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Chance Favors the Prepared Community: Preparing for a Flu Pandemic

Chance Favors the Prepared Community: Preparing for a Flu Pandemic. February 14, 2007 Mark J. Levine, MD MPH. BIRD FLU PANDEMIC?. Influenza Virus. Single-stranded RNA virus Surface membrane spiked with 2 types of protein Hemagglutinin (H) Neuraminidase (N). Influenza Virus Composition.

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Chance Favors the Prepared Community: Preparing for a Flu Pandemic

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  1. Chance Favors the Prepared Community:Preparing for a Flu Pandemic February 14, 2007 Mark J. Levine, MD MPH

  2. BIRD FLU PANDEMIC?

  3. Influenza Virus • Single-stranded RNA virus • Surface membrane spiked with 2 types of protein • Hemagglutinin (H) • Neuraminidase (N)

  4. Influenza Virus Composition Type of nuclear material Neuraminidase Hemagglutinin A/Beijing/32/92 (H3N2) Virus type Geographic origin Strain number Year of Isolation Virussubtype

  5. “The pandemic clock is ticking, we just don’t know what time it is” E. Marcuse

  6. Pandemic influenza: definition • Pandemic influenza, or flu, is a global outbreak of disease that occurs when a new influenza A virus appears in humans, causes serious illness and then spreads easily from person to person.

  7. “A pandemic is the viral equivalent of a perfect storm. There are three essential conditions, which rarely converge, and they are impossible to predict.” Michael Specter, The New Yorker

  8. The three conditions… • A new subtype that has not infected people in the past • Causes severe illness in people • Sustained transmission from person to person • Emergence of pandemic strain = most significant public health emergency caused by a naturally occurring pathogen

  9. Timeline of Emergence of Influenza A Viruses in Humans Avian Influenza H9 H7 Russian Influenza H5 H5 H1 Asian Influenza H3 Spanish Influenza H2 Hong Kong Influenza H1 1918 1957 1968 1977 1997 2003 1998/9

  10. Effects of Typical Flu Season (U.S.) • 5-20% ill • 200,000 hospitalizations • 36,000 deaths

  11. Impact of Past Influenza Pandemics/Antigenic Shifts

  12. Pandemic Prediction: U.S.A. • Planning Assumptions: • 30% attack rate • 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

  13. Pandemic Prediction: Central Region • Planning Assumptions: • 30% attack rate • 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. Out of hospital ???? Expanded capacity- 3900 3200 Standard operations 0 days 10 days Sudden surge from a immediate event

  15. Out of hospital ???? Expanded capacity- 3900 3200 Standard operations 0 days 10 days- 3 months Biological attack or Pandemic ? Care in the community Slowly growing surge from a rolling event:

  16. 1918 Pandemic The Influenza Pandemic of 1918-1919 25-30 percent of the world’s population fell ill500,000 deaths in the US 25-30 percent of the world’s population fell ill500,000 deaths in the US 25-30 percent of the world’s population fell ill500,000 deaths in the US

  17. Avian Influenza H5N1as of February 7, 2007 • 55 countries with documented H5N1 avian influenza in bird populations • 11 countries with documented human cases of H5N1

  18. Nations With Confirmed Cases H5N1 Avian Influenza (Feb ‘07)

  19. Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO as of 02/06/07

  20. Integrated Planning for a Large Scale Health Emergency

  21. The Public Health System Police EMS Corrections MCOs Health Department Philanthropist Churches Community Centers Nursing Homes Home Health Parks Doctors Schools Elected Officials Hospitals Mass Transit Environmental Health Civic Groups CHCs Fire Tribal Health Employers Laboratory Facilities Economic Development Drug Treatment Mental Health Accountants!

  22. National Preparedness Community Preparedness Business and Organizational Preparedness Individual and Family Preparedness

  23. Pandemic Flu Preparedness for Individuals and Families http://www.pandemicflu.gov

  24. Pandemic Flu Preparedness for Businesses http://www.pandemicflu.gov

  25. In a Pandemic… • Despite all preparedness efforts, Virginia will not be spared from a flu pandemic. • All businesses, hospitals and government agencies will feel the effects of a pandemic. • Ten to 25 percent of the workforce may be ill at any one time.

  26. Unlike other disasters, a flu pandemic will touch every population in every part of the country. Moving operations to another location may not be a viable option. • A flu pandemic could cost the U. S. economy billions of dollars in lost productivity and medical expenses. During a pandemic, it will not be business as usual.

  27. The number one thing you can do to prepare for a pandemic is to learn as much as you can and personally plan ahead of time

  28. Local Emergency Planning and Response Framework

  29. Health Districts in Virginia

  30. Preparing for Emergencies in the Face of Uncertainty

  31. Hope? Hope is not a strategy… Julie Gerberding, Director, Centers for Disease Control and Prevention

  32. Chance Favors the Prepared Mind Louis Pasteur

  33. Chance Favors the Prepared Community Mark Levine What is a “Prepared Community?”

  34. Incident Command Structure

  35. Unified Command (Representatives From Local Jurisdictions) Finance/ Administration Logistics Planning Operations Unified Command

  36. Components of Local Response • Communication/Awareness • Surveillance/Investigation • Containment/Control • Distribution of antivirals/vaccine • Healthcare Surge

  37. Components of Local Response • Communication/Awareness • Surveillance/Investigation • Containment/Control • Distribution of antivirals/vaccine • Healthcare Surge

  38. Communication/Awareness • Virginia Department of Health • http://www.vdh.virginia.gov/pandemicflu/ • Henrico County Health Department • http://www.co.henrico.va.us/health/ • CDC • Travel: http://www.cdc.gov/travel/ • Avian flu: http://www.cdc.gov/flu/avian/

  39. Continued… • Education/Information Exchange • Public Health: Epi-X, CDC • Medical community: Public Health Bytes • www.publichealthbytes.org • General community: Promote individual/family preparedness • www.pandemicflu.gov • Media spots • Health Department Web site info

  40. Components of Local Response • Communication/Awareness • Surveillance/Investigation • Containment/Control • Distribution of antivirals/vaccine • Healthcare Surge

  41. Surveillance and Detection-current status- • Surveillance is a routine function of the Health Department and is always ongoing • Influenza surveillance is not something new and is already very extensive • Enhanced surveillance experience/process already in place

  42. Additional Surveillance Efforts • Syndromic Surveillance • Surveillance for symptoms of disease rather than actual cases • May detect a disease outbreak sooner

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