Pandemic Influenza Thanks to Seattle King CountyHealth Department for the original work on this Powerpoint presentation.
Chicken Little and the Sky is Fallingor The Next Major Disaster? Which is it?
Definitions • Epidemic: An increase in disease above what is normally expected • Pandemic: A worldwide epidemic
Why The Concern About Pandemic Influenza? • Influenza pandemics are inevitable: naturally recur at more-or-less cyclical intervals • Can cause: • High levels of sickness and death • Drastic disruption of critical services • Severe economic losses • There will be little warning time between the onset of spread of a pandemic and its arrival in the U.S.
Why The Concern About Pandemic Influenza? • Outbreaks occur simultaneously in many areas • Impacts will last for weeks to months • Pandemics can disproportionately affect younger, working-age people • Current avian influenza outbreak in Asia
America’s Forgotten Pandemic The influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world. Alfred W. Crosby, historian & author America’s Forgotten Pandemic: The Influenza of 1918
1918 Influenza Pandemic • Spread around the globe in 4 - 6 months • Death rate 25-times higher than previous epidemics • 40 – 100 million people died worldwide • Majority of deaths were in persons 18 to 40 years old
Excess US Deaths in Previous Influenza Pandemics • 1918-19: 500,000 - 650,000 • Ten times as many Americans died of flu than died in WW I • 1957-58: 70,000 • 1968-69: 40,000 • Typical annual influenza season: 36,000
How Do Influenza Pandemics Arise? • Wild water fowl are natural reservoirs of influenza • They can spread the virus to domestic birds
How Do Influenza Pandemics Arise? • When avian flu viruses experience sudden changes in genetic structure and • Are capable of infecting humans and • Can reproduce and spread from person to person
DIRECT Genesis of New Human Influenza Viruses 15 HAs 9 NAs Non-human virus Human virus Reassortant virus A reassortment event or shift that could create a pandemic strain could directly occur in humans potentially increasing the likelihood of a pandemic; Humans be come an “Accidental” Host
Current Outbreak: Avian Influenza (H5N1) • Began in fall, 2003. • At least 291 confirmed human cases, 207 deaths worldwide (World Health Organization,12/2007) • No efficient person-to-person transmission • Isolated Human disease • Outbreak spreading, not controlled
Current World Health Organization Phase of Alert The world is presently in phase 3: a new influenza virus subtype is causing disease in humans, but is not yet spreading efficiently and sustainably among humans.
2006 Geographical Distribution of H5N1 Avian InfluenzaFrom the Food & Agriculture Organization of the United Nations
National Impact • Up to 200 million people in- fected • 40 - 90 million people clinically ill • 20 - 46 million (low range estimate only) outpatient medical visits • 360,000 – 9,600,000 people hospitalized • 104,000 – 2,200,000 deaths • US losses estimated at $71-$166 billion • Many geographic areas affected at the same time
Local Impact: Health Status In the first 6 weeks of a pandemic: • 1.2 million people infected • 245,000 - 612,000 clinically ill • 180,000 - 470,000 outpatient medical visits • 24,436 – 57,216 people hospitalized • Up to 11,500 dead
Pandemic Flu Morbity/Mortality • In Snohomish County: • 195,000 persons could become ill • 98,000 persons could require medical care • 450 - 4000 persons could die.
Treatment and Prevention: Vaccine • Vaccines takes 6-8 months to produce following the emergence of a new virus • Supplies will be limited, if available at all • 2nd dose after 30 days will likely be required • New vaccine safety and efficacy has “unknowns”
Treatment & Prevention: Antiviral Drugs • Antiviral agents • Effective in preventing illness • Can prevent severe complications • May not be effective against pandemic virus • Supplies will be limited • Treatment over prevention
Influenza Prevention: What Can We Do? • Specific Recommendations • for Infection Control in • Schools and Workplaces: • Pandemic preparedness planning • Distribution of educational messages and infection control guidance • Social distancing: people stay home when ill • Promotion of respiratory etiquette • Provision of materials for respiratory hygiene/ etiquette: tissues and disposal receptacles
Key Steps for District Preparedness: Mitigation • Identify a district committee to provide support and guidance to schools: In process • Review communicable disease policy and procedures (communication, human resource management, prevention messages, reporting): In process • Develop pandemic flu plan including school closure plan: In process
Key Steps for District Preparedness: Action • Review current public health, district and school pandemic flu plans • Continue staff, student and parent education • Implement incident command protocol
Key Steps for District Preparedness: Response • Track and report absenteeism • Ensure information is translated • Activate incident command management system • Document actions taken • Conduct debriefings
Key Steps for District Preparedness: Recovery Phase • Identify health and grief service providers • Develop template letters • Provide training • Mobilize crisis recovery teams • Continue communication strategies • Establish working relationships with EAP
The Next Pandemic: Where & When? It is not possible to predict precisely where or when the next pandemic will emerge, but… “I think what we’re concerned about is looking at what’s going on in Asia right now with avian flu, and a very big worry is that this is a time bomb ticking.” Dr. Julie L. Gerberding, Director, Centers for Disease Control and Prevention “We may be at almost the last stage before the pandemic virus may emerge.” Dr. Jai P. Narain, World Health Organization, 9/9/05
Pandemic Influenza “Don’t worry about it, it’s probably just a head cold.”