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Introduction to Pandemic Influenza

This course provides an overview of pandemic influenza, its historical significance, and the WHO protocols for combating infectious diseases. It explores the phases of a pandemic, epidemiology, identification of infected individuals, and strategies for containment and response. The course also covers societal impacts, sustaining essential services, non-pharmaceutical interventions, vaccine production, and potential strategies to decrease the impact of a pandemic.

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Introduction to Pandemic Influenza

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  1. Introduction to Pandemic Influenza Public Health emergencies and international disaster response

  2. Objectives • To understand the pattern of infectious disease outbreaks • To understand the historical significance and impacts of pandemic influenza outbreaks • To learn the WHO protocols and guidelines for combating infectious diseases • To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics

  3. World Health Organization Phases of a Pandemic • WHO has six phases for a pandemic that are under review following the H1N1 pandemic • Each Phase has specific activities recommended to governments • Each phase has communication recommendations • International Health Regulations of 2005 • Novel virus and severity of the virus must be linked in new phase release

  4. Epidemiology SARS 5 to 7 days 1 to 2 weeks When symptomatic All ill • Incubation period about 1 to 4 days • 2-3 days for H1N1, 2-8 days for H5N1 • Infective for about 5 to 7 days • up to 2 weeks in high-risk individuals • Infectious up to 24 hours BEFORE symptoms • May be asymptomatic (30 - 50%) How do we identify infected individuals Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg

  5. Dry cough • Pneumonia Clinical Features • Fever (3 - 7 days) • Sore throat • Weakness • Muscle aches • Runny nose • Loss of appetite • Headache • Blocked nose • Lethargy (2 weeks)

  6. Schools Children have longer viral shedding period Greater opportunities for spread Military facilities Close living quarters Field hygiene Incarcerated Prisons Mental facilities Elderly care facilities High Risk Populations

  7. Who is a “close contact”? • People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.

  8. Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg

  9. Droplet Precautions • Prevent infection by large droplets from • Sneezing • Coughing • Talking • Examples • Neisseria meningitidis • Pertussis • Influenza • Avian influenza (probable)

  10. Rapid Response • Strong Surveillance systems will provide the opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response • Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS • Logistical support and trained personnel • A Risk Communication Plan and support from the local authorities • Plan for 6 weeks of support for 10,000 people

  11. Rapid Containment Cannot Be “Business as Usual” “When is it too late to contain?” Start containment Country and WHO involved Results from WHO lab Specimen to WHO lab Results from national lab Specimen to national lab Initial investigation Report to local office Detection of Index Cluster Start of Index Cluster Onset of first case

  12. Societal Impacts • School closures • Air transportation and general movement of goods • Potential Border Closures (Tourism decline) • Economic slow down • Health system overload from flu patients • Care for normal sick is reduced • Supplies and staff become over burdened

  13. Sustaining Essential Services • Planning estimates are that 40% of the work forces will be affected • Essential services will deteriorate slowly • Health services (patient care and Public Health) • Water and Sanitation • Food and agriculture production • Power (fuel and power grids) • Communications • Banking and finance • Transportation • Rule of law (police, courts, prisons, and national security

  14. Non-Pharmaceutical Interventions • Infection controls • Voluntary isolation of sick people • Voluntary quarantine of healthy contacts • School closures • Social distancing • Travel restrictions • Mask use • Hand washing

  15. Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months Enough eggs? Strain selection? Adjuvants? Repeat doses? Expiration?

  16. Unprepared Impact Prepared Weeks Potential Strategies to Decrease the Impact of a Pandemic • Prevent or delay introduction, slow spread • Decrease illness and death • Vaccine when available • Antiviral treatment and isolation for people with illness • Non-pharmaceutical interventions

  17. SummaryCombating a Pandemic; the three keys to success • Knowledge of the virus is critical • Mutations and movement • Laboratory testing capabilities (Field and Lab testing) • Vaccines (6-9 months) • Development • Manufacturing • Distribution • Non-Pharmaceutical interventions • Population compliance or non-compliance

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