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Update Pandemic Influenza Avian Influenza Seasonal Influenza Kevin G. Pearce, MPA Peninsula Health District Virginia Department of Health August 2006 1 Why the concern? • Pandemic (= worldwide) epidemic of a new influenza virus • New virus Most people will have no immunity • Higher disease attack rates & higher death rates than seasonal or “normal” influenza 2 Past influenza pandemics • Pandemic flu is unpredictable, like the flu virus itself • 1968-69 Hong Kong flu – 34,000 deaths in US • 1957-58 Asian flu – 70,000 deaths in US • 1918-1919 Spanish flu – >500,000 deaths in US – Worst case scenario 3 Why the concern? • Pandemic rapid spread around world in repeating waves – 1918 waves circled globe in 6-9 months United Kingdom experience; Jordan E, American Medical Association, 1927 4 High death rate among young adults 1 of every 100 25-34 year olds died Influenza & pneumonia mortality per 100,000 person, by age group 5 Why the concern? • Extremely disruptive – Worker absenteeism – Lost productivity • Unable to get/transport supplies & raw materials – Uncertain infrastructure • Fuel & utilities; telecom & info technology • Public safety personnel & public services • Food & medicine suppliers – Increased demands on health care infrastructure & workforce – Reduced tourism, travel, entertaining, hotels – No help from other areas—they’re affected 6 What if… • On the Peninsula…we saw a 35% attack rate over 2 months (approx. 163,000 ill): Additional events due Most likely Maximum to influenza estimate estimate Deaths 416 707 Hospitalizations 1,843 2,380 Outpatient visits 87,817 124,269 Estimates using CDC’s FluAid 2.0 7 Influenza on the Peninsula 35000 30000 Persons becoming ill with 25000 influenza 20000 15000 10000 5000 Total cases: 0 163,000 1st 2nd 3rd 4th 1st 2nd 3rd 4th 1st Wk Wk Wk Wk Wk Wk Wk Wk Wk 35% of Oct Oct Oct Oct Nov Nov Nov Nov Dec 8 population Does H5N1 avian ABC Original Movie Fatal Contact: Bird Flu in America influenza Tuesday, May 9 at 8/7c Starring Joely Richardson, Stacy Keach, Ann Cusack, Justina Machado, Scott Cohen and David Ramsey Pandemic = ? influenza 9 H5N1 avian influenza • H5N1—current epidemic avian flu strain – Highly pathogenic avian influenza (HPAI) – Continuous circulation in Asia since 2003 • Historically unprecedented avian pandemic – Magnitude & duration of pandemic in birds – Virus is changing 10 H5N1 avian influenza (Nations with confirmed cases July 7, 2006) 11 H5N1 avian influenza • Before 1997, H5 influenza virus never infected humans • Now… – Human cases from close exposure to ill birds – No sustained human-to-human transmission – Few cases, but high fatality (>50%) • 229 cases & 131 deaths, World Health Organization, July 4, 2006 • Treatment primarily supportive – Antivirals (Tamiflu & Relenza) 12 Is H5N1 a pandemic virus? • 3 requirements √ Novel strain - new H &/or N subtype √ Causes significant disease in humans NO Consistent human-to-human transmission • Avian H5N1 influenza virus is not a pandemic virus - but it might become one 13 H5N1 on WHO Pandemic Risk Scale Inter-pandemic phase Low risk of human cases 1 New virus in animals; no Higher risk of human cases 2 human cases Pandemic alert No or very limited human-to- 3 human transmission 3 Virus causes human Evidence of increased human- 4 cases to-human transmission Evidence of significant human- 5 to-human transmission Pandemic Efficient & sustained human-to- 6 human transmission 14 Preparedness Planning • National Strategy for Pandemic Influenza, November 1, 2005 • HHS Pandemic Influenza Plan, November 2005 – www.pandemicflu.gov • Virginia Department of Health Emergency Operations Plan: Pandemic Influenza Attachment, Updated March 2006 – www.vdh.virginia.gov/PandemicFlu/index.asp 15 Preparedness Where do we stand? • No ready-to-use H5N1 vaccine • Antivirals – Limited supply of Tamiflu • Production in next 10 years will treat only 20% of world population – Unclear if Tamiflu will work for treatment – Not enough available to use for prevention 16 Preparedness strategies • Heightened surveillance* • Immediate response at 1st sign of an outbreak* – Respond to limit and confine outbreak – Buy time to make vaccine and take other actions *Applies to both humans and birds 17 Control strategies • Isolation & quarantine • Non-pharmaceutical approaches – Cough & hand hygiene – Travel restrictions – Social distancing • Eliminate mass gatherings • Close schools, theaters, etc. – General public wears masks www.pbs.org/wgbh/amex/influenza/ 18 What should you be doing? Prepare your family • Store a two week supply of food. • Have nonprescription drugs and other health supplies on hand. • Teach your children and model the behavior: – To wash hands frequently with soap and water – To cover coughs and sneezes with tissues – To stay away from others as much as possible if they are sick – To stay home from work and school if sick. • Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in their home. 19 Why? A strong network of prepared people, families, and organizations is vital to a community’s successful response to pandemic influenza. 20 What else should you do? • Get flu shots every year to your entire staff. • Develop adequate stockpiles in case of supply chain disruption. • Plan for personnel decreases and novel ways to accomplish your objectives.
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