Transcript Business Continuity in a Pandemic

Avian Influenza and the
Threat of an Impending
Pandemic
Eden V. Wells, MD, MPH
Michigan Department of
Community Health
Influenza Strains
Type A
– Infects animals and humans
– Moderate to severe illness
– Potential epidemics/pandemics
Type B
Source: CDC
– Infects humans only
– Milder epidemics
– Larger proportion of children affected
Type C
– No epidemics
– Rare in humans
A’s and B’s, H’s and N’s
Classified by its RNA core
– Type A or Type B influenza
Further classified by surface protein
– Neuraminidase (N) – 9 subtypes known
– Hemagluttin (H) – 16 subtypes known
Only Influenza A has pandemic potential
Influenza Virus Structure
Type of nuclear
material
Neuraminidase
Hemagglutinin
A/Moscow/21/99 (H3N2)
Virus
type
Geographic
origin
Strain
number
Year of
isolation
Virus
subtype
Differentiating Influenza
 Seasonal
– Caused by influenza A or B strains circulating in humans
– ~36,000 human deaths annually in USA
 Avian
– Caused by Influenza A
– Shorebirds and water fowl are the reservoir and rarely see
outbreaks, except in current H5N1 strain
– Domestic poultry (chickens and turkeys), causes
morbidity and mortality with outbreaks annually
worldwide
 Pandemic
– When new virus strain occurs
– Humans lack immunity
– Simultaneous epidemics worldwide
– Disease easily transmitted between people
– Significant number of illness and deaths
Influenza A:
Antigenic Drift and Shift
Hemagglutinin (HA) and neuraminadase
(NA) structures can change
Drift: minor point mutations
– associated with seasonal changes/epidemics
– subtype remains the same
Shift: major genetic changes
(reassortments)
– making a new subtype
– can cause pandemic
Seasonal Influenza
October to April
People should get flu vaccine
Children and elderly most prone
~36,000 deaths annually in U.S.
Seasonal Effects
Seasonal Influenza Surveillance
Avian Influenza
The “Bird Flu”
Images from: http://www.usda.gov/oc/photo
Avian Influenza
Infection can be in two forms
– “low pathogenic” (LPAI) - causes mild illness
and may go undetected
– “highly pathogenic” (HPAI) - affects multiple
organs, spreads rapidly among birds,
causes high mortality very quickly
Avian Influenza and
Domestic Poultry
Virus is shed in saliva, nasal secretions, and
feces of infected birds
Virus can survive for long periods in feces,
water, and even on the ground, especially
when environmental temperatures are low
Avian influenza is a reportable disease in
Michigan
The Role of Animals in
Influenza A Infection
Mammals
Domestic Birds
Shore Birds
and Wild
Waterfowl
Humans
Countries with H5N1 in Poultry
(OIE, 8/22/06)
Afghanistan
Albania
Azerbaijan
Burkina Faso
Cameroon
Cambodia
China
Cote d’ Ivoire
Cyprus
Denmark
Dijbouti
Egypt
France
Germany
Hungary
India
Indonesia
Iraq
Israel
Japan
Jordan
Kazakhstan
Laos
Malaysia
Myanmar
Niger
Nigeria
•North Korea
•Pakistan
•Palestian Aut. Territories
•Romania
•Russia
•Serbia and Montenegro
•South Korea
•Sudan
•Sweden
•Thailand
•Turkey
•Ukraine
•Vietnam
Domestic Poultry Surveillance
• Michigan veterinarians are
responsible for overall
livestock and poultry
reportable disease programs
• They conduct investigations
into reports of diseases such
as:
–
–
–
–
–
–
Avian influenza
Rabies
Eastern equine encephalitis
Equine infectious anemia
Tuberculosis
Psittacosis
www.michigan.gov/MDA
H5N1 in Poultry and Wild Birds
(WHO, 8/2/06)
Countries with H5N1 in Wild Birds
(OIE, 8/22/05)
•Afghanistan
•Georgia
•Russia
•Austria
•Germany
•Serbia and Montenegro
•Azerbaijan
•Greece
•Slovakia
•Bosnia and Herzegovina
•Hungary
•Slovenia
•Bulgaria
•Indonesia
•South Korea
•Cambodia
•Iran
•Spain
•Cameroon
•Italy
•Sweden
•China
•Japan
•Switzerland
•Cote d’ Ivoire
•Kazakhstan
•Thailand
•Croatia
•Kuwait
•Turkey
•Czech Republic
•Mongolia
•Ukraine
•Denmark
•Nigeria
•United Kingdom
•Egypt
•Poland
•Vietnam
•France
Wild Bird Surveillance
• Wildlife biologist monitor
diseases of wild birds at the
population level
• Sick or Dead Wildlife website
reporting
• Bird Banding
• Hunter Surveillance
http://www.michigan.gov/dnr
H5N1 Influenza in HumansRisk
Transmission from birds to humans does
not occur easily
– Contact with feces or secretions from infected
birds
– Risk with butchering, preparing, defeathering
of infected birds
– NOT transmitted through cooked food
Implications for Human Health
Asian Strain H5N1 in humans more aggressive
than seasonal flu strains
–
–
–
–
Severe clinical course
Rapid deterioration
High fatality
Low transmissibility human-to-human
Incubation may be longer than seasonal influenza
– Seasonal influenza: 2-3 days
– H5N1: possibly up to 10 days
More studies needed
Confirmed Human Cases of H5N1
(WHO, 8/23/06)
Country
H5N1 Cases
Fatalities
Mortality Rate (%)
Azerbaijan
8
5
63
Cambodia
6
6
100
China
21
14
67
Djibouti
1
0
0
Egypt
14
6
43
Indonesia
60
46
77
Iraq
2
2
100
Thailand
24
16
67
Turkey
12
4
33
Vietnam
93
42
45
Total
241
141
59
http://www.pandemicflu.gov/ (July 7, 2006)
What is the H5N1 Pandemic
Risk?
Three conditions must be met for a pandemic
to start:
– Emergence of a new influenza subtype
– The strain infects humans causing
serious illness
– Spreads easily between humans
Each new H5N1 human case gives the virus
a chance to mutate into a highly
transmissible form, increasing the risk of a
pandemic
MDCH Pandemic Influenza Plan
2005
Revision of 2002 plan
Released November 2005
Appendix to MDCH All-Hazards Response
Plan
Pandemic plan updated as needed
www.michigan.gov/influenza
Leads for Public Health
International: World Health Organization
United States: Centers for Disease Control
and Prevention, DHHS
Michigan: Michigan Department of
Community Health
County: Local Health Department/Jurisdiction
Current WHO Risk
Assessment
th
20
Century Influenza
Pandemics
1918 – 1919, “Spanish Flu” (H1N1)
– Influenza A H1N1 viruses still circulate today
– US mortality: approx. 500,000+
1957-58, “Asian Flu” (H2N2)
– Identified in China (February 1957) with spread to
US by June
– US mortality: 69,800
1968-69, “Hong Kong Flu” (H3N2)
– Influenza A H3N2 viruses still circulate today
– First detected in Hong Kong (early 1968) and
spread to US later that year
– US mortality: 33,800
Estimated Impact
of a Future Pandemic in
Michigan
Characteristic
Moderate
(1957 / ‘68-like)
Severe
(1918-like)
Illness
3.4 million
3.4 million
Outpatient
2.5 million
1.5 million
Hospitalization
51,000
420,000
Deaths
15,000
125,000
(*Michigan figures developed with Flu-Aid 2.0 software, CDC)
Influenza Surveillance
Michigan Disease
LHD’s/
Surveillance System
MDSS
Sentinel Surveillance
Syndromic
Non-MDCH
Labs
– Pharmacy
– ER
Laboratory
WHO Data
National
International
CDC Data
MDCH
Labs
Hospitals
ER
Syndromic
Mi-Flu
Focus
Sentinel
Physicians
LHD’s/
Healthcare
providers
Pharmacy
OTC
Treatment Options
Antiviral Medications
– Neuraminidase Inhibitors
Oseltamivir
Zanamivir
Pandemic strain vaccine
– Minimum 5 month production time
– Need chicken eggs and viral seed stock
Source: CDC
Oseltamivir- Not a Panacea
Limited availability (one manufacturer)
Personal stockpiling could lead to:
– Inappropriate use
– Increased resistance by the virus
(already one documented case)
– Decreased availability for the critically ill
For prophylaxis, multiple courses may be
needed throughout flu season
Human Vaccine for Avian H5N1
Effective vaccine is not yet available
– Small batches of vaccine are undergoing
clinical trials
– Not ready for mass production
US has advance-ordered 20,000,000 doses
May not match strain that causes pandemic
Seasonal influenza vaccine does not protect
against H5N1 strain
Public Health:NonPharmaceutical Interventions
Social distancing
– Schools
– Business practices
– Public gatherings
Respiratory/Cough
Etiquette
Hand Hygiene
Influenza Control Measures
Education to encourage prompt selfdiagnosis
Hand hygiene
Consider masks, if possible, for
symptomatic persons (then send them
home!)
Cancellation of school/social gatherings
Quarantines
Have a Plan!
Develop
Exercise
Update
Review
Exercise
Update….
CDC/EOC-PHIL
Current U.S. Status
No current evidence in U.S. of highly
pathogenic H5N1 in
– Wild birds
– Domestic poultry
– Humans
Images from: http://www.usda.gov/oc/photo
Conclusion
Many unknowns
Simple precautions go a long way
Education is critical to your COOP
Get employees involved in the process
Health Advice
Good Now, Good in a Pandemic
Get your annual flu shot
– Won’t protect against a pandemic strain
Stay at home if you have a fever
Wash hands with soap or hand
sanitizers when you sneeze or cough
Get adequate sleep, eat healthy, stay
hydrated
References
pandemicflu.gov
Michigan Department of Community
Health (www.michigan.gov/flu)
www.who.int
www.cdc.gov
Local Health Department
Chamber of Commerce