Pandemic Influenza

							    Pandemic Flu
Preparedness is Good
      Business
         Karen Seidman, RN, MPH
Consultant, Cuyahoga County Board of Health
              Agenda
 Influenza viruses introduction
 What makes a pandemic
 History of pandemics
 How a future pandemic might look
 Preparing for pandemic influenza
 Preparing your agency 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
  symptoms.
 A person infected with the flu virus can
  transmit it four-five days after symptoms
  start.
        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
  months
 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
 treatment
    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
  deaths
               Epidemic
“The occurrence in a community or region of
  cases of an illness…clearly in excess of
  expectancy…relative to usual frequency of
  the disease in the same area.”

Control of Communicable Disease in Man,
 Abram S. Benenson, editor, American
 Public Health Association, 15th edition,
 1990.
                Pandemic
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
      criteria)
How influenza viruses change

Drift – gradual mutation of the virus
 allowing human to human transmission
   How new influenza viruses
          emerge

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
1957-58

Hong Kong Flu (H3N2) 36,000      700,000       Infants, elderly
1968-69

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
  waves
           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
            pathogenic
 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
   Wild birds carry the virus in gastrointestinal tract
    and excrete it in their feces.
   Domestic birds (chickens) become infected by
    drinking water or eating food contaminated with the
    virus
   The virus becomes aerosolized during defeathering
    or processing the chicken.
   Humans become infected by inhaling the virus.
   Humans can safely eat infected chicken if internal
    temperature has reached 165 degrees
       Current concerns about
           avian (bird) flu
 Historicallyunprecedented disease
  outbreak in poultry caused by H5N1
 Human cases reported as of
  February 27, 2007:
     275 cases
     167 deaths
 No  sustained human to human
  transmission identified.
WHO Phases of Pandemic Alert
Phase 1 Inter- pandemic   Low risk of human cases
        phase
Phase 2 New virus, no     Higher risk of human cases
        human cases
Phase 3 Pandemic alert   No or limited human to
                         human transmission
Phase 4 New virus causes Increased human to
        human cases      human transmission
Phase 5 New virus causes Significant human to
        human cases      human transmission
Phase 6 Pandemic         Efficient, sustained human
                         to human transmission
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
  safety
 US Department of Agriculture has imposed
  import restrictions on birds and bird
  products
 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
  pandemic.
      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
  afterwards
 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
 Callfor advise
 Separate ill person from others
 Practice healthy hygiene
 Wash dishes, laundry and surfaces as
  usual
 Masks – effectiveness of protection not
  documented
         Start planning now
 Delegate responsibility for planning to
  one person and a back up – Pandemic
  Coordinator
 Form a team to assist
     Include representatives of all departments
     Include a labor/employee representative
 Meet   regularly
                  Plan
 Differentiate essential services from
  nonessential services
 Plan to provide essential services with
  reduced work staff
 Identify source of additional staff
  (cross train, volunteers)
 Will pandemic flu increase or decrease
  demand for your services?
         Communication
 Establish  contact with your local health
  department
 Identify other key contacts, especially
  employees, clients, other agencies,
  outside providers
 Establish redundant communication
  systems
         Impact on Employees
 Expect 25% to 40% absenteeism
 Besides illness, employees may experience
  disruption of normal activities, making it
  difficult for them to be at work
       Transportation services may disrupted
       Schools and day care centers may be closed
       Grocery stores may be poorly stocked or closed
       Other services may be disrupted
Pandemic influenza employment
           policies
 Institute a temporary liberal,
  nonpunitive absenteeism policy
 Provide for continuation of health care
  coverage and salary for employees
  unable to work
 Identify trigger
 Protecting Employees at Work
 Ensure  availability of hand washing
  supplies, disposable tissues, regular
  cleaning of the workplace
 Adjust structure to provide social
  distancing
     Add distance between workers
     Limit trips into the community
 Provide   education now
             Recovery
 Identify trigger for end of local wave
 Recall employees
 Inform customers / clients of return to
  normal operations
 Offer emotional / psychological support
  to employees
 Resume prior employee services and
  policies
 Reevaluate and revise plan
Reaching into the Community
 Make  contact with your local health
  department for guidance during
  pandemic influenza
 Encourage employees to participate in
  CERTs and the MRC
             Resources
 Ohio Department of Health Pandemic Flu
  Plan http://www.ohiopandemicflu.gov
 Cuyahoga County Response Plan
  www.ccbh.net
 U.S. Dept. of Health & Human Services
  www.pandemicflu.gov
 World Health Organization Current
  Information
  http://www.who.int/csr/disease/avian_influen
  za/en
                Contacts
   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.