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Avian/Pandemic Influenza Where We’ve Been, Where We Are Now, Where We’re Going

Avian/Pandemic Influenza Where We’ve Been, Where We Are Now, Where We’re Going. LTC Wayne Hachey Office of the Assistant Secretary of Defense (Health Affairs) Force Health Protection and Readiness. November 2006. “Fasten your seatbelts, it's going to be a bumpy night. ”. Bette Davis

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Avian/Pandemic Influenza Where We’ve Been, Where We Are Now, Where We’re Going

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  1. Avian/Pandemic InfluenzaWhere We’ve Been, Where We Are Now,Where We’re Going LTC Wayne Hachey Office of the Assistant Secretary of Defense (Health Affairs) Force Health Protection and Readiness November 2006

  2. “Fasten your seatbelts, it's going to be a bumpy night.” Bette Davis All about Eve 1950

  3. Previous Pandemic Impact Why DoD Is Concerned

  4. The 1918 Pandemic in the U.S. Military

  5. First Wave Jan - Feb 1918 • Civilians from Haskell County Kansas seed Camp Funston

  6. Outbreak was largely ignored by leadership and Civilian Public Health Authorities The Outbreak Emergency Hospital Fort Riley (4 miles from Camp Funston)

  7. Index Epidemic Starts at Camp Devens 12 September 1918

  8. End of September • 25% of the camp is infected • (17% of those with flu develop pneumonia – 35% die) Camp Devens Surgical Ward #16 29 Sept 1918

  9. Pandemic Progression • Sept 12, 1918 Camp Devens • Next 8 Days: 11 Major Camps • By end of September: 31 major camps • By end of October: All major U.S. camps

  10. Impact • In the US:25 million infected, 500,000– 675,000 dead • Only year in 20th century U.S. had negative population growth • 25% of military caught the flu • 1 million soldiers • Higher mortality rate • Flu killed more than bullets • 57,460 died of flu vs. 50,280 in combat • War dept. estimated that it lost 8,743,102 days among enlisted men Soldier receives throat spray for Spanish Flu

  11. Potential Impact on DoDwith the Next Pandemic • 30-35% attack rate • 50% seeking care • 10-20% hospitalization rate • 40% of workforce out • Disruption of essential services • Multiple taskings in the face of decreased manpower • National defense • Humanitarian relief • National response efforts

  12. Plans • National Pandemic Influenza Strategy released Nov 2005 • National Strategy Implementation Plan released 2 May 2006 • DoD has 116 specific tasks • lead for 32 tasks • DoD (HA) has 67 specific tasks • lead for 17 tasks • DoD plan completed September 06 • Combatant Commands plans due end of 06

  13. Plans are Nice but You Need Material to Make It Happen

  14. DoD Surveillance Activities

  15. DoD GEIS (Global Emerging Infections System)International Network

  16. DoD Worldwide Influenza Surveillance Program • Laboratory based influenza surveillance program • Goals: • Detect local respiratory outbreaks • Provide isolates to the World Health Association (WHO) and CDC • Detect emerging strains • 19 sentinel bases (9 USA, 3 Europe, 7 Asia) • Sites also located at Lima, Peru, a travel clinic in Nepal, and the Kwai River Christian Hospital on the Thai-Burmese border • Overall > 200 participating sites

  17. ESSENCE • ESSENCE: syndromic surveillance • Collects data from all military treatment facilities • 443 facilities • 8 million enrollees • Download of patient encounters every 8 hours

  18. Vaccine • Limited supply of prepandemic vaccine • 1.7 million doses (Clade 1) • Current strategy: following FDA approval • Administer to those with direct contact with H5 virus • Widespread administration beginning at WHO phase 4 • Target groups to maintain operational effectiveness

  19. Vaccine • Limited supply and production capability • Primary goal is to obtain adequate supply of vaccine to ensure that DoD continues to provide for National Defense and Domestic Support • With increasing supply will expand to other DoD populations with target goal of protecting total beneficiary population

  20. AntiviralsOseltamivir & Zanamivir • Stockpile established • Primary use is to preserve operational effectiveness • Includes treatment of those with disease • Outbreak prophylaxis • Post exposure/treatment prophylaxis • Fluid plan based on variable disease severity and supply

  21. DoD Stockpile Antiviral Use • Priority mirrors that for vaccine use • First priority will be to treat those with significant disease • Following priorities based on critical roles • Strategic, COOP, Operational • Depending on effectiveness of non-pharmacologic measures to decrease transmission rate • may be able to apply antivirals for community containment measures

  22. Additional Resources • PPE (masks, gloves, face shields, gowns) • to ensure protection for HCW at Military Treatment Facilities • Antibiotics • Essential list determined by Service ID SME to treat secondary pneumonias and not to compete with SNS • Distributed based on typical patient population served • Outpatient, Inpatient, ICU, Referral

  23. Containment Measures • DoD containment strategy based on a layered approach suggested by current modeling • Social Distancing • Infection Control Measures • Pharmacologic • Communication

  24. Communication • DoD Pandemic Flu Watch board • https://fhp.osd.mil/aiWatchboard/index.html • Current disease status • Library • Policy • Plans • Guidance(AI/PI, Antivirals, Vaccine, CPG) • Links

  25. Beneficiary Information Prepandemic influenza information sheets Avian (zoonotic) influenza Pandemic influenza Communication

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