Transcript pandemic - Healthcare Technology Network

Pandemic Influenza
A Local Perspective
David Goodfriend, MD,MPH, Director
Loudoun County Health Department
[email protected]
July 20, 2007
Why Are We Here?
• An influenza pandemic is different from other public health
disasters:
− Simultaneous outbreaks can occur across many regions
− Sharing of human resources or supplies from other communities is
less likely
• Key elements that will affect the public include:
− Human Impact
• Pandemics disproportionately affect younger people
• Potential for high levels of:
 Sickness and death
 Disruption of critical services
 Economic loss
− Business Continuity (COOP)
− Communication
Impact on
Business Functions
•Key Assumptions:
− Economic impact nationwide could range from
$71.3 to $166.5 billion
− The epidemic could persist for two months or
longer
− Psychological impacts on the workforce will be
extreme
− Community containment measures may be
implemented to minimize spread
Pandemic Influenza
1918 Influenza Pandemic
• Spread around the globe in 4 - 6 months
• Death rate 25-times higher than previous
epidemics
• 40 – 100 million people died worldwide
• Majority of deaths were in persons 18 to
40 years old
1918 Flu in the Washington Area
(from the Washington Post, October 4-11, 1918)
“Theaters Closed to Stay Influenza…Movies and Public Dance
Halls also in [Closure] Order, Churches Next Likely”
“Pandemic Extends from Coast to Coast”
“Shortage of Coffins and Grave Diggers”
“Universities Close Classes”
“Ban on Public Funerals”
“2,174 New Cases Reported in City”
“Stagger Hours for Food and Fuel”
Excess US Deaths in Previous
Influenza Pandemics
•1918-19: 500,000 - 650,000
Ten times as many Americans died of flu than died in WW I
•1957-58: 70,000
•1968-69: 40,000
•Typical annual influenza season: 36,000
Definitions
•EPIDEMIC: An increase in disease above what
is normally expected
•PANDEMIC: A worldwide epidemic
Influenza Clarification
• Seasonal Influenza:
− A contagious respiratory illness caused by various influenza
viruses creating a public health problem every year
− Viruses circulate throughout the human population
− Spread easily from person to person
• Avian Influenza A (H5N1):
− Devastating global outbreak in poultry
− Causes severe but rare human infections
− Does NOT spread easily from person to person
• Pandemic Influenza:
−
−
−
−
Currently there is no pandemic of influenza
Appears in the human population periodically
H5N1 is a likely candidate, but is not a pandemic virus to date
Wide geographic spread
Viruses
Type
Characteristics
• Affects Multiple Species including humans
• Avian Influenza is type A
A
• Most Virulent Virus: Although not all strains cause clinical disease
• Classified by surface antigens into subtypes: Hemagglutinin (H), Neuraminidase (N)
• Composed of 8 segments of RNA: Segments make it easier for ‘reassortment’ to occur
• Mostly in humans
• Not categorized into subtypes
B
• Common and less severe then A
• Epidemics occur less often than A
• Human seasonal vaccine: Two strains of type A; one strain of type B
• Humans and swine
C
• Rare, with mild to no symptoms
• By age 15, most people have antibodies
Pandemic Phases
1
Inter-pandemic
phase
2
Low risk of human cases
New virus in animals; no human cases
Higher risk of human cases
3
Pandemic alert
You Are
Here
4
No or very limited human-to-human
transmission
Virus causes human cases
Evidence of increased human-to-human
transmission
5
6
Evidence of significant human-to-human
transmission
Pandemic
Efficient & sustained human-to-human
transmission
Situation Report: Avian Influenza

Widespread and spreading prevalence in migratory birds;
broad host range

Continued outbreaks among domestic poultry

Mammalian infection (cats, pigs, tigers, ferrets) lethal

Virus is evolving

Sporadic human cases
• Mostly in young and healthy persons
• 317 human cases, 191 deaths (~60% mortality rate)
• Rare person-to-person transmission
Sustained and rapid person-to-person transmission
H5N1 Status -- June 2007
Cumulative Confirmed Human Cases of Avian
Influenza A/(H5N1) Reported to WHO
as of June 29, 2007
2003
Country
Cases
Deaths
2004
Cases
Deaths
2005
2006
2007
Total
Cases
Deaths
Cases
Deaths
Cases
Deaths
Cases
Deaths
Azerbaijan
0
0
0
0
0
0
8
5
0
0
8
5
Cambodia
0
0
0
0
4
4
2
2
1
1
7
7
China
1
1
0
0
8
5
13
8
3
2
25
16
Djibouti
0
0
0
0
0
0
1
0
0
0
1
0
Egypt
0
0
0
0
0
0
18
10
19
5
37
15
Indonesia
0
0
0
0
20
13
55
45
26
22
101
80
Iraq
0
0
0
0
0
0
3
2
0
0
3
2
Laos
0
0
0
0
0
0
0
0
2
2
2
2
Nigeria
0
0
0
0
0
0
0
0
1
1
1
1
Thailand
0
0
17
12
5
2
3
3
0
0
25
17
Turkey
0
0
0
0
0
0
12
4
0
0
12
4
Viet Nam
3
3
29
20
61
19
0
0
2
0
95
42
Total
4
4
46
32
98
43
115
79
54
33
317
191
Total number of cases includes number of deaths.
WHO reports only laboratory-confirmed cases
The Disease
Influenza (Flu)
•Symptoms
−Sudden headache
−Dry cough
−Runny nose
−Sore throat
−Muscle aches (myalgia)
−Fatigue/malaise
−Fever up to 104°F (40°C)
•Incubation - 24 to 72 hours
•Most people feel better within days
•Fatigue and cough can last for 2+ weeks
•Patients most infectious 24 hours before symptoms
Viral ‘Shedding’
•
The incubation period can vary from 1 to 4 days, but symptoms normally
appear 2 days after exposure to the virus.
•
Patients are most infectious 24 hours prior to the onset of
symptoms.
•
Viral shedding, the period when persons are contagious, lasts 5 to 7 days
in adults.
•
Persons can also be infected from environmental surfaces contaminated
from infected respiratory secretions.
•
The virus can survive outside a host cell for up to 48 hours on
nonpenetrable surfaces and up to 12 hours on cloth, tissue, or paper.
Treatment or Prophylaxis ?
• Antivirals
− Adamantanes (Amantadine, Rimantadine)
− Neuraminadase inhibitors (Zanamivir, Oseltamivir)
• Therapy more efficient than prophylaxis in preventing
adverse health outcomes
− Uses less drug
− Focuses on those who are ill and will directly benefit from
medication
• Prophylaxis more effective than therapy in
maintaining quality health care and public safety
− Prevents absenteeism from fear of illness
− Prevents time lost from work while ill
Lessons From Past Pandemics
• Large variations in mortality, severity of
illness, pattern of illness, and age groups
• Rapid surge in number of cases over brief
period of time (weeks)
• Tend to occur in waves - subsequent
waves may be more or less severe
Key Lesson – Unpredictability
PREPAREDNESS
Surveillance: Seasonal
Influenza-Like-Illness Trends
Animal Surveillance
• Federal monitoring programs
− Poultry farm surveillance
• State programs
− Wild bird surveillance
− Dead bird surveillance
• Local surveillance
− Dead bird surveillance
Role of Public Health in Pandemics
FEDERAL
•DHHS Pandemic Influenza Plan,
11/2005
•Development of laboratory tests and
reagents
•Development of reference strains
for vaccines
STATE
(Response Plan – 2002, revised 3/2006)
•Surveillance
•Community Disease Control
•Immunization
•Antiviral medications
•Public Information
•Vaccine evaluation and licensure
•Medical Care Planning
•Recommendations on target
populations and priorities
•Public Health Laboratory
•Deployment of federally purchased
vaccine
•Mass vaccination clinic guidelines
•Evaluation of vaccine safety
•Infection Control
•Clinical Guidance
•Maintenance of Essential Health and
Medical Services
•Travel associated risk
•Workforce Support
Role of County in Pandemic:
Local
• All Response is local!
• Loudoun Pandemic Flu Preparedness Task Force
• Craft Public Messages
• Recruit Medical Reserve Corps members
• Develop Plan (available on www.loudoun.gov/flu)
• Exercise Plan
− July 2006: ‘Flu the COOP’ – tested county business continuity
− October 2006: ‘Code Flu 06’ - exercise of mass prophylaxis
POD plan
− 2007: Alternate Care; Non-Medical POD exercise
Role of County in Pandemic:
Local
• Seminars & Educational Outreach Meetings
− County and Town government organizations
− Medical offices
− Private businesses (Nissan North America, AOL, Costco,
Lufthansa, Lockheed Martin, etc.)
− First responders (police, fire, EMS)
− Public and private schools, PTA's
− Retirement communities and senior centers
− Homeowners associations
− Fraternal and civic organizations
− Health fairs
Planning
• Being Able to Work May Be Difficult or Impossible
− Ask your employer how business will continue during a
pandemic
− Discuss staggered shifts or working at home with your
employer
− Discuss telecommuting possibilities and needs, accessing
remote networks, and using portable computers
− Discuss possible flexibility in leave policies
− Discuss with your employer how much leave you can take to
care for yourself or a family member
− Plan for possible loss of income if you are unable to work or
the company you work for temporarily closes
Planning
• Plan for the possibility that usual services
may be disrupted
− Could include services provided by hospitals, other
healthcare facilities, banks, restaurants, government offices,
telephone and cellular phone companies, and post offices
• Stores may close or have limited supplies
− Planning checklists can help you determine what items you
should stockpile to help you manage without these services
• Transportation services may be disrupted and
you may not be able to rely on public
transportation
− Plan to take fewer trips and store essential supplies
Planning
• Public gatherings, such as volunteer
meetings and worship services, may be
canceled
• Prepare contact lists including conference
calls, telephone chains, and email
distribution lists, to access or distribute
necessary information
• Consider that the ability to travel, even by
car if there are fuel shortages, may be
limited
Planning
•Food
•Food and Water Supplies
May Be Interrupted
and Limited
−Temporary shortages could occur
−You may also be unable to get to
a store
−Store 2 weeks of nonperishable food
−Select foods that do not require
refrigeration, preparation (including the
use of water), or cooking
−Insure that formulas for infants and
any child's or older person's special
nutritional needs are a part of your
planning
•Water
−Store two weeks of water, 1 gallon of
water per person per day. (2 quarts for
drinking, 2 quarts for food
preparation/sanitation), in clean plastic
containers
−Avoid using containers that will
decompose or break, such as milk
cartons or glass bottles
Family Emergency Health
Information Sheet
•Think ahead about
issues that could affect
you & your family
•If a mass vaccination
clinic is set up you may
need to provide
medical histories.
•Example:
Family
Blood
Member
Type
John
O Neg
Allergies
Penicillin
Past/Current
Current
Medical
Conditions
Medications
& Dosages
High Blood
Pressure
Lasix 20 mg
daily
Back surgery
Aspirin 85
mg daily
Jane
AB Pos
None
Pregnant
Pre-natal
vitamin daily
Suzy
O Pos
Milk
Asthma
Inhaler as
Eggs
needed
Emergency Contacts Form
Contacts
Name/Phone Number
Local Personal emergency contact
Out-of-town personal emergency contact
Hospitals near: Work
School
Home
Family physician(s)
Loudoun County Health Department
703-777-0234
www.loudoun.gov/flu
Pharmacy
School(s) contact & emergency information
Employer(s) contact & emergency number
Planning
• Schools and Daycare Centers May Be Closed
for an Extended Period of Time
• Talk to teachers, administrators, and parentteacher organizations about your school's
pandemic plan, and offer your help
• Plan now for children staying at home for
extended periods of time, as school closings may
occur along with restrictions on public
gatherings, such as at malls, movie theaters
Planning
• Medical Care for People with Chronic Illness Could
be Disrupted
− In a severe pandemic, hospitals and doctors' offices may be
overwhelmed.
− If you have a chronic disease, such as heart disease, high
blood pressure, diabetes, asthma, or depression, you should
continue taking medication as prescribed by your doctor.
− Make sure you have necessary medical supplies such as
glucose and blood-pressure monitoring equipment.
− Talk to your healthcare provider to ensure adequate access to
your medications.
− If you receive ongoing medical care such as dialysis,
chemotherapy, or other therapies, talk with your health care
provider about plans to continue care during a pandemic.
Planning
• Stay Informed
− Knowing the facts is the best preparation
• Identify sources you can count on for reliable information
• If a pandemic occurs, having accurate and reliable
information will be critical
• Alert Loudoun (http://alert.loudoun.gov)
− Check for information on your local and state
government Web sites
− Listen to local and national radio, watch news
reports on television, and read your newspaper and
other sources of printed and web-based information
− Talk to your local health care providers and public
health officials
Strategies for Preventing
Pandemic Influenza
• Vaccination
− May not be widely available
• Early Detection & Treatment
− Surveillance
− Antiviral drugs may be limited
or ineffective
• Infection Prevention &
Control Measures
Infection Control Strategy
COVER YOUR COUGH
WASH YOUR HANDS
STAY HOME WHEN
SICK
REMEMBER…
• Prepare Family Emergency Plans, Ensure Early
Recognition of Staff/Family Members at Risk
• Prevent Transmission by implementing
appropriate Infection Control Precautions
• Consult your local health department with
suspect or actual cases
• More Information at: www.loudoun.gov/flu
• Submit additional thoughts or questions to
[email protected] or call me at 703-771-5829
Questions…