Transcript flu_joco - PEP (Partnership for Emergency Planning)

Johnson County Public
Health
Partnership for Emergency Planning
January 19, 2006
Influenza Overview
Influenza “The Flu”
 Description
 Viral infection that can
make people of any age ill
 Respiratory transmission
 Symptoms
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Fever
Chills
Cough
Sore throat
Headache
Muscle aches
 Prevention
 Vaccination
 Stay home if ill
Influenza: Who, Where,
and When?
 Nearly everyone susceptible every year
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Illnesses, hospitalizations, deaths
Usually older, younger and those with chronic illness
Influenza and complications (pneumonia)
Most of us have some degree of immunity from
repeated exposures!
 Everywhere
 Can’t predict with certainty
 Seasonal
 Winter
Colds and Flu: The
Difference
 The flu strikes suddenly, colds develop
gradually and fever is unusual
 Influenza is seasonal (winter), colds are
present year round
 Flu has generalized symptoms, colds
are usually confined to upper respiratory
 Only three types of virus cause the flu,
more than 200 cause colds
Composition of the 20052006 Influenza Vaccine
 A/California/7/2004 (H3N2)
 A/New Caledonia/20/99 (H1N1)
 B/Shanghai/361/2002
Naming the Influenza
Virus
A /Fujian /411 /2002 (H3N2)
Virus
type
Virus
Subtype
Strain
Number
Geographic
Origin
Year of
Isolation
Influenza A
 Seen in many animals
 Subtyped based on surface
glycoproteins:
 Hemagglutinins (H)
 Neuraminidases (N)
 Yearly epidemics
 H1, H2, H3
 Mortality varies
 Responsible for known pandemics
Hemagglutinin
Neuraminidase
www.omedon.co.uk/influenza/ influenza/
Influenza B and C
 Influenza B
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Humans mostly
Not subtyped
Less mortality than type A
Associated with epidemics, not
pandemics
 Influenza C
 Usually mild disease
Drift vs. Shift
 Antigenic Drift:
 ‘A & B’ viruses
 Minor change, same
subtype
 Caused by genetic
mutation
 May result in
epidemic
 Antigenic Shift:
 ‘A’ Virus
 Major change, new
subtype
 Caused by change in
gene segments
(genetic reassortment)
 May result in pandemic
Difference between
Epidemic and Pandemic
 Epidemic/outbreak: increase in cases in
a community clearly greater than what is
normally expected.
 Pandemic: a global disease outbreak.
Annual Flu Impact
Nationally
 5%-20% of the population gets the flu
 200,000 hospitalizations
 36,000 deaths
Potential Pandemic
Impact
 Potential impact of pandemic influenza:
 Attack rates up to 35%
 89,000 to 207,000 deaths
 >25% increased demand for inpatient
beds and assisted ventilation
 314,000 – 733,000 hospitalizations
 Up to $166 billion in direct medical costs
 Significant social and economic disruption
www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm
Pandemic Influenza
 Experts believe that another pandemic is
inevitable.
 There will be very little warning
 Outbreaks will probably occur simultaneously
throughout the US.
 The effect on individual communities will be
prolonged
 Healthcare workers will be at increased risk.
20th Century Pandemics
Spanish
1918
H1N1
20 million
deaths
Asian
1957
H2N2
70,000
deaths
Hong
Kong
1968
H3N2
34,000
deaths
Avian
1997-2004 H5N1
Potential
pandemic
Pandemic Influenza
Pandemic Risk?
 Three conditions must be met:
 A new influenza virus subtype emerges;
 It infects humans, causing serious illness;
 It spreads easily and sustainably among
humans
http://www.riley.army.mil/OurPost/Maps.asp
www.ukans.edu
http://hellokansascity.com/images/Liberty%20Memorial%201921.jpg
http://www2.okstate.edu/ww1hist
Slide from: http://www.pbs.org/wgbh/amex/influenza/index.html
Recognizing Avian
Influenza
Clinical Features of Avian
(H5N1) Influenza
 Influenza-like symptoms
 Eye infections
 Encephalitis, Meningitis
 Severe pneumonia or ARDS
 Internal bleeding and hemorrhages
Avian (H5N1) Influenza
 Rapidly mutates
 Documented to cause severe disease in
birds and humans
 Birds that survive infection shed virus in
feces for weeks.
 Has been passed from animals to
humans rarely and Not EASILY.
Courtesy of National Geographic October 2005
Courtesy of National Geographic October 2005
Courtesy of National Geographic October 2005
What Must Occur For H5N1
to Increase Transmissibility
to Humans?
 “Reassortment”: genetic material is
exchanged between human & avian
viruses during co-infection of a human or
pig;
 “Mutation” which is a more gradual
process.
Influenza Virus Reassortment (Shift)
16 HAs
9 NAs
Non-human
virus
Human
virus
Reassortant
virus
Pandemic Response:
Vaccine
 Development
 Manufacturing
 6 – 8 month minimum for first batch
 Technical problems possible
 Distribution to state agencies
 5 – 6 more months to produce all
vaccine
Antivirals
 Can reduce seasonal influenza:
 Oseltamivir (Tamiflu)
 Zanamivir (Relenza)
 2 older drugs:
 amantadine
 rimantadine
Johnson County Public
Health
Disease Containment
Surveillance/Epidemiology
 Identify public health threat
 Disease Containment (DC) collaborates
with Health Officer, state and other
appropriate agencies
 Determine appropriateness for I or Q
 Notify law enforcement/legal whether
voluntary or mandated
 Information dissemination
New Isolation and
Quarantine Law Per HB 2264
 The I&Q bill was passed as part of HB 2264
 Signed into law on 4-12-05
 Clarifies the local health officer’s authority to
order isolation and quarantine of infected
persons or groups
 Gives the local health officer the authority to
order persons exposed to infectious disease to
seek medical evaluation or treatment
 Orders law enforcement officials to assist in the
execution or enforcement of health officer’s
orders
Public Health Options
 Implement “Snow Day” restrictions
 Close schools, daycare centers, etc.
 Cancel large public gatherings (concerts, theaters)
 Minimize other exposures (markets, churches, travel
restrictions)
 Ask non-essential workers to stay home
 Consider additional measures
 Distribution of surgical masks?
 Temperature screening in public venues
 Scaling back transportation services
What You Can Do
 Report unusual events/absenteeism
 Contact Health Department
 Business point of contact?
What You Can Do
 Educate staff
 Develop and practice healthy habits
 Be aware of your area…break chain of
transmission
 Stay home if sick
 Family illness
Mouse
1,676
Germs
per sq. in.
Keyboard
3,295
Germs
per sq. in.
Desktop
20.961
Germs
per sq. in.
80% of germs are
transmitted
by hands:
 Hands spread germs
 Germs cause illness
 Illness cost money
Wash Hands
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When someone coughs or sneezes…..on you
After shaking someone’s hand
Each time you return to your desk
After you use the restroom
After using the water cooler or coffee pot
Before you eat lunch
After going through your mail
After touching money
Whenever you need a refreshing break,
Before you go home for the day
Germiest Workplaces:
-phones
-desks
-computer keyboards
-buses
-restrooms
-day care centers
-escalators & elevators
Johnson County Public
Health Emergency
Response
Mass Prophylaxis
Dispensing (MPD)
 Epidemiology and Investigation have determined that there is
something going on
 They have notified appropriate agencies
 Now what?
 Is there something we can give?
 Medication
 Vaccination
 Who is going to get these medications/vaccinations?
 Those *most* at risk based on Epidemiology and Investigation
 Priority Prophylaxis
 Those providing support and assistance with Dispensing operations
 Critical Infrastructure
 Open Site Community Dispensing combined with Closed Site
Dispensing
 General Public
 Dispensing only if deemed necessary
New Concept for
Closed Site Dispensing of
Medications
 Health Department would contact the Business
Point of Contact (BPOC) and notify them of
decision to Dispense
 BPOC would receive appropriate forms and
health information to distribute to staff
 Medications
 For Dispensing of pills, BPOC would bring
completed forms to designated Open Site
 Forms would be processed and BPOC would be
provided the medications/prescriptions to take back
to workers/families
New Concept for
Closed Site Vaccination
 Health Department would contact the Business
Point of Contact (BPOC) and notify them of
decision to Dispense
 BPOC would receive appropriate forms and
health information to distribute to staff
 Vaccination
 For vaccination, Johnson County would coordinate
with the businesses to which sites/when
workers/families should bring completed forms to
Open Sites
Business Interest
 If interested, please contact me to set up
a meeting/discussion
 Process needs individualization and
further discussion
QUESTIONS?
Contact Information
Nancy Tausz
Disease Containment Director
[email protected]
913-826-1222
Ida Nesmith
Disease Containment Program Manager
[email protected]
913-826-1270
Liz Ticer
Public Health Emergency Coordinator
[email protected]
913-477-8316