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Texas Pandemic Influenza Preparedness. Cynthia Morgan, PhD, RN Pandemic Influenza Program Coordinator, Acting Anita Wheeler, BSN, RN School Nurse Consultant. Agenda. Everything you wanted to know about pandemic influenza but couldn’t find anyone to ask What you can do to prepare your family

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texas pandemic influenza preparedness

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
everything you wanted to know
Everything you wanted to know. . .
  • 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
epidemiology of avian flu in humans
Epidemiology of Avian flu in humans
  • 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
seasonal vs pandemic flu


Known virus

Vaccine available (usually)

High mortality young & old esp. w/ health problems


Irregular intervals

Novel virus

No or mismatched vaccine

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

Seasonal vs Pandemic Flu
composition of seasonal vaccines
Composition of Seasonal Vaccines
  • 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
antigenic change
Antigenic change
  • 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





Indirect Infection



countries with h5n1 influenza in animals humans
Countries with H5N1 Influenza in animals & humans

Countries with H5N1 influenza in animals

Countries with H5N1 influenza in humans













Through June 15, 2006

bird and human cases h5n1
Bird and Human Cases H5N1

June 13, 2006

Bird Cases

Human Cases

the h5n1 flu threat to humans
The H5N1 Flu Threat to Humans
  • 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…

why the concern with h5n1
Why the Concern with H5N1?
  • 1918 (H1N1) flu and H5N1 avian flu are the only “kissing cousins” among the 169 known avian flu viruses.
1918 influenza pandemic
1918 Influenza Pandemic
  • 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
most fatal event in the last 300 yrs


cytokine storm
Cytokine Storm
  • 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
society during a pandemic
Society during a pandemic
  • Healthcare system
  • Work
  • School
  • Travel
  • Supplies
  • Services
prevention containment nonpharmaceutical
Prevention & Containment – Nonpharmaceutical
  • Public Health population focused measures
  • Personal protective measures
  • Business contingency planning
  • Care of sick at home
potential community measures to decrease transmission
Potential Community Measures to Decrease Transmission
  • 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

evidence for use of masks
Evidence for use of masks
  • 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
influenza antiviral drug questions
Influenza Antiviral Drug Questions
  • 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 $$ come from?
influenza antiviral drug questions40
Influenza Antiviral Drug Questions
  • How much supply will there be?
  • Will feds or state have control over distribution decisions?
  • Where do the $$ come from?
    • How should it be used?
    • Who should get it?
  • How can it be delivered?
influenza vaccine questions
Influenza Vaccine Questions
  • 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?
current method
Current method
  • 1950’s technology
    • Depends on eggs and chicks
    • Shortages often due to problems here
    • Requires 4-6 months for vaccine production
new method
New method
  • Cell cultures
    • Less room
    • More dependable
    • Requires 4-6 weeks for vaccine production
vaccine consumption 2000
Vaccine Consumption - 2000

Source: WHO Global Influenza Program

texas plan challenges in health systems response
Texas Plan Challenges InHealth Systems Response
  • 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
texas plan challenges in communication
Texas Plan Challenges InCommunication
  • Risk Communication
  • Pre-event message preparation for the public
  • Educating decision makers
  • Communication technology
  • Interoperability
how can you prepare
How can you prepare?
  • 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
how can you prepare50
How can you prepare?
  • 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
considerations in school planning
Considerations in School Planning


local planning is critical
Local Planning Is Critical

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

mitigation and prevention activities
Mitigation and Prevention Activities

►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

pandemic preparedness
Pandemic Preparedness

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

►Delegate Crisis


local school considerations
Local School Considerations

►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

pandemic recovery period
Pandemic Recovery Period

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

school specific websites
School Specific Websites
  • 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