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PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE . Frank Agodi PhD student Walden University PUBH: 8165-2 Instructor: Dr. Raymond Thron Spring, 2011. AGENDA. Introduction What is Pandemic Influenza? Review Influenza Basics History of influenza Epidemiology of Influenza

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pandemic influenza preparedness and response

PANDEMIC INFLUENZA PREPAREDNESS AND RESPONSE

Frank Agodi

PhD student

Walden University

PUBH: 8165-2

Instructor: Dr. Raymond Thron

Spring, 2011

agenda
AGENDA
  • Introduction
  • What is Pandemic Influenza?
  • Review Influenza Basics
  • History of influenza
  • Epidemiology of Influenza
  • Routes of transmission
  • How does Seasonal Flu defer from Pandemic Flu?
  • Data statistics of Influenza
  • Prevention of Influenza
  • Conclusion
  • Questions
  • Feedback
  • References
  • Supplemental Reading
introduction
INTRODUCTION
  • For the past 400 years, epidemics resembling influenza have been recorded in many countries.
  • Epidemics from as early as the 16th Century in England and the 18th Century in the USA are recognizable as influenza, even in the absences of precise knowledge of their causative
  • In 1997 and again since 2003, there has been concern about the Influenza A(H5N1) virus which continues to circulate causing outbreaks in birds and occasional human infections
    • http://www.unicef.org/avianflu/index.html
slide4

WHAT IS PANDEMIC INFLUENZA?

  • Pandemic = worldwide epidemic
    • New influenza virus  No immunity
    • Spreads from person-to-person
      • Presumed to be like seasonal flu: respiratory droplets
    • Can cause severe disease
  • Incubation Period
    • Presumed like seasonal flu: 1 to 5 days
  • Contagious Period
    • Presumed to be similar to seasonal flu
  • Timing
    • Waves that last weeks and could begin anytime
flu basics viral infection
FLU BASICS VIRAL INFECTION
  • Fever
  • Headache
  • Muscle aches
  • Extreme fatigue
  • Dry cough
  • Sore throat
  • Runny or stuffy nose

CDC Public Health Image Library

flu basics viral infection flu complications
FLU BASICS VIRAL INFECTION - Flu Complications
  • Bronchitis
  • Pneumonia
  • Dehydration
  • Worsening of chronic illness
  • Sinus or ear problems in children
  • Death
    • ~65/100,000 infections
    • 80-90% >65 y/o

CDC Public Health Image Library

history of influenza
HISTORY OF INFLUENZA
  • 1976 to 2006 deaths range 3,000-49,000
  • First flu pandemic in 40 years, 2009-2010
    • United States mortality 12,000
    • January 2-8, 2011, WHO, (2011) reported worldwide 4,331 specimen, 706 positive influenza A
      • Four deaths, (two influenza A; two influenza B)

CDC. 2011. Flu view: A weekly influenza surveillance report prepared by the influenza division. Retrieved from

http://www.cdc.gov/flu/keyfacts.htm#whatis

epidemiology of influenza
EPIDEMIOLOGY OF INFLUENZA -
  • Influenza pandemic occurs when major mutation happens
  • It happens in two ways:
    • Genetic re-assortment
    • Repeated transmission
does age matter

EPIDEMIOLOGY OF INFLUENZA -

Does Age Matter?

Age at death, per 100,000 persons in each age group, United States, 1911–1918

-JK Taubenberger and DM Morens.1918 Influenza: the Mother of All Pandemics. EID, Jan. 2006

routes of transmission
ROUTES OF TRANSMISSION
  • Novel virus
  • Human-to-human transmission
    • “R0” = number of people an infected person infects
  • Severity of illness
    • Case fatality ratio (CFR)
  • More distance between persons  spread of germs less likely
  • Transmission“Respiratory droplets
    • An infected person infects ~1.5—3 others
how does seasonal flu differ from pandemic flu
HOW DOES SEASONAL FLU DIFFER FROM PANDEMIC FLU?
  • Seasonal Flu outbreaks follow predictable seasonal patterns; occurs annually, usually in winter, in the temperate climates.
  • Usually some immunity are built up from previous exposure
  • Healthy adults usually not at risk for serious complications; the very young, the elderly and those with certain underlying health conditions at increased risk for serious complications.

http://www.cdc.gov/flu/

We can get more info about seasonal flu in CDC site above.

how does seasonal flu differ from pandemic flu14
HOW DOES SEASONAL FLU DIFFER FROM PANDEMIC FLU?
  • Pandemic Flu occurs rarely (three times in 20th century – last in 1968).
  • No previous exposure
  • Little or no pre-existing immunity
  • Healthy people may be at increased risk for serious complications.

http://www.cdc.gov/flu/

Info about how seasonal flu differ from pandemic flu can be read from the CDC site above.

seasonal flu
SEASONAL FLU
  • Occurs annually and is caused by influenza virus
  • Strikes in the fall and winter
  • Usually less severe than pandemic flu because many people may have developed some immunity
  • Vaccines developed based on known flu strains and available annually
pandemic flu
PANDEMIC FLU
  • Usually, there is no pre-existing immunity or previous exposure.
  • Flu shots will not be available at first they have to made.
  • It may take 4 to 6 months or longer to prepare a flu shot for this virus
pandemic flu avian influenza h5n1 key facts
PANDEMIC FLU - Avian Influenza H5N1: Key Facts
  • Transmission to humans: Rare
    • Extensive contact with infected birds
  • Contagiousness
    • Very rarely spread between humans
    • Spread among birds: increasing
      • Birds and poultry in Southeast Asia, Asia, Indonesia, Europe, Africa, Middle East…
  • Severity
    • Of 281 people infected with H5N1 Avian Flu, 169 (60%) have died
data statistics of influenza
DATA STATISTICS OF INFLUENZA
  • The WHO has reported cases of influenza A (H1N1)
    • Asia, Africa, Pacific and Europe
    • Indonesia and Vietnam have the highest
    • In Egypt they reported 121 confirmed cases
      • 40 have been fatal

WHO. 2011. Global Alert and Response.CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April 2009 – March 13, 2010. Retreivedromhttp://www.who.int/csr/don/2011_01_20/en/index.html

CDC shows the statistics for hospitalization and deaths due to H1N1

pandemic flu vaccine and drugs
Pandemic Flu Vaccine and Drugs
  • Vaccine
    • Delayed production
    • May require two doses
  • Drugs
    • Supplies: limited
    • Distribution: unfamiliar
  • Prioritization rationing  fear…
how to slow a pandemic latest cdc guidance
How To Slow a Pandemic: Latest CDC Guidance
  • Ill persons should be treated and stay away from others
  • Exposed persons should stay away from others and receive prophylaxis
  • More ‘social distance’ between children in schools and childcare
  • More social distance between adults at work and play
prevention and planning it begins at home
Prevention and PlanningIt Begins At Home
  • The more you prepare yourself and your family, the more likely you can fulfill roles in an emergency
prevention of influenza
PREVENTION OF INFLUENZA

Centers for Disease Prevention and Control. (2010). CDC says “take 3” actions

to fight the flu. Retrieved from http://www.cdc.gov/flu/protect/jpreventing.htm

U. S. Department of Health and Human Service. Flu.gov. (2011). Prevention and treatment. Retrieved from http://pandemicflu.gov/individualfamily/prevention/index.html

Note! Preventive steps are provided in the links above.

Stay home if you are sick until 24 hours after fever (100 F or 37.8 C)is gone [http://pandemicflu.gov/individualfamily/prevention/index.html]

Limit contact with others

Cover your nose and mouth when you sneeze or cough (use tissue or bend of your arm)

Throw away used tissue

Use alcohol hand sanitizer

Avoid touching your eyes, nose or mouth

prevention of influenza25
PREVENTION OF INFLUENZA
  • Annual vaccination
    • Injection
      • Inactivated
    • Nasal mist
      • Live attenuated
  • Prophylactic medicines
  • Avoid ill persons
  • Respiratory hygiene & etiquette: “Cover your cough”

southbirminghampct.nhs.uk

prevention of influenza step 1 flu vaccine
PREVENTION OF INFLUENZA Step 1 Flu Vaccine

Centers for Control Disease and Prevention. (2010). CDC says “take 3” actions

to fight the flu Retrieved from http://www.cdc.gov/flu/protect/preventing.htm

Note! Info on steps to prevent spread of influenza could be read on the above link.

  • 1st (most important)
  • Protects against the three viruses
    • Influenza A - H3N2
    • Influenza B
    • 2009 - H1N1
  • High risk populations

As early as 6 months of age

Children younger than 6 months can not receive the vaccine

Person caring (vaccinated)

pandemic influenza planning federal and state perspectives

Pandemic Influenza PlanningFederal and State Perspectives

Overall Goals

Reduce deaths

Reduce illnesses

Reduce social disruption

current pandemic planning assumptions
Current Pandemic Planning Assumptions
  • We’ll have some notice
  • Don’t expect federal or state “response”
  • Duration of event: weeks to months
  • Absenteeism
    • Plan for 30-40% for at least 2 weeks
  • Vaccine
    • Late, limited
  • Anti-virals
    • Insufficient stockpile for preventive treatment
    • Sufficient for some treatment
federal and state public health roles
Federal and State Public Health Roles
  • Leadership—in collaboration with emergency management
  • Information—regular updates, interim guidance
  • Coordination—with multiple agencies and jurisdictions, e.g. counties, state agencies
  • Evaluation—measure interventions’ effects
public health s legal authorities
Public Health’s Legal Authorities
  • CDC  State Public Health  County or City Health Departments
  • Federal—guidance only
    • www.pandemicflu.gov
    • www.cdc.gov
  • State—guidance and legal authority
    • http://www.cdph.ca.gov/Pages/DEFAULT.aspx
  • County/Local Health Departments—where guidance and legal authority meet real people
    • http://www.acphd.org/
slide32

Federal Guidance

  • DHS/HHS/CDC—leadership
  • All Federal Cabinet Level Agencies
    • Justice
    • Defense
    • Commerce
    • Treasury
pandemic severity
Pandemic Severity
  • CDC’s Pandemic Severity Index
  • Category 1 –mild
  • Category 3 –moderate
  • Category 5 –catastrophic
  • Interventions α Severity Index
  • Category 1
    • Ill persons stay home
    • Schools generally not closed
  • Category 5
    • Almost everyone stays home!
conclusion
CONCLUSION
  • The pandemic wave passes through
  • Public Health impacts
    • Illnesses and deaths
    • Other impacts are losses to business sector
  • Plans refined
  • Vaccine or anti-flu drugs become available
references
REFERENCES

Georgia State University. 2010. Office of Emergence Management. H1N1 General Info. Retrieved from http://www.gsu.edu/oem/37808.html

Centers for Disease Prevention and Control. (2010). CDC says “take 3” actions to fight the flu. Retrieved from http://www.cdc.gov/flu/protect/jpreventing.htm

references37
REFERENCES

Centers for Disease Prevention and Control. (2010). Cold versus flu. Retrieved from http://www.cdc.gov/flu/about/qa/couldflu.htm

Louie, J. K., Acosta, M., Jamieson, D. J. & Honein, M. A. (2010). Severe 2009 H1N1 influenza in pregnant and postpartum women in California. New England Journal of Medicine. 362, 27-35.

references38
REFERENCES

Payaprom, Y., Bennett, P., Burnard, P., Alabaster, E. & Tantipong. (2009). Understandings of influenza and influenza vaccination among high risk urban Dwelling Thai adults: a qualitative study. Journal of Public Health. 32 (1). 26

references39
REFERENCES

U. S. Department of Health and Human Service. Flu.gov. (2011). Prevention and treatment. Retrieved from http://pandemicflu.gov/individualfamily/prevention/index.html;http://pandemicflu.gov/individualfamily/prevention/index.html

U. S. Department of Health and Human Service. Flu.gov. (2011). Prevention and treatment. Retrieved from http://pandemicflu.gov/individualfamily/prevention/index.html;http://www.flu.gov/individualfamily/prevention/medicine/index.html

references40
REFERENCES

World Health Organization. 2011. Global Alert and Responses. CDC Estimates of 2009 H1N1 Influenza Cases, Hospitalizations and Deaths in the United States, April 2009 – March 13, 2010. Retrieved from http://www.who.int/csr/don/2011_01_20/en/index.html

supplimental information
SUPPLIMENTAL INFORMATION
  • http://www.cdc.gov/flu/about/qa/couldflu.htm
  • http://www.cdc.gov/flu/protect/jpreventing.htm
  • http://www.flu.gov/individualfamily/prevention/medicine/index.html
  • http://www.gsu.edu/oem/37808.html
  • http://pandemicflu.gov/individualfamily/prevention/index.html
  • http://www.who.int/csr/don/2011_01_20/en/index.html
questions
QUESTIONS
  • Questions
  • Feedback
  • Thanks