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

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

2. Seasonal Avian Pandemic Influenza

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 Seasonal Influenza?

4. 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

5. 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

6. What is Avian Influenza? • All flu is bird flu • Current concern is H5N1 • Worldwide poultry outbreak • Rare, but severe in humans • NOT EASILY SPREAD HUMAN TO HUMAN

7. Nations With Confirmed Cases H5N1 Avian Influenza (May 19, 2006) Source: http://www.pandemicflu.gov/#map

8. Current H5N1 situation in humans • 229 human cases, world-wide since December of 2003 (as of 7/4/06) • 130 deaths • 57 % mortality rate (fatality)

9. Situation Summary: Avian Influenza • Widespread occurrence in migratory birds • Continued outbreaks among domestic poultry • Asymptomatic infections in domestic ducks • Lethal infections in mammals (cat, pigs) • Still lacks ability to travel easily human to human, but every infection provides another opportunity for the virus to change

10. 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

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12. Will Avian (Bird) 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. What is Pandemic Influenza ? • A global influenza outbreak • Caused by a brand new (novel) flu virus • Can occur 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

14. 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

15. 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.

17. What is New York State doing to prepare?

18. Unprepared Impact Prepared Weeks HHS Pandemic Influenza Doctrine: Saving Lives • Slow spread, decrease illness and death, buy time • Antiviral treatment and isolation for people with illness • Quality medical care • Quarantine for those exposed (antiviral prophylaxis if available) • Social distancing, travel restrictions • Infection control • Vaccine when available • Maintain essential services • Local decisions • Communication

19. 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

20. What is Ontario County doing to prepare? • Public Health Emergency Planning since 2003 • White Powder Plan • ChemPak Plan • Medical Reserve Corps • Isolation and Quarantine Protocol • Strategic National Stockpile Plan • 9 County Public Health Mutual Aid Agreement • Points of Distribution Plan • Surveillance Program in Hospitals and Schools • Pandemic Flu Plan

21. Pandemic Flu Plan • Based on NYSDOH Guidelines • Involves Multiple Local Stakeholders • Joint Planning with other counties in our region to create a standardized plan

22. General Assumptions in a Pandemic • Vaccine may not be available initially • Antivirals may be limited or ineffective • Neighboring communities will also be affected We need to prepare

23. Community-Based Infection Control Strategies Social Distancing • Voluntary self-shielding • Stay at home • 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

24. 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.

25. 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 homeif ill

26. What can YOU do to prepare?

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. Individual and Family Preparedness Checklist • Store a supply of food and water • General emergency supplies • Flashlight, batteries, radio, etc. • Have non-prescription drugs and other health supplies on hand • Get involved in your community • Talk to your families, friends and neighbors DO IT NOW!!!!!

30. On-Line Resources www.pandemicflu.gov www.ontariocountypublichealth.com Ontario County Public Health 585-396-4343 1-800-299-2995

31. God Bless You! Achoo!