Transcript Communities at Risk” Are We Doing Enough? Feb 25, 2003

Preparing for Pandemic
Influenza
Cherise J Rohr-Allegrini, Ph.D., M.P.H.
San Antonio Metro Health District
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What is Avian Flu and what
do we do about it?
What is Pandemic Flu?
How should hospitals
prepare?
Avian Flu (H5N1)
is
NOT
Pandemic Influenza

Avian flu is caused by avian influenza viruses,
which occur naturally among birds and
ocassionally infect humans. Occassionally, a
highly pathogenic strain emerges – H5N1.
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Seasonal flu is a contagious respiratory illness
caused by influenza viruses infecting humans.
Generally, most susceptible to severe illness and
death are very young and very old.

Pandemic flu a global outbreak, or pandemic, of
a highly pathogenic strain that spreads easily
from person to person. Otherwise healthy young
adults severely affected.
Currently there is no pandemic flu.
WHO Criteria for Pandemic
Influenza

The emergence of a
disease
(or strain/subtype)
new to a population

The agent infects
humans, causing
serious illness
o The agent spreads
easily and sustainably
among humans
Where are we now?
Pandemic Alert Phase 3
Human infection(s) with a new subtype, but no humanto-human spread
12-26-03 to 4-19-06 HUMAN H5N1 CASES
Azerbaijan
Cambodia
Cases
8
6
Deaths
5
6
China
Egypt
Indonesia
Iraq
16
12
31
2
11
2
23
2
Thailand
22
14
Turkey
Viet Nam
12
93
4
42
TOTAL
202
109
Pandemic Period Phase 6
Increased and sustained transmission in
general population
What does that mean for the
1.5 million people in the
San Antonio/Bexar County area?
Wave 1:
 25-50% Attack Rate
 325,000-750,000
infected
 4% hospitalization
 13,000-30,000
 1.5-5% Fatality Rate
 5000 deaths
Wave 2:
 5% Attack Rate
 75,000 infected
 4% hospitalization
 3000
 1.7% Fatality Rate
 1275 deaths
Health Systems Response:
Demand for services may require nonstandard approaches
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Discharge of all but critically ill hospital patients
Expansion of hospital capacity by using all
available space and less than code compliance
beds
Increase of patient ratio to hospital staff
Stop elective procedures
Set up alternate treatment facilities
What do Hospitals Need to Do to
Prepare NOW?
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Develop Emergency Plan specific for Pandemic
Influenza
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Educate staff
• Avian vs. Pandemic flu
• Infection control procedures
• Respiratory Hygiene Etiquette
• Policies and Procedures for care of pandemic
patients
• Training for non-clinical staff to assist clinicians
• Personal protective measures
What do Hospitals Need to Do to
Prepare NOW?
 Staffing Concerns
• Determine # of staff, report to local SNS
Coordinator
• Maintain accurate call down lists
• Identify # of Reservists on staff
• Medical staff who work at multiple facilities
should choose a primary
• Identify possible volunteers whose primary
commitment is to your facility
• Make contingency plans for 20-50% reduction
of current workforce
Health Systems Response
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Determine your surge capacity
Facility Access
• When to limit?
• How to limit?
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Occupational Health
• How to manage ill workers?
• Time-off policies
• Vaccination and antivirals
Health Systems Response in a
Pandemic
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Activate Pandemic Response Plan
Report to the RMOC
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Number of patients on ventilators
Number of available ventilators
Number of beds occupied
Number of beds available
Estimates of staffing levels (MDs, nurses)
Report to SAMHD
• Emergency room visit trends: syndromic
surveillance
SNS
• If available
Strategic National Stockpile (SNS)
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A repository of antibiotics,
antidotes, antitoxins, and
life support medications
Delivered within 12 hrs of
request
If a vaccine is available,
administer immediately to
staff and family members:
• Critical Government
Officials
• First Responders (Including
Hospital Staff)
• Critical Services (City and
County, including Utilities)
• Volunteers
Vaccines and medicines will
be in short supply and will
have to be allocated on a
priority basis
Public Information and
Communication
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Pre-Pandemic:
• Coordinate with SAMHD PIO, COSA PIO,
Hospital PIOs to generate talking points and
community education
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Pandemic:
• JIC established by COSA EOC to include
COSA PIO, SAMHD PIO and collaborate with
hospital PIOs
• One Message to public
Summary
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Avian flu (H5N1) is a health concern
• It is NOT pandemic Influenza
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Each Hospital should have a contingency plan
specific for pandemic influenza to include:
• Emergency procedures
• Infection Control*
• Public Information
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Vaccine for pandemic flu may or may not be
available
• If not, focus on personal protective measures
Pandemic Influenza
Planning Group
CDC Emergency Response
(770) 488-7100
SAMHD Emergency Response
(210) 207-5777
SAMHD – Fernando Guerra, MD, Director
(210) 207-8731
SAMHD PHEP Epidemiology- Cherise Rohr-Allegrini, PhD,
(210) 207-8911
SAMHD PHEP - Roger Pollock, Program Manager
(210) 207-8752
SAMHD PHEP Epidemiology - Roger Sanchez
(210) 207-8876
SAMHD PHEP – Frank Chance, SNS Coordinator
(210) 207-2145
SAMHD PHEP – Phil Vaughan, BL-3 Lab Coordinator
(210) 207-5883
http://www.sanantonio.gov/health
http://www.pandemicflu.gov