Pandemic Flu and You

DJ Holcombe, MD, MSA, FACPJJ Naponick, MD, MPH

Administrator/Medical Director Department of Health & Hospitals

Office of Public HealthRegion 6

Topics of Discussion

Seasonal Influenza Avian InfluenzaPandemic InfluenzaImpact & PlanningPublic Health RoleYour RoleResources

So you’ve got the flu?

mild to severe respiratory illness of sudden onset caused by an influenza virus

highly infectious-spreads rapidly from person to person

some strains more severe than others

occurs every year killing 36,000 people in U.S. and 550 in Louisiana

What is influenza (flu)?

Symptoms of Influenza

sudden onset of symptoms

fever, headache, aching muscles, weakness

respiratory symptoms cough, sore throat, difficulty breathing

incubation period = time from exposure to virus to development of symptoms

varies for influenza , but generally 1 to 4 days

Seasonal Flu is just that, seasonal.Pandemic Flu is not.

How does influenza spread?

Breathing in droplets produced when infected person talks/coughs/ sneezes

Touching an infected person or surface

contaminated with the virus and then touching your own or someone else’s face

Influenza A Virus

Hemagglutinin (H)–16 subtypes(attachment, penetration)

Neuraminidase (NA)–9 subtypes(release)

8 viral genes(assembly, replication)

M2 protein(penetration)

Hemagglutinin (H)–16 subtypes(attachment, penetration)

Antigenic Drift vs. Shift

Antigenic drift: major changes in the form of one or both of the two principle antigens on the viral surface

our immune system has greater difficulty recognizing them

Antigenic shift: radical changes in the form of the one or both of the two principle antigens on the viral surface

our immune system can’t recognize them at all

What’s Next?

The Avian Menace, our false feathered friends.

Avian (Bird) Influenza

An infection occurring naturally among birds caused by avian influenza viruses (e.g. H5N1 virus)

Birdswild birds worldwide carry the virus – usually no illnessdomesticated birds - can become ill and die

Humans can become infected with avian influenza -> severe illness and deathmost cases from close contact with infected poultry very rarely may have spread from one person to anothercases/deaths since 2003 = 359/226

• 2003: 4/4• 2004: 46/32• 2005: 98/43• 2006: 115/79• 2007: 86/59• 2008: 10/9

Influenza A Subtypes:The Omnipresent Zoonoses

Viral MutationsUnlocking the Key to Infection

Will H5N1 become the next pandemic?

Avian Flu not yet Pandemic Flucurrent outbreaks of H5N1 Avian Flu in poultry and birds are the largest ever documented

Impossible to predict next pandemic flu event

If not H5N1, then another

Plan now

How do we protect ourselves from our feathered friends?

Poultry SurveillanceCulling the infected flocks.

Stopping the Avian Flu: Surveillance

Avian Flu: Sampling Flocks

Understanding Pandemic Flu

Epidemic: serious outbreak in a single community, population or region

Pandemic: an epidemic spreading around the world affecting hundreds of thousands of people, across many countries

Pandemic flu: a pandemic that results from an influenza virus strain that humans have not been previously exposed to

Putting Pandemic Flu into Perspective

2001 terrorist attack with anthraxkilled five people

2002 outbreak of West Nile Viruskilled 284 people nationally in six months

2003 SARS outbreakkilled over 800 people world widefroze Asian economiesfrightened millions of people into wearing masks on the streets

History of Pandemic Influenza1968-1969

Worldwide 700,000 deaths (34,000 in US)

1957-1958Worldwide 1.5 million deaths (70,000 in US)

1918 Worldwide 40-50 million deaths (500,000–650,000 in US)

Typical Influenza Season36,000 deaths in US

The Spanish Flu of 1918

Mortality in 1918

Public Health Measures in 1918

Personal Protective Equipment (1918)

Law Enforcement in the 1918 Flu

Lessons from Past PandemicsOccurs unpredictably, not always in winter

Variations in mortality, severity of illness and pattern of illness

Rapid surge in number of cases over brief period of time, often measured in weeks

Tend to occur in waves - subsequent waves may be more or less severe

Pandemic Flu: Current Status and Requirements

Currently no pandemic influenza in the world

For pandemic influenza to occur, three conditions must be met:

a new influenza A virus appears or “emerges” in the human populationit causes serious illness in people it spreads easily from person to person worldwide

Interpandemic

Larger clusters, localized

Limited spread among humans

Pandemic

Current Status

WHO Global Influenza Preparedness Plan, 2005. Available at: http://www.who.int/csr/resources/publications/influenza/GIP_2005_5Eweb.pdf

Pandemic alert

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

New virus in

humans

Little/no spread among humans

Small clusters, localized

Limited spread among humans

Increased and

sustained spread in general human

population

Current status of

H5N1

No new virus in humans

Animal viruses low risk

to humans

No new virus in humans

Animal viruses low risk

to humans

Current H5N1 status

Pandemic Flu (Category and Projected Death

Rates)

Pandemic Influenza Impacts

Estimated Impact in Louisiana

3 Million infectedBetween 600,000-1.4 million clinically illBetween 300K-700K requiring outpatient careBetween 10,000 – 22,500 hospitalizedBetween 3,000 – 6,000 deaths

Impact on Infrastructure

Significant disruption of transportation, commerce, utilities, public safety and communications Limited to no assistance from State and Federal governments due to nation-wide impact

Impact on Health CareIllness rates will soar

Many people will require some medical care

Health care facilities will be overwhelmed

Symptoms may be severe

Complications: may be more frequent healthy people may be at increased risk

Impact on Business

Impact on Business Owners

Up to 40% employee absenteeismPossible increase/decrease in demand for products or servicesDisruption of communication & supply chainsFewer employees and customers

Issues to AddressModification of:

• customer/employee interaction

• sick leave & work location

Communication/education Collaboration Infection Control

Pandemic Flu Simulation

Making Vaccines

Will there be a vaccine?

Because the virus will be new, there will be no vaccine ready to protect against pandemic flu

A specific vaccine cannot be made until the virus has been identified

Seasonal flu vaccine or past flu immunization will not provide protection

Medications During Pandemic Flu

Antiviral Medicationscan prevent complications if taken within first 48 hours of illnessmay not be effective against a pandemic flu virusextremely limited supply nowwould be prioritized initial use probably only for treatment, not prophylaxis

Antiviral Medications

Amatadine (Symmetrel)

Rimantadine (Flumadine)

Zanamivir (Relenza)

Oseltamivir (Tamiflu)

Influenza Containment Strategy: Community

ResponseBasic ActivitiesSurveillance and quarantine of early casesPublic information and educationPromote “respiratory hygiene” and hand washing

Enhanced ActivitiesFocused measures to increase social distanceCommunity-wide measures to increase social distance

Isolation and Quarantine

isolate ill individuals with certain contagious diseases

quarantine contacts (those exposed to such contagious diseases) play a role in the early stages of the pandemiclegal measures possible

probably would rely on voluntary cooperation

once beyond initial cases“stay home when you are sick”

Influenza Prevention

VaccinationStay at home when sickCover your coughWash hands regularlyAvoid touching eyes, nose and mouthAvoid close contact with people who are sick

Infection Control - Our Basic Protection

Hand HygieneWash hands regularly with soap & waterIf no water available: 60%-95% alcohol-based sanitizer

Cover your cough strategy

Environmental cleaning1:10 bleach solutionEPA registered disinfectant

Gloves & surgical masks

Hand washing

Alcohol-based Hand Sanitizers

Different Masks for Different Folks

Community Wide Measures

Reduce Social Contact by canceling large gatherings, mass transit, schoolDecision based on location of flu activity:

Outbreak not local: large gatherings cancelledOutbreak in local/neighboring county: small gatherings cancelled

School closings determined by State Department of Health & Hospitals Department of Education Local School Boards.

Workforce Support

Psychological and physical strain on personnel responding in emergency situation

Psychological stress for families

Plan for staff to have adequateSleepFoodAccess to psychological and spiritual support

Guidance Personal/Family Planning

Personal protection: Hand hygiene and respiratory etiquetteSurgical masks: proven effective for droplet precautions Seasonal influenza vaccination

Stockpiling: One to three week essential water, food, supplies, medicines

Community Goals in Pandemic Flu

Limit death and illness

Preserve continuity of essential government and business functions

Minimize social disruption

Minimize economic losses

Public Health Role in Pandemic

Facilitate planningDisease tracking & controlCommunication about public health issuesCoordinate mass antiviral medication and vaccination clinicsIssue isolation and quarantine orders

Get Informed! Be Prepared!

State Draft Pandemic Flu Planhttp://www.dhh.state.la.us/offices/publications/pubs-145/Pandemic%20Influenza%20Plan_100906.pdf

Family Readiness Guidehttp://www.dhh.state.la.us/offices/publications/

Official Pandemic Flu Web Sitehttp://www.pandemicflu.gov/

Centers for Disease Control and Preventionhttp://www.cdc.gov/flu/pandemicflu/

Even though local, state and federal agencies have plans to protect the public, you are responsible for your own safety,

even in an emergency!