Texas Pandemic Influenza Preparedness - PowerPoint PPT Presentation

Texas Pandemic Influenza Preparedness

Cynthia Morgan, PhD, RN

Pandemic Influenza Program Coordinator, Acting

Anita Wheeler, BSN, RN

School Nurse Consultant

• Everything you wanted to know about pandemic influenza but couldn’t find anyone to ask
• What you can do to prepare your family
• What you can do to prepare your school
• What you can do to prepare your students & their families

• Definitions
• Examine reasons pandemics occur
• Look at the progress of Avian H5N1 Influenza
• Discuss why we are concerned
• Review current prevention efforts
• Consider the state of the science

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• Avian (Bird) Flu is a disease of birds
• All Avian Flu viruses are endemic in waterfowl & do not harm them
• Wild birds mix with domestic chickens in back yard farms
• Domestic chicken flocks mix in live poultry markets
• People mix with sick or dead chickens
• People catch Avian Flu

Annually

Known virus

Vaccine available (usually)

High mortality young & old esp. w/ health problems

Pandemic

Irregular intervals

Novel virus

No or mismatched vaccine

High mortality in 20-50 year olds; mortality in young similar to seasonal flu

Pandemics of the 20th Century

• 2004 – 2005
• A / New Caledonia / 99 / H1N1
• A / Fugian / 02 / H3N2
• 2005 – 2006
• A / New Caledonia / 99 / H1N1
• A / California / 03 / H3N2
• 2006 – 2007 (recommended)
• A / New Caledonia / 99 / H1N1
• A / Wisconsin / 05 / H3N2

Pandemics of the 20th Century

• Antigenic ‘drift’ occurs in HA and NA
• Associated with seasonal epidemics
• Continual development of new strains secondary to genetic mutations
• Antigenic ‘shift’ occurs in HA and NA
• Associated with pandemics
• Appearance of novel influenza A viruses bearing new HA or both HA & NA

Mechanisms of Antigenic Shift

Reassortment in humans

Direct Infection

Non-human

virus

Human

virus

Indirect Infection

Reassorted

virus

Countries with H5N1 influenza in animals

Countries with H5N1 influenza in humans

51

18

11

10

5

2

2

1

2005

2006

2004

2003

Through June 15, 2006

June 13, 2006

Bird Cases

Human Cases

• A new virus to which humans have no immunity - Yes
• The virus causes significant human illness or death - Yes
• The virus spreads easily from person-to-person – NO

The Avian Flu (H5N1) virus has 2 out of 3 of these today…

• 1918 (H1N1) flu and H5N1 avian flu are the only “kissing cousins” among the 169 known avian flu viruses.

• 20-40 million persons died worldwide, possibly more
• Death rate 25 times higher than previous epidemics
• 500-650,000 deaths in the U.S.: Ten times as many Americans died of flu than died in WW I
• The epidemic preferentially affected and killed younger, healthy persons
• The epidemic was so severe that the average life span in the U.S. was depressed by 10 years

U.S. LIFE EXPECTANCY AT BIRTH

55

15

15

55

• Has been suggested as an explanation for the devastating nature of the 1918 flu
• Is an over reactive immune response that causes multiple organ system failure
• Evidence indicates H5N1 deaths are caused by this

• Healthcare system
• Work
• School
• Travel
• Supplies
• Services

• Public Health population focused measures
• Personal protective measures
• Business contingency planning
• Care of sick at home

• Travel advisories/limit travel to affected areas
• Screening travelers from affected areas*
• Limit large public gatherings; close schools
• Encourage telecommuting
• Limit availability of public transportation
• Hand hygiene, respiratory hygiene/cough etiquette
• Quarantine of exposed persons*
• Education to allow early identification and isolation of cases*

* Note: Some measures may be most useful early in outbreak and with strains that are not efficiently transmitted

• Limited evidence available on benefits of masks in preventing healthcare or community influenza transmission
• Use prudent at least in healthcare settings
• SARS studies have shown clear benefit mask use in healthcare setting

• How much supply will there be?
• Will feds or state have control over distribution decisions?
• How should it be used?
• Who should get it?
• How can it be delivered?
• Where does the $$ come from?

12/07?? 50 million courses

• How much supply will there be?
• Will feds or state have control over distribution decisions?
• Where do the $$ come from?
• How should it be used?
• Who should get it?
• How can it be delivered?

• When will it be available?
• How much will there be?
• How effective will it be?
• Who will own it?
• How should it be delivered?
• Who should get it?
• Who will pay for it?

• 1950’s technology
• Depends on eggs and chicks
• Shortages often due to problems here
• Requires 4-6 months for vaccine production

• Cell cultures
• Less room
• More dependable
• Requires 4-6 weeks for vaccine production

Source: WHO Global Influenza Program

• Assuring essential workers are prophylaxed and/or vaccinated
• Surge Capacity
• Emergency Systems for Advance Registration of Volunteer Health Professionals Program (ESAR-VHP)
• Availability of PPE
• Disaster Mental Health
• Dead bodies

• Risk Communication
• Pre-event message preparation for the public
• Educating decision makers
• Communication technology
• Interoperability

• Visit the DSHS website at: www.dshs/state/tx/us
• Follow the Pandemic Influenza link to the state’s plan.
• Appendix F “Personal Protective Strategies

• Get seasonal flu vaccine
• Stay informed
• Stockpile supplies, food, & some $$
• Talk to MD and RPh about extra routine meds
• Don’t forget pets
• Have a family plan
• Know your business’ continuity plan

• http://www.pandemicflu.gov
• http://www.cidrap.umn.edu/cidrap/
• http://www.cidrap.umn.edu/services/email/change
• http://www.cdc.gov/flu/pandemic/
• http://www.psandman.com/indxpand.htm
• http://www.dshs.state.tx.us

▶THE ROLES OF SCHOOLS IN THE COMMUNITY▶COMMUNICATING/COORDINATING WITH PUBLIC HEALTH/GOVERNMENT OFFICIALS▶UPDATING SCHOOL CRISIS PLANS▶LEARNING ABOUT PREVENTING INFECTIONS▶EDUCATING PARENTS, KIDS, STAFF▶INFORMING/COUNTERING DISINFORMATION▶MAINTAINING THE LEARNING ENVIRONMENT

Planning must be broad/interactive/cross-cutting/coordinated: city government, civil agencies health departments, community centers, medical providers, businesses, schools, private/voluntary/faith based organizations

►Liaison with state/local health officials►Clear Roles/responsibilities of staff►Roles of school nurses ►Assign key roles►Review health needs of students►Improve health activities

►Update crisis plans►Educate staff, students & parents►Account for Procedures

►Delegate Crisis

Communication/Authority

►Maintain operations & the learning environment►Triage/isolate students and staff►Use good health practices: handwashing, disinfect, etc.►Address misinformation►Plan for school closure►Disseminate community information

► Utilize schools as clinics, hospitals, morgues, vaccination sites or vaccine storage sites

School Houses were turned into temporary hospitals during the 1918 Influenza Pandemic

►Allocate time for recovery► Involve kids & parents► Counsel► Debrief► Plan anniversaries► Facility remediation

• www.itsasnap.org/snap/about.asp
• www.scrubclub.org/home.php
• www.cdc.gov/flu/protect/covercough.htm
• www.cdc.gov/germstopper/
• www.pandemicflu.gov/plan/schoolchecklist.html
• www.state.gov/m/a/os/c17204.htm
• www.tea.state.tx.us/pandemic_spellingsltr.html

Questions?