Transcript Avian Flu, a Flu Pandemic Potential Impact to Public Health

Are We Ready?
Influenza Pandemic Summit
June 20, 2006
Sponsored by:
Nuclear, Biological, Chemical (NBC)
Public Health Workgroup
Funded by:
New York State Department of Health
Influenza 101
What do WE need to know?
Paula Calkins Lacombe, B.S. M.S.
Director of Public Health
Clinton County Health Department
June 20, 2006
Outline

Describe
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Seasonal Influenza
Avian Influenza
Pandemic Influenza
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Differences between cold and flu
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Factors In Emergence of Flu Pandemic
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Strategies to Reduce Impact Public Health
Flu – What it is and is NOT

The actual term for flu is
influenza

It is respiratory infection

It is not a GI illness with
vomiting, diarrhea

It is not a cold
Flu or Cold
Is It a Cold or the Flu?
Symptoms
Cold
Flu
Fever
Rare
Characteristic, high
(102-104°F); lasts 3-4 days
Headache
Rare
Prominent
General Aches,
Pains
Slight
Usual; often severe
Fatigue, Weakness
Quite mild
Can last up to 2-3 weeks
Extreme Exhaustion Never
Early and prominent
Stuffy Nose
Common
Sometimes
Sneezing
Usual
Sometimes
Sore Throat
Common
Sometimes
Chest Discomfort,
Cough
Mild to
moderate;
hacking cough
Common; can become severe
Complications
Sinus
congestion
or earache
Bronchitis, pneumonia;
can be life-threatening
Prevention
None
Annual vaccination; antiviral medicines - see
your doctor
Treatment
Only temporary
relief of
symptoms
Antiviral medicines - see your doctor
Source: National Institute of Allergy and Infectious Diseases, National Institutes of
Health, April 2001.
Flu Viruses
 Three

types of flu virus
A,B,C ( A & B cause the most serious illness)
 Type A
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Many subtypes that cause most serious
disease in humans
Can cause human epidemics and pandemics
Can sicken many other birds and mammals.
chickens, ducks, geese, pigs, and horses
Mutation
 Viruses


routinely mutate
Antigenic drift - small changes in the viruses
Antigenic shift – occurs when rare, abrupt
and major change in a type A virus that results
in new subtype not previously found in
humans (Novel virus)
• If this new virus has the ability to spread easily to
humans can lead to pandemic
How is Flu Spread

Close contact – spread by
exposure to large
respiratory droplets, direct
contact, or near-range
exposure to aerosols,
within 3 feet.

Little evidence of airborne
transmission over long
distances or prolonged
periods of time (as is seen
with M. tuberculosis).
Influenza Infection Timeline
British Columbia Ministry of Health
Types of Influenza/Flu

Seasonal Flu:
Contagious respiratory
illness caused by influenza
viruses occurs every year

Avian Flu:
Bird flu is caused by avian
influenza viruses; occurs
naturally among birds.

Pandemic Flu:
Currently none. A flu
pandemic is a global outbreak
with a new influenza A virus
that causes serious human
illness and that spreads
easily from person to
person.
Seasonal Influenza
 Seasonal






influenza
Outbreaks are predictable - seasonal patterns
Occur annually- usually in winter
People usually build up some immunity from
previous exposure
Most healthy adults – no serious complications
Highest risk of complications – elderly and very
young
Vaccines are usually available
Seasonal Influenza

Average deaths in US
per year 36,000

Modest impact on
society
Influenza A Virus
AVIAN INFLUENZA
Avian Flu
 Why
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
all the concern?
Subtype H5N1 is an influenza Type A
Before 1997 only found in birds and few other
animals
Bird influenza viruses can mutate into a form
which is easily transmitted human to human.
This will represent a dramatic antigenic shift.
Humans have no immunity to this virus thus
the risk.
Avian Flu
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Reassortment
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Mixing vessels
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Avian viruses & human viruses may also
“reassort” in another animal and create a new
virus
Humans – with those who survive H5N1
Pigs get avian and human influenza
If virus changes (New/Novel virus) and develops
ability to spread human to human an influenza
pandemic can begin
June 6 – WHO (World Health Organization)
2004
Country
2005
2006
Total
cases
deaths
cases
deaths
cases
deaths
cases
deaths
Azerbaijan
0
0
0
0
8
5
8
5
Cambodia
0
0
4
4
2
2
6
6
China
0
0
8
5
10
7
18
12
Djibouti
0
0
0
0
1
0
1
0
Egypt
0
0
0
0
14
6
14
6
Indonesia
0
0
17
11
32
26
49
37
Iraq
0
0
0
0
2
2
2
2
Thailand
17
12
5
2
0
0
22
14
Turkey
0
0
0
0
12
4
12
4
Viet Nam
29
20
61
19
0
0
93
42
Total
46
32
95
41
81
52
225
128
Why It is Spreading in Asia
 Large,
dense population of people, poultry,
and animals in close quarters
 Lifestyle
 Additional
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
mammals involved
Housecats in Netherlands
Tigers in Thailand
Pigs in China
Avian Influenza

Avian influenza (Bird Flu) is not the same as pandemic
flu

No one knows if this current avian virus (H5N1) will
cause the next pandemic
IF Bird Flu Arrives in the US…

It does NOT mean that lots of people will get sick

People who have gotten sick from bird flu had a lot of
contact with sick birds and touched them with their
bare hands

Bird flu is easy for birds to catch, but hard for people to
catch
Bird Handling Advice
 Even
in the absence of bird flu, you should
not handle wild birds
 Many
healthy birds can carry germs that
can make people sick
 Wear
gloves if you have to touch a wild
bird, and wash your hands afterward
PANDEMIC INFLUENZA
Could it Happen,
and What if it Does?
What is a Pandemic Flu?
A
global influenza
outbreak caused
by a brand new
(novel) flu virus
Facts About a Flu Pandemic
 No
immunity
 Occurs
rarely
no previous exposure
3x in 20th century not
since 1968
 Complications



More severe symptoms
With more frequent complications
Can effect young and healthy people
Facts About a Flu Pandemic
 Death
toll high
 Health
In US,1918 pandemic
675,000
systems Overwhelmed
 Vaccine
Not available early on,
not for 6-8 months
 Antivirals
Limited supply of
effective anitvirals
Pandemic Flu

Societal impact
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Widespread restrictions to travel
Closings of schools, businesses
Cancellation of large public gatherings
Economy

Potential for severe impact on domestic and
world economy
Assumptions

Vaccine
• Will not be available
• Takes 6 – 8 months to produce
• May need two doses

Decreased Workforce
• Plan 25 – 50% unavailable to work

Time is our friend
Timeline of Human Flu Pandemics
Major pandemic
The appearance of a new influenza strain in the
human population
Influenza Pandemics 20th Century
Credit: US National Museum of Health and
Medicine
1918: “Spanish Flu”
A(H1N1)
1957: “Asian Flu”
A(H2N2)
1968: “Hong Kong Flu”
A(H3N2)
20 - 40 million deaths
1 - 4 million deaths
1 - 4 million deaths
675,000 US deaths
70,000 US deaths
34,000 US deaths
Deja Flu - Similarities in 1918
 Originated
 The
in birds
avian influenza virus we are seeing in
Southeast Asia attacks humans similar to
1918; those with healthiest immune
system are most susceptible
1918 Influenza Pandemic
This May 29, 1919 photograph showed rows of tents that had been set up
on a lawn at Emery Hill in Lawrence, Massachusetts where victims of the
1918 influenza pandemic were treated.
Deja Flu - Similarities in 1918
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1918 numbers extrapolated to today
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1.7 million deaths in U. S.
30 – 384 million deaths worldwide
Age projected deaths in U.S.

< 5 years
233,000
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15 – 24 years
214,000

25 – 34 years
378,000

35 – 44 years
268,000

> 65 years
426,000
From APIC News -Vol. 24
Issue 2- Preparing for the Next Pandemic by Michaie Osterholm, PHD, MPH, Director, Center for Infectious Disease Research and Policy
Flu Pandemic Timeline
•
Past shown several waves of illness
•
Each wave lasts about six to eight weeks
•
Can be separated by 3 - 9 months
Factors in Emergence of
Flu Pandemic
 Microbial
 Host
adaptation and change
susceptibility to infection
 Climate
and weather
 Changing
ecosystems
Factors in Emergence

Economic development and land use

Human demographics and behavior
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Technology and industry

International travel and commerce
Factors in Emergence
 Poverty
 War
and social inequality
and famine
 Lack
of political will
 Breakdown
of public health measures
What Can We Do About It?
Share Responsibility!
Faith
Communities
Healthcare
Delivery
System
Individual
Local /State /
Federal
Public Health
System
Business
Government
& Workers
Education,
Law
Enforcement,
Emergency
Services
Planning Will Make A Difference
Unprepared
Impact
Prepared
Weeks
Key Public Health
Strategies to Reduce Impact
 Surveillance
Monitor disease activity
 Coordination
Local, state, and federal
planning, systems and
resources
Key Public Health
Strategies to Reduce Impact
 Utilize
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Limit exposure of cases (sick)
Limit exposure of contacts to others
 Social
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Isolation and Quarantine
Distancing
Closing schools
Reduce crowds and places where people
gather
Work from home
Key Public Health
Strategies to Reduce Impact
 An
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
informed and responsive public
Develop public education and
communications to keep the public
informed.
Essential to minimizing the health effects
Key Public Health
Strategies to Reduce Impact
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Reduce stress on health care system
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Care for people at home or other facilities
Protect limited assets – use effectively
Empower people to do so
Ethics – Discuss NOW!
Hot lines, support services
Keep people healthy
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Back to basics
Respiratory Etiquette and Hand Hygiene
Key Public Health
Strategies to Reduce Impact
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Distribute vaccine
rapidly when available
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Establish PODs – clinics
Use antivirals effectively

Protect limited asset
Messages to Take Home

Understand the facts about
Influenza and a Pandemic

Communicate what you have
learned
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Integrate the messages and
apply them to your setting

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Make plans
Communicate, Cooperate,
and Collaborate
References
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References
Animal Health Diagnostic Center
Center for Infectious Disease Research and Policy
Michigan State University’s College of Veterinary Medicine
National Center for Food Protection and Defense
Townsends, Inc.
Wildlife Conservation Society
WHO Global Influenza Preparedness Plan
APIC News -Vol. 24 Issue 2 -Preparing for Pandemic Flu: Is Time Running Out
British Columbia Ministry of Health Plans
CDC and NYSDOH
Presentations
Speaker 1: Alfonso Torres
Executive Director, Animal Health Diagnostic Center; and Associate Dean of Veterinary Public Policy, College of Veterinary Medicine,
Cornell University
Speaker 2: William Karesh
Director, Field Veterinary Program, Wildlife Conservation Society
Speaker 3: Spangler "Buzz" Klopp
Corporate Veterinarian, Townsends, Inc.
Speaker 4: Michael Osterholm
Director, Center for Infectious Disease Research and Policy and Associate Director, National Center for Food Protection and Defense,
University of Minnesota
Speaker 5: Lonnie King
Dean, College of Veterinary Medicine, Michigan State University