Human disease 2003-2006 • Human cases – 258 cases with 154 deaths • > 50% case fatality rate • How people get it • Direct contact with poultry • Very limited person-to-person spread • Effective person-to-person spread is not occurring at this time Human cases are from Dec. 26, 2003 through November 29, 2006

  18. Avian Influenza H5N1Human Cases – 2003-2006 * * Human cases through October 16, 2006

  19. Nations With Confirmed Cases H5N1 Avian Influenza(July 7, 2006) www.pandemicflu.gov (accessed October 22, 2006)

  20. Avian Influenza (H5N1) 2006 • Unprecedented animal epidemic • Poultry or wild bird outbreaks in > 53 nations in Asia, Africa, Europe • Unlike most avian influenza, it has infected people causing severe illness • Have conditions been met for a pandemic? • Novel antigens – no human immunity - Yes • Serious human infection – Yes • Effective person-to-person spread – Not yet • Will it cause a pandemic? We don’t know

  21. Another pandemic will occur someday

  22. Pandemic Influenza ImpactUtah Projections Projections are based on the U.S. estimates included in the HHS Pandemic Influenza Plan, and based on Utah 2005 population estimate (2,529,000); these estimates don’t account for age differences in populations

  23. Pandemic Influenza ProjectionsUtah – Moderate (1957/68-like) At peak – 150 admissions per day

  24. Pandemic Influenza ProjectionsUtah – Severe (1918-like) At peak – 1700 admissions per day

  25. Pandemic InfluenzaExamples of Community Impact • High absenteeism rates at work/school (20-40%) • Possible school closures • Event cancellations – concerts, meetings, conventions • Travel restrictions and decreased tourism • Economic and business impact • Shortages of supplies • Difficulty keeping police & firemen, doctors, nurses, and other critical service providers working • Hospitals full – delayed care for routine or even urgent illnesses

  26. Pandemic InfluenzaStrengthening Public Health Capacity • All Hazards Disaster Planning • Epidemiology & Disease Surveillance • Laboratory Testing & Response • Information & Communication Systems • Effective Risk Communication • Training & Exercises • Hospital Preparedness

  27. Pandemic Influenza PlanningSome planning assumptions • Simultaneous outbreaks across Utah and U.S. • Limited ability to share resources across jurisdictions • In a given community, the epidemic will last 6-8 weeks • No vaccine for first 6-8 months and shortages after that • Shortages of antiviral medications and probably of antibiotics and other medical supplies • Illness rates and absenteeism of 25% or more • Need for care may exceed capacity of health care system

  28. Pandemic Influenza Plan • Utah Pandemic Influenza Plan – a roadmap • Identified what public health needs to do • Pandemic influenza workgroup • Local health department planning • Identified issues requiring broader input and help to address • Governor’s Taskforce • Too big for (any) government alone • Local governments, faith-based & community organizations, businesses, families, individuals

  29. Pandemic Influenza Preparedness • Communications and coordination • Public/risk communications • Agency/partner coordination and communication • Health care surge capacity • Antiviral medication stockpile • Vaccine planning • Maintaining essential services • Supporting vulnerable populations & essential responders

  30. Pandemic Influenza PreparednessCommunity Mitigation • Home isolation • Family quarantine • School closure • Cancellation of mass gatherings • Social distancing and respiratory hygiene

  31. Pandemic Preparedness in Schools • Planning • Maintaining core operations during pandemic • Communication • public health and other agencies/partners • students and parents • Infection control policies, procedures, supplies • Keeping school safe, reducing spread of influenza • Continuity of student learning & operations • School closure planning

  32. Pandemic and Avian InfluenzaAdditional information Utah: http://www.pandemicflu.utah.gov HHS: http://www.pandemicflu.gov John M. Barry The Great Influenza: The Epic Story of the Deadliest Plague In History Neustadt R, Fineberg H. The Epidemic that Never Was: Policy-making and the Swine Flu Affair

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