Influenza – What in the world do YOU need to know?

1. Influenza – What in the world do YOU need to know? Kristine A. Smith, M.A.

2. Flu Facts

3. Acute, febrile respiratory illness affecting nose, throat, bronchial tubes and lungs Epidemics caused by influenza viruses A and B(Type C uncommon in people; no epidemics) Occurs worldwide, causing considerable morbidity (illness) and mortality (death) each year Symptoms appear rapidly What is Influenza?

4. Symptoms • Fever, dry cough, sore throat, muscle aches/pain, headache, lack of energy, possibly runny nose • Fever and body aches for 3-5 days • Cough and lack of energy - 2 weeks • Symptoms similar to other upper respiratory diseases such as adenovirus, rhinovirus, parainfluenza, legionellosis, etc.

5. How You Get the Flu? • Typical incubation: 2 days Range: 1-4 days • Viral shedding • Can begin 1 day before symptom onset • Peak shedding first 3 days of illness • Correlates with temperature • Subsides after 5 days in adults, can be 10+ days in children • Transmission is predominately droplet spread

6. The Burden of Seasonal Influenza • Globally: 250,000 to 500,000 deaths each year • In the United States each year: • 36,000 deaths • >200,000 hospitalizations • $37.5 billion in economic costs from influenza and pneumonia

7. How Influenza Viruses Change? • Antigenic Drift: • Small changes in virus over time • New strains appear and replace older strains • May not be recognized by antibodies to older strains • Antigenic Shift: • Abrupt, major change (reassortment) • Results in novel strain or new subtype • Can cause pandemic influenza

8. What is an Influenza Pandemic ? • A global influenza outbreak • Caused by a brand new (novel) flu virus • Most severe occur with changes in both surface proteins • Viruses can be isolated at any time of year • Because it is a new virus, few or no people would be immune • Many people would get sick in every part of the world • Asia is the source of many outbreaks because swine, birds and humans live under the same roof, providing opportunity for viral mixing

9. Credit: US National Museum of Health and Medicine Influenza Pandemics 20th Century 1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu” A(H1N1) A(H2N2) A(H3N2) 20-40 m deaths 675,000 US deaths 1-4 m deaths 70,000 US deaths 1-4 m deaths 34,000 US deaths

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

11. If a Pandemic Happens: What to expect… • At the peak of a moderate pandemic influenza outbreak (i.e. 35% attack rate, 6 week duration), New York State (excluding New York City) can expect: • 14,916 influenza-related hospital admissions per week • 3,728 influenza-related deaths per week • 2,609 deaths in the hospital • Influenza patients will most likely utilize: • 63% of hospital bed capacity • 125% of intensive care capacity • 65% of hospital ventilator capacity

12. Will Avian Flu Cause the Next Pandemic? • No one knows! • The H5N1 virus could change to spread more easily among humans-but it might not. • It could “swap genes” with another animal virus, or with a human flu virus

13. Avian Influenza • The H5N1 strain of avian influenza (bird flu) is present in birds in many countries across several continents. • Bird flu is NOT the same as pandemic flu • Some human cases of avian influenza have also occurred • Cases occurred after close contact with infected birds • No sustained person to person transmission • Human death rate is high >57%

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

15. H5N1 Outbreak: December 2003 –July 20, 2006 • Laboratory confirmed human cases: • 231 human cases • 133 human deaths • Case fatality rate 57 percent • Cases occurred in countries with endemic infection of poultry • Nearly all human cases had poultry/bird exposure • No sustained person-to-person transmission identified • No influenza A viruses with human and avian genes detected yet Source: World Health Organization

16. Situation Report: Avian Influenza • Widespread prevalence in migratory birds; broad host range • Continued outbreaks among domestic poultry • Mammalian infection (cats, pigs, etc.) - lethal • Virus is evolving • Sporadic human cases (>190 reports to date) • Most in young and healthy, Case-fatality 57% • Rare person-to-person transmission Sustained and rapid person-to-person transmission

17. What is New York State doing to prepare?

18. WHO Pandemic Phases

19. NYSDOH Planning Process • Original plan drafted using internal DOH workgroups – August 2004 • Based on federal DHHS August 2004 pandemic plan • NYSDOH revised plan and incorporated recent guidance issued in the updated DHHS November 2005 plan • Additional workgroup members added from: • Local health departments • Hospitals and hospital associations • NYSDOH plan: www.health.state.ny.us • Federal plan: www.pandemicflu.gov

20. Current Status of NYS Planning • With the Disaster Preparedness Commission (DPC) agencies, SEMO is coordinating development of a State pandemic plan that will become an annex of the State’s Comprehensive Emergency Management (“All Hazards”) plan • Local Health Departments are developing county-specific plans—due date August 30, 2006 • Hospitals and Regional Resource Centers are planning for surge capacity • Pandemic preparedness town meetings, regional partner meetings, regional media forums are being held

21. NIMS training for emergency responders Point of Dispensing (POD) training for Local Health Departments Laboratory specimen collection and submission training Informatics training for key partners using HIN, HPN, HERDS Multiple tabletop and functional exercises held: ProtEX NY state POD exercise, November 2005 2006 versions Nov. 9 in NYC, Syracuse CDEx full functional exercise, June 2006 (more than 200 agencies participated) Extensive Training is Underway

22. Federal Partners Healthcare Delivery System Local/State/ Federal Public Health System Businesses & Workers Education System Public Health Emergency Preparedness - A Shared Responsibility! • Local – state – federal • Domestic – international • Public – private • Multi-sector • Animal – human • Health protection – homeland security – economic protection

23. Businesses, school systems, community infrastructure providers, and other employers should develop plans for continuity of essential operations and modified operation with a significantly reduced workforce • 25 to 30% of persons may become ill during a 6 to 8 week outbreak • An additional 10% of the workforce may be absent due to illness of a family member • Others may stay home due to a fear of becoming infected

24. What can YOU do to prepare?

25. General Infection Control Assumptions in a Pandemic • Core prevention and control measures (e.g., vaccination and antivirals) will not be available or will be limited • We must prepare for that!

26. Individual Infection Control Strategies • Respiratory hygiene/cough etiquette and hand hygiene are effective strategies to stop the spread of germs • We should make good hygiene a habit now

27. What is Respiratory Hygiene/Cough Etiquette? • Cover mouth/nose when sneezing or coughing • If no tissue, use elbow instead of hands • Use tissues and dispose of appropriately • Perform hand hygiene after contact with respiratory secretions • Distance yourself from others (more than 3 feet)

28. What is Hand Hygiene? • Traditional hand washing • Soap and hot water • Minimum of 20 seconds (the time it takes to sing “Happy Birthday” twice) • Alcohol based hand rubs • Acceptable means to disinfect/sanitize EXCEPT when hands are visibly soiled

29. Did You Ask About Masks? • Recommended for: • Health care workers with direct patient contact • Those at high risk for complications of influenza • Symptomatic persons • Contacts of ill persons

30. More About Masks • Benefit of wearing masks by well persons in public settings has not been established • Persons may choose to wear a mask as part of an individual protection strategy that includes respiratory hygiene/cough etiquette, hand hygiene, and social distancing • If you wear a mask, keep your hands away from your face! • Clean your hands each time you touch your mask!

31. Individual or GroupInfection Control Strategies • Isolation and quarantine: reduces influenza transmission by separating infected persons from uninfected persons, and exposed persons from non-exposed persons • Isolation of ill persons will be valuable during all phases of pandemic influenza • Quarantine of those exposed to ill persons is justified when there are a limited number of cases

32. Work or School Based Infection Control Strategies • Respiratory hygiene/cough etiquette, hand hygiene • Stay away if ill (staff stay home, students do not go to classes) • Encourage self-reporting of illness that develops • Active screening for illness in staff/students • Send staff/students home(with mask) if ill

33. Community-Based Infection Control Strategies • Social distancing • Snow days, voluntary self-shielding • Cancellation of public events • concerts, sports events, movies, plays • Closure of schools and workplaces • office buildings, shopping malls • Closure of recreational facilities • community swimming pools, youth clubs, gymnasiums

34. Individual and Family Preparedness is Crucial! • We might have to take care of ourselves and those around us • How many would be ready?

35. To plan for a pandemic Store a supply of food and water Have non-prescription drugs and other health supplies on hand Get involved in your community Start now to limit the spread of germs and prevent infection Hand hygiene Respiratory hygiene Stay home if sick Parents need to model behavior! Family Preparedness Checklist

36. Questions Contact Information: (518) 486-1642 kas10@health.state.ny.us Additional Resources: • Contact your local health department • Websites – www.nyhealth.gov or www.pandemicflu.gov