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Influenza Pandemic Training

Influenza Pandemic Training. Preparing for the Worse. By: Magdy Akladios, PhD, PE, CSP, CPE, CSHM. Introduction. Objectives. What is a Pandemic?. The word "pandemic" is used to describe a disease that affects people on a worldwide scale.

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Influenza Pandemic Training

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  1. Influenza Pandemic Training Preparing for the Worse By: Magdy Akladios, PhD, PE, CSP, CPE, CSHM

  2. Introduction

  3. Objectives

  4. What is a Pandemic? • The word "pandemic" is used to describe a disease that affects people on a worldwide scale. • Flu pandemics have occurred roughly every 20 to 30 years throughout history, the most serious being the misnamed: • "Spanish flu" of 1918 • "Asian flu" of 1957 • "Hong Kong flu" of 1968

  5. What is an Epidemic? • Epidemic: a disease attacking or affecting many individuals in a community or a population simultaneously

  6. Conditions Resulting in a Pandemic • The emergence of a new flu strain • The ability of that strain to infect humans and cause serious illness • The ability to spread easily among humans

  7. Seasonal Fluvs.Pandemic Flu

  8. Seasonal Flu • Outbreaks follow predictable seasonal patterns • Usually some immunity built up from previous exposure • Healthy adults usually not at risk for serious complications • Vaccine developed based on known flu strains • Adequate supplies of anti-virals are usually available and can usually meet public and patient needs • Average US deaths approximately 36,000/yr • Symptoms include: • Fever, cough, runny nose, muscle pain. • Deaths often caused by complications, such as pneumonia

  9. Impact of Seasonal Flu • Generally causes modest impact on society (e.g., some school closing, encouraging people who are sick to stay home) • Manageable impact on domestic and world economy

  10. Pandemic Flu • Occurs rarely (only 3 times in 20th century - last in 1968) • No previous exposure (little or no preexisting immunity) • Healthy people may be at increased risk for serious complications • Health systems may be overwhelmed • Vaccine probably would not be available in the early stages of a pandemic (effective antivirals may be in limited supply) • Number of deaths could be high • Symptoms may be more severe and complications more frequent

  11. Impact of a Pandemic • May cause major impact on society: • Widespread restrictions on travel • Closings of schools and businesses • Cancellation of large public gatherings • Potential for severe impact on domestic and world economy

  12. The State of Your Health: Texas

  13. Adult Health Indicators • Percentage of Adults with Asthma (2004): • TX: 12.8% US: 13.2% • Percentage of Adults with Diabetes (2004): • TX: 7.6% US: 7.0% • Percentage of Adults with Obesity (2004) • TX: 25.8% US: 23.2% • Percentage of Adults with Hypertension (2003) • TX: 24.6% US: 24.8% • Estimated New Cancer Cases (2005) • TX: 86,880 US: 1,372,910 • Estimated Persons Living With AIDS (2004 Yr End) • TX: 29,891 US: 415,193 • Cumulative Number AIDS Cases (2004 Yr End) • TX: 64,479 US: 918,286 • Human West Nile Cases (2005 Cases as of 5/06) • TX: 195 US: 2,983

  14. Child Health Indicators • % of Children Estimated Lifetime Prevalence of Childhood Asthma (2003) • TX: 13.1% US: 12.4% • % of Children Overweight High School Students (2003): • TX: 13.9% US: 11.1% • % of Fully Immunized Children Aged 19-35 Months (2004) • TX: 72.5% US: 80.9% • Infant Mortality Per 1,000 Live Births (2004) • TX: 6.1 US: 6.6 • % of Low Birth-weight Babies (2003) • TX: 7.9% US: 7.9%

  15. Other Public Health Indicators • Number of Primary Care Health Professions Shortage Areas (As of 9/30/05): • TX: 346 US: 4,577 • Receipt of CDC Environmental Public Health Tracking Grant: • TX: None US: 21

  16. Who is most at Risk for Pandemic Flu?

  17. Pandemic Flu • A flu pandemic occurs when a new flu virus against which the human population has no immunity appears. • This results in several, simultaneous epidemics worldwide with enormous numbers of infections and deaths.

  18. What Helps Spread a Pandemic? • With the increase in global transport and communications, as well as urbanization and overcrowded conditions, epidemics due to the new flu virus are likely to quickly take hold around the world.

  19. Pandemic Dark History

  20. A Lesson from the Past • Pandemics are a reality. Health records show at least 10 influenza pandemics over the past 300 years: • 1732-1733 • 1781-1782 • 1800-1802 • 1830-1833 • 1847-1848 • 1857-1858 • 1889-1900 • 1918-1919 • 1957-1958 • 1968-1969

  21. NUMBER OF DEATHS IN MOST RECENT PANDEMICS • US Deaths: • 1918/19: 500,000+ • 1957/58: 70,000+ • 1968/69: 34,000 • Worldwide Deaths: • 1918/19: 40,000,000+ • 1957/58: 1,000,000-2,000,000 • 1968/69: 700,000+

  22. "Spanish flu" Pandemic of 1918 • Over 40 million people perished worldwide • Age range of fatalities: 15 to 35 years, mostly healthy • 99% of deaths occurred in people younger than 65 years

  23. The Effects of the 1918 Pandemic on Texas • Reports of pandemic fears preceded the disease into Texas by about two weeks. • But by September 23, there were definite accounts of it near Austin and Dallas. • On October 4th, 35 counties were reporting the presence of influenza, with anywhere from one to 2,000 cases per county. • El Paso imposed a quarantine. • The Dallas Morning News declared that surviving the pandemic required "medical attention, good nursing, fresh air, nutritious food, plenty of water, and cheerful surroundings." • The Texas State Board of Health offered schools several suggestions on ways to prevent flu outbreaks. • By the end of October, over 106,000 Texans in the state's urban centers had been afflicted. • Over 2,100 had died.

  24. The Bad News If a pandemic strikes, it will come to Texas.

  25. "Hong Kong” flu Pandemic of 1968 • This was a much "milder" flu pandemic • It killed 1 million people across the globe

  26. Pandemic Impact on the US

  27. $$$ Economic Impact $$$ • flu pandemic may strike in waves, each of which could last up to 6 – 8 weeks • An especially severe pandemic could lead to widespread illness, a large number of deaths, and significant economic loss • Everyday life would be disrupted because so many people in so many places would become seriously ill at the same time. • Impact could range from school and business closings to the interruption of basic services as public transportation and food delivery.

  28. How would a Pandemic Impact the US Economy? • A pandemic could deliver a "shock" to the economy, with immediate demand- and supply-side effects, as well as longer-term supply-side effects. • The general slowdown in economic activity would reduce gross domestic product (GDP). • Business confidence would be dented • The supply of labor would be restricted

  29. More Impact on US Economy • Supply chains would be strained as transportation systems were disrupted • Default rates on consumer and business debt would rise • The stock market would initially fall and rebound later • A serious recession in the US economy with immediate costs ranging from $500 billion – $675 billion.

  30. Predictions from Financial Leaders • WBB Securities LLC predictions: • A one-year economic loss of $488 billion • A permanent economic loss of $1.4 trillion • Congressional Budget Office predictions: • A $675 billion hit to the US economy • World Bank predictions: • Cost on global economy: $800 billion a year

  31. Impact on Health Services • A substantial portion of the world's population would require medical care • Healthcare facilities would be overwhelmed, creating a strain on hospital staff, and a shortage of beds, ventilators, and other supplies. • To cope with the demand, "surge capacity" at nontraditional sites, such as schools, may need to be created. • The need for vaccine is likely to outstrip supply and the supply of antiviral drugs is also likely to be inadequate early in a pandemic. • Difficult decisions would need to be made regarding who gets these vaccines and antivirals.

  32. How Real is this Threat?

  33. What is the Likelihood of a 2007 Pandemic? • The evolution of flu viruses cannot be predicted. • This makes it difficult to know if or when a virus might mutate to become easily transmittable among humans. • Therefore, it is impossible to say when another pandemic will arise, or whether it will be mild or severe. • However, the World Health Organization (WHO) asserts that once a virus allows for efficient human-to-human transmission, a pandemic can occur.

  34. A Wide Range of Estimates • Experts' range: 2 million to > 50 million • All of these predictions are scientifically grounded • Some estimates are based on extrapolations from past pandemics: • The most precise predictions are based on the 1968 pandemic, but even in this case estimates are 1 million – 4 million deaths • Similarly, based on the number of deaths from the 1918 Spanish flu pandemic, estimates are 20 million – >50 million • The specific characteristics of a future pandemic virus cannot be predicted. It may affect 20% -- 50% of the total population

  35. Best case scenarios of the next pandemic:2 to 7 million people could die, and tens of millions would require medical attention worldwide

  36. High Mortality Rates • Number of people who become infected • Virulence of the virus • Underlying characteristics and vulnerability of affected populations • Availability and effectiveness of preventive measures

  37. 2 Scenarios for the Potential Impactof a Flu Pandemic on the US

  38. Moderate (1958/68-like) • Illness: 90 million (30%) • Outpatient medical care: 45 million (50%) • Hospitalization: 865,000 • ICU care: 128,750 • Mechanical ventilation: 64,975 • Deaths: 209,000

  39. Severe (1918-like) • Illness: 90 million (30%) • Outpatient medical care: 45 million (50%) • Hospitalization: 9,900,000 • ICU care: 1,465,000 • Mechanical ventilation: 742,500 • Deaths: 1,903,000

  40. A Pandemic is due soonThe question is not “if”, but “when”

  41. What Interventions Might Reduce the Impact of a Pandemic?

  42. Overview • Depending on the contagiousness of the virus, a variety of approaches could reduce the number of flu cases to fewer than that of an annual flu season.

  43. Method • The scientists simulated a virtual outbreak on computers at the Los Alamos National Laboratory

  44. 1st, With No Interventions • The results showed that, with NO intervention, a pandemic flu with low contagiousness could peak after 117 days and infect about 33% of the US population. • A highly contagious virus could peak after 64 days and infect about 54% of the population.

  45. 2nd, a Variety of Scenarios

  46. Possible Scenarios • The researchers tested different interventions: • distributing antiviral treatments to infected individuals and others near them to reduce symptoms and susceptibility • vaccinating people, possibly children first, with either 1 or 2 shots of a vaccine not well matched to the strain that may emerge • social distancing, such as restricting travel and quarantining households; and closing schools

  47. Interventions w/a less contagious virus • Utilize the 3 most effective single measures included: • Distributing several million courses of antiviral treatment to targeted groups 7 days after a pandemic alert; • School closures; and • and vaccinating 10 million people per week with 1 dose of a poorly matched vaccine. • The results also showed that vaccinating school children first is more effective than random vaccination when the vaccine supply is limited. • Regardless of contagiousness, social distancing measures, alone, had little effect.

  48. Interventions w/a highly contagious virus • All single-intervention strategies left nearly half the population infected. • In this instance, the only measures that reduced the number of cases to below the annual flu rate involved a combination of at least three different interventions, including a minimum of 182 million courses of antiviral treatment.

  49. Decline in Travel and Leisure Activities • International travel would dramatically decline as people avoided flu "hotspots“ • Governments may restrict travel • People would quarantine themselves by staying at home more

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