Pandemic Planning: A Nation Prepared

2. Pandemic Planning:A Nation Prepared U.S. Department of Health and Human Services Mike Leavitt, Secretary

4. HHS Pandemic Influenza Preparedness Planning • ADM John O. Agwunobi • Assistant Secretary for Health

7. Pandemics Do Happen! H9* 1998 1999 H5* 2003 1997 2003-2006 H7* 1980 1996 2002 2003 2004 H1 H3 H2 H1 1977 1915 1925 1935 1945 1955 1965 1975 1985 1995 2005 1918 Spanish Influenza H1N1 1957 Asian Influenza H2N2 1968 Hong Kong Influenza H3N2 *Avian Flu

9. Planning Assumptions: Health Care • 50% or more of those who become ill will seek medical care • Number of hospitalizations and deaths will depend on the virulence of the pandemic virus

14. Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006)

15. Phases of a Pandemic: Where We Are Now

16. HHS Pandemic Influenza Plan • Support the National Strategy for Pandemic Influenza • Outlines planning assumptions and doctrine for health sector pandemic preparedness and response • Public Health Guidance for State and Local Partners • 11 Supplements with detailed guidance

18. HHS Pandemic Influenza Doctrine: Saving Lives • Prevent or at least delay introduction into the United States • May involve travel advisories, exit or entry screening • For first cases, may involve isolation / short-term quarantine of arriving passengers

20. HHS Pandemic Influenza Doctrine: Saving Lives • Clearly communicate to the public • Prepare people with information • Encourage action steps to prepare now • Provide updates when new information emerges • Use trusted messengers • Coordinate to ensure consistent messages • Address rumors and inaccuracies

23. Challenges in Pandemic Vaccine Preparedness • Expand production of current (egg-based) vaccine • Evaluate dose-sparing technology (adjuvants, intramuscular vs. intradermal route) • Accelerate development of modern (non-egg) vaccines • Target new antigens

25. Avian Influenza Vaccine Production • Working with the National Institutes of Health • Current H5N1 Vaccine – 40 million doses being produced • Second Clade 2 Avian Influenza vaccine

26. Antivirals and Medical Supplies: Influenza Treatments • Stockpile • Tamiflu: 5+ million treatment courses in Strategic National Stockpile (SNS) with 12.4 million treatment courses ordered • Tamiflu oral suspension: 97,000 courses in SNS with an additional 260,000 on order (arrival date to be determined) • Relenza: 84,000 courses in SNS with 1.75 million treatment courses ordered • Strategy • Procure 81 million courses of antivirals • 6 million courses to be used to contain an initial U.S. outbreak • 75 million courses to treat 25 percent of U.S. population • Accelerate development of promising new antiviral candidates

27. Antivirals and Medical Supplies: Influenza Treatments • $350 million appropriated in FY 2006 to upgrade state and local response capacity for pandemic influenza • $100 million of the funding is scheduled to be awarded to all 50 states; 7 territories; Puerto Rico; Washington, D.C.; New York City; Chicago; and Los Angeles County and allocated according to a base + population formula • $250 million will be awarded later this year. Application for funding is supplemental to current cooperative agreements

28. State and Local Pandemic Influenza Planning Checklist • Community Leadership and Networking • Surveillance • Health System Partnerships • Infection Control and Clinical Care • Vaccine Distribution and Use • Antiviral Drug Distribution and Use • Community Disease Control and Prevention • Communications • Workforce Support

32. Complacency is the enemy of health protection! www.pandemicflu.gov

34. Avian Influenza (AI) Preparedness and Response Veterinary Services March, 2006

35. Topics Covered • Avian Influenza Overview • USDA’s AI Interventions • Targeted surveillance • Border protection • Trade restrictions & OIE guidelines • Outreach & education • Preparedness & response

36. Avian Influenza Overview • Avian influenza (AI) - identified in the early 1900s • High pathogenic avian influenza (HPAI) – causes contagious illness, death in birds; Low pathogenic (LPAI) causes mild to no illness • Vast majority of AI viruses found in birds do not represent a public health concern

37. Hemagglutinin Neuraminidase M2 PB1 PB2 PA HA NP NA MA NS M1 Matrix Avian Influenza Overview (cont.) • Virus is characterized by H and N type (surface proteins). • 144 different characterizations of the virus, based on 16 H types and 9 N types • AI viruses mutate easily; only H5 and H7 viruses have the potential to mutate from an LPAI to an HPAI form. • AI viruses vary widely in pathogenicity from strain to strain. Therefore not all H5N1 viruses are infectious for people or pathogenic to poultry.

38. Species Affected Genetic Reservoirs H3, H7 H1, H2, H3 Intermixing H5N1 Commercial, LBMs Others H10 H1-12 H14-15 H1-2, 4-7, H9-13, 15-16 Other Aquatic Birds? H1, H3, H4, H7, H13 H1, H3

39. How is the virus spread among birds? • Direct contact between healthy and infected birds • Infected fecal matter • Can be found on surface of unwashed egg shells from infected birds

40. Three HPAI Findings in U.S. • 1924 – “Fowl Plague” affected live bird markets in the Northeastern U.S. • 1983 – destruction of 17 million birds in PA • 2004 – quickly contained and eradicated in TX

41. AI Surveillance • APHIS and States conduct surveillance through: • National Poultry Improvement Plan (NPIP) • State and University laboratories • Export testing at slaughter • State movement requirements

42. AI Surveillance (cont.) • APHIS’ safeguarding system encompasses: • Targeted surveillance • Cooperative efforts with States and Industry • Outreach and education • Trade restrictions • Anti-smuggling programs

43. LPAI Surveillance and Control Plan • Federally-coordinated and State-assisted LPAI H5/H7 LPAI Control Program • Commercial poultry • Live bird marketing system • Since 1986, APHIS and States have monitored live bird markets (LBMs) in Northeast U.S.

44. Surveillance: NPIP • Establishes standards for evaluation of poultry breeding stock and hatchery products • “Avian influenza free” certification for commercial companies • New LPAI program that will provide for H5 and H7 AI monitoring

45. Surveillance: NPIP (cont.) • New LPAI program that will provide for H5 and H7 AI monitoring • Program components: “AI monitored” program, surveillance specifications, and State LPAI response and containment plans

46. LBMs – Surveillance • Uniform Standards published in 2004 provide guidelines for markets, dealers and producers: • Licensing requirements and education • Bird testing and recordkeeping • Sanitation and biosecurity • Surveillance and inspections • LPAI positive facilities

47. LBMs – Surveillance (cont.) • States enforce LPAI program standards • Federal indemnification provided for participating States with positive diagnosis of H5 or H7 LPAI • APHIS initiated cooperative agreements with 21 States

48. LPAI Surveillance – National Animal Health Laboratory Network (NAHLN) • 37 States participate in the network. NAHLN labs: • Provide laboratory services nationwide • Provide laboratory data for reporting • Respond to foreign animal disease outbreaks • Focus on animal diseases

49. Border Protection & Risk of Introduction of Asian Strain of H5N1 • USDA works closely with DHS to prevent smuggling of illegal poultry and poultry products. • USDA’s Smuggling Interdiction and Trade Compliance unit and DHS’ Customs and Border Patrol actively monitor U.S. ports. • Legally imported birds from other countries are tested for AI.

50. Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1 Migratory Birds – Overlap of summer breeding grounds in Alaska, Northeast Canada • Genetic separation of H5 AI viruses between New & Old World • Asian birds rarely get off course and go to N. America • Risk from wild birds is low