PANDEMIC The tragedies our world has suffered. The tragedies that are still yet to come.
OBJECTIVES: • By the end of this presentation, the audience will: • Communicate an understanding of pandemic (epidemic) • Give examples of pandemics during our nation’s history • Provide a brief description of the WHO’s staging of Pandemics • Verbalize complications with WHO handling of H1N1
Definition of Pandemic: • Epidemic: a disease occurrence that exceeds the normal or expected frequency in a community or region. • Pandemic: Worldwide distribution of the disease occurrences.
History of Pandemics: • Bubonic Plague (the Black Plague): Epidemic; confined to Europe in the 1300’s • Antonine Plague (165-180): • Believed to have been smallpox or measles that was brought to Europe by soldiers returning from the Near East. • May have killed as many as 5 million initially • During second outbreak in the middle of the third century, it was rumored that 5,000 people a day were dying in Rome.
History Cont: • Cholera: • The first outbreak occurred in India in 1816 • Became a pandemic by spreading from Bengal, across India, and to China and the Caspian Sea • The second pandemic affected Europe and North America in the late 1820’s; since then, there have been five other cholera pandemics. • The seventh and most recent outbreak (1961-66) began in Indonesia and reached Bangladesh, India, and the Soviet Union
History Cont: • http://www.youtube.com/watch?v=IFfAh0ozfHk • http://www.youtube.com/watch?v=rbYwNOcKqqc
History Cont: • Asian Flu Pandemic (1957-58) • Quickly identified due to scientific advances • Vaccine production began shortly after the outbreak occurred in China • A small supply of vaccines were available when the flu reached the U.S. • Spread quickly when school started in the fall • Nearly 70,000 Americans were killed; worldwide total reached 2 million
History Cont: • It was during the Asian Flu Pandemic of 1957-58 that the WHO panel found that spread often followed public gatherings. • Observed that in many countries the pandemic broke out first in camps, army units, and schools • Hypothesized that avoiding crowds may be important to controlling the spread
Department Of Defense Training Tool on Pandemics • http://www.youtube.com/watch?v=N-uaPa99oSs
H1N1 Pandemic • 2009 H1N1 flu virus: • New influenza virus strain first detected in the US in April 2009 • Spread from person to person in much the same way that regular seasonal influenza virus spread • Declared a pandemic by WHO on June 11, 2009 • FDA approved four Influenza A (H1N1) 2009 Monovalent Vaccines on September 15, 2009. • http://www.youtube.com/watch?v=lFl3FRNpU4E
Childhood Obesity Pandemic • Childhood obesity has become the newest pandemic of the 20th century • Instead of an infectious viral spread; its infections spread by means of chronic diseases in children, which develop into adult diseases, such as: Cardiovascular disease, diabetes, cancer, and asthma, to name a few. • Unfortunately, childhood obesity can not be controlled by a vaccination; it requires a more rigorous intervention.
Childhood Obesity Pandemic Cont. • As to date, the interventions for childhood obesity are: • Educate parents, educators, and children (as early as preschoolers) on eating healthy and making healthy choices. • In cooperate physical activities at home and at school • As parents, educators, and healthcare providers set the example, eat and live a healthy lifestyle; after all, children live by what they see.
Assessing the severity of an influenza pandemic: • The major determinant of the severity of an influenza pandemic, as measured by the number of cases of severe and illness and deaths it causes, is the inherent virulence of the virus
Properties of the influenza virus • Influenza pandemic is caused by a virus that is either entirely new or has not circulated recently and widely in the human population. • Creates an almost universal vulnerability to infection • While not all people become infected during a pandemic, nearly all are susceptible
Properties cont: • Contagiousness of the virus will influence the speed of spread, both within countries and internationally • Usually have a concentrated adverse impact in specific age groups • Economically productive age group will be more disruptive to societies and economies that when the very young/old are most severely affected
Population vulnerability: • People with underlying chronic conditions such as cardiovascular disease, HTN, asthma, and RA are more likely to experience sever or lethal infections • The prevalence of these conditions, combined with other factors such as nutritional status, can influence the severity of a pandemic in a significant way.
Subsequent waves of spread: • The overall severity of a pandemic is further influenced by the tendency to encircle the globe in at least two, sometimes three waves. • The severity of subsequent waves can differ dramatically in some or even most countries. • Different patterns of spread can also influence the severity of subsequent waves. • Ex: if school children are mainly affected in the first wave, the elderly can bear the brunt of illness during the second with higher mortality seen because of the greater vulnerability of this population
Capacity to respond: • The quality of health services influences the impact of any pandemic • The same virus that causes only mild symptoms in countries with strong health systems can be devastating in other countries where health systems are weak, supplies of medicines, including antibiotics, are limited or frequently interrupted, and hospitals are crowded, poorly equipped, and under-staffed.
Current WHO phase of pandemic alert: • Phase 1: no viruses circulating among animals have been reported to cause infections in humans. • In nature, influenza viruses circulate continuously among animals, especially birds.
Phase cont: • Phase 2: an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat. • Phase 3: an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-human transmission sufficient to sustain community level outbreaks
Phase cont: • Phase 4: verified human-human transmission of an animal or human-animal influenza reassortant virus able to cause “community level outbreaks”. • Phase 5: human-human spread of the virus into at least two countries in one WHO region • The declaration of Phase 5 is a strong signal that a pandemic is imminent and that the time to finalize the organization, communication, and implementation of the planned mitigation measures is short. • http://www.youtube.com/watch?v=br80HSGGPek&feature=related
Phase cont: • Phase 6: THE PANDEMIC PHASE • Characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. • Designation of this phase will indicate that a global pandemic is under way.
Phase cont: • Post peak period: pandemic disease levels in most countries with adequate surveillance will have dropped below peak observed levels. • Signifies that pandemic activity appears to be decreasing; however, it is uncertain if additional waves will occur and countries will need to be prepared for a second wave.
Phase cont: • Post-pandemic period: influenza disease activity will have returned to levels normally seen for seasonal influenza. • Expected that the pandemic virus will behave as a seasonal influenza A virus. • At this stage it is important to maintain surveillance and update pandemic preparedness and response plans accordingly. • An intensive phase of recovery and evaluation may be required.
REFERENCE LIST: • Allender, J.A., C. R. (2010). Community Health Nursing. Philadelphia: Lippincott Williams & Wilkins. • Idaho Department of Health and Welfare. (2007). Retrieved from History of Pandemic Influenza: http://www.healthandwelfare.idaho.gov/Health/PanFluHome/History/tabid/872/ • Kimm, S.Y.S., MD, & Obarzanek, E., PhD. (2002). Childhood Obesity: A New Pandemic of the New Millennium. Official Journal of the American Academy of Pediatric, 110: 1003-1007. Retrieved from http://pediatrics.aappublications.org/cgi/content/full/110/5/1003 • National Council of Teachers of Mathematics. (n.d.). Retrieved from The History of Pandemics: http:// www.nctm.org/resources/content.aspx?id=10826 • The Pandemic. (n.d). Retrieved from The Great Pandemic The United States in 1918-1919: http://1918.pandemicflu.gov/the_pandemic/04.htm • World Health Organization. (2009). Retrieved from Assessing the severity of an Influenza Pandemic: http://www.who.int • World Health Organization. (2010). Retrieved from Pandemics (H1N1) 2009 - update 84: http://www.who.int/csr/disease/swineflu/laboratory22_01_2010/en/print.html