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Pandemic Influenza and Schools: Preparing to Respond

Pandemic Influenza and Schools: Preparing to Respond. Learning Objectives. Understand the history and current status of avian influenza and the potential for pandemic influenza Describe the issues and efforts surrounding preparations for pandemic influenza

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Pandemic Influenza and Schools: Preparing to Respond

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  1. Pandemic Influenzaand Schools: Preparing to Respond

  2. Learning Objectives • Understand the history and current status of avian influenza and the potential for pandemic influenza • Describe the issues and efforts surrounding preparations for pandemic influenza • Identify components to be included in your district's crisis management and/or pandemic influenza plan • Describe steps districts can take to develop their pandemic influenza plan

  3. Outline • Background • Planning for Pandemic Influenza • How Can Schools Prepare? • Developing Your Plan • Questions and Discussion • Evaluation

  4. Background

  5. Influenza-Speak • Seasonal flu • Avian flu • Pandemic flu What do they mean? How are they different?

  6. Seasonal Flu • Illness in humans caused every year by influenza viruses • e.g. H1N1, H1N2, H3N2 influenza A viruses, influenza B viruses • 5%-20% of the U.S. population gets the flu every year • Estimated 36,000 annual deaths in U.S. Adapted from CDC Influenza (Flu) Key Facts

  7. Seasonal Flu • Spread by respiratory droplets (coughing and sneezing) • Usually person-to-person: can infect others from 1 day before getting sick to 5 days after becoming sick • Sometimes from touching infected surfaces • Vaccine offers effective protection • Vaccines are developed to match the viral strains expected to circulate each year Adapted from CDC Influenza (Flu) Key Facts

  8. Avian (Bird) Flu • Illness in birds caused by avian influenza viruses • Low pathogenic types • Highly pathogenic types (e.g. H5N1) • Illness in humans caused by avian influenza viruses • Spread by direct or close contact with infected poultry or contaminated surfaces • No vaccine currently commercially available Adapted from CDC Influenza (Flu) Key Facts

  9. Pandemic Flu • Increased and sustained transmission of influenza in the general population • Generally caused by a “new” influenza virus to which few, if any, people have immunity • New viruses result from new combinations on viral proteins: i.e. a major change in influenza A virus (“antigenic shift”) • Results in viruses that can spread easily from person to person and can cause serious illness due to low levels of immunity in a population

  10. Pandemics in the Past 100 Years • 1918-1919: H1N1 influenza A virus • 500,000 U.S. deaths • 20-50 million worldwide deaths • H1N1 still in circulation today • 1957-58: H2N2 influenza A virus • 70,000 U.S. deaths • 1968-1969: H3N2 • 32,000 U.S. deaths • H3N2 still in circulation today Adapted from CDC Influenza (Flu) Key Facts

  11. WHO Pandemic Phases Inter-Pandemic Period • Phase 1: No new influenza virus subtypes have been detected in humans. An influenza virus subtype that has caused human infection may be present in animals. If present in humans, the risk of human infection or disease is considered low • Phase 2: No new influenza virus subtypes have been detected in humans. However, a circulating animal influenza virus subtype poses a substantial risk of human disease

  12. WHO Pandemic Phases Pandemic Alert Period • Phase 3: Human infection(s) with a new subtype, but no human-to-human spread, or at most rare instances of spread to a close contact • Phase 4: Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans

  13. WHO Pandemic Phases Pandemic Alert Period • Phase 5: Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans, but may not yet be fully transmissible (substantial pandemic risk) Pandemic Period • Phase 6: Pandemic occurring – increased and sustained transmission in the general population

  14. Current Status • Through February 2007, there have been 273 laboratory-confirmed cases of avian influenza A/H5N1 among humans reported to WHO • 167 deaths • 11 countries – far and middle east, Indonesia, northern Africa • Avian influenza A/H5N1 has been confirmed in poultry and/or wild birds in these areas as well as India, Russia and Europe

  15. Planning for Pandemic Influenza

  16. Planning Goals • Prevent/minimize morbidity and mortality • Limit disease spread • Mitigate disease, suffering and death • Minimize social disruption • Minimize economic effects

  17. Reducing Morbidity and Mortality • Primary strategies for combating pandemic flu • Vaccination • Antiviral medications • Community control measures

  18. Primary Strategies - Vaccination • Vaccination would be the single most effective intervention, BUT: • Unlikely that a well-matched vaccine will be available when a pandemic begins • Current technology would require 4-6 months for vaccine development after the pandemic begins • Once developed, production capacity would limit availability

  19. Primary Strategies - Antivirals • Antivirals could be used for both treatment and prophylaxis, BUT: • Effectiveness of current antivirals against a future pandemic strain is unknown • Quantities are limited

  20. Primary Strategies – Community Control Measures • Two approaches: • Decrease the probability that contact will result in infection • Cough etiquette, hand hygiene, infection control • Decrease contact between infected and uninfected individuals • Isolation, quarantine, travel advisories, cancellation of mass gatherings, social distancing, school closures

  21. Primary Strategies – Community Control Measures • These “nonpharmaceutical interventions” will • Help buy time for production and distribution of vaccine • Reduce the total number of cases, thus reducing community morbidity and mortality

  22. Pandemic outbreak: no intervention Daily cases Pandemic outbreak: With intervention Days since first case Primary Strategies – Community Control Measures CDC, 2007

  23. Primary Strategies – Community Control Measures Collins SD, Frost WH, Gover M, Sydenstricker E: Mortality from influenza and pneumonia in the 50 largest cities of the United States First Edition Washington: U.S. Government Printing Office 1930.

  24. Primary Strategies: Community Control Measures Mayor closes “theaters, moving picture shows, schools, pool and billiard halls, Sunday schools, cabarets, lodges, societies, public funerals, open air meetings, dance halls and conventions until further notice” Closing order withdrawn Levins, H. What he knew in 1918 could save millions of lives. St. Louis Post-Dispatch Jul. 08 2006.

  25. Primary Strategies – Community Control Measures • Mathematical modeling has shown that closing schools at the outset of a pandemic could decrease attack rates in a community by about 33% • Compared to the attack rate when not implementing any control measures • School closures would likely occur in concert with other control measures National Academy of Sciences, 2006

  26. Recommendations for closing schools will depend upon the severity of the pandemic. For example: Category 1 – no closure Category 2 & 3 – short-term closure (~4 weeks) Category 4 & 5 – longer-term closure (~12 weeks) Primary Strategies – Community Control Measures CDC, 2007

  27. Who will implement these strategies?

  28. Public Health Officials • Federal, state and local public health agencies maintain the lead role in preparing for and responding to pandemic influenza • Examples • Federal – Centers for Disease Control and Prevention (CDC) • State – Texas Department of State Health Services (TDSHS) • Local – Harris County Public Health & Environmental Services (HCPHES)

  29. Public Health’s Authority • Chapter 81 of the Texas Health and Safety Code establishes the role of the health authority, a physician appointed to administer laws related to public health within their jurisdiction • Including laws related to community control measures • Such measures include isolation, quarantine, immunization, detention, restriction, disinfection, decontamination, disinfestation, chemoprophylaxis, preventive therapy, prevention and education

  30. Public Health’s Authority • The authority to compel disease control measures is derived from the state’s inherent “police powers” • Police powers refer to the authority of a state government to enact laws and promote regulations to safeguard the health, safety and welfare of its citizens

  31. Public Health’s Authority • There are 172 local health authorities in Texas, many affiliated with local health departments • Areas without local health authorities are “covered” by TDSHS regional health authorities • Contact TDSHS Division of Regional and Local Services to determine your local health authority: • 1-800-248-7770 • feedbackophp@dshs.state.tx.us

  32. Public Health and Pandemic Planning

  33. Roles and Responsibilities • Federal Agencies (CDC, etc.) • Supporting the establishment of stockpiles of vaccines and antivirals • Facilitating (and funding) state and local planning • Providing guidance to the private sector • Overall domestic incident management • TDSHS • Developing and exercising preparedness and response plans • Managing federal pandemic preparedness grant funding to local agencies • Maintaining state-purchased stockpiles of medications

  34. Roles and Responsibilities • Local Health Departments • Developing and exercising preparedness and response plans • Integrating non-health entities in pandemic planning • Providing education to the public and other key stakeholders on pandemic influenza • Monitoring local disease status • Providing local incident management • In Texas, decision-making regarding pandemic influenza will be made at the local level

  35. HCPHES Pandemic Flu Plan • The HCPHES Pandemic Influenza and Highly Infectious Respiratory Diseases Plancan be accessed at www.hcphes.org. Contents: • Assumptions • Roles and Responsibilities • Command and Control • Surveillance • Prevention and Containment • Emergency Response • Communicating with the Public

  36. HCPHES Plan - Assumptions • 30% of population may become ill • 1,093,286 persons ill in Harris County • 15% of population will seek outpatient care • 546,643 persons in outpatient settings • 0.3 to 3% of population will be hospitalized • 10,933 - 109,328 persons hospitalized • 0.07 to 0.64% of population may die • 2,551 - 23,323 deaths

  37. HCPHES Plan - Assumptions • The duration of illness for an uncomplicated case of influenza is five days • Medical care services may be severely taxed or overwhelmed • Illness rates may be up to 40% among school-aged children and 20% among working adults • 30% or more of the workforce may be out of work due to illness at the peak of a major pandemic influenza wave. • This includes work loss while caring for oneself or for ill family members

  38. HCPHES Plan - Surveillance • In addition to conducting year-round monitoring of influenza in the health-care sector, HCPHES collaborates with area schools to track reports of influenza-like illness among students • Participating schools submit weekly reports of influenza-like illness activity to HCPHES via fax • Other health departments in Texas conduct similar surveillance

  39. HCPHES Plan – Prevention/Containment • Discusses local plans for the three strategies of pandemic prevention and containment: • Vaccines • Antivirals • Community Control Measures

  40. HCPHES Plan – Vaccines and Antivirals • HCPHES will coordinate decision-making regarding vaccine and antiviral allocation • Once vaccines are available, HCPHES will implement its Mass Vaccination Plan to provide flu vaccine to the public • Once antivirals are widely available, HCPHES will implement its Mass Dispensing Plan to provide public sector distribution of antivirals

  41. HCPHES Plan – Community Control Measures • As the local health authority, HCPHES will develop and enact control measures within its jurisdiction. Examples: • Isolation and quarantine • Social distancing • Cancelling mass gatherings • Closing schools • The types of measures implemented will depend upon the location of cases, size of clusters, availability of vaccine, pandemic severity, etc. • Measures will be undertaken in coordination with other local, state and federal officials

  42. What’s Your Plan? • Contact your local health department, local health authority or TDSHS to learn about pandemic planning in your area • Contact TDSHS Division of Regional and Local Services to determine your local health department: • 1-800-248-7770 • feedbackophp@dshs.state.tx.us

  43. How Can Schools Prepare?

  44. School Planning • Schools face several unique challenges: • Planning assumptions estimate that in the absence of intervention, illness rates would be highest among school-aged children (~40%) • Children may be more likely to spread influenza than adults • Unlike many sectors, schools must focus upon protecting their workforce AND their students • Schools must address continuity of instruction

  45. School Planning • Every Independent School District (or the equivalent) should ensure plans to protect the health and safety of their staff and students during a pandemic • Plans should build upon existing Emergency Operations Plans (EOPs)

  46. School Planning • The U.S. Department of Education’s Practical Information on Crisis Planning: A Guide for Schools and Communities is a useful tool for developing and enhancing EOPs • www.ed.gov/emergencyplan

  47. School Planning • Four domains must be considered when developing plans to prepare for and respond to pandemic influenza: • Planning and Coordination • Infection Control Policies and Procedures • Continuity of Core Operations and Student Instruction • Communications

  48. 1. Planning and Coordination • Planning and coordination refers to: • Determining who is responsible for making decisions related to the response to a pandemic • Carrying out activities before, during and after a pandemic • Developing and maintaining the response plan

  49. 1. Planning and Coordination • Key activities: • Identify the authorities responsible for executing community response plans and activities, including case identification, isolation, quarantine and community control measures • On Page 1 of its Pandemic Influenza Plan, Tomball ISD describes the role of HCPHES, references the HCPHES pandemic influenza plan and lists HCPHES contact information

  50. 1. Planning and Coordination • Key activities: • Identify the authority responsible for activating the district’s pandemic influenza plan • Provide the contact information for this person(s) to the public health authority so that information regarding community control measures can be communicated efficiently

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