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Pandemic Influenza

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					Escambia County Health Department




                                          Pandemic Influenza
                                                A Guide for Healthcare Providers



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                                    Trusted Professionals Protecting
                                    You Since 1821
                                   Main Menu
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•        Historical Background                     •      Treatment Algorithm and Proper
                                                          use of Antiviral Medications
•        Flu Definitions                           •      Healthcare Facility Preparedness

•        Nature of the Virus                       •      Community Preparedness

•        Physician Testing and                     •      Personal Preparedness
         Reporting
                                                   •      Worried Well
•        The Roles of ECHD and the
         Bureau of Laboratories                    •      FAQ

•        Infection Control Procedures              •      More Information


    If you suspect that a patient may have avian influenza, click here and call the Escambia
            County Health Department immediately at (850)595-6683 if necessary.
                    Historical Background
                                Choose from the following menu options,
                                          or click anywhere to continue.




The Spanish Flu
Effects of Past Pandemics on the U.S.
The Next Influenza Pandemic
Florida’s At-Risk Characteristics



                                                              Main Menu
                        The Spanish Flu




• In the spring of 1918, as the nation mobilized for war, Private Albert
  Gitchell reported to an Army Hospital in Kansas where he was
  diagnosed with the flu -- a disease doctors knew little about
• Before the year was out, America would be ravaged by a flu pandemic
  that killed 675,000 in the U.S. and 25 to 50 million worldwide—
  more than all the war deaths of this century combined
Historical Background                                          Main Menu
      Effects of Past Pandemics on the U.S.
        Pandemic        Estimated U.S.   Influenza A   Populations at
                            Deaths          Strain      greatest risk

     1918 – 1919          500,000          H1N1        Young, healthy
     Spanish Flu                                          adults


     1957 – 1958           70,000          H2N2           Infants,
      Asian Flu                                           Elderly


     1968 – 1969           34,000          H3N2           Infants,
     Hong Kong                                            Elderly
         Flu
Historical Background                                           Main Menu
             The Next Influenza Pandemic
• An influenza pandemic occurs
  when a novel and highly
  contagious strain of the
  influenza virus emerges,
  affecting populations around
  the world
• Historically, influenza
  pandemics have occurred every
  11 to 39 years
• It has been more than 30 years
  since the last pandemic
• Experts advise that another
  influenza pandemic may occur
  within the next few years, but
  no one can predict exactly
  when
Historical Background                      Main Menu
            Florida’s At-Risk Characteristics

  • The 4th most populous state in the
    U.S.
  • Demographic and population density
    characteristics provide significant
    risks for rapid spread of influenza
  • Tourism increases risk of infection
    transmission introduced from affected
    countries
  • Vast natural areas function as
    important breeding areas and flyways
    for wild bird and duck populations
  • Robust agricultural economy
    supports significant domestic poultry
    businesses
Historical Background                           Main Menu
                                           Flu Definitions
                                       Choose from the following menu options,
                                                 or click anywhere to continue.



Seasonal or ―Regular‖ Flu
Pandemic Flu
Projected Number of Episodes of Illness,
    Healthcare, Utilization, and Death (HHS Plan, 2005)
Avian ―Bird‖ Flu
Criteria Required for a Pandemic
Pandemic Challenges


                                                                     Main Menu
                  Seasonal or “Regular” Flu
   • The ―normal‖ yearly flu of late fall and
     winter
   • Some immunity built up from previous
     exposures
   • Most at risk are young children, older
     adults, pregnant women, and the
     immunocompromised
   • About 226,000 Americans are hospitalized
   • 36,000 die from the disease
   • Most deaths occur among people older
     than 65 (90%)
   • Prevention = competent vaccine & good
     hygiene practices

Flu Definitions                                 Main Menu
                           Pandemic Flu
  • Global outbreak of the flu that occurs when a new virus ―emerges‖
    in the human population
  • Occurs over a very wide area (several countries or continents)
  • 30% or more of the population likely to become ill
  • Lasts longer and occurs at unexpected times
  • No pre-existing immunity
  • Symptoms usually more severe
  • Different groups may be at higher risk
  • At least 2 waves are likely
  • For an up-to-date chart of reported cases of
    H5N1, visit
      http://www.who.int/csr/disease/avian_influenza/country/cases_table_2006_1
      0_31/en/index.html

Flu Definitions                                                       Main Menu
        Projected Number of Episodes of Illness,
          Healthcare, Utilization, and Death
                      (HHS Plan, 2005)
                          Moderate            Severe
     Characteristic    (1958/68 - like)     (1918 - like)

           Illness     90 Million (30%)   90 Million (30%)
   Outpatient Care     45 Million (50%)   45 Million (50%)
    Hospitalization        865,000           9,900,000
         ICU Care          128,750           1,485,000
       Mechanical           64,875             742,500
       Ventilation
          Deaths           209,000           1,903,000
Flu Definitions                                       Main Menu
                       Avian “Bird” Flu
  • Usually infects wild birds and poultry
  • Wild birds carry the viruses in their intestines, but
    usually do not get sick
  • Wild birds can easily transmit the virus to
    domesticated birds like chickens, ducks, and
    turkeys
  • Domestic birds usually acquire the virus by coming
    in contact with contaminated excretions—they
    usually die
  • May be transmitted to other species
  • On rare occasions, the virus spreads to humans
  • Human to human transmission can occur
  • Potential for a flu pandemic
  • High mortality rate (100% poultry / 80% human)
  • No current approved vaccine
  • Current antiviral drugs somewhat ineffective
Flu Definitions                                             Main Menu
           Criteria Required for a Pandemic
  • The new strain is widespread
    and endemic
  • There are continuous outbreaks
    in poultry
  • It has resulted in lethal
    mammalian infections
  • Virus is evolving
  • Sporadic human cases
       – mostly young, healthy adults
       – Case fatality rate is 50%
       – Rare instances of person-to-person
         transmission
  • Sustained and rapid human-to-
    human transmission
Flu Definitions                               Main Menu
                  Pandemic Challenges

   • Almost all locations will
     be affected simultaneously
   • There will not be enough
     vaccine
   • There will not be enough
     antiviral medicine
   • The healthcare system will
     be stretched beyond its
     limits
Flu Definitions                         Main Menu
                             Nature of the Virus
                                   Choose from the following menu options,
                                             or click anywhere to continue.


Virology
Disease Mechanism
The Next Pandemic Strain
Cause of a Pandemic Flu
How the Flu Spreads in the Environment
How the Flu Spreads among Humans
Clinical Symptoms in Humans



                                                                 Main Menu
                                 Virology
  • A globular particle (about 100 nm
    in diameter)—smallest unit of ―life‖
       – Cannot ―move‖ or replicate on its own
       – Sheathed in a lipid bilayer (derived
         from the plasma membrane of its host)
  • 8 RNA Molecules
       –   HA genes (Hemagglutinin)
       –   NA genes (Neuraminidase)
       –   NP (Nucleoproteins)
       –   Variety of matrix, proteins,
           and polymerases
  • 16 HA and 9 NA subtypes
  • 144 combinations possible                    Virus Subtype: H5N1

Nature of the Virus                                             Main Menu
                      Disease Mechanism




Nature of the Virus                       Main Menu
                  The Next Pandemic Strain
• Virus subtype H5N1 is the most likely pandemic
  candidate TODAY
     –   Can survive 35 days in low temperatures (4° C/39° F)
     –   Can survive 6 days in high temperatures (37° C/98.6° F)
     –   Can survive on surfaces for several weeks
     –   Is NOT killed by refrigeration or freezing




Nature of the Virus                                      Main Menu
                      Cause of a Pandemic Flu

  Antigenic Drift
       – Mild genetic re-assortment of H & N types
       – Occurs every year, resulting in a new yearly vaccine


  Antigenic Shift
       – Over periods of time, human viruses re-assort with avian
         viruses leading to major changes in the proteins of influenza
       – Normal hosts for the flu that lead to shifts are migratory birds
         such as ducks and geese
       – There is limited or no immunity to these strains, leading to
         pandemics

Nature of the Virus                                               Main Menu
  How the Flu Spreads in the Environment

   • International movement/travel
   • Illegal commerce (fighting
     cocks, captive birds, etc.)
   • Commercial meat imports
   • Migratory birds
   • Foodborne – raw, undercooked
     meat, blood or eggs
   • Close contact with infected
     animal


Nature of the Virus                  Main Menu
     How the Flu Spreads among Humans

  • Contact with a person’s mouth,
    nose, or eyes
  • Coughing or sneezing
  • Unwashed hands
  • Sharing personal items
  • Patient is infectious 1-2 days before
    and up to 5 days after symptoms
    start
  • Other influenza types show patients
    shedding cells from 3 to 21 days

Nature of the Virus                         Main Menu
               Clinical Symptoms in Humans

  • Fever
  • Cough
  • Sore throat
  • Muscle aches
  • Conjunctivitis
  • Meningitis
  • May cause severe breathing problems and
    pneumonia
  • Primary and secondary pneumonia can be fatal
Nature of the Virus                          Main Menu
     Physician Testing and Reporting
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                                              or click anywhere to continue.


Physician Testing and Reporting Procedures
Specimen Collection Information
Specimen Collection Procedures
Response Protocol
WHO Phase 3 Response
WHO Phases 4/5 Response
WHO Early Phase 6 Response


                                                                  Main Menu
   Physician Testing and Reporting Procedures

  • If it is suspected that a patient may have avian influenza,
    compare the case to the current case definitions
  • For Case Definitions, click here
  • If the case meets the case definitions of Moderate or
    High-suspicion of infection, immediately call:
               Escambia County Health Department:
                          (850)595-6683
                        Fax: (850)595-6268
       After hours, weekends, holidays: (850)418-5566
  • ECHD will come to the location of the case and provide
    swabs for testing
Physician Testing and Reporting                          Main Menu
           Specimen Collection Information
  • Specimens must be collected prior to treating the patient with antivirals
  • Beyond the first 3 to 5 days post onset of disease, the probability of
    recovering virus is low
  • Sputum, tracheal aspirates or bronchiolar lavage specimens are
    recommended
  • Oropharyngeal swab specimens and lower respiratory tract specimens
    (e.g., bronchoalveolar lavage or tracheal aspirates) appear to contain the
    highest quantity of virus for influenza H5N1 detection
  • Nasal or nasopharyngeal swab specimens are acceptable, but may contain
    less virus
  • Commercial rapid influenza antigen testing in the evaluation of suspected
    influenza H5N1 cases should be interpreted with caution-- These tests
    have relatively low sensitivities, and:
     – a negative result would not exclude a diagnosis of influenza H5N1
     – a positive result does not distinguish between seasonal and avian
        influenza A viruses

Physician Testing and Reporting                                      Main Menu
           Specimen Collection Procedures

  • Oropharyngeal swab
  1. Have the patient give a deep cough
  2. Swab the oropharynx, or far back in the throat, using a Dacron
     tipped plastic shaft swab
  3. Reinsert the swab back into the culturette and crush the ampoule
     at the base of the culturette OR: Insert the swab into a tube of
     transport media; remove excess shaft from the swab and close the
     tube tightly
  • Sputum, tracheal or nasopharyngeal washes/aspirates or bronchial
     lavage: Follow facility protocols for collection of these specimen
     types
  4. Label each specimen with the patient’s name and specimen type
  • ECHD will pack and ship the sample to the state laboratory
Physician Testing and Reporting                                 Main Menu
                          Response Protocol

  • The provider should follow the proper response
    protocol for a suspected/confirmed case as
    follows:
  • WHO Phase 3 Response – click here
  • WHO Phases 4/5 Response – click here
  • WHO Early Phase 6 Response – click here

  • Combined Response Table - click here


Physician Testing and Reporting               Main Menu
                          WHO Phase 3 Response
                          High-Suspicion          Act without waiting for lab result


                                                  Act without waiting for lab result if rapid testing shows influenza A is present,
                          Moderate-Suspicion
                                                  otherwise wait for lab confirmation to implement measures


                                                  Voluntary isolation in healthcare facility if in need of healthcare or Self
                          Location
                                                  isolate at home otherwise

 Management of Case       Treatment               Includes a full course of antiviral agent to which organism is sensitive, if any

                          Follow-up               CHD checks on case location and status daily

                                                  Household members and others in similar prolonged face-to-face contact
                          Definition of Contact
                                                  with the patient

                                                  Locate all contacts, on and off site - No activity restrictions for contacts
                          Location                (Voluntary agreement for contacts)



 Management of Contacts
                                                  Antivirals for all contacts, including exposed healthcare workers.
                                                  If any contacts have or develop symptoms:
                          Treatment               - Manage case as phase 4/5 infection till proved not to be H5N1
                                                  - Treat contact as new case if the original case was high suspicion




                                                  Instruct contacts to call CHD immediately if symptoms develop - No action
                          Follow-up
                                                  needed




Physician Testing and Reporting                                                             Response Protocol Home
                   WHO Phases 4/5 Response
                            High-Suspicion          Act without waiting for lab result


                            Moderate-Suspicion      Implement phase 3 containment measures while waiting for lab result

                                                    FORMAL ISOLATION ORDER
                            Location                in hospital if in need of healthcare or at home otherwise

   Management of Case
                            Treatment               Includes a full course of antiviral agent to which organism is sensitive, if any

                            Follow-up               CHD checks on patient location and status twice daily

                                                    Persons who have been in the same room with the patient or talking with the
                            Definition of Contact
                                                    patient face-to-face for 5 minutes or more

                                                    Locate all contacts on and off site -VOLUNTARY QUARANTINE
                                                    Immediate self-quarantine of all contacts to home.
                            Location



                                                    Antivirals for all contacts, including exposed healthcare workers.
   Management of Contacts                           If contacts have or develop symptoms:
                                                    - Treat contact as a new case of phase 4/5 infection and initiate contact
                            Treatment               tracing, until proved not to be H5N1




                                                    Instruct contacts to call CHD immediately if symptoms develop- CHD checks
                            Follow-up
                                                    on location and status of all contacts once daily




Physician Testing and Reporting                                                                    Response Protocol Home
                WHO Early Phase 6 Response
                            High-Suspicion          Act without waiting for lab result


                            Moderate-Suspicion      Implement phase 4/5 containment measures while waiting for lab result


                                                    FORMAL ISOLATION ORDER
                            Location                in hospital if in need of healthcare or at home otherwise


   Management of Case       Treatment               Includes a full course of antiviral agent to which organism is sensitive, if any

                            Follow-up               CHD checks on patient location and status twice daily

                                                    Persons who have been in the same room with the patient or talking with the
                            Definition of Contact
                                                    patient face-to-face for 5 minutes or more
                                                    Locate all contacts on and off site -FORMAL QUARANTINE ORDER
                                                    all contacts at home or in designated location
                            Location




   Management of Contacts                           Antivirals for all contacts, including exposed healthcare workers.
                                                    If contacts have or develop symptoms
                                                    - Treat contact as a new case of phase 6 infection and initiate contact tracing,
                            Treatment               until proved not to be H5N1




                                                    Instruct contacts to call CHD immediately if symptoms develop- CHD checks on
                            Follow-up
                                                    location and status of all contacts twice daily



Physician Testing and Reporting                                                                  Response Protocol Home
                   The Roles of ECHD and
               the Bureau of Laboratories
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The Role of ECHD
The Role of the Bureau of Laboratories




                                                             Main Menu
                           The Role of ECHD
   Upon notification of a moderate or
   high suspicion case,
   The Health Department will:
   • Alert state laboratory of testing
   • Ensure ability to obtain test kit within
     30 min from the state lab if unavailable
     at case location
   • Gather test kit, cooler, and forms
   • Acquire sample from case within 30 min of arrival at
     case location
   • Transport sample to state lab within 6 hrs
   • Alert state laboratory about delivery of case specimen
Roles of ECHD and Bureau of Laboratories               Main Menu
    The Role of the Bureau of Laboratories


  The Bureau of Laboratories will:
  • Provide guidance to hospital and clinical laboratories for specimen
    collection and handling
  • Transport specimens when a novel strain is suspected, in
    conjunction with the Division of Disease Control and partner
    agencies
  • Procure appropriate reagents from the CDC or other appropriate
    sources to detect and identify the novel virus strain
  • Partner with local private labs without virus strain identification
    capacity to obtain and use rapid antigen testing kits
  • Inform ECHD of the test result, which will then be passed on to
    the healthcare provider
Roles of ECHD and Bureau of Laboratories                        Main Menu
            Infection Control Procedures
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                                               or click anywhere to continue.




Enhanced Precautions for Avian Flu
The Waiting Room
Disinfectants
Healthcare Facility Signs
Infection Control for Healthcare Workers



                                                                   Main Menu
       Enhanced Precautions for Avian Flu
  • CDC recommends the use of Standard, Contact, Airborne isolation
    and the use of eye protection when dealing with individuals under
    evaluation for avian influenza
  • Contact precautions include use of gloves and gown dedicated
    equipment (such as stethoscopes, disposable blood pressure cuffs,
    disposable thermometers, etc) for all patient contact
  • Airborne precautions
       – Place the patient in an airborne isolation room (AIR)
       – Use a fit-tested respirator when entering the room
  • Personal Protective Equipment (PPE) should always be used in
    conjunction with basic infection control measures




Infection Control Procedures                                     Main Menu
                          The Waiting Room


  • Post signs in languages appropriate to the populations
    served with instructions to cover the mouth/nose with a
    tissue when coughing and to dispose of used tissues
  • Implement frequent hand washing / cleansing after
    contact with respiratory secretions
  • Implement spatial separation, ideally ≥3 feet, of persons
    with respiratory infections in common waiting areas,
    when possible
  • Provide tissues and hand soap for patients
  • Disinfect items and surfaces, paying particular attention
    to frequently touched items
Infection Control Procedures                           Main Menu
                               Disinfectants

  • Certain disinfectants are recommended for specific
    materials and surfaces
  • Find a list of recommended disinfectants for use in
    healthcare facilities here:
    Table of Disinfectants – click here
  • Interim recommendations for infection control in health-
    care facilities caring for patients with known or suspected
    avian influenza are available at:
  http://www.pandemicflu.gov/plan/healthcare/maskguidancehc.html



Infection Control Procedures                             Main Menu
                   Healthcare Facility Signs

  • The following are suggested signs to print and
    post in a healthcare facility to aid in infection
    control:
  • Travelers’ Alert – click here
  • Don’t Spread the Flu – click here




Infection Control Procedures                      Main Menu
  Infection Control for Healthcare Workers
  • Receive current flu vaccine as soon as possible
  • Observe good hand and respiratory hygiene at all
    times
  • Monitor for symptoms of flu-like illness (cough, sore
    throat, difficulty breathing)
  • Use appropriate personal protective equipment
    (PPE)
  • Observe all other infection control practices
  • PPE should be used in correspondence with the
    current phase as follows:

  Personal Protective Equipment – click here

  • A helpful guide for the sequence of donning PPE is below:

  Sequence for Donning PPE – click here

Infection Control Procedures                                    Main Menu
           Treatment Algorithm and
   Proper Use of Antiviral Medications
                               Choose from the following menu options,
                                         or click anywhere to continue.




Determining Necessary Treatment
Recommendations for Prioritizing Antivirals
Vaccine Testing



                                                             Main Menu
     Determining Necessary Treatment
  • If the patient meets the moderate or high suspicion case
    definitions, a full course of antiviral agents to which the
    organism is sensitive should be administered
  • Antivirals should also be administered to all contacts,
    including exposed healthcare workers
  • The following document includes helpful information
    concerning Treatment/Prophylaxis Algorithm:
  • Treatment/Prophylaxis Algorithm – click here




Treatment and Antiviral Medications                      Main Menu
   Recommendations for Prioritizing Antivirals
  1.    Hospitalized patients with influenza
  2.    HCWs and EMS workers with direct patient contact
  3.    Highest risk outpatients
  4.    Pandemic health responders, public safety and key
        government decision makers
  5.    Other high risk outpatients
  6.    Outbreak response
  7.    Prophylaxis HCWs in ER, ICU, EMS dialysis
  8.    Pandemic societal responders and other HCWs
  9.    Other outpatients
  10.   Prophylaxis for highest risk outpatients
  11.   Prophylaxis for other HCWs with patient contact

Treatment and Antiviral Medications                   Main Menu
                           Vaccine Testing
  • There are currently no avian influenza vaccines approved in the
    U.S. for use on humans
  • Vaccine candidate under development (Clade 1)
       – Use as ―pre-pandemic‖ vaccine
  • Hope for improvement and acceleration in cell-based technology to
    expedite vaccine production vs. egg based production which
    requires 3 eggs for each vaccine dose produced (300 million doses
    requires 900 million eggs)
  • Genetic identification of current H5N1 and previous strains from
    the 1918 pandemic have further promise for vaccine production
  • Protocol for testing in place between DOH labs and Bureau of
    Epidemiology
  • Close coordination with CDC; testing not available at private
    reference labs
Treatment and Antiviral Medications                           Main Menu
  Healthcare Facility Preparedness
                          Choose from the following menu options,
                                    or click anywhere to continue.




Begin Your Planning NOW
Equipment




                                                        Main Menu
                 Begin Your Planning NOW
   • Think about ways to keep your practice open during a pandemic
            - Divide office into infectious/non-infectious sections
   • What will you do if 1 out of 3 staff members are ill?
   • What are the necessary functions that will need to be done?
            - Develop basic procedures such as who staff members should call when
              ill, etc.
            - Practice plan through frequent drills
            - If desired, consult ECHD to determine feasibility of plan




Healthcare Facility Preparedness                                          Main Menu
                               Equipment
  • The following is a table of sample calculations for
    estimating healthcare personal protective
    equipment needs during a pandemic event:

     Estimate PPE needs – click here




Healthcare Facility Preparedness                 Main Menu
             Community Preparedness
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                                or click anywhere to continue.




Florida Plan
ESF 8 Functions
Response Plans




                                                    Main Menu
                         Florida Plan


   • The primary Support Function addressing this pandemic
     possibility is designated as Emergency Support Function 8 or
     ESF 8
   • ESF 8 response is based on the principle that all emergencies
     are local, and we are engaged to provide human and material
     resource to help impacted communities through preplanning
     and mitigation
   • Coordination of Health and Medical Resources along pre-
     existing lines of Emergency Management using an ―All
     Hazards‖ approach which should be familiar in response to the
     numerous weather disasters in the State of Florida
Community Preparedness                                        Main Menu
                         ESF 8 Functions
  • Mass Casualty Systems               • Environmental Health Services
  • Epidemiology/Disease Surveillance   • County/Regional Health Dept.
    and Control                           Support
  • Immunizations                       • Lab Services
  • Facility Assessments                • FEMORS/DMORT
  • Evacuation/Repopulation             • SanPacs
  • Risk Communications                 • Oxygen
  • Renal Facility Support              • EMS Services
  • Nutritional Services                • Hospital Infrastructure/Staffing
  • Statistical Reporting               • Disaster Medical Assessment Teams
  • Behavior Health/CISD                • Special Needs Shelters
  • Rapid Impact Assessment/Urban       • Pharmaceuticals/State and Nation
    Search & Rescue                       Strategic Stockpiles
  • DEET (Bug Spray)


Community Preparedness                                              Main Menu
                         Response Plans

  • The Escambia County Health Department will
    follow the procedures outlined in the Florida
    Department of Health Pandemic Influenza Plan
    during all phases of a pandemic
  • In case of a suspected or confirmed case, the
    Escambia County Health Department will follow
    the ECHD Pandemic Influenza Plan
  • View the ECHD Plan for Pandemic Influenza:
     click here


Community Preparedness                      Main Menu
                   Personal Preparedness
                         Choose from the following menu options,
                                   or click anywhere to continue.




Storage and Supplies
Plan for Disruption




                                                       Main Menu
                   Storage and Supplies

  • Store at least 2 weeks’ worth
    of food
  • At least 1 gallon of water
    per person per day
  • Consider special needs
  • Rotate stock every 6 months
  • Store medical and health supplies
  • Create an emergency kit - Checklists are
    available at www.ready.gov
Personal Preparedness                          Main Menu
                        Plan for Disruption
  • Prepare for work disruption - Make
    backup plans
  • Ask about flu pandemic plans at your
    child’s school
  • Transportation services may be
    disrupted - Prepare backup plans
  • Plan for the possibility that usual
    services may be disrupted--banks,
    stores, restaurants, government
    offices, post offices, etc.
  • Stay informed and up-to-date through
    trusted media outlets
Personal Preparedness                         Main Menu
                                  Worried Well
                             Choose from the following menu options,
                                       or click anywhere to continue.




Worried Patients
Screening Tool p.1
Screening Tool p.2
Frequently Asked Questions
More Information


                                                           Main Menu
               Worried Patients

  • Patients may be concerned
    that they have avian influenza,
    whether they are experiencing
    symptoms or not
  • It is important to be
    understanding of concerns
  • The screening tool on the next
    page may be used as a
    questionnaire for worried
    patients

Worried Well                          Main Menu
                   Screening Tool p.1
 1. Have you recently visited one of these countries? - Azerbaijan,
    Cambodia, China, Djibouti, Egypt, Indonesia, Iraq, Malaysia,
    Romania, Russia, Thailand, Turkey, Vietnam, other
 • If the answer is NO: Explain that avian influenza has not been
    found in the United States - Unless one has traveled to one of the
    countries with suspected or confirmed cases, it is highly unlikely
    that this is avian flu
 • If the answer is YES: Move on to the next question
 2. Have you been in close contact (within 3 feet) of someone that has
    been diagnosed with avian influenza?
 3. Have you been in close contact with sick or dead wild or domestic
    birds or their feces?
 4. Have you worked with live H5N1 influenza virus in a laboratory?
 • If the answer to 3/4/5 is NO: Explain that avian influenza is spread
    through contact of the virus or infected animals and humans
 • If the answer to any of the above is YES: Move on to the next
    question
Worried Well                                                    Main Menu
                 Screening Tool p.2
  5. Are you experiencing fever greater than or equal to
     100.4° F along with sore throat, cough, or shortness of
     breath?
  • If the answer is NO: If the patient is not experiencing any
     symptoms, do not test. If the patient is experiencing
     some but not all symptoms, follow the YES instructions
     below
  • If the answer is YES: Compare the patient to the Case
     Definitions and if necessary, call the Escambia County
     Health Department immediately at (805)595-6683 for
     testing

                     For printable format, click here

Worried Well                                             Main Menu
         Frequently Asked Questions
                   Choose from the following menu options,
                       or click anywhere to continue.

• What is avian influenza – or ―bird flu‖?
• What is a pandemic? Could bird flu become the next
  pandemic?
• How would a pandemic impact this community?
• Is there a vaccine for bird flu that will protect humans?
• How is Escambia County preparing for a pandemic?
• Can I prepare for a pandemic?
• With concerns about bird flu, is it safe to eat chicken and duck
  in the United States?
• What do I do if I see a dead bird?
• If I have chickens or live near a poultry farm, what should I
  do?

                                                             Main Menu
What is avian influenza – or “bird flu”?

Avian influenza - commonly called "bird flu" - is an
infection caused by influenza viruses that occur naturally
in birds. One strain of bird flu – the H5N1 virus -- has
recently killed birds in a number of countries and some
humans who were in close contact with those infected
poultry were infected. At this time, there is no H5N1 bird
flu in the United States and the U.S. government is
watching closely to make sure we detect H5N1 bird flu if
it were to arrive in the United States.




                                                    FAQ Home
          What is a pandemic?
Could bird flu become the next pandemic?
A pandemic is a worldwide outbreak of disease in humans – there is
not an influenza pandemic in the world at this time. There have
been three influenza pandemics since 1918 that affected the United
States. Scientists tell us that a pandemic occurs every 30-40 years
and there has not been a pandemic in more than 35 years. An
influenza pandemic happens when a new influenza virus emerges,
most people have little or no immunity, and there is no vaccine for
the virus. In a pandemic situation, the disease spreads easily
person-to-person, causes serious illness, and can sweep across the
country and around the world in very short time. Studies confirm
that the bird flu virus H5N1 is able to mutate rapidly. If H5N1
adapts to allow easy human-to-human transmission, a pandemic
could ensue — although this has not happened at this point.

                                                             FAQ Home
How would a pandemic impact this community?

 An especially severe influenza
 pandemic could lead to high levels
 of illness, death, social
 disruption, and economic loss.
 Everyday life would be disrupted
 because so many people in so many
 places become seriously ill at the
 same time. Impacts can range from
 school and business closings to the
 interruption of basic services such
 as public transportation and food
 delivery. The federal government
 estimates that 25-30% of people
 living in the United States would be
 affected by a pandemic.
                                        FAQ Home
         Is there a vaccine for bird flu
           that will protect humans?
There currently is no commercially-available vaccine to
protect humans against H5N1 virus that is being seen in
Asia, Europe, and Africa. A pandemic vaccine cannot be
produced until a new pandemic influenza virus emerges
and is identified. The U.S. Department of Health and
Human Services (HHS) is addressing the problem in a
number of ways -- developing pre-pandemic vaccines
based on current lethal strains of H5N1, collaborating
with industry to increase the Nation's vaccine production
capacity, and seeking ways to expand or extend the
existing supply.


                                                    FAQ Home
            How is Escambia County
           preparing for a pandemic?
Your health department, government, hospitals and businesses
are taking the threat of a pandemic very seriously and began
planning months ago. The effects of a pandemic can be lessened
by these advance preparations. The focus of the health
department’s work is educating the public about pandemic and
the current status of bird flu, preparing to make every effort to
contain the infection using public health measures such as
contact tracing and isolation, planning on how to maintain
essential services if an outbreak should occur, and providing
other government agencies and businesses with the tools they
need to prepare effectively.




                                                             FAQ Home
          Can I prepare for a pandemic?
Yes, there are several steps that individuals, families and
communities can take to prepare:
• Practice good public health measures like frequent hand washing and
  staying home when you are sick. Keep your immunizations up to date,
  including tetanus and, for those at risk, the pneumonia shot, which
  would decrease the risk of complications from any influenza infection.
• Just as you do for hurricane season, you can keep a supply of non-
  perishable food and your prescription medication on hand in case you
  have to stay home as protection from the virus.
• Begin staying informed through the local news media and websites
  like www.PandemicFlu.gov and www.BeReadyEscambia.com – both
  local news media and websites will be the first place to get
  information on protecting yourself if a pandemic impacts Escambia
  County.
• There is a checklist for family preparedness at www.PandemicFlu.gov.
  If you are a business owner, there are also checklists for business
  preparedness at www.PandemicFlu.gov.
                                                                 FAQ Home
 With concerns about bird flu, is it safe to
eat chicken and duck in the United States?
Yes, it is safe to eat properly cooked poultry in the
United States. The United States bans imports of
poultry from areas with bird flu. The H5N1 bird
flu virus has not been found in the United States.
Cooking destroys germs, including the bird flu
virus.




                                                 FAQ Home
  What do I do if I see a dead bird?

If you see a dead bird, to not touch it with your bare
hands. Put on gloves and then place the bird into two
plastic bags – this is called ―double-bagging‖ – before
you throw it in the trash. To report dead birds, you
should contact the Florida Fish and Wildlife
Conservation Commission through their online
reporting form at www.MyFWC.com/bird. Their
contact number in Tallahassee is (888)404-3922.




                                                    FAQ Home
If I have chickens or live near a poultry farm,
               what should I do?
Remember, the deadly H5N1 bird flu
virus is not in the United States at
this point so there is no reason to be
alarmed about living near chickens
or a poultry farm. Information about
protecting chickens from bird flu is
available through the Florida
Department of Agriculture at
www.doacs.state.fl.us. Information
about wild birds is available through
the Florida Fish and Wildlife
Conservation Commission at
www.MyFWC.com.
                                           FAQ Home
                     More Information
       For more information about bird flu and pandemic
               preparedness, visit these websites:
•   www.PandemicFlu.gov
•   www.Ready.gov
•   www.CDC.gov/flu/avian
•   www.BeReadyEscambia.com
•   www.who.int/csr/disease/avian_influenza/en
•   Physicians can claim the following activity for 1 1/2 hours of
    CME/AMA PRA Category 2 credit:
    http://www2.sph.unc.edu/nccphp//training/flu_pandemic/certificate.htm
            For the latest information on pandemic flu for
             Escambia County healthcare providers, visit
      www.escambiahealth.com and click on the link for providers.
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