Pandemic Influenza

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					     Pandemic Flu
 Preparedness is Good

Protecting Our Employees, Our most
         Valuable Resource
 Influenza viruses introduction
 What makes a pandemic
 History of pandemics
 How a future pandemic might look
 Preparing for pandemic influenza
          Influenza (or flu)
 The flu is a contagious respiratory illness
  caused by a virus.
 It can cause mild to severe illness, and at
  times can lead to death.
 A person infected with the flu virus can
  transmit it one-two days before they have
 A person infected with the flu virus can
  transmit it four-five days after symptoms
        Influenza spread
Spread by contact with an infected
  person through:
 Sneezing
 Coughing
 Touching items recently contaminated
  by a person with the flu virus
       Influenza symptoms
Symptoms include:
 Fever (usually high) and chills
 Extreme tiredness (fatigue)
 Body aches
 Sore throat
 Non-productive cough (dry)
 Runny or stuffy nose
 Headache
 Diarrhea (rare in seasonal flu)
              Seasonal flu
 Occurs    yearly during the winter
 Every year in the US on average:
     >200,000 people are hospitalized
     36,000 people die
 Most people who get the flu recover
 within 1-2 weeks without medical
    The difference between
 seasonal flu and pandemic flu
 Seasonal   flu is predictable while
  pandemic flu is not predictable
 Pandemic flu is caused by a new flu
  virus strain so everyone is susceptible
 Pandemic flu infects large numbers of
  people of different ages all over the
  world and causes serious illness and
A  worldwide outbreak of disease in
  numbers clearly in excess of normal.
 Characteristics
     A new influenza virus emerges (H5N1
      meets this criteria)
     It can infect humans, causing serious
      illness (H5N1 meets this criteria)
     It spreads easily and sustainably among
      humans (H5N1 does NOT meet this
How influenza viruses change
Drift – gradual mutation of the virus
 allowing human to human transmission
   How new influenza viruses
Shift – genetic material is exchanged
 between human and avian viruses
 during co-infection of a human or a pig
 - reassortment
 Past influenza pandemics
Pandemic             Deaths in   Deaths        Population
                     the US      Worldwide     Affected

Spanish Flu (H1N1)   500,000     40 million    Persons 20-40
1918-1919                                      years old

Asian Flu (H2N2)     70,000      1-2 million   Infants, elderly

Hong Kong Flu (H3N2) 36,000      700,000       Infants, elderly

Russian Flu (H1N1)   8,300                     Persons under 20
1977-78                                        years old
        Pandemic waves
 Pandemics     occur in multiple waves of
  disease outbreaks
 The first wave in a local area is likely
  to last six to eight weeks
 The time between pandemic waves
  varies and can not be easily predicted.
 The severity of illness may vary among
           Avian influenza
 Normal  reservoir is wild bird population
 H5N1 is a new avian influenza virus
 H5N1 currently is found in birds in
  Asia, Europe and Africa but not in
  North America
 H5N1 might cause pandemic influenza
      High pathogenic vs. low
 Low Pathogenic Avian Influenza (LPAI)
  virus – common in wild birds with no
  symptoms or minor symptoms, not a risk to
  human health
 High Pathogenic Avian Influenza (HPAI)
  virus – also found in wild birds, can cause
  severe illness and death in domestic birds,
  can spread rapidly, capable of causing
  severe disease and death in humans
Transmission of virus from birds
          to humans
 People  can get avian flu through direct
  contact with nasal secretions from
  infected birds
 The regions of the world where
  humans have been affected keep
  domesticated chickens as pets which
  roam in and around their homes
 Inhalation, rather than consumption of
  the virus is the mode of transmission
       Current concerns about
           avian (bird) flu
 Historicallyunprecedented disease
  outbreak in poultry caused by H5N1
 Human cases reported as of
  October 31, 2006:
     256 cases
     152 deaths
 No  sustained human to human
  transmission identified.
     Case reported 8/21/06
 35 year old female from Garut, West Java
  Province, Indonesia
 Hospitalized 8/17 with severe respiratory
  disease, died shortly after
 Third confirmed case from Garut that week
 Chickens purchased from a market and
  added to local flocks in late June;
  throughout July/August large numbers of
  chickens died
     Case reported 8/17/06
9  year old girl from Garut district, West
  Java Province, Indonesia
 Developed symptoms on 8/1,
  hospitalized on 8/14 and died on 8/15
 Reports of recent chicken deaths in
  her household
       Case reported 8/14/06
 17 year old male from West Java
  Province, Indonesia
 Developed symptoms on 7/26
 Hospitalized on 8/9, recovering
 Chicken/duck deaths in patient’s
  household and neighborhood, patient
  disposed of chicken carcasses
 20 year old male cousin symptomatic
  on 7/26, treated 8/5 and died on 8/6
Avian flu in the United States
 At this time (HPAI) H5N1 has not been
  detected in North America
 The US Fish & Wildlife Service monitors
  migratory patterns of wild birds
 The Ohio Department of Agriculture
  monitors and tests poultry to ensure food
 US Department of Agriculture has imposed
  import restrictions on birds and bird
 What to expect from pan flu
 Unlike  other disasters
 Will not damage property or cause
  obvious damage like a natural disaster
 If people are absent from work public
  services may be interrupted
 Daily routines may be disrupted and
  you may be asked to take actions to
  limit the spread of the virus
    Protection against the fIu
 A vaccine to protect people from pandemic
  flu is not available now.
 A vaccine may not be available at the start
  of a flu pandemic.
 Antivirals will also be in limited supply and
  might not be effective against a new flu virus
 The best protection is to practice healthy
  hygiene to stay well now and during a flu
      Practice healthy hygiene
 Clean   hands often
     Wash with soap and water or
     Clean with hand sanitizer
 Cover mouth and nose when you
  sneeze or cough and clean hands
 Keep hands away from face
 Stay away from people who are sick
         Prepare at home
 Plan now to care for yourself or loved
  ones who get the flu.
 Determine what supplies you will need
  to provide care at home.
 Plan how you will care for someone in
  your household who becomes sick.
 Remember your pets when planning.
            Stock up now
 Reduce your need to go out during a local
  flu pandemic (self shielding) by stocking
  extra food, water and supplies at home.
 If you do get sick and have extra supplies
  on hand, you will help reduce the spread of
  pandemic flu by staying home.
 If stores are open during pandemic flu they
  may be poorly stocked.
                Home care
   Contact doctor or hospital’s help line for
   Physically separate ill person from others in
    the household
   Designate one person as caregiver
   Restrict patient to home during infectious
    period except to travel to obtain medical
   Restrict visitors
   Cover your cough
            Home care

 Hand  hygiene – thoroughly cleanse
  hands with soap and water and/or
  alcohol based hand sanitizer
 Wash dishes in dish washer or with
  warm water and soap
 Wash patient’s bed linen and clothes
  in washing machine, unnecessary to
  separate from other household laundry
 Clean environmental surfaces as usual
              Home care
 Caregiver  and/or patient may use
  masks during interactions however the
  effectiveness of masks has not been
 Patient is advised to wear a mask
  when leaving home to obtain medical
 Have disposable tissues available for
  patient and provide a bag for disposal
   Prepare your workplace
Ask about plans:
 for employees who get sick during a
  pandemic and need to stay home
 to keep the business functioning if key
  staff can’t come to work
 for sick leave, benefits and wages
  when employees are asked to remain
  at home
       Prepare at school
Ask about plans:
 to prepare for an influenza pandemic
  at your child’s school or day care
 to encourage parents to keep sick
  children home in order to reduce the
  spread of the flu during a local
         Help your community

   Volunteers are needed
   Assist local communities in the event of an
   Promote community awareness of potential
    hazards and preparedness measures
   Assist with training exercises
   Supplement staffing at events
   Assist with evacuations and traffic control
   Rebecca Hysing (216) 201-2001 x1602,
 Ohio Department of Health Pandemic Flu
 Cuyahoga County Response Plan
 U.S. Dept. of Health & Human Services
 World Health Organization Current
   Cuyahoga County Board of Health
    (216) 201-2000
   Cleveland Department of Public Health
    (216) 664-2324
   Lakewood Health Department
    (216) 529-7690
   Shaker Heights Health Department
    (216) 491-1480
   American Red Cross – Cleveland Chapter
    (216) 431-3010
Thank you
 Please remember
to wash your hands.

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