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Transcript of Pandemic Planning: A Nation Prepared U.S. Department of Health and Human Services Mike Leavitt,...
Pandemic Planning:A Nation Prepared
U.S. Department of Health and Human Services
Mike Leavitt, Secretary
HHS Pandemic Influenza
Preparedness Planning
HHS Pandemic Influenza
Preparedness Planning
ADM John O. AgwunobiAssistant Secretary for Health
ADM John O. AgwunobiAssistant Secretary for Health
Pandemics Do Happen!
H1
H1H3
H2
H7*
H5*
H9*
1918Spanish
Influenza H1N1
1957Asian
Influenza H2N2
1968Hong Kong
Influenza H3N2
1980
1997
1915
*Avian Flu
2003 2004
1977
1996
2002
1925 1935 1945 1955 1965 1975 1985 1995 2005
2003-2006
1998
19992003
Planning Assumptions: Health Care
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
• 50% or more of those who become ill will seek medical care• Number of hospitalizations and deaths will depend on the
virulence of the pandemic virus
Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006)
Phases of a Pandemic: Where We Are Now
HHS Pandemic Influenza Plan
• Support the National Strategy for Pandemic Influenza
• Outlines planning assumptions and doctrine for health sector pandemic preparedness and response
• Public Health Guidance for State and Local Partners
• 11 Supplements with detailed guidance
HHS Pandemic Influenza Doctrine: Saving Lives
• Prevent or at least delay introduction into the
United States
– May involve travel advisories, exit or entry
screening
– For first cases, may involve isolation / short-
term quarantine of arriving passengers
HHS Pandemic Influenza Doctrine: Saving Lives
• Clearly communicate to the public
– Prepare people with information
– Encourage action steps to prepare now
– Provide updates when new information emerges
– Use trusted messengers
– Coordinate to ensure consistent messages
– Address rumors and inaccuracies
Challenges in Pandemic Vaccine Preparedness• Expand production of current (egg-based) vaccine • Evaluate dose-sparing technology
(adjuvants, intramuscular vs. intradermal route)• Accelerate development of modern (non-egg)
vaccines • Target new antigens
Avian Influenza Vaccine Production
• Working with the National Institutes of Health– Current H5N1 Vaccine – 40 million doses being
produced– Second Clade 2 Avian Influenza vaccine
Antivirals and Medical Supplies: Influenza Treatments• Stockpile
– Tamiflu: 5+ million treatment courses in Strategic National Stockpile (SNS) with 12.4 million treatment courses ordered
– Tamiflu oral suspension: 97,000 courses in SNS with an additional 260,000 on order (arrival date to be determined)
– Relenza: 84,000 courses in SNS with 1.75 million treatment courses ordered
• Strategy– Procure 81 million courses of antivirals
• 6 million courses to be used to contain an initial U.S. outbreak
• 75 million courses to treat 25 percent of U.S. population
• Accelerate development of promising new antiviral candidates
Antivirals and Medical Supplies: Influenza Treatments $350 million appropriated in FY 2006 to upgrade
state and local response capacity for pandemic influenza
$100 million of the funding is scheduled to be awarded to all 50 states; 7 territories; Puerto Rico; Washington, D.C.; New York City; Chicago; and Los Angeles County and allocated according to a base + population formula
$250 million will be awarded later this year. Application for funding is supplemental to current cooperative agreements
State and Local Pandemic Influenza Planning Checklist
Community Leadership and Networking Surveillance Health System Partnerships Infection Control and Clinical Care Vaccine Distribution and Use Antiviral Drug Distribution and Use Community Disease Control and Prevention Communications Workforce Support
www.pandemicflu.gov
Complacency is the enemy of health protection!
Protecting American Agriculture34
Avian Influenza (AI) Preparedness and Response
Veterinary ServicesMarch, 2006
Protecting American Agriculture
Topics Covered
Avian Influenza OverviewUSDA’s AI Interventions
• Targeted surveillance• Border protection • Trade restrictions & OIE guidelines• Outreach & education• Preparedness & response
Protecting American Agriculture
Avian Influenza Overview
Avian influenza (AI) - identified in the early 1900s
High pathogenic avian influenza (HPAI) – causes contagious illness, death in birds;
Low pathogenic (LPAI) causes mild to no illness
Vast majority of AI viruses found in birds do not represent a public health concern
Protecting American Agriculture
Avian Influenza Overview (cont.)
Virus is characterized by H and N type (surface proteins).
144 different characterizations of the virus, based on 16 H types and 9 N types
AI viruses mutate easily; only H5 and H7 viruses have the potential to mutate from
an LPAI to an HPAI form.
AI viruses vary widely in pathogenicity from strain to strain. Therefore not all H5N1
viruses are infectious for people or pathogenic to poultry.
HA
PB1PB2PA
NPNAMANS
M2
Hemagglutinin Neuraminidase
M1
Matrix
Species Affected
Genetic Reservoirs
Intermixing
H1, H3
H1, H2, H3H3, H7
Commercial,LBMsOthers
H1-12H14-15
H1-2, 4-7,H9-13, 15-16
H10
H1, H3, H4, H7, H13
Other AquaticBirds?
H5N1
Protecting American Agriculture
How is the virus spread among birds?
Direct contact between healthy and infected birds
Infected fecal matter
Can be found on surface of unwashed egg shells from
infected birds
Protecting American Agriculture
Three HPAI Findings in U.S.
1924 – “Fowl Plague” affected live bird markets in the Northeastern U.S.
1983 – destruction of 17 million birds in PA
2004 – quickly contained and eradicated in TX
Protecting American Agriculture
AI Surveillance
APHIS and States conduct surveillance through:
• National Poultry Improvement Plan (NPIP)• State and University laboratories• Export testing at slaughter• State movement requirements
Protecting American Agriculture
AI Surveillance (cont.)
APHIS’ safeguarding system encompasses:• Targeted surveillance
• Cooperative efforts with States and Industry
• Outreach and education
• Trade restrictions
• Anti-smuggling programs
Protecting American Agriculture
LPAI Surveillance and Control Plan
Federally-coordinated and State-assisted LPAI H5/H7 LPAI Control Program
Commercial poultry Live bird marketing system
Since 1986, APHIS and States have monitored live bird markets (LBMs) in Northeast U.S.
Protecting American Agriculture
Surveillance: NPIP
Establishes standards for evaluation of poultry breeding stock and hatchery products
“Avian influenza free” certification for commercial companies
New LPAI program that will provide for H5 and H7 AI monitoring
Protecting American Agriculture
Surveillance: NPIP (cont.)
New LPAI program that will provide for H5 and H7 AI monitoring
Program components: “AI monitored” program, surveillance specifications, and State LPAI
response and containment plans
Protecting American Agriculture
LBMs – Surveillance
Uniform Standards published in 2004 provide guidelines for markets, dealers and producers:
• Licensing requirements and education
• Bird testing and recordkeeping
• Sanitation and biosecurity
• Surveillance and inspections
• LPAI positive facilities
Protecting American Agriculture
LBMs – Surveillance (cont.)
States enforce LPAI program standards
Federal indemnification provided for participating States with positive diagnosis of H5 or H7 LPAI
APHIS initiated cooperative agreements with 21 States
Protecting American Agriculture
LPAI Surveillance – National Animal Health Laboratory Network (NAHLN)
37 States participate in the network. NAHLN labs:• Provide laboratory services nationwide
• Provide laboratory data for reporting
• Respond to foreign animal disease outbreaks
• Focus on animal diseases
Protecting American Agriculture
Border Protection & Risk of Introduction of Asian Strain of H5N1
USDA works closely with DHS to prevent smuggling of illegal poultry and poultry products.
USDA’s Smuggling Interdiction and Trade Compliance unit and DHS’ Customs and Border
Patrol actively monitor U.S. ports.
Legally imported birds from other countries are tested for AI.
Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1
• Genetic separation of H5 AI viruses between New & Old World• Asian birds rarely get off course and go to N. America• Risk from wild birds is low
Migratory Birds – Overlap of summer breeding grounds in Alaska, Northeast Canada
Protecting American Agriculture
Trade Restrictions
USDA maintains trade restrictions on countries affected by H5N1:
Albania, Azerbaijain, Cambodia, Cameroon, People’s Republic of China, Egypt, France (VS defined restricted zone only), India, Indonesia, Iraq, Iran, Italy, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Myanmar, Niger, Nigeria, Poland, Romania, Russia, Slovakia, Slovenia, Switzerland, South Korea, Taiperi China, Thailand, Turkey, Ukraine and Vietnam
Poultry and poultry products from those countries are strictly prohibited.
USDA works with trading partners and the World Organization for Animal Health (OIE) to maintain safe
trade.
Protecting American Agriculture
World Organization for Animal Health (OIE) – Reporting and Guidelines
OIE guidelines state that:HPAI and all H5/7 LPAI must be reported to the OIE.
Poultry meat and table eggs do not transmit LPAI Trade in poultry and poultry products can continue despite a
finding of LPAI
Recommends certain health measures for the trade in poultry and poultry products based on risk and AI status
Compartmentalization allows countries to document separation based on biosecurity
Protecting American Agriculture
Outreach & Education
USDA’s Biosecurity for the Birds Campaign is an extensive and far-reaching outreach initiative
designed to: Educate non-commercial poultry owners about the
signs of AI & other poultry diseases
Promote the importance of practicing biosecurity
Encourage rapid reporting of clinical signs of disease and/or unexpected deaths
Protecting American Agriculture
USDA AI Web Sitewww.usda.gov/birdflu
Information about “Biosecurity for the Birds” programLinks to other Federal entities working on AIFact Sheets and other information resources
Q&A on AINews Releases
Technical Briefings
Protecting American Agriculture
Preparedness in the Event of an Outbreak
Key is early detection and rapid responseUSDA maintains a comprehensive emergency
response structure: Partnerships with local, State, and Federal
organizations Integration with the National Response Plan Continual collaboration with HHS, DHS and other
Federal entities Diagnostic capabilities
Protecting American Agriculture
Response to an Outbreak in Poultry
Guidelines
Stamping out
National Response Plan
First responders
Vaccines
Protecting American Agriculture
Response for AI in Wild Birds
Manage wildlife threats
Assess risk wildlife poses to susceptible livestock and poultry
Containment, survey and surveillance, and population management
Protecting American Agriculture
Questions?
Convention Center Floor Plan 2 – Exhibit Hall and Ballrooms
BREAK OUT SESSIONS ROOM LOCATIONS
Community/Volunteer Groups E 21B
Private Sector/Business E 21C
Schools K-12 E 21 A
Convention Center Floor Plan 1 – Exhibit Hall and Break out Sessions
BREAK OUT SESSIONS -- ROOM LOCATIONS
Assisted Living/Long Term Care E 10C
Colleges and Universities E 10D
Community/Volunteer Groups E 21B (see floor plan 2)
Fire/EMS E 11A
Healthcare E 10 A&B
Law Enforcement/Judiciary E 11C
Local Government E 11B
Private Sector/Business E 21C (see floor plan 2)
Schools K-12 E 21 A (see floor plan 2)
LUNCH Exhibit Hall B