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Pandemic Flu

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					Pandemic Flu Planning
 Mark D. Smith, MPH, CSP, CIH,
            CHMM
       October 11, 2007
              Introduction
What shall I cover?

 1. What is the Pandemic Flu or as it is
 also called the Avian Flu?
 2. How will it impact this country?
 3. What is the role of the industrial
 hygienist regarding the Pandemic Flu?
               Introduction
 Will use term H5N1 virus, Pandemic Flu
 and Avian Flu interchangeable

 A pandemic disease is
   World-wide outbreak
   No or limited vaccine available
   No immunity within the general population
             Introduction
 Influenza epidemics occur every 1-3 years

 31 recorded pandemics since 1580

 Come in waves during winter months

 May be multiple waves over a two-year
 period
             Introduction
 Overwhelm healthcare

 Have been 3 major pandemic events since
 1900 – last one was 1968

 1918 Spanish Flu (H1N1) – 529,000 to
 675,000 deaths in US. 50-100 x 106
 deaths worldwide
              Introduction
 Much of the planning and estimates are
 based on previous pandemic events

 One estimate of mortality - 50% of the
 population

 No tight models
                  H5N1
 What does this term mean?
 Classification scheme for influenza viruses
 H and N denote surface proteins found on
  the virus
 H - hemagglutinin
 N - neuraminidase
Anatomy of the Influenza Virus
             Drift and Shift
 Antigenetic Changes
   Structure of Hemagglutinin(H) and/or
    neuraminidase (N) changes
 Drift – minor changes, same subtype –
  results in minor changes
 Shift – major change – new subtype-
  pandemic potential
          Avian Flu - History
 1996 Virus (H5N1) first isolated in
  Guangdong province of China
 1997 Poultry farm outbreak, plus 18
  human cases in Hong Kong
 2003-2004 – Poultry outbreaks in
  Thailand, Japan, Viet Nam, Cambodia,
  China, Lao PDR
   Concurrent human cases
         Avian Flu - History
 2005 Poultry outbreak in Russia,
 Kazakhstan, Turkey, Romania

 2006 virus detected in migratory birds in
 US

 No US poultry or human cases – so far
       H5N1 Characteristics
A. Highly virulent
B. Carried and spread by birds- which can
   migrate
C. Human cases have seen in Asia, Africa
   and Europe
D. Human cases have resulted from contact
   with poultry
        H5N1 Characteristics
 Carried in the intestines of wild birds –
  doesn’t make them ill

 Highly contagious among domestic fowls
   90-100% mortality within 48 hours
               Cases and Mortality
                      Avian Flu - Cases and Fatalities Since 2003
         350
                      329



         300



         250


                                                                 201
         200
Number




         150



         100



         50



          0

                  Total Cases                                 Fatalities
       H5N1 Characteristics
 60% case-fatality rate in humans

 Fatalities mostly individuals under 40
 years of age

 Differs from general at-risk populations
 (old and very young)
       H5N1 Characteristics
 So far has been predominantly a bird
 disease

 Human cases have resulted from contact
 with birds, in very large number

 Very limited human-to-human cases –
 perhaps 3-4 recorded
      H5N1 Characteristics
 Fears
 1. Disease becomes easily transmissible
    person to person
 2. Maintains its current lethality
 3. Evolves (mutates or reshuffles genes) to a
    worst case virus
          H5N1 Symptoms

Similar to other cases of influenza
40% of school children will become infected
20% of the working adult population will be
  infected
2-day incubation period
50% of those who become ill will seek
  medical treatment
      Disease Transmission

 Spread to hand-to-mouth contact with
 contaminated surfaces

 Example – touching your hand to your
 mouth after using a handrail
              Transmission
 Spread by droplet -
  airborne
 Sneezing, coughing
  creates relatively
  large airborne
  droplets containing
  the virus
           Workers At Risk
 Laboratory (clinical) workers
 Poultry handlers
 Healthcare workers
 Travelers
 Employees working abroad
 Individuals who have frequent contact with
 large numbers of people
WHO Current Risk Phase
Characterizing Risk of Exposure
 Very high – frequent contact with those
  individuals who are infective (e.g.
  healthcare workers)
 High risk – mostly medical personnel
 Medium risk – schools or high volume
  retail
 Low risk – infrequent contact with others –
  e.g. office personnel)
Characterizing Risk of Exposure
 Impact on the Work Environment
 Up to 40% absenteeism
 Cascading failures and slow down
 Supply of raw materials and production
 Change in business practice
   Eliminate person to person contact
   Different hours
   Home deliver increase
     Industrial Hygiene’s Role
Classic Approach
1. Identification (might include
   anticipation) – Pretty well covered by
   public health
2. Evaluation – identification of at-risk job
   titles or impact to the business
3. Control – may be the area of greatest
   value
                Controls
 Engineering – limited options
 Administrative – numerous options
 Personal protective equipment – mostly
 respirators
  Industrial Hygiene – Engineering
               Controls
 Sneeze guard or barriers
 Negative/positive pressure - mostly for
  healthcare
 Local air filtration (portable HEPA) devices
  – also mostly for healthcare
Industrial Hygiene - Administrative
 Planning

   Should address the entire continuum from
    pre-event to post-event

   Look at protecting employees, but secondarily
    continuity of business operations
  Industrial Hygiene - Planning
 Pre-Event Planning Issues
     Pay             - Insurance
     Training        - Drills and practice
     Key personnel   - Establish a team
     Key functions   - PPE
     Supplies        - Sanitization supplies
     Security        - Counseling
     Safety          - Work at home
Industrial Hygiene – Administrative
              Controls
 Training
   Company-Specific Avian Flu Plan
   Employee Roles
   Characteristics of the Disease
   PPE use
   Sanitation (tissues, hand cleaner, surface
    cleaning)
   Cough etiquette and social distancing
Industrial Hygiene – Administrative
              Controls




 Business closure
 Hand-washing – availability including trash can
 Avoid hand-to-face contact
 Surface decontamination – Identification of high-risk surfaces,
  frequency and agent
 Social distancing – 6 feet minimum
Industrial Hygiene – Administrative
              Controls
 Tissues – relatively
  inexpensive
 Hand sanitizer
    60-70% alcohol
    Foam or gel
    Wall-mounted dispenser
    Used extensively in
     hospitals
    Impressive record with
     respect to infection control
    Not as good as
     handwashing
Industrial Hygiene – Administrative
              Controls
 Hand Sanitizers- fire safety concerns
   Flammable contents
   Maintain horizontal distance (6-9 inches)
    between sources of ignition (electrical
    equipment, switches, outlets, etc).
   Maintain vertical distance to sources of
    ignition (nothing below)
   Storage - check fire codes
Industrial Hygiene – Administrative
              Controls
 Medical monitoring of employees – look
  for signs and symptoms of disease
 Biosafety Level (BSL) 3 – (facilities and
  procedures) for biomedical research labs
  handling Avian Flu
 BSL 2 practices for clinical labs conducting
  PCR assays in a biosafety cabinet
Industrial Hygiene – Administrative
              Controls
 Limit travel, especially to areas that have a
  high incidents of the disease

 Flexible scheduling – limit the number of
  employees that work in the same area

 Telecommuting
                 Vaccine
 Not commercially available

 Best vaccine would fit the characteristics
 of the Pandemic Flu, which hasn’t
 emerged yet

 A vaccine has been produced based on
 the current form of H5N1 and been added
 to the Strategic National Stockpile
   Industrial Hygiene - Vaccine
 Vaccination for common flu will prevent
 co-infection with Avian flu – although low
 risk

 More importantly it may prevent mixing of
 common flu with Avian Flu
   Industrial Hygiene - Vaccine
 April 2007 – FDA approves first vaccine
 for H5N1 human virus

 2 injections, one month apart

 Individuals 18-64 years of age

 45% reached acceptable antibody levels
     Industrial Hygiene – PPE
 PPE - mostly respiratory protection.
 However, it will vary based on industry
   For example – OSHA suggests eye protection
    gloves and other barriers for poultry workers
  Industrial Hygiene – Respiratory
              Protection
 Respiratory Protection
     N-95 respirators are acceptable
     Disposable
     Who gets it?
     How many will you need?
     What if there is a second or third wave?
     Can you get them?
     Where will they be stored?
     Security (respirators will be a target for theft)?
  Industrial Hygiene – Respiratory
              Protection
 Respiratory Protection – Regulatory
 Issues
     Medical Evaluation
     Training
     Fit-Testing
     Recordkeeping
     Surveillance for proper use
     Written plan – including change schedule
     Facial Hair – Shave or PAPR?
    Industrial Hygiene – Respiratory
                Protection
 FDA Approved a respirator for public
    health medical emergencies in May 2007
   3M models 8612F and 8670F
   Sized for adults
   Also NIOSH certified
   N-95 rating
                Opinions
 I don’t believe the Avian Flu be as bad as
  speculated
 Why?
   Media hype
   It may pass through an intermediate
    mammalian host, thereby moderating its
    virulence
   Knowledge is power
                 Opinion
 Healthcare has been working on surge
 capacity for several years

 The longer we wait, the better
      Sources of Information
 http://www.pandemicflu.gov/index.html
 http://www.cdc.gov/flu/avian/
 http://www.osha.gov/dsg/guidance/avian-
  flu.html
 http://en.wikipedia.org/wiki/Human_mortali
  ty_from_H5N1#History

				
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