Pandemic Influenza Preparedness

1. Pandemic Influenza Preparedness Response Guidance forHealthcare Workers and Healthcare Employers Educational material developed through funding from OSHA Susan Harwood Grant #SH-16624-07-60-F-54

2. Introduction • Any Pandemic Disease • is a global disease outbreak • occurs when a new virus emerges • spreads where people have no immunity • is a disease for which there is no vaccine • spreads easily person-to-person • causes serious illness • sweeps around the world in a short time

3. Initial Control Measures • After a pandemic disease starts, everyone in the world is at risk • Countries might try to delay or stop the arrival of the virus through • border closures • travel restrictions • quarantines

4. Effects of A Severe Pandemic • Everyday life would come to a standstill due to • high levels of illness, death, social disruption, and economic loss • everyone being ill at the same time • interruptions of basic services such as public transportation and food delivery

5. History of Flu Pandemics • Deaths in USA from past influenza pandemics • 1918 – 500,000 • 1957 – 70,000 • 1968 – 34,000

6. By 1918, most PHS officers understood how diseases spread Without antibiotics, PHS officers were limited in their ability to fight disease The Public Health Service

7. The Influenza Pandemic occurred in three waves in the United States throughout 1918 and 1919. Devastation of 1918 Avian Flu http://www.pandemicflu.gov/

8. 1918 – Rapid-paced Outbreaks • The 1918 influenza pandemic occurred too rapidly for the PHS to develop a detailed study of the pandemic • After the pandemic, they developed a map with approximate dates of the outbreak

9. [Credit: Office of the Public Health Service Historian]

10. Effects on Healthcare System • Healthcare facilities would be overwhelmed including shortage of • hospital staff • beds • ventilators • supplies

11. Healthcare Worker Demands • Healthcare will be affected since healthcare workers will be ill, too • (including first responders, nurses, physicians, pharmacists, technicians and aides, building maintenance, security and administrative personnel, social workers, laboratory employees, food service, housekeeping, and mortuary personnel)

12. Healthcare Facility Demands • Healthcare will be affected since healthcare resources will be expected to meet non-pandemic associated healthcare needs in a variety of workplace settings • (including medical and dental offices, schools, physical and rehabilitation therapy centers, health departments, occupational health clinics, and prisons, free-standing ambulatory care and surgical facilities, and emergency response settings)

13. Cornerstones of Preparedness • Cornerstones of effective pandemic influenza preparedness and response • Risk Assessment • Policy Development • Procedure Execution

14. Each Facility is Unique • To insure adequate preparation of healthcare workers • make preparations for each facility • collaborate with local, state, and federal partners • follow related standards and guidelines

15. Specific Areas for Planning • Infection Control Plans • Risk Communication Tools • Self-triage • Instructions for Home Care of Flu Patients • Diagnosis and Treatment of Staff During a Pandemic • Technical Information Available Through Internet Sources • Supply Checklists

16. Permission of Gary Brookins and the Richmond Times-Dispatch

17. January 12, 2006 Pandemic planning summit The state of West Virginia HHS and other federal agencies Public health officials Emergency management and response leaders Summit for Pandemic Planning

18. North America • The United States Northern Command has a role in protecting our health • Resources are available at their website • Information Sheet • Personal Training Brief • Readiness Guide • Newsletter • Department of Defense Influenza Watchboard http://www.northcom.mil/Avian%20Flu/index.html

19. PandemicFlu.gov • State Pandemic Plans http://www.pandemicflu.gov/plan/states/stateplans.html • Site contains list of pandemic plans that are currently available on state websites

20. Agreement - WV & U.S. Dept. of Health and Human Services January 12, 2006 HHS Secretary Mike Leavitt and Governor Joe Manchin III signed a Planning Resolution detailing HHS‘s and West Virginia's shared and independent responsibilities for pandemic planning WV Pandemic Planning

21. WV for Pandemic Planning • WV Federal Funding - 2006 • $940,502 - Phase One funding from U. S. Dept. of Health and Human Services (HHS) for pandemic planning activities • $1,688,192 - revised Phase Two of Health and Human Services’ local and state allocations • $620,408 - awarded to help strengthen the state's capacity to respond to a pandemic influenza outbreak.

22. Bureau for Public Health Health and Human Resources WV Department of Military Affairs and Public WV Agencies Involved in Planning

23. WV Pandemic Flu Website • http://www.wvflu.org/ • West Virginia Bureau for Public Health - Threat Preparedness505 Capitol Street • Suite 200 • Charleston, WV 25301Phone: (304) 558-6900 ext. 2005 Fax: (304) 558-0464

25. WV Pandemic Flu Brochure

26. Influenza

27. Influenza - History • Clinical Background • Three pandemics in the 20th Century • Three types: A, B, & C • Only Type A influenza viruses cause pandemics • Influenza A virus variations • Virulence • Infectivity to specific hosts • Modes of transmission • Clinical presentation of infection

28. Influenza Type A: Subtypes • Only Type A is divided into subtypes • Based on presence of two viral surface proteins (antigens) • Hemagglutin (H) • Neuraminidase (N) • Number of surface proteins identified in influenza A viruses • 16 hemagglutinin • 9 neuraminidase

29. Pandemic Subtypes • In the 20th Century, 3 different subtypes have caused pandemics • H1N1 • H2N2 • H3N2 • Subtypes are designated as H protein type (1-16) solely, OR followed by the N protein type (1-9)

30. Terminology • Avian (bird) flu is caused by influenza A viruses that occur naturally among birds • Different subtypes of these viruses exist because of changes in certain proteins on the surface of the influenza A virus and the way the proteins combine • hemagglutinin[HA] • neuraminidase [NA] • Each combination represents a different subtype • All known subtypes of influenza A viruses can be found in birds • The avian flu currently of concern is the H5N1 subtype

31. H5N1 spreading rapidly first appeared in Asia epizootic (an epidemic in nonhumans) panzootic (affecting animals of many species, especially over a wide area) killing tens of millions of birds spurring the culling of hundreds of millions of birds to stem its spread Most references to "bird flu" and H5N1 in the popular media refer to thisstrain H5N1 Virus http://en.wikipedia.org/wiki/H5n1

32. Seasonal Influenza • Refers to periodic outbreaksof acute onset viral respiratory infection caused by circulating strains of human influenza A and B viruses • Between 5–20 percent of the population may be infected annually • Most people have some immunity to the currently circulating strains of influenza virus • Thus, the severity and impact of seasonal influenza is substantially less than during pandemics

33. Avian Influenza: Bird Flu • Caused by type A influenza viruses that infect wild birds and domestic poultry • Some forms of the avian influenza are worse than others • Generally divided into two groups • low pathogenic avian influenza • highly pathogenic avian influenza

34. Low Pathogenic Avian Influenza • Naturally occurs in wild birds and can spread to domestic birds • In general, poses little threat to human health • Has the potential to mutate into highly pathogenic avian influenza and is, therefore, closely monitored

35. High Pathogenic Avian Influenza • Can spread rapidly • Has a high death rate in birds • H5N1 • now rapidly spreading in birds in some parts of the world • one of the few avian influenza viruses to have crossed the species barrier to infect humans • the most deadly of those viruses that have crossed the barrier

36. Humans and H5N1 • Most cases of H5N1 infections in humans have resulted from contact with infected poultry or surfaces contaminated with secretion/excretions from infected birds • Spread of H5N1 from person to person has been limited to rare, sporadic cases • H5N1 does not commonly infect humans • In humans, there is little or no immune protection against H5N1 (Information from November 2006)

37. Influenza Pandemic Patterns • Many scientists believe that since no pandemic has occurred since 1968, it is only a matter of time before another pandemic occurs • A pandemic may occur in waves of outbreaks with each wave in a community lasting 8 to 12 weeks • One-to-three waves may occur

38. Critical Response Elements • Rapid detection of unusual influenza outbreaks • Isolation of possible pandemic viruses • Immediate notification of national and international health authorities

39. URL: http://www.who.int/en/ • WHO is the directing and coordinating authority for health within the United Nations system. It is responsible for providing leadership on global health matters, shaping the health research agenda, setting norms and standards, articulating evidence-based policy options, providing technical support to countries and monitoring and assessing health trends. • WHO URL for Avian Influenza http://www.who.int/topics/avian_influenza/en/

40. Public Health Map/GIS Map Library World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry and wild birds between January and June 2007

41. Public Health Map/GIS Map Library World : Areas reporting confirmed occurrence of H5N1 avian influenza in poultry and wild birds Since 2003, status as of Dec. 7, 2007 (latest available update)

42. WHO Pandemic Alert & Response System • URL: http://www.who.int/csr/en/ • Purpose: The world requires a global system that can rapidly identify and contain public health emergencies and reduce unneeded panic and disruption of trade, travel and society in general

43. WHO Pandemic Alert System • Phase 1 & 2 • The “Inter-Pandemic Period” • There is a novel influenza A virus in animals but no human cases have been observed • Phase 2 indicates that an animal influenza subtype that poses a risk to humans has been detected

44. WHO Pandemic Alert System • Phase 3, 4 & 5 • The “Pandemic Alert Period” • A novel influenza virus causes human infection with a new subtype, but does not exhibit efficient and sustained human-to-human transmission

45. WHO Pandemic Alert System • Phase 6 • The “Pandemic Period” • A new influenza A virus develops the capacity for efficient and sustained human-to-human transmission in the general population • The WHO declares that an influenza pandemic is in progress

46. Sentinel Provider Network • Operated by the CDC (Centers for Disease Control and Prevention • URL: http://www.cdc.gov/

47. CLINICALDIAGNOSIS

48. Clinical Presentation of Influenza • Varies from “no symptoms” at all in seasonal influenza to “fulminant” (fully symptomatic) disease in pandemic strains that result in severe illness and death (even among previously healthy adults and children) No Symptoms --------------------- > Fulminant

49. Clinical Diagnosis • Clinical Diagnosis of Seasonal Influenza • sudden onset of fever • respiratory illness • muscle aches • headaches • nonproductive cough • sore throat • runny nose • ear infections • gastrointestinal symptoms

50. Accuracy of Diagnosis • It has been reported that the use of the influenza-like case definition is • 63 to 78% accurate in identifying culture-confirmed cases of influenza (a sensitivity of 63 to 78%) • 55 to 71% accurate in excluding influenza (specificity of 55 to 71%)