Pandemic Influenza

Avian InfluenzaMaine Department of Health & Human Services

Maine Center for Disease Control & Prevention(formerly Bureau of Health)

Dora Anne Mills, M.D., M.P.H.

1.1. Pandemic Influenza &Pandemic Influenza &Avian Influenza 101Avian Influenza 101

2.2. Preparedness EffortsPreparedness Efforts

1. Pandemic Influenza & Avian Influenza 101

InfluenzaSeasonal influenza

Avian influenza

Pandemic influenza

All Influenza:

RNA viruses

Genetic engines

A: HemagglutininNeuraminidase

Seasonal InfluenzaOctober – April

Influenza Type AH3N2, H1N1

Influenza Type B

Vaccine

Avian Influenza (Bird Flu)Influenza A

Domestic poultry – can be deadlyHigh vs. low pathogenic

Wild birds – carriers

Virus in fecal droppings, saliva/nasal discharge

Recent Avian Influenza Outbreaks Affecting Humans

1997 H5N1 Hong Kong

1999 H9N2 Hong Kong

2003 H7N7 Netherlands

2004 H7N3 Canada

2004 H5N1 Southeast Asia

Pandemic InfluenzaGlobal outbreak

Highly contagious

Deadly

Recent Pandemics1918 Spanish flu (H1N1)

5,000 deaths in Maine500,00 in U.S.40,000,000 worldwide

1957 Asian flu (H2N2)70,000 deaths in U.S.1-2,000,000 worldwide

1968 Hong Kong flu (H3N2)34,000 deaths in U.S.700,000 worldwide

Past Pandemic InfluenzaEstimates for Maine

Moderate (1957/1968)

Severe(1918)

Illness 390,000 390,000Hospitalization 5,000 40,000Deaths 1,100 9,100

H5N1Detected in Asia since 1997

Deadly – 50% mortality in humans

Transmitted birds to mammals and limited human to human

Evolving quickly

H5N1 Activity as of September 29, 2006

253 human cases (thru 10/13/06)

In 58 countries

148 deaths

Mortality rate = 58%

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Humans Infected (Total=253) Human Deaths (Total=148)

Human Infections and Human Deaths by H5N1by Month, October 13, 2006

2. Preparedness EffortsA. Avian Influenza PreparednessB. Pandemic Influenza Preparedness

A. Avian Influenza Preparedness

DetectionTesting in:

Migratory birdsPoultry industry

Preparedness PlanningPoultry workers

Backyard flock owners

Others – bird lovers, hunters

General PublicFood safety

Bird handling

B. Pandemic Influenza Preparedness

“Pan Flu”

Significant Issues forPan Flu Planning

Detection and TrackingCare for Isolated and IllVaccines and AntiviralsFood and Other SupportBasic Services and Economic ImpactCommunicationQuarantine and Isolation

Pandemic AssumptionsAttack rate of 25%-35%

Duration of up to year or more in 2 waves

Each wave lasting 6-8 weeks in community

Healthcare system will be severely taxed, if not overwhelmed

Social Disruption fromPandemic Influenza

Absenteeism in essential sectors

Health, law enforcement, food and fuel supplies, education

Economic impact

Psychological stress

2006 vs 1918Advantages in 2006

Healthier populationBetter medical carePreparedness

Advantages in 1918Smaller populationLess travelMore self-reliance

Federal Preparedness

www.pandemicflu.gov

Components of Federal Plan

SurveillanceLaboratory DiagnosticsHealthcare PlanningInfection ControlClinical GuidelinesVaccineAntiviral Drugs

Community Disease ControlTravel-Related Risks of DiseaseCommunicationsWorkforce Support

Selected Components

Vaccine

Antivirals

Community Disease Control

Vaccines

Assumptions for Vaccination

Two doses will be required

Vaccine unavailable for 3-6 months

Production will be 3-5 million doses (15 µg)per week 10,000 doses per week in Maine

Vaccine Priority Groups

Vaccine and antiviral manufacturersHealth care providers

Those at high risk for severe disease

Public health emergency response workers

Key government leaders

400,000 in Maine

Recommendations for Vaccine and Antivirals may be modified based on:

VirulenceTransmissibilityDrug resistanceGeographic spreadAge-specific attack ratesMorbidity and mortality rates

What You Can Do NowAnnual seasonal influenza vaccination

Pneumococcal vaccination

Antivirals

AntiviralsAdamantanes

AmantadineRimantadine

Neuraminidase inhibitorsOseltamivir (Tamiflu)Zanamivir (Relenza)

Assumptions for Antivirals

Resistance to adamantanes

Neuraminidase inhibitors will be effective in decreasing morbidity and mortality

Current national stockpile = 5 million courses; goal is 80 million courses

? Maine stockpile

Some Antiviral Priority Groups1. Patients admitted to hospital 2. Infected health care workers and EMS

providers3. Infected high-risk patients4. Infected pandemic responders and

government decision-makers5. Exposed health care workers

Equals 40 million courses (150,000 courses for Maine)

Cost of Antiviral Treatment5-Day Course for an Adult

Oseltamivir (Tamiflu) $72.10

Zanamivir (Relenza) $61.80

Personal Stockpiles of Antivirals

Supply

Effectiveness

Resistance

Shelf life

Stockpiles of Antivirals

Institutional

State

Community Disease Control

Challenges to Containment

Short incubation period of 1-5 days

Ability of persons with asymptomatic infection to transmit virus

Early symptoms of illness are likely to be non-specific, delaying recognition

Goal of Community Disease Control

To limit or slow spread of pandemic influenza

Social Distancing

Containment Measures for Ill Individuals

Patient isolation

Management of contactsContact tracingContact monitoringQuarantine

Containment Measures For Groups of Exposed or At-Risk Persons

Quarantine

Containment measures for specific sites or buildings

Containment Measures For Communities

Promotion of community-wide infection control measures

Social distancing (snow days)

Unresolved IssuesRole of airborne transmission

Effectiveness of antivirals

Coordination between states and countries

State of Maine Preparedness

www.maineflu.gov

Overarching Roles of Major State Agencies Involved with Pandemic Influenza Response PlanningGovernor

Incident CommanderMEMA

Coordinator of state’s planning and response to all emergencies

Maine CDCDevelops public health emergency response plansStrategy lead in state’s response to Pandemic InfluenzaSits with Governor during public health emergencies

Maine Department of AgricultureDevelops response plans for zoonosesStrategy lead in state’s response to Avian InfluenzaSits with Governor during animal health emergencies

What Has Maine Been Doing?

1997 – 2001Two statewide Pan Flu ConferencesStatewide PlanTwo exercises

2001 – 2005Post 9/11 Federal Funds

• Early Detection System• Communication Systems• Response System

December, 2005 Pan Flu Conference

Maine’s Planning Efforts 2006

3-part process:

1. Update Maine’s Pandemic Influenza Plan

2. Development of sub-state Pandemic Influenza plans

A. County plansB. Hospital plans

3. Exercise and drills of the plans4. September 20th Summit

- 1,100 attended

Overarching Framework

Early detection

Response systems

Communications

Training

Exercises and drills

•Emergency management

•Healthcare•Many stakeholders

involved•May-August 2006

plans drafted•August 2006-2007

exercise plans•www.maineflu.gov for

contact information

County Preparedness

• 2006 Plans drafted

• 2007 Exercise plans

www.maineflu.gov for contact information

Hospital Preparedness

http://www.fchn.org/healthreform/documents/fchn%5Fpandemicfluplan.pdf

Pandemic PreparednessCan Be Daunting!

Need to:

Keep focused on the known

Be creative

Don’t wait for someone else

School Preparedness

School Preparedness - Maine

200,744 enrolled in Maine elementary and secondary schools

66,000 enrolled in Maine post-secondary schools

Resources for School Pandemic Influenza Preparedness

www.pandemicflu.gov

www.maineflu.gov

Pandemic Flu K-12 Checklist Format

Planning and Coordination

Continuity of Student Learning and Core Operations

Infection Control Policies and Procedures

Communication Planning

http://www.pandemicflu.gov/plan/schoolchecklist.pdf

                                                                           

               

               

                

         

               

               

                

               

               

                

                                                                                                                                                      

www.acha.org

Some Highlights of ACHA Guidelines

Planning that allows employees to work from home

Providing for ill students

Addressing health and safety issues

Addressing business continuity

Making contingency plans for completion of courses

Some Highlights of ACHA Guidelines (cont’d)

Testing and rehearsing the plans

Identifying key members of the Pandemic Planning Committee

Identifying appropriate channels of communication and chain of command

Identifying the role of student health services

Compiling a list of supplies that would be needed

Disaster Planning does not equal Public Health Emergency Planning.

Preparedness isEveryone’s Job –

No one ever died of preparedness!