Johnson County Public Health

1. Johnson County Public Health Partnership for Emergency Planning January 19, 2006

2. Influenza Overview

3. Description Viral infection that can make people of any age ill Respiratory transmission Symptoms Fever Chills Cough Sore throat Headache Muscle aches Prevention Vaccination Stay home if ill Influenza “The Flu”

4. Influenza: Who, Where, and When? • Nearly everyone susceptible every year • Illnesses, hospitalizations, deaths • Usually older, younger and those with chronic illness • Influenza and complications (pneumonia) • Most of us have some degree of immunity from repeated exposures! • Everywhere • Can’t predict with certainty • Seasonal • Winter

6. Colds and Flu: The Difference • The flu strikes suddenly, colds develop gradually and fever is unusual • Influenza is seasonal (winter), colds are present year round • Flu has generalized symptoms, colds are usually confined to upper respiratory • Only three types of virus cause the flu, more than 200 cause colds

7. Composition of the 2005-2006 Influenza Vaccine • A/California/7/2004 (H3N2) • A/New Caledonia/20/99 (H1N1) • B/Shanghai/361/2002

8. Naming the Influenza Virus A /Fujian /411 /2002 (H3N2) Virus Subtype Virus type Strain Number Year of Isolation Geographic Origin

9. Influenza A • Seen in many animals • Subtyped based on surface glycoproteins: • Hemagglutinins (H) • Neuraminidases (N) • Yearly epidemics • H1, H2, H3 • Mortality varies • Responsible for known pandemics

10. Hemagglutinin Neuraminidase www.omedon.co.uk/influenza/ influenza/

11. Influenza B and C • Influenza B • Humans mostly • Not subtyped • Less mortality than type A • Associated with epidemics, not pandemics • Influenza C • Usually mild disease

12. Antigenic Drift: ‘A & B’ viruses Minor change, same subtype Caused by genetic mutation May result in epidemic Antigenic Shift: ‘A’ Virus Major change, new subtype Caused by change in gene segments (genetic reassortment) May result in pandemic Drift vs. Shift

13. Difference between Epidemic and Pandemic • Epidemic/outbreak: increase in cases in a community clearly greater than what is normally expected. • Pandemic: a global disease outbreak.

14. Annual Flu Impact Nationally • 5%-20% of the population gets the flu • 200,000 hospitalizations • 36,000 deaths

15. Potential Pandemic Impact • Potential impact of pandemic influenza: • Attack rates up to 35% • 89,000 to 207,000 deaths • >25% increased demand for inpatient beds and assisted ventilation • 314,000 – 733,000 hospitalizations • Up to $166 billion in direct medical costs • Significant social and economic disruption www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm

16. Pandemic Influenza • Experts believe that another pandemic is inevitable. • There will be very little warning • Outbreaks will probably occur simultaneously throughout the US. • The effect on individual communities will be prolonged • Healthcare workers will be at increased risk.

17. 20th Century Pandemics

18. Pandemic Influenza

19. Pandemic Risk? • Three conditions must be met: • A new influenza virus subtype emerges; • It infects humans, causing serious illness; • It spreads easily and sustainably among humans

21. http://www.riley.army.mil/OurPost/Maps.asp www.ukans.edu

22. http://hellokansascity.com/images/Liberty%20Memorial%201921.jpghttp://hellokansascity.com/images/Liberty%20Memorial%201921.jpg

23. http://www2.okstate.edu/ww1hist

24. Slide from: http://www.pbs.org/wgbh/amex/influenza/index.html

25. Recognizing Avian Influenza

26. Clinical Features of Avian (H5N1) Influenza • Influenza-like symptoms • Eye infections • Encephalitis, Meningitis • Severe pneumonia or ARDS • Internal bleeding and hemorrhages

27. Avian (H5N1) Influenza • Rapidly mutates • Documented to cause severe disease in birds and humans • Birds that survive infection shed virus in feces for weeks. • Has been passed from animals to humans rarely and Not EASILY.

28. Courtesy of National Geographic October 2005

29. Courtesy of National Geographic October 2005

30. Courtesy of National Geographic October 2005

31. What Must Occur For H5N1 to Increase Transmissibility to Humans? • “Reassortment”: genetic material is exchanged between human & avian viruses during co-infection of a human or pig; • “Mutation” which is a more gradual process.

32. DIRECT Influenza Virus Reassortment (Shift) 16 HAs 9 NAs Non-human virus Human virus Reassortant virus

33. Pandemic Response:Vaccine • Development • Manufacturing • 6 – 8 month minimum for first batch • Technical problems possible • Distribution to state agencies • 5 – 6 more months to produce all vaccine

34. Antivirals • Can reduce seasonal influenza: • Oseltamivir (Tamiflu) • Zanamivir (Relenza) • 2 older drugs: • amantadine • rimantadine

36. Johnson County Public Health Disease Containment

37. Surveillance/Epidemiology • Identify public health threat • Disease Containment (DC) collaborates with Health Officer, state and other appropriate agencies • Determine appropriateness for I or Q • Notify law enforcement/legal whether voluntary or mandated • Information dissemination

38. New Isolation and Quarantine Law Per HB 2264 • The I&Q bill was passed as part of HB 2264 • Signed into law on 4-12-05 • Clarifies the local health officer’s authority to order isolation and quarantine of infected persons or groups • Gives the local health officer the authority to order persons exposed to infectious disease to seek medical evaluation or treatment • Orders law enforcement officials to assist in the execution or enforcement of health officer’s orders

39. Public Health Options • Implement “Snow Day” restrictions • Close schools, daycare centers, etc. • Cancel large public gatherings (concerts, theaters) • Minimize other exposures (markets, churches, travel restrictions) • Ask non-essential workers to stay home • Consider additional measures • Distribution of surgical masks? • Temperature screening in public venues • Scaling back transportation services

40. What You Can Do • Report unusual events/absenteeism • Contact Health Department • Business point of contact?

41. What You Can Do • Educate staff • Develop and practice healthy habits • Be aware of your area…break chain of transmission • Stay home if sick • Family illness

42. Mouse 1,676 Germs per sq. in. Keyboard 3,295 Germs per sq. in. Desktop 20.961 Germs per sq. in.

43. Hands spread germs Germs cause illness Illness cost money 80% of germs are transmitted by hands:

44. Wash Hands • When someone coughs or sneezes…..on you • After shaking someone’s hand • Each time you return to your desk • After you use the restroom • After using the water cooler or coffee pot • Before you eat lunch • After going through your mail • After touching money • Whenever you need a refreshing break, • Before you go home for the day

45. Germiest Workplaces: -phones -desks -computer keyboards -buses -restrooms -day care centers -escalators & elevators

46. Johnson County Public Health Emergency Response

47. Mass Prophylaxis Dispensing (MPD) • Epidemiology and Investigation have determined that there is something going on • They have notified appropriate agencies • Now what? • Is there something we can give? • Medication • Vaccination • Who is going to get these medications/vaccinations? • Those *most* at risk based on Epidemiology and Investigation • Priority Prophylaxis • Those providing support and assistance with Dispensing operations • Critical Infrastructure • Open Site Community Dispensing combined with Closed Site Dispensing • General Public • Dispensing only if deemed necessary

48. New Concept for Closed Site Dispensing of Medications • Health Department would contact the Business Point of Contact (BPOC) and notify them of decision to Dispense • BPOC would receive appropriate forms and health information to distribute to staff • Medications • For Dispensing of pills, BPOC would bring completed forms to designated Open Site • Forms would be processed and BPOC would be provided the medications/prescriptions to take back to workers/families

49. New Concept for Closed Site Vaccination • Health Department would contact the Business Point of Contact (BPOC) and notify them of decision to Dispense • BPOC would receive appropriate forms and health information to distribute to staff • Vaccination • For vaccination, Johnson County would coordinate with the businesses to which sites/when workers/families should bring completed forms to Open Sites

50. Business Interest • If interested, please contact me to set up a meeting/discussion • Process needs individualization and further discussion QUESTIONS?