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CDC Meeting on Community Mitigation of Pandemic Influenza. Nearly all slides are from Presentations made at the Stakeholders Meeting Community Mitigation During Pandemic Influenza in the US Atlanta, GA December 11-12, 2006. What actions should we take in a pandemic?.

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cdc meeting on community mitigation of pandemic influenza

CDC Meeting on Community Mitigation of Pandemic Influenza

Nearly all slides are from Presentations made at the

Stakeholders Meeting

Community Mitigation During Pandemic Influenza in the US

Atlanta, GA

December 11-12, 2006

what actions should we take in a pandemic
What actions should we take in a pandemic?
  • Mandatory or voluntary?
  • Which combinations of actions?
  • In what order?
  • At what point in the outbreak?
  • What evidence is there that these actions will work?
potential tools in our toolbox
Potential Tools in Our Toolbox
  • Our best countermeasure – vaccine – will probably be unavailable during the first wave of a pandemic
  • Antiviral treatment may not be available in sufficient quantities.
  • The effectiveness of antiviral treatment is not clear.
some possible actions
Reporting of cases

Isolation of Sick

Quarantine of contacts

Closing schools

Restrictions/curfew on children/teens

Closing facilities where people gather

Increased sanitizing and PPE

Social distancing of adults in workplace (liberal leave, tele-commuting, shifts)

Closing non-essential offices

Vaccine/antivirals when if available

Some Possible Actions
slide5

#1

Pandemic outbreak:

No intervention

#2

Daily

Cases

Pandemic outbreak:

With intervention

#3

Days since First Case

Purpose of Community-Based Interventions

1. Delay outbreak peak

2. Decrease peak burden on hospitals/ infrastructure

3. Diminish overall cases and health impacts

researchers taking two approaches to study effectiveness
Researchers taking two approaches to study effectiveness
  • Modeling influenza outbreak using mathematical tools
  • Looking back at data from 1918 to look for evidence that certain interventions worked.
epidemiology drives approach

Mild

Moderate

Severe

Case Fatality Rate

≤ 0.1%

0.1 - 0.5%

≥ 0.5%

Isolation

Yes

Yes

Yes

Treatment

Yes

Yes

Yes

Quarantine

No

???

Yes

Prophylaxis

High-risk individuals

High-risk individuals

Yes

School Closure

Reactive

Punctuated

Proactive

Protective sequestration

High-risk individuals

High-risk individuals

Children

Community social distancing

High-risk individuals

Encouraged

Encouraged + selective closures

Workplace protections

Encourage good hygiene

Social distancing

Aggressive social distancing

Liberal leave policies

Confirmed influenza

Influenza-like illness

ILI and/or sick family members

Epidemiology Drives Approach

SAMPLE

what do the modeling results mean
What do the Modeling Results Mean?
  • Not proof of efficacy or effectiveness, BUT offer reason for optimism regarding non-pharmaceutical interventions
  • Suggest that maximal effectiveness will be achieved by appropriate targeting of intervention and timing (early implementation)
  • Need to be evaluated based upon assumptions and validated against experience
factors affecting ability of communities to implement community measures
Factors Affecting Ability of Communities to ImplementCommunity Measures
  • Maintenance of critical infrastructure
  • Extent of social cohesion, organization and trust
  • Government stability, political will
  • Communication with remote areas
  • Higher population densities in cities
  • Financial support, compensation
    • Individuals, businesses, governments
macroeconomic analysis
Macroeconomic Analysis
  • Preliminary macroeconomic analyses of the impact of community-wide interventions have been done, using several economic models
  • These models predict supply-side impacts that range from a decrease in overall economic impact as a result of community-wide interventions, to a modest increase in impact
  • These estimates do not incorporate the costs associated with lives lost during a severe pandemic
  • If an economic value is assigned to lives lost during a severe pandemic, community-wide interventions result in a 5-10 fold decrease in overall cost
slide21
Recent Analyses Suggest That Community Actions May Significantly Reduce Illness and Death Before Vaccine is Available

Early and uniform implementation of:

  • School closure
  • Keeping kids and teens at home
  • Social distancing at work and in the community
  • Encouraging voluntary home isolation by ill individuals and voluntary home quarantine by the household contacts
  • Treating the ill and providing targeted antiviral prophylaxis to household contacts (if available)
  • Implementing measures early and in a coordinated way
evidence to support school closure
Evidence to Support School Closure
  • Children are more susceptible to flu and more contagious than adults
  • Children are believed to be the main introducers of influenza into households.
  • School closure during influenza epidemics has resulted in significant decreases in the diagnoses of respiratory infections, visits to physicians, and emergency departments.
  • Reducing infection in children (via vaccines) has reduced flu rates in all ages in community
slide29

Labor Status of Parents

66 million

18 million

5 million

8 million

9 million

Source: U.S. Census Bureau, Population Division, Current Population Survey, 2003 Annual Social and Economic Supplement

http://www.census.gov/population/www/socdemo/hh-fam/cps2003.html

community mitigation summary
Community Mitigation Summary
  • Ill persons should be isolated (home vs hospital)
  • Voluntary home quarantine for household contacts
  • Social distancing measures
    • School closures may have profound impact
    • Workplace social distancing and liberal leave NOT closure (for most)
    • Cancellation of public events
  • Individual infection control measures
    • Hand washing and cough etiquette for all
    • Mask use for ill persons, PPE stratified by risk
    • Disinfection of environmental surfaces as needed
additional considerations
Additional Considerations
  • Planning for adverse impacts of actions
  • Duration of implementation
  • Intervention fatigue
  • Socioeconomic disparities
  • Sustained, predictable absenteeism
  • Economic impact
what can be done now
What Can Be Done Now?
  • Education of leadership in State and local government about the need for cross-sectoral planning
  • Engagement of non-health communities: education, private sector, labor, NGO’s
  • Examination of relevant authorities, and scenario-based discussions of implementation with leaders & public.
  • [Seen handout on 13 recommendations]
slide34

It is better to have approximate answers to the right question than to have the exact answer to the wrong one.Irene Eckstrand, NIH