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Two Manuscripts in Draft (Working Titles) 1. “Empowering Individuals and Families in The Event of a Flu Pandemic” (Possible Subtitle: “The Home Flu Kit”) Stan N. Finkelstein, M.D. Shiva Prakash Karima Nigmatulina Richard Larson, Ph.D.

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Two Manuscripts in Draft(Working Titles)

1.“Empowering Individuals and Families in The Event of a Flu Pandemic” (Possible Subtitle: “The Home Flu Kit”)

Stan N. Finkelstein, M.D.

Shiva Prakash

Karima Nigmatulina

Richard Larson, Ph.D.

2.“Pandemic Influenza Planning: How Ready are the Fifty States?”

Richard Larson, Ph.D.

Karima Nigmatulina

Stan N. Finkelstein, M.D.


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“Empowering Individuals and Families in The Event of a Flu Pandemic”

Stan N. Finkelstein, M.D.

Shiva Prakash

Karima Nigmatulina

Richard Larson, Ph.D.


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Underlying Framework

RoAverage number of new cases of illnesses generated by each infected person (Reproductive Ratio)

Frequency of Social Contact

Probability of contact with infected person

P

Ro =

P


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Why is this important?

  • Vaccines and medicines are likely to be unavailable or, at best, in scare supply

  • Individuals can choose to implement these measures for themselves

  • Our proposed interventions are relatively low cost


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Why is this important? (continued)

  • Potentially more immediately effective than larger scale efforts

  • Our hypothesis: Multiple measures in the home, can significantly reduce transmission


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Potential Modes of Transmission

  • Large droplet

    • Travel up to 3ft

    • Settle quickly

    • Indirect transmission through intermediate

  • Aerosols

    • Remain airborne

    • Long life in environment

    • Air handling

  • Droplet nuclei

    • Effect of evaporation and humidity

  • Inconclusive data regarding primary mode


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Hand Washing

  • Studies in nursing homes and daycares

    • Reporting of numbers of ill

  • Studies with healthcare workers

    • Looked at bacteria and virus counts on hands

  • Overall showed correlation between hand washing and lowered risk of respiratory infection

  • Accounting for compliance and proper technique?


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Hand Washing

  • Soap and warm water for 20-30 seconds minimum

  • Compliance issue

  • Alcohol rubs have advantages

    • Hands don’t remain wet

    • More compliance

    • Proper use more likely (at least 2mL for effectiveness)

  • Soap and water effective otherwise


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Masks

  • Effectiveness is disputed, limited data

    • Relatively cheap

    • Easy to stockpile

  • Common surgical mask can be effective when used on ill person

    • Contain large droplets, but unlikely to contain small droplets or aerosols

    • Use in hospitals/close contact environment

    • Reduce air speed

  • N95 respirator useful for well person

  • No studies that can show isolated effect of masks

    • SARS


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Air Filtration

  • High Efficiency Particulate Air filters (HEPA) effective for very small particles (including viruses)

  • Particularly important in places with less ventilation

  • Relationship between infiltration, filter efficiency, air circulation rate in room

  • Require maintenance, vital for effectiveness

  • Moderate costs


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Negative Air Pressure

  • Created with exhaust fan placed in window facing outward

  • Creates pressure gradient between room and external environment

  • Prevents contaminated air leakage from within patient room to external environment

  • Effective in a patient care room and in home care setting

  • Protects well individuals caring for ill


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Ultra Violet Light

  • Potential to disinfect air and surfaces

  • UV-C light filters

    • Air is filtered through device, exposed to concentrated UV light and circulated out

  • Ceiling fixtures--> relative air temperatures important

  • Lower humidity levels desirable

  • Most effective in areas without much movement (offices, school rooms)


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Humidity and Temperature Control

  • Transmission dependent on environmental factors

  • Higher relative humidity levels and temperature lower transmission

  • Conflict with necessary conditions for UV light use


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~Next Steps~

  • Can we model influenza transmission in the home environment?

  • Are there data regarding transmission rates from an ill family member to another?

  • Can use model to examine effects of specific measures, singly or in combination?

  • Recommendation of simple home care kit


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“Pandemic Influenza Planning:How Ready are the Fifty States?”

Richard Larson, Ph.D.

Karima Nigmatulina

Stan N. Finkelstein, M.D.


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Review of Fifty States’ Pandemic Flu Plans

  • BACKGROUND

    • 2002: Congress provides funding to states for public health emergency planning and required states to develop pandemic plans as a condition of funding

    • 2005: PHS issues guidelines and offers assistance, but mandates each state to develop its own plan


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Review of Fifty States’ Pandemic Flu Plans

  • OUR APPROACH

    • We reviewed all fifty state plans, in detail, accessing whatever information could be obtained from individual state “Pandemic Flu” or health department websites

    • “Point in Time” – Summer, 2007


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Review of Fifty States’ Pandemic Flu Plans

  • FINDINGS

    • Great variation in effort expended

    • Tremendous strengths in some; gaping holes in others

    • Rarely able to identify names specific individuals who were main contributors to the plans

    • Generally inadequate attention to non-pharmaceutical interventions


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Review of Fifty States’ Pandemic Flu Plans

  • “MODEL” Outline for State Pandemic Flu Plan

    • Medical Preparedness

    • Organization of Response

    • Surveillance

    • Communication

    • Non-Pharmaceutical Interventions

      • Hygiene

      • Social Distancing


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Non-Pharmaceutical Interventions: Hygiene


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Non-Pharmaceutical Interventions: Hygiene


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Non-Pharmaceutical Interventions: Hygiene


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Non-Pharmaceutical Interventions: Hygiene


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Non-Pharmaceutical Interventions: Social Distancing


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Non-Pharmaceutical Interventions: Social Distancing


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Non-Pharmaceutical Interventions: Social Distancing


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Review of Fifty States’ Pandemic Flu Plans

  • BOTTOM LINE:

    • NPI’s need to be taken more seriously!!!


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