Transcript pandemic influenza - Nassau Schools Emergency Planning

PANDEMIC INFLUENZA
BACKGROUND AND GUIDANCE FOR SCHOOLS
Influenza
• Respiratory infection
• Transmission: contact with respiratory secretions
from an infected person who is coughing and
sneezing
• Incubation period: 1 to 5 days from exposure to
onset of symptoms
• Communicability: Maximum 1-2 days before to 45 days after onset of symptoms
• Timing: Peak usually occurs December through
March in North America
Common Influenza Symptoms
• Rapid onset of:
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Fever
Chills
Body aches
Sore throat
Non-productive cough
Runny nose
Headache
Influenza is a serious illness
• Annual deaths: 36,000
• Annual hospitalizations: >200,000
• Total economic costs: $37.5B
• Who is at greatest risk for serious
complications?
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persons 65 and older
persons with chronic diseases
infants
pregnant women
nursing home residents
Definitions
• Epidemic: An increase in disease above
what is normally expected
• Pandemic: A worldwide epidemic
How Do Influenza Pandemics
Arise?
• Wild water fowl are natural reservoirs of
influenza
• They can spread the virus to domestic
birds
How Do Influenza Pandemics
Arise?
• When avian flu viruses experience sudden
changes in genetic structure
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• Are capable of infecting humans
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• Can reproduce and spread from person to
person efficiently
Why Be Concerned About
Pandemic Influenza?
• Influenza pandemics are inevitable: naturally recur at
more-or-less cyclical intervals
• Can cause:
– High levels of sickness and death
– Drastic disruption of critical services
– Severe economic losses
• There will be little warning time between the onset of
spread of a pandemic and its arrival in the U.S.
Outbreaks occur simultaneously in many areas
• Impacts will last for weeks to months and likely to
occur in successive waves
• Pandemics can disproportionately affect younger,
working-age people
• Current avian influenza outbreak in Asia
Timeline of Emergence of
Influenza A Viruses in Humans
Avian
Influenza
Russian
Influenza
Asian
Influenza
Spanish
Influenza
H1
1918
H9
H5
H7
H5
H1
H3
H2
Hong Kong
Influenza
1957 1968 1977
1997 2003
1998/9
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 m deaths
1-4 m deaths
1-4 m deaths
675,000 US deaths
70,000 US deaths
34,000 US deaths
Planning Assumptions: Health Care
• 50% or more of those who become ill will seek medical care
• Number of hospitalizations and deaths will depend on the virulence
of the pandemic virus
Moderate (1957-like)
Severe (1918-like)
Illness
90 million (30%)
90 million (30%)
Outpatient medical care
45 million (50%)
45 million (50%)
Hospitalization
865,000
9, 900,000
ICU care
128,750
1,485,000
Mechanical ventilation
64,875
745,500
Deaths
209,000
1,903,000
The 1918
Influenza
Pandemic
Chicken Little and the Sky is Falling
or The Next Major Disaster?
Which is it?
Current Outbreak:
Avian Influenza (H5N1)
• Began in fall, 2003.
• At least 252 confirmed human cases in
Asia, Africa and Europe
148 deaths in Asia and Africa
(World Health Organization, 10/06)
• Mammalian infection (cat, pig)
• No efficient person-to-person
transmission
• Isolated Human disease
• Case-fatality rate > 50%
• Outbreak spreading, not controlled
Current Avian Outbreaks
Clinical illness with H5N1 compared
with typical human influenza illness
• More severe illness in younger persons
• Primary viral pneumonia appears to be
more common and with rapid onset
• Incubation period may be longer 1-4+ days
(up to 14 days?)
• Duration of infectious period likely longer,
particularly in adults 1d. prior to 7d. after
(in adults; children ~longer)
Adapted from Guillermo Herrera, CDC, 2005
Pandemic Effects: Strain on
Resources
• Health care shortages
– Vaccine / Antivirals
– Hospital beds / equipment
– Masks
• Personnel shortages
• Disruption of essential society
functions
• Panic
Vaccines, Antivirals, and
Medical Supplies
Pandemic Influenza Vaccine
Questions
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When will it be available?
How much will there be?
Who will own it?
Who should get it?
How should it be delivered?
Treatment and Prevention:
Vaccine
• Vaccines takes 6-8 months to produce
following the emergence of a new virus
• Supplies will be limited, if available at all
– 2nd dose after 30 days will likely be required
– New vaccine safety and efficacy has
“unknowns”
Treatment & Prevention:
Antiviral Drugs
• Antiviral agents
– Effective in preventing illness
– Can prevent severe complications
– May not be effective against
pandemic virus
• Supplies will be limited
– Treatment over prevention
Nassau County Department of Health
Pandemic Influenza Preparedness Strategies
• Distribution Planning
– First Responder Prophylaxis
– Municipality operated PODs
– Employer operated PODs (regional)
– DOH operated PODs
– School operated PODs through municipalities
Points of Distribution
• Community based sites used to distribute
vaccines or medications to healthy citizens
• Would the schools be used?
• Municipalities will coordinate POD
planning within their communities.
Individual and Family
Preparedness
– We will have to take care of ourselves and those around
us.
– During a pandemic, public health will maximize resources
for the greatest impact on the population as a whole.
– Schools should communicate with local/ state public
health agencies and/or emergency responders about the
assets/services the districts could contribute to the
community.
Influenza Prevention:
What Can We Do?
Specific Recommendations
for Infection Control in
Schools and Workplaces:
 Pandemic preparedness planning
 Distribution of educational messages
and infection control guidance
 Social distancing: people stay home when ill
 Promotion of respiratory etiquette
 Provision of materials for respiratory hygiene/
etiquette: tissues and disposal receptacles
ISSUES FOR SCHOOL
DISTRICTS TO THINK ABOUT
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Absenteeism among children AND staff
Resources limited: vendors, buses
Role of school nurses
Communication with parents and staff and community
Advantages and disadvantages to closing schools
(amount of closure time)
Working with local municipalities
Implications with State aide
Policies sending sick children home (isolation within the
school, masks, etc)
Policies for allowing previously sick children to return to
schools
RESOURCES FOR SCHOOLS
Nassau County Health Department, with
direction from the New York State Health and
Education Departments, will provide guidance to
schools districts
• To create plans
• To create communication materials for students,
staff and parents
• To provide guidance for closing schools
Key Step for District Preparedness
• Incorporate the pandemic influenza plan
as an annex in the school district’s all
hazards plan.
COMMUNICATION
Before a Pandemic Hits
• Develop strong relationships with your
school communities
– Build confidence that information will be
distributed accurately and quickly
- Consider community meetings that describe
current plans in place
COMMUNICATION
Before a Pandemic Hits
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School Websites
Lunch Menus
PTAs
Letters to the Community
BOE Meetings
Marquis
Proactive
COMMUNICATION
Before a Pandemic Hits
• Establish relationship with Public Health
Officials early on
• Review/update procedures for
communicable disease reporting
Pandemic Influenza
“Don’t worry about it, it’s probably just a head cold.”
Acknowledgments
Presentation compiled and adapted from multiple slide
sets from the:
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Centers for Disease Control and Prevention
HHS National Vaccine Program Office
New York State Department of Health
Connecticut Department of Health
Kansas Department of Health
Department of Defense
Washington Department of Health