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Avian Influenza

VIEWS: 5 PAGES: 43

									            Avian Influenza:
    What it Means to an Environmental
             Health Specialist




Larry D. Michael, RS, MPH
Program Manager
Dairy and Food Protection Branch
NCDENR
              Overview
 Pandemic Influenza
 Why the Concern?
 Current Status of Avian Influenza
 Public Health Impact
 Avian Influenza and Poultry Consumption
 What Should You Do?
               Pandemic Influenza
   Worldwide epidemics
    – Potential excess death and illness
    – Multiple waves possible
         Six to eight weeks long




                                Goode., B., Avian Influenza Seminar, April 2007
    Pandemic “Prerequisites”

 New flu virus emerges
 New flu virus causes disease in humans
 Novel virus can be efficiently transmitted
  person to person


               Dr. Asamoa-Baah, Assistant Director General,
               WHO Communicable Diseases
WHO Pandemic Alert Phase




          Avianflu.gov
Osterholm, M., University of Minnesota
             Avian Influenza (AI)
                 “Bird Flu”
   Migratory waterfowl are
    the natural reservoir
    – Carry virus in intestines
    – Virus shed in feces and
      respiratory secretions
    – Usually do not get sick
    – Many more flu types
   Source of potential
    pandemic strains
                                  Goode, B., Avian Influenza Seminar, April 2007
     Why the Concern over H5N1?
   Pandemic influenza viruses
    – Appear in the human population periodically
    – H5N1 is a likely candidate, but is not a pandemic virus yet
   Antigenic drift
    – Genetic composition of the viruses change as they mutate
      in their replications
   Antigenic shift
    – Reassortment of genetic material from two different species
      as virus subtypes merge.
Key Prevention Method!
Nations w/ Confirmed Cases H5N1


                




             Avianflu.gov   www.pandemicflu.gov, April 2007
            Federal Pandemic Plans
   National Strategy for Pandemic Influenza



   Homeland Security Council Implementation
    Plan for the National Strategy for Pandemic
    Influenza


   HHS Pandemic Influenza Plan
         – Strategic Plan
         – Public Health Guidance for State and
           Local Partners
         – HHS Operational Plan (incl.
           continuity of operations
NC Pandemic Influenza Plan

   Communicable Disease Control Section,
    DHHS
    – http://www.epi.state.nc.us/epi/gcdc/pandemic.html
 Planning Assumptions in the US
 Susceptibility to pandemic influenza will be
  universal.
 Overall, 30% of the population will become ill.
 50% of those who are ill will seek outpatient
  medical care.
 The number of hospitalizations and deaths will
  depend on the virulence of the pandemic virus.



                                        Smith, N.M., CDC
           US Burden of Influenza
   Seasonal
     – >200,000 hospitalizations
     – 36,000 deaths
   Pandemic
                          Moderate (1957-like)   Severe (1918-like)
Illness                     90 million (30%)     90 million (30%)
Outpatient medical care     45 million (50%)     45 million (50%)
Hospitalization                 865,000             9, 900,000
ICU care                        128,750              1,485,000
Mechanical ventilation          64,875                745,500
Deaths                          209,000              1,903,000

                               CDC
                     North Carolina Impact
                                                      Moderate                    Severe
                                Seasonal             Pandemic*                 Pandemic*
Doctor visits                     750,000             1.6 million              1.6 million

Hospital visits                       6,000                  35,000                  290,000

Deaths                                1,100                    7,950                   65,300

* Based on CDC software FluAid 2.0: Assumes a 35% attack rate, NC population of 8.5 million people.
          In North Carolina…
   290,000 Needing hospitalization
    – How many licensed and staffed beds in NC?
   Between 2,600 and 6,100 will need
    ventilation equipment
    – How many ventilators do we have?
    Planning Assumptions in the US
   The typical incubation period for influenza averages
    2 days.
   Persons who become ill may transmit infection for
    one-half to one day before the onset of illness.
   On average about 2 secondary infections will occur
    as a result of transmission from someone who is ill.
   In an affected community, a pandemic outbreak will
    last about 6 to 8 weeks.
   Work/school absenteeism may be as high as 40% at
    the peak.
   At least two pandemic disease waves are likely.
                           CDC
 Potential Strategies to Decrease
    the Impact of a Pandemic
 Antiviral   treatment and isolation
 Quarantine    for those exposed
 Social   distancing
 Vaccine   when available
                                                                                   Deaths Rates / 100,000 Population
                                                                                            (Annual Basis)
                                                    9/
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                                                        /1




                                                                                       2000
                                                                                              4000
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                                                                                   0
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                                                 10 /19
                                                   /1 18
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                                                   /1




Goode, B., Avian Influenza Seminar, April 2007
                                                      9/ 8
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                                                   /2 18
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                                                         1
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                                                     /2
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 Date
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                                                                                                                                                     1918 Death Rates: Philadelphia v St. Louis




                                                 12 19
                                                   /2 18
                                                  Graphic from Brant Goode (CDC)




                                                      8/
                                                                                                                                   St. Louis




                                                         19
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                                                                                                                                   Philadelphia
                                                          St. Louis
                                                                St. Louis               Estimated attack rate
                                                                                        before interventions:
                                  14000
Death Rate / 100,000 Population




                                  12000
                                              First death recorded                                2.2%
                                  10000         Mayor closes “theaters, moving picture
       (Annual Basis)




                                   8000         shows, schools, pool and billiard halls,
                                                Sunday schools, cabarets, lodges, societies,
                                   6000
                                                public funerals, open air meetings, dance
                                   4000         halls and conventions until further notice”
                                   2000
                                                                                Closing order withdrawn
                                         0
                                             21 8

                                             28 8

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                                                                         Date


                                                                                Source: Lipsitch M, Hatchett R, Mecher C
Is Avian Influenza a
 Concern in Food?
Overreaction?
     What if H5N1 Made it to the
      US (No Human Cases)?
   Survey in NE USA
      – 46% would stop buying/eating poultry
      – 25% would reduce buying/eating poultry
      – 27% would keep buying/eating
      – 2% don’t know



Harvard School of Public Health Project on the Public and Biological Security, January 17-25, 2006
Adapted from Slenning, B.D., 2006
      Value of Poultry to NC
 Primary production of poultry is worth
  approximately 2.7 Billion to the state.
 Approximately 16 Billion when you add the
  entire poultry food chain (processing,
  marketing, transportation, restaurants, etc.)
 Nearly 20% of NC population works in an
  agriculture/food-related job.
                     Adapted from Slenning, B.D., 2006.
                     Data excerpted from NCDA and Consumer Services
            Is Poultry Safe?
   Food products of concern
    – Raw Poultry
    – Raw Eggs
 No documented cases of Avian Influenza
  from eating poultry products
 Extensive monitoring and control program
           Approved Source
– Inspected by NCDA &
  Consumer Services,
  Meat and Poultry
  Inspection Service
– USDA
      USDA Poultry
       Inspection Legend
      USDA Red Meat
       Inspection Legend
             Asian Sources
 Restrictions on live
  birds, poultry and
  poultry products from
  Asian countries
 Processed poultry is
  not imported from
  Asia.
       Birds on a Two-wheeler




World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
                   Lack of Hygiene




World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
                Asian Wet Market




World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
                        Intermingling




World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
            Slaughtering/Selling
               in Same Area




World Health Organization, www.searo.who.int/LinkFiles/Publications_and_Documents_factors.pdf
     What’s the Worst-case
          Scenario?
 Finding it in Food?
 Sustained Person-to-Person Transmission of
  H5N1?
Proper Cooking
 Will Kill H5N1
             What Now?

 Vaccination
 Good personal hygiene
 Stay home if ill
 Develop a COOP at work
 Educate
 Stay informed
 Get involved
        Pandemic Flu Planning
   Two weeks supply of water and food
    – Fluids with electrolytes
   RTE canned meats, fish, fruits, vegs, soups
   Protein or fruit bars
   Dry cereal or granola
   Peanut butter or nuts
   Dried fruit
   Pet food
       Pandemic Flu Planning
   Prescription and nonprescription drugs
   Soap/hand sanitizing gel
   Thermometer
   Flashlight
   Batteries
   Portable radio
   Manual can opener
   Toilet paper
  Online Resources

    www.who.org
     www.cdc.gov
www.ncpublichealth.com
Dairy and Food Protection Branch


   Larry Michael
    – (919) 715-0927
    – Larry.Michael@ncmail.net

								
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