Transcript W01_MONTO_WHITLEY

Pandemic Influenza
Preparedness and Response
National Strategy
Raymond A. Strikas, MD
Associate Director for Adult Immunization
Immunization Services Division
National Immunization Program
Coordinating Center for Infectious Diseases
Centers for Disease Control and Prevention
Defining a Pandemic: WHO Phases
Phase 1.
No new influenza virus subtypes detected in humans.
If animals are infected, risk to humans is low.
Phase 2.
No new influenza virus subtypes detected in humans.
However, a circulating animal influenza virus subtype
poses a substantial risk of human disease.
Phase 3.
Isolated human infections, no human-to-human
spread except rare close contacts.
Phase 4.
Small, highly localized cluster(s), limited human-tohuman transmission.
Phase 5.
Larger localized cluster(s) limited human-to-human
spread. Substantial pandemic risk.
Phase 6.
Pandemic phase: Sustained transmission among
humans occurs.
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Current Situation
• National plan revised, available 11/2/05
• H5N1 vaccine
– Clinical trials, 90 mcg (30 mcg?) x2
– Adjuvants or Intradermal?
• Antiviral drugs
– Drug resistance, stockpile supplies
• Isolation and quarantine
– Executive order April 2005
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FY2006 Emergency Supplemental
Budget: $3.8 Billion
• $350 million for upgrading State and local response capacity
• $162 million for Strategic National Stockpile
• $50 million for laboratory capacity and research at CDC
• $246 million for international activities, disease surveillance,
vaccine registries, research, and clinical trials ($150 m. to CDC)
• $2,750 million to support, at the Secretary’s discretion,
other core preparedness activities, such as expanding
the domestic production capacity of influenza vaccine,
developing and stockpiling pandemic vaccine, and stockpiling
antivirals and other medical supplies necessary to protect and
preserve lives in the event of an outbreak of pandemic influenza.
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National Strategy for Pandemic Influenza - 1
• Announced 11/1/05
• Available at www.pandemicflu.gov
• Goals:
– Stopping, slowing, otherwise limiting spread
of a pandemic to the United States
– Limiting domestic spread, and mitigating
disease, suffering, and death
– Sustaining infrastructure and mitigating impact
to economy and functioning of society
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National Strategy for Pandemic Influenza - 2
• Three Pillars of the National Strategy:
– Preparedness and Communications
– Surveillance and Detection
– Response and Containment
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National Strategy for Pandemic Influenza - 3
• Preparedness and Communications
– Planning for a pandemic
– Communicating expectations
– Producing and stockpiling vaccines, antivirals,
and medical material
– Establishing distribution plans for vaccines
and antivirals
– Advancing scientific knowledge and
accelerating development
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National Strategy for Pandemic Influenza - 4
• Surveillance and Detection
– Ensuring rapid reporting of outbreaks
– Using surveillance to limit spread
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National Strategy for Pandemic Influenza - 5
• Response and Containment
– Containing outbreaks
– Leveraging national medical and public
health surge capacity
– Sustaining infrastructure, essential
services and the economy
– Ensuring effective risk communications
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Roles and Responsibilities - 1
• Federal
– Advancing international preparedness
– Supporting establishment of countermeasure
stockpiles and production capacity
– Ensuring federal depts., agencies have
developed, exercised plans
– Facilitating state and local planning
– Providing guidance to the private sector and
the public, in conjunction with states and
communities
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Roles and Responsibilities - 2
• States and localities
– Ensuring all reasonable measures taken
to limit spread of outbreak
– Establishing comprehensive, credible
preparedness and response plans, and
exercising them
– Integrating non-health entities into planning
– Establishing state and community-based
stockpiles and distribution systems
– Identifying key spokespersons
– Providing public education campaigns
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Roles and Responsibilities - 3
• Private Sector
– Establishing an ethic of infection control
in the workplace
– Establishing contingency systems to maintain
delivery of essential goods and services
– Establishing mechanisms to allow workers to
provide services from home (where possible)
– Establishing partnership with other sector
members to maintain essential services
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Roles and Responsibilities - 4
• Individuals and families
– Taking precautions to prevent spread of
infection if an individual or family member
has symptoms of influenza
– Being prepared to follow public health
guidance – may include limits on public
gatherings and travel
– Keeping supplies at home to support
essential needs for several days if necessary
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National Pandemic Influenza Plan
• Issued 11/2/05, revised from draft of 8/04
• Two parts:
– Strategic Plan
– Public Health Guidance to State and Local
Partners
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National Pandemic Influenza Plan
Doctrine - 1
• Preparedness will require coordination in
all sectors
• An informed and responsive public is
essential to minimizing pandemic health
effects
• Domestic vaccine production capacity
sufficient to produce vaccine for the entire
US population is critical
• Quantities of antiviral drugs sufficient to
treat 25% of the population should be
stockpiled
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National Pandemic Influenza Plan
Doctrine - 2
• Sustained human-to-human transmission anywhere
in the world will trigger US pandemic response
• Protective public health measures will be employed
to reduce transmission, prevent or delay outbreaks
(when possible)
• At onset of a pandemic, HHS will procure vaccine
and distribute to state and local health departments
for pre-determined priority groups
• At onset of a pandemic, antiviral drugs from public
stockpiles will be distributed to health care providers
for administration to pre-determined priority groups
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National Pandemic Influenza Plan,
Part 2: Public Health Guidance to State and Local Partners
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Introduction
Surveillance
Laboratory Diagnostics
Healthcare Planning
Infection Control
Clinical Guidelines
Vaccine Distribution and Use
Antiviral Drug Distribution and Use
Community Disease Control and Prevention
Managing Travel-related Risks of Disease
Public Health Communications
Workforce Support: Psychosocial Considerations and
Information Needs
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State & Local Pandemic Planning:
Accomplishments
• All states submitted a plan by July ’05
• Plans under formal review by CDC;
feedback due soon
• 29/49 have conducted tabletop exercises
(ASTHO survey, 11/05)
• 14/49 have conducted functional (e.g.,
vaccination) exercises to form more
comprehensive response
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State Level Pandemic Planning:
Challenges
• Indeterminate availability of vaccine or
antiviral drugs
• Surge capacity of health care system
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So Now What for State Planning?
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Ensure all appropriate planning partners are involved
Ensure coordination
Establish incident command/control
Promote/facilitate development of local plans
Ensure tribes are involved/addressed
Review legal authorities
Annual review/updating of plan
Move beyond “plan to plan”
See State and Local Pandemic Planning Checklist,
http://www.cdc.gov/flu/pandemic/pdf/PandemicFluCh
ecklist.pdf
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CDC Roles
• Refine CDC Concept of Operations plan
• Refine role in HHS Pandemic Plan
• Train and equip Laboratory Response Network
• Consult overseas via WHO
• Manage overseas assets
• Special lab capacity: vaccine seed, antivirals’
efficacy and safety testing, reagents
• Research
• Business and private sector roundtables
• Strategic National Stockpile
• Carry out DHHS assignments
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Remember…
• “[Hurricane] Katrina was the most
anticipated natural disaster in American
history, and still government managed to fail
at every level.”
• David Brooks, NY Times, 9/11/05
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Resources
• www.pandemicflu.gov
• http://www.cdc.gov/flu/pandemic/
• http://www.who.int/csr/disease/avian_influenza/en/
• http://www.astho.org/templates/display_pub.php?pub_id=1383&admin=1
• http://www.cste.org/specialprojects/Influenzaplans/StateMap.asp
• http://www.naccho.org/topics/infectious/emerging/avian.cfm
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