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									Influenza – What in the world
      do YOU need to know?

              Kristine A. Smith, M.A.
Flu Facts
What is Influenza?
 Acute, febrile respiratory
  illness affecting nose,       Symptoms appear rapidly
  throat, bronchial tubes
  and lungs
 Epidemics caused by
  influenza viruses A and B
  (Type C uncommon in
  people; no epidemics)
 Occurs worldwide,
  causing considerable
  morbidity (illness) and
  mortality (death) each

 Fever, dry cough, sore throat, muscle aches/pain,
  headache, lack of energy, possibly runny nose

 Fever and body aches for 3-5 days

 Cough and lack of energy - 2 weeks

 Symptoms similar to other upper respiratory diseases
  such as adenovirus, rhinovirus, parainfluenza,
  legionellosis, etc.
How You Get the Flu?

                                   Transmission is
 Typical incubation: 2 days
  Range: 1-4 days                  predominately droplet spread

 Viral shedding
    Can begin 1 day before
     symptom onset
    Peak shedding first 3
     days of illness
       Correlates with
       Subsides after 5 days in
        adults, can be 10+ days
        in children
The Burden of Seasonal Influenza

 Globally: 250,000 to 500,000 deaths each year

 In the United States each year:
   36,000 deaths
   >200,000 hospitalizations
   $37.5 billion in economic costs from influenza
      and pneumonia
How Influenza Viruses Change?

 Antigenic Drift:
   Small changes in virus over time
   New strains appear and replace older strains
   May not be recognized by antibodies to older strains

 Antigenic Shift:
   Abrupt, major change (reassortment)
   Results in novel strain or new subtype
   Can cause pandemic influenza
What is an Influenza Pandemic ?

 A global influenza outbreak
    Caused by a brand new (novel) flu virus
    Most severe occur with changes in both surface proteins
    Viruses can be isolated at any time of year

 Because it is a new virus, few or no people would be

 Many people would get sick in every part of the world

 Asia is the source of many outbreaks because swine,
  birds and humans live under the same roof, providing
  opportunity for viral mixing
      Influenza Pandemics 20th Century

Credit: US National Museum of Health and

   1918: “Spanish Flu”                     1957: “Asian Flu”   1968: “Hong Kong Flu”
       A(H1N1)                                A(H2N2)                A(H3N2)

       20-40 m deaths                      1-4 m deaths          1-4 m deaths
       675,000 US deaths                   70,000 US deaths      34,000 US deaths
  Timeline of Emergence of
Influenza A Viruses in Humans

                                              H9      H7
                                  Russian    H5
                    Hong Kong
                     Influenza   H1
  Spanish    Influenza H3

  1918            1957 1968 1977             1997    2003
If a Pandemic Happens:
What to expect…

 At the peak of a moderate pandemic influenza outbreak
  (i.e. 35% attack rate, 6 week duration), New York State
  (excluding New York City) can expect:
    14,916 influenza-related hospital admissions per week
    3,728 influenza-related deaths per week
          2,609 deaths in the hospital

 Influenza patients will most likely utilize:
    63% of hospital bed capacity
    125% of intensive care capacity
    65% of hospital ventilator capacity
Will Avian Flu Cause the Next

No one knows!

The H5N1 virus could change to spread
 more easily among humans-but it might

It could ―swap genes‖ with another animal
 virus, or with a human flu virus
Avian Influenza

 The H5N1 strain of avian influenza (bird flu) is present in
  birds in many countries across several continents.
    Bird flu is NOT the same as pandemic flu

 Some human cases of avian influenza have also
   Cases occurred after close contact with infected birds
   No sustained person to person transmission

 Human death rate is high >57%
Nations With Confirmed Cases
H5N1 Avian Influenza (July 21, 2006)
H5N1 Outbreak:
December 2003 –July 20, 2006
 Laboratory confirmed human cases:
   231 human cases
   133 human deaths
 Case fatality rate 57 percent
 Cases occurred in countries with endemic infection of
 Nearly all human cases had poultry/bird exposure
 No sustained person-to-person transmission identified
 No influenza A viruses with human and avian
  genes detected yet
                                    Source: World Health Organization
Situation Report: Avian Influenza

 Widespread prevalence in migratory birds; broad host

 Continued outbreaks among domestic poultry
 Mammalian infection (cats, pigs, etc.) - lethal
 Virus is evolving
 Sporadic human cases (>190 reports to date)
   • Most in young and healthy, Case-fatality 57%
   • Rare person-to-person transmission
  Sustained and rapid person-to-person transmission
What is New York State
     doing to prepare?
 WHO Pandemic Phases
Interpandemic Phase 1: No new influenza virus subtypes in
period        human; subtype that has caused human
                infection may be present in animals
                Phase 2: As above, but circulating animal
                subtype poses substantial risk of human
Pandemic        Phase 3: Human infection w/ new subtype, no
alert period    human-to-human (HTH) spread, or rare spread
                to close contact
                Phase 4: Small clusters w/ limited HTH
                transmission, highly localized spread,
                suggesting virus not well adapted to human
                Phase 5: Larger clusters, but HTH spread still
                localized, virus increasingly better adapted to
                humans, but not yet fully transmissible
Pandemic        Increased and sustained transmission in
period          general population
NYSDOH Planning Process

 Original plan drafted using internal DOH workgroups –
  August 2004
 Based on federal DHHS August 2004 pandemic plan
 NYSDOH revised plan and incorporated recent guidance
  issued in the updated DHHS November 2005 plan
 Additional workgroup members added from:
    Local health departments
    Hospitals and hospital associations
 NYSDOH plan:
 Federal plan:
Current Status of NYS Planning

 With the Disaster Preparedness Commission (DPC)
  agencies, SEMO is coordinating development of a
  State pandemic plan that will become an annex of the
  State’s Comprehensive Emergency Management
  (―All Hazards‖) plan
 Local Health Departments are developing county-
  specific plans—due date August 30, 2006
 Hospitals and Regional Resource Centers are
  planning for surge capacity
 Pandemic preparedness town meetings, regional
  partner meetings, regional media forums are being
Extensive Training is Underway
 NIMS training for            Multiple tabletop and
  emergency responders          functional exercises held:
                                  ProtEX NY state POD
                                   exercise, November 2005
 Point of Dispensing
                                  2006 versions Nov. 9 in
  (POD) training for Local         NYC,
  Health Departments               Syracuse

 Laboratory specimen
  collection and submission
  training                        CDEx full functional
                                   exercise, June 2006
                                   (more than 200 agencies
 Informatics training for         participated)
  key partners using HIN,
Public Health Emergency Preparedness -
A Shared Responsibility!

 Local – state – federal
 Domestic –
  international             Healthcare                    Federal
 Public – private           System

 Multi-sector                           Federal Public
 Animal – human
                              Businesses            Education
 Health protection –         & Workers              System

  homeland security –
  economic protection
    Businesses, school systems,
community infrastructure providers, and
other employers should develop plans for
continuity of essential operations and
modified operation with a significantly
reduced workforce
25 to 30% of persons may become ill during a 6 to 8 week
An additional 10% of the workforce may be absent due to
 illness of a family member
Others may stay home due to a fear of becoming infected
What can YOU do to
General Infection Control
Assumptions in a Pandemic

                 Core prevention and control
                  measures (e.g., vaccination
                  and antivirals) will not be
                  available or will be limited
                 We must prepare for that!
Individual Infection Control Strategies

Respiratory hygiene/cough etiquette and
 hand hygiene are effective strategies to
 stop the spread of germs

              We should
               make good
               hygiene a
               habit now
What is Respiratory Hygiene/
Cough Etiquette?

Cover mouth/nose when sneezing or
  If no tissue, use elbow instead of hands
Use tissues and dispose of appropriately
Perform hand hygiene after contact with
 respiratory secretions
Distance yourself from others
 (more than 3 feet)
What is Hand Hygiene?

Traditional hand washing
  Soap and hot water
  Minimum of 20 seconds
   (the time it takes to sing
   ―Happy Birthday‖ twice)

Alcohol based hand rubs
  Acceptable means to disinfect/sanitize EXCEPT
   when hands are visibly soiled
Did You Ask About Masks?

 Recommended for:
  Health care workers with
   direct patient contact
  Those at high risk for
   complications of influenza
  Symptomatic persons
  Contacts of ill persons
More About Masks
 Benefit of wearing masks by well persons in
  public settings has not been established
  Persons may choose to wear a mask as part of an
   individual protection strategy that includes respiratory
   hygiene/cough etiquette, hand hygiene, and social
      If you wear a mask,
       keep your hands away
       from your face!
      Clean your hands
       each time you touch
       your mask!
 Individual or Group
 Infection Control Strategies

 Isolation and quarantine: reduces influenza transmission
  by separating infected persons from uninfected persons,
  and exposed persons from non-exposed persons

   Isolation of ill persons will be valuable during all phases
    of pandemic influenza
   Quarantine of those exposed to ill persons is justified
    when there are a limited number of cases
Work or School Based
Infection Control Strategies

 Respiratory hygiene/cough etiquette, hand hygiene
 Stay away if ill (staff stay home, students do not go
  to classes)
 Encourage self-reporting of illness that develops
 Active screening for
  illness in staff/students
 Send staff/students home
  (with mask) if ill
 Infection Control Strategies
 Social distancing
   Snow days, voluntary self-shielding
 Cancellation of public events
   concerts, sports events, movies,
 Closure of schools and
   office buildings, shopping malls
 Closure of recreational facilities
   community swimming pools, youth
    clubs, gymnasiums
Individual and Family Preparedness
is Crucial!
We might have to take care of ourselves and
 those around us
How many would be ready?
Family Preparedness Checklist

 To plan for a pandemic       Start now to limit the
   Store a supply of food      spread of germs and
     and water                  prevent infection
   Have non-prescription        Hand hygiene
     drugs and other health      Respiratory hygiene
     supplies on hand            Stay home if sick
   Get involved in your            Parents need to
                                      model behavior!

    Contact Information:
    (518) 486-1642

Additional Resources:
 Contact your local health department
 Websites – or

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