Download 1 - Champaign County Prepares

Champaign-Urbana Public Health District
Pandemic Influenza Annex
February 2010
Champaign-Urbana Pandemic Annex
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Champaign-Urbana Public Health District
PANDEMIC INFLUENZA ANNEX
Table of Contents
Table of Contents
List of Tables
List of Figures
Section 1 INTRODUCTION
1.1 Background .............................................................................................. 1-1
1.2 Seasonal Influenza ................................................................................... 1-1
1.3 Pandemic Influenza .................................................................................. 1-2
1.4 Seasonal Influenza vs. Pandemic Influenza ............................................. 1-3
1.5 Avian Influenza ........................................................................................ 1-4
1.6 Swine Influenza ....................................................................................... 1-4
1.7 Phases of Pandemic Influenza ................................................................. 1-4
1.8 Pandemic Severity Index ......................................................................... 1-6
1.9 Potential Impacts of a Pandemic .............................................................. 1-7
Section 2 PURPOSE AND OBJECTIVES
2.1 Purpose..................................................................................................... 2-1
2.2 Objectives ................................................................................................ 2-1
Section 3 PLANNING AND ASSUMPTIONS
Section 4 DIRECTION AND CONTROL
Section 5 RESPONSIBILITIES
5.1 Champaign-Urbana Public Health District .............................................. 5-1
5.2 Specific Responsibilities of Champaign-Urbana Public Health
District Divisions and Sections ................................................................ 5-2
5.2.1 Public Health Administrator ........................................................ 5-2
5.2.2 Emergency Response Planner ...................................................... 5-2
5.2.3 Public Information Officer ........................................................... 5-3
5.2.4 Communicable Disease Control, Epidemiology and
Immunization Section .................................................................. 5-3
5.2.5 Wellness and Health Promotion Division .................................... 5-4
5.2.6 Infectious Disease Prevention and Management Division .......... 5-4
5.2.7 Environmental Health Division ................................................... 5-4
5.2.8 All Divisions and Sections ........................................................... 5-4
5.3 Champaign County Coroner .................................................................... 5-5
5.4 Local Hospitals, Clinics, Providers and Other Health System
Partners .................................................................................................... 5-5
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Table of Contents
5.5
5.6
5.7
5.8
Illinois Department of Public Health ....................................................... 5-6
United States Department of Health and Human Services ...................... 5-6
Centers for Disease Control and Prevention ............................................ 5-6
World Health Organization...................................................................... 5-7
Section 6 CONCEPT OF OPERATIONS
6.1 Interpandemic/Pandemic Alert Period Actions ....................................... 6-1
6.2 Pandemic Response Period Actions ........................................................ 6-3
6.3 Post-Pandemic (Recovery) Period Actions ............................................. 6-7
Section 7 PRIORITIZATION OF VACCINES AND ANTIVIRAL
MEDICATIONS
Section 8 MITIGATION STRATEGIES
8.1 Infection Prevention and Control Guidelines for Non-Healthcare
and Healthcare Settings ........................................................................... 8-1
8.1.1 Overview...................................................................................... 8-1
8.1.2 General Guidelines for Non-Healthcare Settings ........................ 8-3
8.1.3 General Guidelines for Healthcare Settings (Hospitals,
Health Centers, Etc.) .................................................................... 8-8
8.2 Personal Protective Equipment .............................................................. 8-10
8.2.1 Overview.................................................................................... 8-10
8.2.2 Assorted Personal Protective Equipment................................... 8-11
8.2.3 Pandemic Response Period ........................................................ 8-15
8.2.4 Post-Pandemic (Recovery) Period ............................................. 8-17
8.3 Non-Pharmaceutical Intervention .......................................................... 8-17
8.3.1 Overview.................................................................................... 8-17
8.3.2 Non-Pharmaceutical Intervention Community Control
Measures .................................................................................... 8-18
8.3.3 Criteria for Determining Community Control Measures........... 8-20
Section 9 RISK COMMUNICATION
9.1 Overview.................................................................................................. 9-1
9.1.1 Coordination ................................................................................ 9-1
9.1.2 Risk Communication Principles .................................................. 9-1
9.1.3 Risk Communication Planning Assumptions and
Considerations ............................................................................. 9-2
9.1.4 Vulnerable Population Considerations ........................................ 9-2
9.1.5 Desired Outcomes ........................................................................ 9-3
9.2 Communications Infrastructure ............................................................... 9-3
9.2.1 Interpandemic/Pandemic Alert Period ......................................... 9-3
9.2.2 Pandemic Response Period .......................................................... 9-3
9.2.3 Post-Pandemic (Recovery) Period ............................................... 9-4
9.3 Communicating with the General Public ................................................. 9-4
9.3.1 Message Development ................................................................. 9-4
9.3.2 Public Education and Awareness Campaign ............................... 9-5
9.3.3 Message Dissemination ............................................................... 9-5
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9.4
9.5
9.6
9.7
9.8
Working with the Media .......................................................................... 9-6
9.4.1 Communicating with the Media................................................... 9-6
9.4.2 Spokesperson Training................................................................. 9-7
Coordinating with Healthcare Public Information Officers..................... 9-7
Communicating with Key Partners .......................................................... 9-8
Risk Communication/Public Education Strategies and Key
Messages .................................................................................................. 9-9
9.7.1 Interpandemic/Pandemic Alert Period ......................................... 9-9
9.7.2 Pandemic Response Period ........................................................ 9-10
9.7.3 Post-Pandemic (Recovery) Period ............................................. 9-12
Risk Communication Guidance for Hospitals ....................................... 9-12
9.8.1 Risk Communication Strategies ................................................. 9-12
9.8.2 Education and Training .............................................................. 9-14
Section 10 MAINTENANCE OF ESSENTIAL SERVICES
Section 11 PLAN DEVELOPMENT AND MAINTENANCE
11.1 Plan Development .................................................................................. 11-1
11.2 Distribution ............................................................................................ 11-1
11.3 Review and Update ................................................................................ 11-1
Section 12 ACRONYMS AND ABBREVIATIONS
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Table of Contents
List of Tables
Table 1-1 Seasonal Influenza vs. Pandemic Influenza ................................................ 1-3
Table 1-2 CDC Pandemic Severity Index Chart .......................................................... 1-7
Table 1-3 Potential Impacts - Estimated Number of Episodes of Illness,
Healthcare Utilization and Deaths Associated with Moderate and
Severe Pandemic Influenza Scenarios for the U.S. Population and
Champaign County .......................................................................................... 1-8
Table 6-1 Pandemic Flu Plan Periods Compared to World Health
Organization Phases ......................................................................................... 6-1
Table 6-2 Interpandemic/Pandemic Alert Actions ...................................................... 6-1
Table 6-3 Level 1 Pandemic Response Actions .......................................................... 6-3
Table 6-4 Level 2 Pandemic Response Actions .......................................................... 6-3
Table 6-5 Level 3 Pandemic Response Actions .......................................................... 6-4
Table 6-6 Level 4 Pandemic Response Actions .......................................................... 6-5
Table 6-7 Level 5 Pandemic Response Actions .......................................................... 6-5
Table 6-8 Level 6 Pandemic Response Actions .......................................................... 6-7
Table 6-9 Post-Pandemic (Recovery) Actions ............................................................. 6-7
Table 7-1 Prioritization of Vaccine and Antiviral Distribution ...................................7-1
Table 8-1 Non-Pharmaceutical Intervention Recommendations Based on
Pandemic Severity Index ............................................................................... 8-20
List of Figures
Figure 1-1 Pandemic Influenza Phases ........................................................................ 1-5
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Section 1
INTRODUCTION
1.1 Background
Influenza pandemics (or flu) pose a substantial threat to public health as they have the
potential to inflict significant illness and death across a broad range of the community,
including the young and healthy. A pandemic constitutes a global health emergency.
Because the population has little or no immunity to the circulating strain of influenza,
pandemics have the capacity to cause serious morbidity. The 20th century saw three
influenza pandemics: the 1918 Spanish Flu that resulted in approximately 675,000
deaths in the U.S., with an estimated 40 to 50 million deaths worldwide; the 1957
Asian Flu; and the 1968 Hong Kong Flu. Although there is no way to predict when
the next influenza pandemic will occur, health experts at the Centers for Disease
Control and Prevention (CDC) and the World Health Organization (WHO) believe
that education and outreach are critical to preparing for a pandemic. The emergence
and spread of the highly pathogenic avian H5N1 influenza strain in other parts of the
world, as well as the more recent emergence and spread of the H1N1 influenza virus
(commonly called swine flu), has led many scientists and public health experts to
conclude that another influenza pandemic is imminent.
1.2 Seasonal Influenza
Influenza is a contagious respiratory illness caused by common influenza viruses that
are present in our community—primarily on a seasonal basis. Common symptoms
include fever, extreme tiredness, muscle aches, headache, runny or stuffy nose, dry
cough and sore throat. Nausea, vomiting and diarrhea can also occur, though these
symptoms are more common in children than adults. Influenza can exacerbate
underlying medical conditions—particularly pulmonary or cardiac disease—and can
even lead to secondary bacterial or viral pneumonia. The risk for complications,
hospitalization and deaths from influenza is higher among older adults (65 and over),
young children and those persons with certain underlying medical conditions.
Approximately 36,000 people die in the U.S. each year due to seasonal flu. The best
way to prevent the flu is by getting a flu vaccination each fall. Champaign County
residents can schedule appointments for a flu vaccination with the Champaign-Urbana
Public Health District (CUPHD) (www.c-uphd.org) by calling (217) 531-2922. Flu
vaccinations typically occur from October through March. The location for the flu
vaccination is 201 West Kenyon Road, Champaign, Illinois.
Flu is primarily transmitted from person to person by droplet spread or direct contact.
Droplet spread refers to spray with relatively large, short-range droplets produced by
sneezing, coughing, talking or singing. These droplets may spray up to three feet and
can land directly in the eyes or be inhaled through the nose or mouth. Transmission
can also occur through contact with respiratory secretions, such as when touching
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surfaces contaminated with the virus and then touching the eyes, nose or mouth. For
most adults, the period of communicability ranges from 24 hours before symptoms
appear to up to three to five days after symptoms develop. Children and some adults
may be infectious for seven or more days after the onset of symptoms. The incubation
period is usually two days, but can vary from one to four days. While a fever can
typically last three to seven days, coughing and muscle aches can last up to two weeks.
Influenza viruses are primarily divided into two types: A and B viruses. The
remarkable variation of influenza strains—particularly type A—and their ability to
cause annual epidemics of respiratory illness of varying intensity and severity,
continue to be the focus of intense investigation. Only type A viruses are known to
cause pandemics. Type A viruses are further divided into subtypes based on the
specific hemagglutinin (H) and neuraminidase (N) proteins on the virus surface.
Hemagglutinin binds to the cell surface to initiate infection. Neuraminidase is
involved in the release of virus from infected cells. The emergence of new H or N
proteins in the 20th century led to three separate pandemics. For example, the 1918
pandemic resulted from the emergence and spread of the H1N1 virus, while the 1968
pandemic was associated with the H3N2 virus. The 1957 pandemic was associated
with the emergence and spread of the H2N2 virus; however, this virus subtype stopped
circulating in 1968. Pandemics are believed to have occurred for at least 300 years at
unpredictable intervals.
1.3 Pandemic Influenza
A pandemic flu occurs when there is an abrupt and major change in the protein
structure of the Influenza A virus, resulting in a new subtype. This is known as
antigenic shift. This change may occur in two ways. When two viruses infect the
same cell, they may share genetic material—a process known as reassortment—and
result in a new human virus. A virus may also undergo random mutation resulting in
an adaptive form more likely to survive in the host. This second type of change may
occur during sequential infection of humans and other mammals, and lead to a virus
more efficiently transmitted amongst humans.
Three conditions must be met for a pandemic to start:

A new flu virus subtype must emerge for which there is little or no human
immunity

It must infect humans and cause illness

It must spread easily and sustainably (i.e., continue without interruption) among
humans
In the event of a pandemic, any vaccine or therapeutic drug is likely to be delayed
and/or in short supply. Because of these characteristics, pandemic flu is likely to last
several months and affect a large percentage of the population—both at the national
and global level—thereby overloading healthcare systems and causing major social
and economic disruption.
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INTRODUCTION
Recent outbreaks of avian flu, which began in Asia in 1996, and the H1N1 virus (or
swine flu), currently pose the greatest threat of triggering a flu pandemic. The H1N1
virus, which began in Mexico in 2009, is easily transmitted from person-to-person. If
the avian flu strains mutate into a virus that is just as easily transmitted from personto-person, a pandemic can occur. Scientists and public health experts are concerned
that this virus could be particularly lethal to humans. If such a pandemic were to
develop, it would likely originate in Asia and quickly spread across the globe to North
America, including Champaign County. This scenario is typical of the patterns
exhibited by past pandemics.
1.4 Seasonal Influenza vs. Pandemic Influenza
Table 1-1
Seasonal Influenza vs. Pandemic Influenza
SEASONAL
Outbreaks follow predictable seasonal patterns;
occur annually, usually in winter, in temperate
climates
Usually some immunity built up from previous
exposure
Healthy adults are usually not at risk for serious
complications; the very young, the elderly and
those with certain underlying health conditions are
at increased risk for serious complications
Health systems can usually meet public and
patient needs
Vaccine developed based on known flu strains
and available before annual flu season
Adequate supplies of antivirals are usually
available
Average U.S. deaths approximately 36,000 per
year
Symptoms include fever, cough, runny nose,
muscle pain; deaths are often caused by
complications such as pneumonia
Generally causes modest impact on society (e.g.,
some school closings, people who are sick are
encouraged to stay home)
Manageable impact on domestic and world
economies
Champaign-Urbana Pandemic Annex
PANDEMIC
Occurs rarely (three times in 20th century – last time
in 1968)
No previous exposure; little or no pre-existing
immunity
Healthy people may be at increased risk for serious
complications
Health systems may be overwhelmed
Vaccine probably would not be available in the early
stages of a pandemic
Effective antivirals may be in limited supply because
the demand during a pandemic could possibly
overwhelm current national stockpiles
Number of deaths could be quite high (e.g., U.S.
1918 death toll was approximately 675,000)
Symptoms may be more severe and complications
more frequent
May cause major impact on society (e.g., widespread
restriction on travel, closings of schools and
businesses, cancellation of large public gatherings)
Potential for severe impact on domestic and world
economies
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1.5 Avian Influenza
Avian influenza (or bird flu) is an infection caused by avian influenza viruses, which
occur naturally among birds. Wild birds worldwide carry the viruses in their
intestines, but usually do not get sick from them. However, avian influenza is very
contagious among birds and can make some domesticated birds—including chickens,
ducks and turkeys—very sick and even kill them. Infection from avian influenza
viruses in domestic poultry causes two main forms of disease, high pathogenic and
low pathogenic. The low pathogenic form may go undetected and usually causes only
mild symptoms.
Avian influenza virus refers to influenza A viruses found chiefly in birds, although
infections with these viruses can occur in humans and other mammals. The risk of
human infection from avian influenza is generally low; however, confirmed cases of
human infection from several subtypes of avian influenza viruses have been reported
since 1997. Influenza A (H5N1) virus is an influenza A virus subtype that occurs
mainly in birds; it is highly contagious among birds and can be deadly to them. While
the H5N1 virus does not usually infect humans, some cases have occurred. Most of
the individuals who have contracted the virus in recent years have had direct or close
contact with H5N1-infected poultry or H5N1-contaminated surfaces. As of May 6,
2009, there have been 423 confirmed human Influenza A (H5N1) cases in 25
countries. Of these, 268 humans died as a result of contracting the H5N1 virus.
1.6 Swine Influenza
Swine flu is a respiratory disease caused by type A influenza viruses that lead to
regular outbreaks in pigs. People do not normally get swine flu, although human
infections can and do happen.
A novel influenza A (H1N1) virus thought to be of swine origin was first detected in
Mexico in April 2009. The virus continues to infect people, spreading from person-toperson and sparking a growing outbreak of illness in the U.S. and worldwide.
It is thought that the H1N1 flu spreads in the same way regular seasonal influenza
viruses spread (i.e., mainly through the coughs and sneezes of people who are sick
with the virus). It is uncertain at this time how severe this novel H1N1 outbreak will
be in terms of illness and death as compared to other influenza viruses. As of June 9,
2009, there have been 25,288 reported human cases of influenza A (H1N1) in 73
countries. Of these, 139 humans have died as a result of contracting the H1N1 virus.
1.7 Phases of Pandemic Influenza
In a 2009 revision of its phase descriptions, the WHO retained the use of a six-phased
approach for easy incorporation of new recommendations and approaches into existing
national preparedness and response plans. The grouping and description of pandemic
phases have been revised to make them easier to understand, more precise and based
upon observable phenomena. Phases 1 through 3 correlate with preparedness,
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INTRODUCTION
including capacity development and response planning activities, while Phases 4
through 6 signal the need for response and mitigation efforts. Furthermore, periods
after the first pandemic wave are elaborated to facilitate post-pandemic recovery
activities.
Figure 1-1
Pandemic Influenza Phases
In nature, influenza viruses circulate continuously among animals, especially birds.
Even though such viruses might theoretically develop into pandemic viruses, in Phase
1, no viruses circulating among animals have been reported to cause infections in
humans.
In 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.
In 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-tohuman transmission sufficient to sustain community-level outbreaks. Limited humanto-human transmission may occur under some circumstances, for example, when there
is close contact between an infected person and an unprotected caregiver. However,
limited transmission under such restricted circumstances does not indicate that the
virus has gained the level of transmissibility among humans necessary to cause a
pandemic.
Phase 4 is characterized by verified human-to-human transmission of an animal or
human-animal influenza reassortant virus able to cause community-level outbreaks.
The ability to cause sustained disease outbreaks in a community marks a significant
upwards shift in the risk for a pandemic. Any country that suspects or has verified
such an event should urgently consult with the WHO so that the situation can be
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jointly assessed and a decision made by the affected country if implementation of a
rapid pandemic containment operation is warranted. Phase 4 indicates a significant
increase in risk of a pandemic but does not necessarily mean that a pandemic is a
forgone conclusion.
Phase 5 is characterized by human-to-human spread of the virus into at least two
countries in one WHO region. While most countries will not be affected at this stage,
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.
Phase 6, the pandemic phase, is 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.
During the post-peak period, pandemic disease levels in most countries with
adequate surveillance will have dropped below peak observed levels. The post-peak
period 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.
Previous pandemics have been characterized by waves of activity spread over months.
Once the level of disease activity drops, a critical communications task will be to
balance this information with the possibility of another wave. Pandemic waves can be
separated by months and an immediate “at-ease” signal may be premature.
In the post-pandemic period, influenza disease activity will have returned to levels
normally seen for seasonal influenza. It is 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.
1.8 Pandemic Severity Index
The Pandemic Severity Index (PSI) is a proposed classification scale for reporting the
severity of influenza pandemics in the U.S. The PSI was accompanied by a set of
guidelines intended to help communicate appropriate actions for communities to
follow in potential pandemic situations. Released by the U.S. Department of Health
and Human Services (HHS) on February 1, 2007, the PSI was designed to resemble
the Saffir-Simpson Hurricane Scale classification scheme.
The PSI was developed by the CDC as a new pandemic influenza planning tool for use
by states, communities, businesses and schools, as part of a drive to provide more
specific community-level prevention measures. The index and guidelines were
developed by applying principles of epidemiology to data from the history of the last
three major flu pandemics and seasonal flu transmission, mathematical models, and
input from experts and citizen focus groups.
During the onset of a growing pandemic, local communities cannot rely upon
widespread availability of antiviral drugs and vaccines. The goal of the index is to
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INTRODUCTION
provide guidance as to what measures various organizations can enact that will slow
down the progression of a pandemic, easing the burden of stress upon community
resources, while definite solutions, like drugs and vaccines, can be brought to bear on
the situation. The CDC expects adoption of the PSI will allow early coordinated use
of community mitigation measures to affect pandemic progression.
The index focuses less on how likely a disease will spread worldwide (i.e., become a
pandemic) and more upon how severe the epidemic actually is. The main criterion
used to measure pandemic severity will be the Case Fatality Ratio (CFR), the
percentage of deaths out of the total reported cases of the disease.
The actual implementation of PSI alerts is expected to occur after the WHO announces
Phase 6 pandemic phase (human-to-human) in the United States. This would likely
result in the immediate announcement of a PSI level 3-4 situation.
The analogy of category levels was introduced to provide an understandable
connection to hurricane classification schemes, with specific reference to the recent
aftermath of Hurricane Katrina. Like the Saffir-Simpson Hurricane Scale, the PSI
ranges from 1 to 5, with Category 1 pandemics being the most mild (equivalent to
seasonal flu) and level 5 being reserved for the most severe, worst-case scenario
pandemics (such as the 1918 Spanish flu).
Table 1-2
CDC Pandemic Severity Index Chart
CATEGORY
1
2
CFR
Less than
0.1%
0.1% to
0.5%
3
0.5% to 1%
4
1% to 2%
5
2% or higher
EXAMPLE(S)
Seasonal Flu
Asian Flu and
Hong Kong Flu
Spanish Flu
1.9 Potential Impacts of a Pandemic
The CDC estimates that in the U.S. alone, an influenza pandemic could affect up to
200 million people, causing between 200,000 and 1,900,000 deaths.
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Section 1
Table 1-3
Potential Impacts - Estimated Number of Episodes of Illness, Healthcare Utilization and
Deaths Associated with Moderate and Severe Pandemic Influenza Scenarios for the U.S.
Population and Champaign County
Moderate (1958/68 – like)
Characteristics
Severe (1918 – like)
U.S.
Champaign
County
U.S.
Champaign
County
Illness
90 Million
57,315
90 Million
57,315
Outpatient Care
45 Million
28,658
45 Million
28,658
Hospitalization
865,000
551
9,900,000
6,305
ICU Care
128,750
82
1,485,000
946
Mechanical
Ventilation
64,875
41
742,500
473
Deaths
209,000
133
1,903,000
1,212
1 Estimates are based on extrapolation from past pandemics in the U.S. and do not
include the potential impacts of interventions not available during the 20th century
pandemics.
2 The calculations used to determine the figures in the table are based on the following
assumptions:

Champaign County accounts for 0.063684 percent of the total U.S. population.

Susceptibility to the pandemic influenza subtype will be universal.

The clinical disease attack rate will be 30 percent in the overall population.
Illness rates will be highest among school-aged children (about 40 percent) and
decline with age. Among working adults, an average of 20 percent will become
ill during a community outbreak.

Of those who become ill with influenza, 50 percent will seek outpatient medical
care.
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Section 2
PURPOSE AND OBJECTIVES
2.1 Purpose
The CUPHD Pandemic Influenza Plan (Plan) provides guidance to public health and
regional partners regarding detection, response and recovery from an influenza
pandemic. The Plan describes the unique challenges posed by a pandemic that may
necessitate specific leadership decisions, response actions and communication
mechanisms. Specifically, the purpose of the Plan is to:

Define preparedness activities that should be undertaken before a pandemic
occurs to enhance the effectiveness of response measures.

Describe the response, coordination and decision-making structure that will
incorporate the healthcare system in Champaign County, other local response
agencies, and state and federal agencies during a pandemic.

Define roles and responsibilities for CUPHD, local healthcare partners and local
response agencies during all phases of a pandemic.

Describe public health interventions in a pandemic response and the timing of
such interventions.

Serve as a guide for local healthcare system partners, response agencies and
businesses in the development of pandemic influenza response plans.

Provide technical support and information on which preparedness and response
actions are based.
2.2 Objectives
The primary objectives of the Plan are to:

Limit the number of illnesses and deaths

Preserve continuity of essential functions (government and business)

Minimize social disruption

Minimize economic losses
The Plan will be coordinated with other CUPHD preparedness plans and activities and
will be coordinated with the plans of community, state and federal partners.
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Section 3
PLANNING AND ASSUMPTIONS
The CDC developed a list of assumptions to guide pandemic influenza planning for
federal, state and local governments, businesses, individuals and families. These
assumptions are based on a careful analysis of previous pandemic influenza events and
currently available information regarding seasonal influenza viruses. The following
represent key assumptions critical to the development of the Plan.

Susceptibility to the pandemic influenza virus will be universal.

Efficient and sustained person-to-person transmission signals an imminent
pandemic.

The clinical disease attack rate will likely be 30 percent or higher in the overall
population during the pandemic. Illness rates will be highest among school-aged
children (about 40 percent) and decline with age. Among working adults, an
average of 20 percent will become ill during a community outbreak.

Some persons will become infected but not develop clinically significant
symptoms. Asymptomatic or minimally symptomatic individuals can transmit
infection and develop immunity to subsequent infection.

Of those who become ill with influenza, 50 percent will seek outpatient medical
care.

With the availability of effective antiviral drugs for treatment, this proportion may
be higher in the next pandemic.

The number of hospitalizations and deaths will depend on the virulence of the
pandemic virus. Estimates differ about tenfold between more and less severe
scenarios. Two scenarios are presented based on extrapolation of past pandemic
experience (Table 1-3). Planning should include the more severe scenario.

Risk groups for severe and fatal infection cannot be predicted with certainty but
are likely to include infants, the elderly, pregnant women and persons with
chronic medical conditions.

Rates of absenteeism will depend on the severity of the pandemic.

In a severe pandemic, absenteeism attributable to illness, the need to care for ill
family members and fear of infection may reach 40 percent during the peak weeks
of a community outbreak, with lower rates of absenteeism during the weeks
before and after the peak.

Certain public health measures (e.g., closing schools, quarantining household
contacts of infected individuals, “snow days”) are likely to increase rates of
absenteeism.

The typical incubation period (interval between infection and onset of symptoms)
for influenza is approximately two days.
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
Persons who become ill may shed virus and can transmit infection for up to one
day before the onset of illness. Viral shedding and the risk of transmission will be
greatest during the first two days of illness. Children usually shed the greatest
amount of virus and therefore are likely to pose the greatest risk for transmission.

On average, infected persons will transmit infection to approximately two other
people.

In an affected community, a pandemic outbreak will last about six to eight weeks.

Multiple waves of illness (periods during which community outbreaks occur
across the country) could occur, with each wave lasting two to three months.
Historically, the largest waves have occurred in the fall and winter, but the
seasonality of a pandemic cannot be predicted with certainty.
3-2
Champaign-Urbana Pandemic Annex
Section 4
DIRECTION AND CONTROL
The CUPHD Public Health Administrator is responsible for the direction and control
of all public health activities in coordination with the Champaign County Emergency
Operations Center (EOC).
CUPHD will be the lead agency in the pandemic influenza response per the guidance,
protocols and authorities listed in this Plan. The response will be initiated based on
discussion between the CUPHD Public Health Administrator, the Infectious Disease
and Management Division staff, the Illinois Department of Public Health (IDPH), the
CDC (as appropriate), the Champaign County Emergency Management Agency
(EMA) and the Champaign County Board.
Once Champaign County activates the EOC, CUPHD will coordinate its activities
through the EOC by providing a qualified staff member to serve as the EOC’s Health
Officer.
Champaign-Urbana Pandemic Annex
4-1
Section 5
RESPONSIBILITIES
5.1 Champaign-Urbana Public Health District

Facilitate countywide pandemic planning and preparedness efforts.

Coordinate the community’s emergency public health response through the EOC
and the Champaign County Emergency Operations Plan (EOP).

Educate the public, healthcare system partners, response partners, business,
community-based and organization elected leaders about influenza pandemics,
expected impacts and consequences, and preventive measures.

Provide training and technical support to assist the preparedness planning efforts
of local agencies, community-based organizations (CBOs) and government
entities serving vulnerable populations.

Conduct countywide surveillance to track the spread of the human disease and its
impact on the community. Through liaison with agriculture and wildlife agencies,
facilitate surveillance in animals within Champaign County and monitor
surveillance data.

Identify and declare disease of public health significance and communicate such
declarations to health system partners.

Coordinate planning for and implementation of disease containment strategies and
authorities.

Provide ongoing technical support to the healthcare system, including current
surveillance guidelines, recommendations for clinical case management, infection
control measures and laboratory testing.

Support the healthcare system’s planning and response efforts for medical surge
capacity, including mass casualty and mass fatality incidents.

Support the development and management of local antiviral medication
stockpiles.

Implement protocols for the use of limited supplies of influenza vaccine and
antiviral medications consistent with national guidelines.

Direct distribution and administration of vaccine, including mass vaccination
efforts.

Provide effective communications to the public, the media, elected officials,
healthcare providers, business and community leaders throughout public health
emergencies.
Champaign-Urbana Pandemic Annex
5-1
Section 5
5.2 Specific Responsibilities of Champaign-Urbana
Public Health District Divisions and Sections
5.2.1 Public Health Administrator

Communicate and coordinate directly with the Champaign County Board
Chairperson, Champaign County EMA, executive heads of cities and towns,
Champaign Board of Health and healthcare partners regarding pandemic
preparedness and response activities.

Coordinate directly with healthcare partners and make decisions regarding
strategies, thresholds and methods for reallocating resources, and temporary
restructuring of health system operations in response to a pandemic.

Authorize and communicate public health directives regarding social distancing
strategies and other protective actions to elected leaders, the business community,
schools, healthcare partners and other partners.

Assign responsibilities to CUPHD staff for planning and responding to the
pandemic.

Ensure business continuity of critical CUPHD functions during all phases of the
pandemic.

Direct isolation and quarantine of individuals and groups, as needed, based on
recommendations from the Chief Communicable Disease Investigator.
5.2.2 Emergency Response Planner

Coordinates bioterrorism/public health emergency response planning for CUPHD.

Participates in the development of plans and systems that include all the partners
in the local public health jurisdiction.

Develops public health emergency response plans for CUPHD that are fully
integrated with other local government plans within CUPHD jurisdiction.

Develops and implements simulation exercises to ensure the effectiveness of the
emergency plans and systems for CUPHD.

Collaborates with IDPH, regional staff, CUPHD administrative personnel and
other health departments to develop plans and policies to be able to respond in the
event of a public health emergency.

Prepares, updates and maintains mutual aid agreements with other health-related
agencies and offices within the CUPHD jurisdiction.

Prepares necessary reports describing the activities, accomplishments and status
of emergency response preparedness and planning functions.

Coordinates and facilitates meetings of CUPHD personnel and terrorism task
force partners.
5-2
Champaign-Urbana Pandemic Annex
RESPONSIBILITIES

Writes grant applications and monitors contracts.

Establishes and maintains a cooperative and effective working relationship with
hospitals, EMS agencies, emergency services, government officials, employees
and other health-related partners.

Performs other duties as required.
5.2.3 Public Information Officer

Provide accurate, timely information to the public regarding preparations for a
pandemic, the impacts of the outbreak, local response actions and disease control
recommendations.

Educate the public on how they can protect themselves from becoming infected
and infecting others.

Activate and direct the management of public information call centers focused on
providing health information to the public.
5.2.4 Communicable Disease Control, Epidemiology and
Immunization Section

Carry out countywide surveillance, epidemiological investigation and disease
control activities.

Provide information and technical support on surveillance, epidemiology and
clinical issues—including case identification, laboratory testing, management and
infection control—to healthcare providers and facilities.

Make decisions regarding the need for individual and group isolation and
quarantine.

Work with the CUPHD PIO to develop and disseminate risk communications
messages to the public.

Provide recommendations to the CUPHD Public Health Administrator regarding
measures to sustain the functionality of the local healthcare system.

Advise the CUPHD Public Health Administrator regarding the need for and
potential consequences of social distancing measures.

Coordinate receipt of vaccines in and develop strategies for storage, distribution
and allocation of vaccines among healthcare system partners.

Follow established or recommended modifications to established protocols for
prioritizing limited supplies of antiviral medicines and vaccines in Champaign
County.
Champaign-Urbana Pandemic Annex
5-3
Section 5
5.2.5 Wellness and Health Promotion Division

Lead pandemic planning and preparedness efforts for CUPHD in conjunction with
local, state and federal response partners.

Conduct training, drills and evaluated exercises to enhance CUPHD’s readiness to
respond to a pandemic.

Coordinate planning and response activities with hospitals and community health
clinics in collaboration with the Communicable Disease Investigator and
Infectious Disease Prevention and Management Division.

Advise the CUPHD Public Health Administrator regarding the potential social
and economic impacts of social distancing measures, and the extent to which
implementation of such measures is feasible.

Coordinate department-wide business continuity efforts specific to the potential
impacts of a pandemic.

Coordinate countywide pandemic planning, education and outreach efforts with
school systems, the business community and CBOs.

Coordinate with economic development agencies and chambers of commerce
regarding the economic consequences of a pandemic.
5.2.6 Infectious Disease Prevention and Management Division

Participate in planning activities focused on developing capacity for communitybased influenza evaluation and treatment clinics.

Lead and coordinate all mass vaccination response activities.

Lead efforts with community partners to manage a client care call center.

Develop infection control plans for CUPHD sites, with technical assistance from
the Communicable Disease Investigator, to protect staff and clients.
5.2.7 Environmental Health Division

Assist in surveillance for animal influenza viruses through liaison with the Illinois
State Departments of Agriculture and Natural Resources.

Work with the CUPHD PIO to develop and disseminate risk communications
messages to the public concerning zoonotic influenza virus transmission, food
safety and animal waste disposal issues.
5.2.8 All Divisions and Sections

Identify mission critical functions that must be maintained during all hazards,
including a pandemic.

Identify staff that can be cross-trained to perform emergency response functions.
5-4
Champaign-Urbana Pandemic Annex
RESPONSIBILITIES

Identify functions that can be temporarily discontinued or performed via
telecommuting for several weeks.

Be prepared to mobilize all necessary staff to support the CUPHD pandemic
influenza response, as directed by the CUPHD Public Health Administrator.
5.3 Champaign County Coroner

Lead mass fatality planning and response efforts.

Coordinate with and support hospitals regarding mass fatalities planning and
response.

Incorporate funeral home directors into planning efforts for pandemic response.

In conjunction with community partners, coordinate planning and development of
victim assistance centers.
5.4 Local Hospitals, Clinics, Providers and Other
Health System Partners

Healthcare system partners will participate in a CUPHD Pandemic Flu Committee
facilitated by the CUPHD to maximize the healthcare system’s ability to provide
medical care during a pandemic. Specific steps include:
 Identify and prioritize response issues affecting the countywide healthcare
system during a pandemic.
 Develop mechanisms to efficiently share information and resources between
health system partners, and communicate with CUPHD and relevant
emergency operations centers, as appropriate.
 Coordinate with the CUPHD Public Health Administrator regarding policy
level decisions regarding the operations of the local healthcare system.
 Assure that healthcare professionals receive relevant communications from
CUPHD in a timely manner.

Hospitals and other healthcare facilities will develop pandemic response plans
consistent with the healthcare planning guidance contained in this Plan.
Healthcare facility pandemic response plans will address medical surge capacity
to sustain healthcare delivery capabilities when routine systems are overwhelmed.

Healthcare facilities and healthcare providers will participate in local influenza
surveillance activities.

Hospitals will develop infection control plans to triage and isolate infectious
patients and protect staff from disease transmission.
Champaign-Urbana Pandemic Annex
5-5
Section 5
5.5 Illinois Department of Public Health

Coordinate statewide pandemic planning and preparedness efforts.

Coordinate statewide surveillance activities.

Operate a CDC Laboratory Response Network public health reference laboratory
for novel influenza virus testing.

Coordinate submission of pandemic epidemiological data to the CDC and
dissemination of statewide data situation updates to local health jurisdictions.

Coordinate development and implementation of disease containment strategies
across multiple counties and regions within the state.

Provide state assistance, when available, and request federal assistance to support
the local health and medical response.

Receive antiviral medications and other medical supplies form the Strategic
National Stockpile (SNS) and immediately deploy these supplies to local health
departments and health districts based on population.

Educate and inform the public on the course of the pandemic and preventive
measures.
5.6 United States Department of Health and Human
Services

Provide overall guidance on pandemic influenza planning within the U.S.

Coordinate the national response to an influenza pandemic.

Provide guidance and tools to promote pandemic preparedness planning and
coordination for states and local jurisdictions.

Provide guidance to state and local health departments regarding prioritization of
limited supplies of antiviral medications and vaccines.

Determine and communicate the pandemic phase for the U.S. based on the global
pandemic phase (established by the WHO) and the extent of disease spread
throughout the country.
5.7 Centers for Disease Control and Prevention

Conduct national and international disease surveillance.

Serve as a liaison to the WHO.

Develop reference strains for vaccines and conduct research to understand
transmission and pathogenicity of viruses with pandemic potential.

Develop, evaluate and modify disease control and preventions strategies.
5-6
Champaign-Urbana Pandemic Annex
RESPONSIBILITIES

Support vaccination programs; monitor vaccine safety.

Investigate pandemic outbreaks; define the epidemiology of the disease.

Monitor the nationwide impact of a pandemic.

Coordinate the stockpiling of antiviral drugs and other essential materials within
the SNS.

Activate the SNS when the WHO raises the global pandemic alert level to Phase 4
and deploy antiviral supplies to each state.

Coordinate the implementation of international–U.S. travel restrictions.

Under federal authority, implement isolation, quarantine and social distancing
measures on tribal lands, as needed.
5.8 World Health Organization

Monitor global pandemic conditions and provide information updates.

Facilitate enhanced global pandemic preparedness, surveillance, vaccine
development and health response.

Declare global pandemic phase and adjust phases based on current outbreak
conditions.
Champaign-Urbana Pandemic Annex
5-7
Section 6
CONCEPT OF OPERATIONS
The WHO uses a series of six phases of pandemic alert as a system for informing the
world of the seriousness of the threat and the need to launch progressively more
intense preparedness activities. The organization recently added a post-pandemic
period to the end of their six phases. This Plan divides the six threat phases and the
post-pandemic period into three broader periods. The chart below shows the
comparison of the three broader periods to the phases used by the WHO.
Table 6-1
Pandemic Flu Plan Periods Compared to World Health Organization Phases
Period
WHO Pandemic Phases
Interpandemic/Pandemic Alert
1-5
Pandemic Response
6
Post-Pandemic (Recovery)
Post-Pandemic Period
During the Interpandemic/Pandemic Alert Period, CUPHD will conduct surveillance
and preparedness activities to track any emerging novel viruses and prepare
Champaign County for the health impact of a potential pandemic flu.
During the Pandemic Response Period, CUPHD will undertake response activities to
limit the number of illnesses and deaths, preserve continuity of essential functions for
both government and business, and minimize social disruption and economic losses.
The Post-Pandemic (Recovery) Period will include an assessment of the situation,
bring an end to many response activities, and restore normal services and routines
within Champaign County. A post-pandemic recovery will also require the treatment
of the many physical and psychosocial effects that will have taken a toll on the greater
population. Recovery from a pandemic will begin when it is determined by the
CUPHD Health Administrator that adequate supplies, resources and response system
capacity exist to manage a return to normal activities. In consultation with IDPH,
CUPHD will recommend specific actions to restore the healthcare system to normal
status.
6.1 Interpandemic/Pandemic Alert Period Actions
Table 6-2
Interpandemic/Pandemic Alert Actions
WHO Phase
Actions

Periodically review existing plans (e.g., pandemic flu plan, mass
vaccination/antiviral plan, alternate medical care plans, medical surge plan,
Champaign-Urbana Pandemic Annex
6-1
1
Section 6
WHO Phase
2
Actions

mass casualty plan, etc.)
Continue vaccination efforts for seasonal influenza and pneumonia, if
advisable

Same activities as Phase 1


Same activities as Phase 1 and Phase 2, in addition to the following:
Activate the CUPHD Pandemic Flu Committee composed of key
community response leaders; hospitals; college, university and school
systems. The committee meets quarterly to track the pandemic threat and
develop impact estimates
Prepare and conduct public education/preparedness campaign following
guidance found in the Risk Communication section of the Plan
Plan and conduct pandemic tabletop and functional exercises
Begin stockpiling critical resources (e.g., antivirals, N95 masks, syringes)
based on impact estimates and financial resources available
Review and/or implement pre-disaster contracts for anticipated resource
needs
Select and train CUPHD personnel that will work in the County EOC should
it be activated
Update Medical Reserve Corps contact information. Begin recruiting new
members
The CUPHD Pandemic Flu Committee continues to meet quarterly, or
more frequently as needed, to track the pandemic threat and refine impact
estimates
Increase the emphasis on the public education/preparedness campaign
following guidance found in the Risk Communication section of the plan
Increase emphasis on stockpiling critical resources (e.g., antivirals, N95
masks, syringes) based on impact estimates and financial resources
available
Encourage school systems, colleges and universities to develop distance
learning curriculum should school closures occur in the Pandemic
Response Period
Begin training agencies to conduct fit testing for N95 masks
Continue to review and/or implement pre-disaster contracts for anticipated
resource needs
Update contact information of CUPHD staff and points of contact for key
partners
Cross-train staff to perform multiple critical duties in the event of significant
absenteeism
Update Medical Reserve Corps contact information. Increase emphasis on
recruiting new members
Increase emphasis on community vaccination efforts for seasonal influenza
and pneumonia, if advisable

3









4






5
6-2

Same activities as Phase 4, but with increased emphasis/urgency
Champaign-Urbana Pandemic Annex
CONCEPT OF OPERATIONS
6.2 Pandemic Response Period Actions
The Pandemic Response Period is broken down into six levels describing the local
spread and progression of pandemic flu activity. The primary public health and
emergency measures for each level are summarized in the following tables. The
activities listed in the tables are purposefully general so that response actions can be
modified and updated based on the latest state and federal guidance and
epidemiological information. The response actions in each level build upon activities
of previous levels. These tables do not include risk communication as a response
component. Risk communication is critical enough to warrant a section of its own.

Level 1: Increased and sustained transmission, but outbreaks and the spread of
novel influenza is still outside North America
Table 6-3
Level 1 Pandemic Response Actions
Response
Component
Actions

Pandemic Influenza
and Management





Vaccine/Antivirals



Community
Infection Control
and Healthcare
Planning



CUPHD Pandemic Flu Committee meets weekly, or more frequently as
needed, and distributes situation reports to CUPHD staff and the
Champaign County Board
Coordinate with IDPH and neighboring counties
Implement county employee health monitoring
Monitor status/guidelines for vaccine from CDC and IDPH
If sufficient antivirals are available, activate plan to provide antivirals to
priority groups
If vaccine is available, activate plan to provide vaccination first to priority
groups, and then to the general public
Ensure that law enforcement is capable of providing security for public
health workers and citizens waiting to be vaccinated
Continue vaccination efforts for seasonal influenza and pneumonia, if
advisable
Review federal/state guidance on traveler screening and coordinate with
county stakeholders (e.g., bus, train and air)
Review CDC and state travel alerts and advisories and issue as
appropriate
Recommend home or hospital isolation of recent travelers to affected
countries that have influenza-like illness. Monitor CDC/IDPH websites for
latest guidelines. Recommend home quarantine for contacts of influenzalike cases
Level 2: Outbreaks of novel influenza detected in North America
Table 6-4
Level 2 Pandemic Response Actions
Response
Component
Pandemic Influenza
and Management
Actions

Champaign-Urbana Pandemic Annex
CUPHD Pandemic Flu Committee to meet daily, or as needed, and
distribute situation reports internally to CUPHD staff and the Champaign
6-3
Section 6
Response
Component
Actions








County Board
Review CDC and IDPH guidelines
Continue to coordinate with IDPH and neighboring counties
Coordinate with Champaign County Mental Health Board to activate
mental health response and initiate community support services
Meet with hospitals, Emergency Medical Services (EMS) and EMA to
review plans for alternate medical care and transport
Continue county employee health monitoring
Implement workforce support activities
Assess local resource needs for hospitals and long term care facilities,
and assist in helping them meet those needs
Monitor and disseminate information to healthcare provider groups and
partners
Monitor WHO/CDC/IDPH bulletins and modify surveillance activities, as
needed
Surveillance and
Laboratories

Vaccine/Antivirals

Same activities as Level 1


Same activities as Level 1, in addition to the following:
Review CDC/IDPH guidance on social distancing; limit or suspend public
gatherings, if indicated. Consider closure of schools.
Monitor hospital/urgent care center activity; activate alternate healthcare
delivery plan, if necessary
Community
Infection Control
and Healthcare
Planning


Level 3: First case of novel influenza detected in Champaign County
Table 6-5
Level 3 Pandemic Response Actions
Response
Component
Actions


Pandemic Influenza
and Management
Surveillance and
Laboratories
Vaccine/Antivirals







Community
Infection Control
and Healthcare
Planning
6-4

Same activities as Level 1 and 2, in addition to the following:
Notify IDPH, CDC and neighboring counties of cases identified in
Champaign County, and consult regarding contact tracing. If advisable,
conduct contact tracing and implement appropriate isolation/quarantine
and disease prevention measures
Coordinate with EMA to activate the Champaign County EOC
Same activities as Level 2, in addition the following:
Monitor number of cases and geographic/demographic distribution of
cases
Continue to monitor absenteeism and influenza-like illness
Same activities as Level 1 and 2, in addition to the following:
Administer antivirals, if available, to case(s) and contacts. Consult
CDC/IDPH guidance on appropriate antiviral treatment
Conduct contact tracing of influenza case(s) in coordination with hospitals.
Implement isolation of case(s) and quarantine of contacts; treat with
antivirals as per latest CDC/IDPH guidelines
Implement isolation of all individuals presenting with influenza-like illness
and quarantine of contacts. Monitor CDC/IDPH websites for latest
guidance on isolation/quarantine protocols for influenza-like illness
Champaign-Urbana Pandemic Annex
CONCEPT OF OPERATIONS
Response
Component
Actions





Consider suspension of all public events and closure of schools
Issue travel advisories to limit travel within and outside of county
Monitor healthcare system volume and capacity. Review alternate care
plans and activate, if necessary
Review mass fatalities plan and modify as necessary
Level 4: Epidemic level of novel influenza in Champaign County
Table 6-6
Level 4 Pandemic Response Actions
Response
Component
Pandemic Influenza
and Management
Surveillance and
Laboratories
Actions

Same activities as previous levels


Monitor number of cases, hospitalizations and deaths in the county
Monitor geographic and demographic distribution of cases; if advisable,
continue monitoring absenteeism and influenza-like illness
Monitor and disseminate data reports to providers, surveillance partners
and media
Continue to monitor WHO/CDC/IDPH bulletins and modify surveillance
activities as needed


Vaccine/Antivirals
Community
Infection Control
and Healthcare
Planning


Same activities as previous levels


Same activities as Level 3, in addition to the following:
Monitor CDC/IDPH guidelines for community control measures and modify
pandemic plan as necessary
Review state/federal guidance on traveler screening and suspend
screening, if advisable
Activate or continue operation of alternate care sites
Activate medical surge plan



Level 5: End of first pandemic wave in Champaign County
Table 6-7
Level 5 Pandemic Response Actions
Response
Component
Actions


Pandemic Influenza
and Management



Champaign-Urbana Pandemic Annex
CUPHD Pandemic Flu Committee to meet daily, or as necessary, and
distribute situation reports internally to CUPHD staff and Champaign
County Board
Coordinate with CDC and IDPH to modify pandemic plan in preparation for
second wave
Obtain status reports and feedback from partner agencies on first
pandemic wave
Scale back or suspend activities of alternate care, mass fatalities,
isolation/quarantine and volunteer plans
Review alternate triage, mass fatalities, isolation/quarantine, volunteer,
hotline and mass clinic plans, and modify as needed, in preparation for
6-5
Section 6
Response
Component
Actions






Surveillance and
Laboratories








Vaccine/Antivirals




Community
Infection Control
and Healthcare
Planning






6-6
second wave
Continue monitoring county employee health
Implement workforce support activities for period between pandemic
waves
Assess local resource needs for hospitals and long-term care facilities and
assist in helping them to meet these needs
Same activities as Level 4, in addition to the following:
Evaluate surveillance activities per CDC guidelines
Assess health impact (e.g., number of cases, hospitalizations, deaths,
hardest hit demographics, geographic distribution of cases, etc.)
Assess economic impact (e.g., absenteeism, business and school
closures, etc.)
Assess vaccine/antiviral distribution, coverage and adverse events
Resume sentinel data collection for early detection of second wave
Monitor and disseminate data reports to providers, sentinel partners and
media
If vaccine is available, continue or start mass vaccination efforts. Monitor
status/guidelines for antivirals and vaccine from CDC and IDPH and
modify priority groups and vaccination plan as necessary
Update mass clinic partners and providers on vaccine/antiviral guidelines
and the need to continue mass vaccination in advance of second wave
Access mass clinic supplies and restock as needed
If vaccine is available for the novel virus, activate or continue operating a
plan for mass vaccination to provide vaccination to priority groups and
then the general public. Track doses and monitor inventories, demand,
distribution, costs and adverse events. Otherwise, continue procurement
efforts for vaccine, review the mass vaccination plan and conduct mass
clinic trainings as needed
If sufficient antivirals are available, activate or continue operating a plan
for providing antivirals to priority groups. Monitor inventories, demand,
distribution, costs and adverse events. Otherwise, continue procurement
efforts for antivirals and conduct mass clinic trainings as needed
Continue vaccination for seasonal influenza and pneumonia, if advisable
Review CDC and IDPH guidelines on social distancing measures and
modify pandemic plan as necessary
Lift suspensions on public events, end closures of school and businesses,
if advisable
Consider maintaining suspension or limitations on public gatherings
Consider maintaining travel advisories
Implement isolation of individuals presenting with influenza-like illness and
quarantine of contacts
Monitor CDC/IDPH website for latest guidelines on isolation/quarantine
protocols
Suspend or scale back activities of alternate care and mass fatalities plans
Level 6: Second/Subsequent waves of pandemic flu activity
Champaign-Urbana Pandemic Annex
CONCEPT OF OPERATIONS
Table 6-8
Level 6 Pandemic Response Actions
Actions

Refer to tables for Levels 3 through 5
6.3 Post-Pandemic (Recovery) Period Actions
Table 6-9
Post-Pandemic (Recovery) Actions
Response
Component
Actions




Convene CUPHD Pandemic Flu Committee and review CDC and IDPH
guidelines regarding end of pandemic
Terminate all contingency plans
Conduct debriefings to obtain feedback from CUPHD staff and partner
agencies and organizations (e.g., hospitals, other healthcare providers,
EMA, transportation officials)
Implement support activities for county employees
Participate in EOC debriefing activities
Document lessons learned and disseminate findings to partner agencies;
modify pandemic plan and other contingency plans as needed
Review expenses of response activities and prepare expense report
Terminate surveillance activities
Prepare summaries on morbidity and mortality by demographic subgroups
Evaluate vaccine/antiviral distribution and coverage processes
Assess social and economic impact (e.g., absenteeism, closures, gaps in
essential services and cost estimates)
Obtain feedback from surveillance partners and evaluate surveillance
activities. Incorporate improvements into surveillance plan
Terminate mass vaccination and antiviral plans
Inventory supplies and manage any remaining vaccine/antivirals as
directed by CDC and IDPH
Coordinate with federal, state and county surveillance efforts to assess
vaccine and antiviral coverage, efficacy and safety
Conduct debriefings of mass clinic staff and partners to evaluate clinic
operation. Modify mass vaccination plans as needed
Remove restriction on travel
Lift social distancing measures (e.g., quarantine, closures, suspensions)
Evaluate compliance with, and efficacy of, social distancing measures
Evaluate alternate care/triage operations and mass fatality operations
Champaign-Urbana Pandemic Annex
6-7



Command and
Control
Surveillance and
Laboratories











Vaccine/Antivirals


Community
Infection Control
and Healthcare
Planning
Section 7
PRIORITIZATION OF VACCINES AND ANTIVIRAL
MEDICATIONS
Two federal advisory committees, the National Vaccine Advisory Committee (NVAC)
and the Advisory Committee on Immunization Practices (ACIP), offer guidance for
the distribution and prioritization of vaccines during a pandemic event. While under
normal conditions the distribution of vaccines would be given to those most at risk of
experiencing grave health consequences, a severe pandemic will require the
consideration of additional principles. A pandemic event will have a large effect on
the entire community; therefore, it is essential that public health officials prioritize the
“preservation of a functioning society.”
CUPHD has used NVAC and ACIP’s recommendations as the foundation for local
vaccine and antiviral prioritization planning. In Champaign County, decisions
regarding vaccine and antiviral distribution will be made in close coordination
between CUPHD, IDPH and Champaign County EMA, with additional consultation
from the Champaign County Board of Health and a certified bioethicist. Through a
process that takes careful account of developing local infection rates, those individuals
who are essential to the provision of healthcare, public safety and the maintenance of
critical infrastructure will receive priority in the distribution of vaccines and antivirals.
The following table is the prioritization of vaccine and antiviral distribution during a
pandemic event.
Table 7-1
Prioritization of Vaccine and Antiviral Distribution
Tier
1A
1B
1C
1D
2A
Group Description
Healthcare Workers
 Healthcare workers with direct patient contact and critical healthcare support staff
 Vaccine and antiviral manufacturing personnel
Highest Risk Groups
 Patients 65 and older with at least one high-risk condition
 Patients 6 months to 64 years with at least two high-risk conditions
 Patients hospitalized in the past year because of pneumonia, influenza or another highrisk condition
Household Contacts and Pregnancy
 Household contacts of children under 6 months
 Household contacts of severely immunocompromised individuals
 Pregnant women
Pandemic Responders
 Key government leaders and critical pandemic public health responders
Other High-Risk Groups
 Patients 65 and older with no high-risk conditions
 Patients 6 months to 64 years with one high-risk condition
 Children 6 months to 23 months
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Tier
2B
3
4
7-2
Group Description
Critical Infrastructure Groups
 Other public health emergency responders, public safety workers, utility workers, critical
transportation workers and telecommunications workers
Other Key Government Healthcare Decision-Makers;
Individuals Providing Mortuary Services
Healthy Patients 2 to 64 Years without any High-Risk Condition
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It is highly unlikely that a vaccine will be available when a pandemic begins. This
means that we must be prepared to face the first wave of a pandemic without a
vaccine. Evidence to determine the best strategies for protecting people during a
pandemic is very limited. The CDC has proposed a pandemic mitigation framework
that is based upon the use of infection prevention control and the application of nonpharmaceutical interventions (NPIs). It is recommended that the non-vaccine
mitigation measures be initiated early, before explosive growth of the disease, and in
the case of severe pandemics, that they be maintained consistently during a pandemic
wave within the community.
8.1 Infection Prevention and Control Guidelines for
Non-Healthcare and Healthcare Settings
8.1.1 Overview
This section provides general infection control guidance, including the use of personal
protective equipment (PPE) for both non-healthcare settings (e.g., workplaces, jails,
schools) and healthcare settings.
The CDC, WHO, IDPH and OSHA have all issued guidelines and recommendations
that are consistent with current scientific knowledge and accepted infection prevention
and control practices. These guidelines will undergo modification as more is learned
about the characteristics of the pandemic influenza strain, and as new medications and
vaccines become available. Strategies that may be appropriate at the early onset of the
pandemic, such as isolation and quarantine of individuals suspected or infected with
pandemic flu, may not be sustainable over the course of the pandemic. Supplies may
become scarce, human resources may fluctuate and care delivery may require
modification. After pandemic flu begins circulating in Champaign County, full
community cooperation will be necessary to control the spread of the disease.
The essential goal of infection prevention and control is to minimize the transmission
of illness from infected individuals to uninfected individuals. This is accomplished
through practices designed to prevent the spread of disease throughout all levels of the
community.
This section is divided into two broad categories:

General infection control guidelines for non-healthcare facilities (e.g., businesses,
schools, boarding and care facilities, jails) and home care.

More detailed infection control guidelines for licensed and acute care facilities.
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The primary Infection Control objectives during the Interpandemic/Pandemic Alert
Period are to:

Implement effective control measures to slow the spread of pandemic flu.

Ensure common understanding of appropriate infection control measures across
all levels of care in Champaign County.
Modes of Influenza Transmission
The mode of transmission defines how an infectious viral particle is transmitted from
an infected person (commonly referred to as a source person) to a well person
(commonly referred to as a susceptible person) and causes infection. The major mode
of transmission for influenza is not entirely clear; however, the pattern of person-toperson spread is generally consistent with spread through close contact (e.g., exposure
to large respiratory droplets, direct contact or near-range exposure to aerosols). Some
studies support airborne transmission through small particle aerosols; however, there
is little evidence of airborne transmission over long distances or prolonged periods of
time. Unfortunately, the relative contributions and clinical importance of the different
modes of influenza transmission are currently unknown.

Droplet Transmission – Droplet transmission occurs when a person who has
symptomatic illness, or who is a carrier of the virus, generates droplets containing
virus when they cough, sneeze or talk. These droplets then contact the
conjunctivae (the covering of the eyeball) or the mucous membranes of the nose
or mouth of a susceptible person, causing infection. Transmission via largeparticle droplets (greater than 10 µm in diameter) requires close contact between
source and recipient persons, because droplets do not remain suspended in the air
and generally travel only short distances (about three feet) through the air.
Because droplets do not remain suspended in the air, special air handling and
ventilation are not required to prevent droplet transmission.

Contact Transmission – Direct contact transmission involves skin-to-skin
contact and physical transfer of virus from an infected person to a susceptible
person. Indirect-contact transmission involves contact of a susceptible host with a
contaminated intermediate object—usually inanimate—in the person’s
environment. Transmission via contaminated hands and fomites (inanimate
objects) has been suggested as a contributing factor in some studies; however,
there is insufficient data to determine the proportion of influenza transmission that
is attributable to direct or indirect contact. In an experimental study, influenza
viruses could be transferred from hard, non-porous surfaces such as stainless steel
and plastic to hands for 24 hours, and from tissues to hands for up to 15 minutes.
Virus can survive on hands for up to five minutes after transfer from an
environmental surface. Higher humidity shortens virus survival.

Airborne Transmission – Airborne transmission occurs by dissemination into
the air of either airborne droplet nuclei (less than 5 µm in diameter) or small
particles in the respirable size range containing the infectious agent.
Microorganisms carried in this manner may be dispersed over long distances by
air currents and may be inhaled by susceptible individuals who have not had face-
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to-face interaction with the infectious individual. Organisms transmitted in this
manner must be capable of sustaining infectivity, despite desiccation and
environmental variation that generally limit survival in the airborne state.
Preventing the spread of agents that are transmitted by the airborne route requires
the use of special air handling and ventilation systems (e.g., negative pressure
rooms).

Small Particle Aerosols – There is no evidence that influenza transmission can
occur across long distances (e.g., through ventilation systems) or through
prolonged residence in air, as seen with airborne diseases such as tuberculosis.
However, transmission may occur at shorter distances through inhalation of small
particle aerosols (droplet nuclei), particularly in shared spaces with poor air
circulation.
In summary, the precise mode of transmission and the relative contribution of each
mode of transmission are not known; however, several observations suggest that
influenza is spread primarily through close contact and does not travel long distances.
Our recommendations are thus based on close contact spread.
8.1.2 General Guidelines for Non-Healthcare Settings
Schools, Businesses, Jails, Boarding and Care Facilities, Etc.
The most important element in limiting the spread of influenza is to prevent
introduction of the virus into the respiratory tract. During the alert period and
throughout the pandemic, each facility in Champaign County should establish and
implement basic infection control practices to limit transmission of and exposure to
pandemic influenza. This includes policies, such as those mandating “no work while
sick” and the use of appropriate personal hygiene, to decrease the spread of pandemic
flu in the workplace.
Infection Control Practices to Prevent Spread of Disease
The following recommendations are based on what is known about the modes of
influenza transmission. The most important concept in preventing the spread of
influenza is to prevent the direct and indirect inoculation of the respiratory tract.
There are four major ways to accomplish this:

Protect the well with hand hygiene and personal protective equipment

Hand hygiene:
If hands are visibly soiled, wash them with warm water and soap.
If hands are not visibly soiled, perform hand hygiene.
Perform hand hygiene after contact with a person who may be ill, after
removing mask or gloves, or after touching items or surfaces that may be
soiled.

Persons in contact with individuals suspected to be infected with influenza
(e.g., during transport of an ill person; in the home; in the jails; or in a
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daycare, school or work setting) can protect themselves by doing the
following:
Wear a surgical or procedure mask when in close contact (less than three
feet) with an infectious person. A mask should be changed and discarded
when it becomes moist. Perform hand hygiene after touching or discarding a
mask.
Wear gloves if there is likely to be contact with respiratory secretions.
Discard gloves immediately after use and perform hand hygiene.

Limit contact between infected and uninfected persons
Whenever possible, isolate infected persons. In the workplace or at school,
persons with symptoms of influenza (e.g., fever, headache, muscle aches, cough,
runny nose or sore throat) should be sent home. If they cannot be sent home
immediately, they should be confined to a separate room. If contact between
infected and uninfected cannot be avoided (e.g., during transport in a car), place a
surgical or procedure mask over the nose and mouth of the ill person, and open
the windows to increase air circulation.
For workers uncertain of potential exposure (such as in a day care center), wear a
surgical or procedure mask when in close contact (less than three feet) with a
potentially infectious person. Change the mask when it becomes moist, and
perform hand hygiene after discarding the mask. Wear gloves if there is contact
with respiratory secretions; discard gloves immediately after use and perform
hand hygiene.

Contain infectious respiratory secretions of the ill
All persons with signs and symptoms of a respiratory infection, regardless of
presumed cause, should:

Cover their nose and mouth when coughing or sneezing, preferably with a
tissue or cloth

Use tissues to contain respiratory secretions

Dispose of tissues in the nearest waste receptacle after use

Perform hand hygiene after contact with respiratory secretions and
contaminated objects or materials
Schools, workplaces, businesses and other places where people congregate should
ensure availability of supplies to facilitate use of tissues, proper disposal and hand
hygiene. Wherever possible, such places should:


Provide tissues and garbage receptacles

Provide facilities for hand hygiene (either sink, water and soap, or alcoholbased hand rub dispensers)
Promote air circulation and keep environment clean
Good air circulation has been shown to decrease the chance of spreading
respiratory viruses. When caring for a patient in the home or at a residential
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facility, place the patient in a separate room with an operable window. Keep the
window open as the climate permits, and if necessary use a fan to circulate the
fresh air. UV light can kill the influenza virus; open the shades and allow sunlight
into the room.
Tissues used by the ill person and other waste should be placed in a bag and
disposed of with other household waste.
Laundry may be washed in a standard washing machine with warm or cold water
and detergent. It is not necessary to separate soiled linen and laundry used by a
patient with influenza from other household laundry. Care should be used when
handling soiled laundry (e.g., avoid “hugging” the laundry) to avoid selfcontamination. Hand hygiene should be performed after handling soiled laundry.
Soiled dishes and eating utensils should be washed either in a dishwasher or by
hand with warm water and soap. Separation of eating utensils for use by a patient
with influenza is not necessary.
Environmental surfaces can be cleaned using normal procedures. An EPAregistered hospital disinfectant can be used according to the manufacturer’s
instructions, but is not necessary. There is no evidence to support the widespread
disinfection of the environment or air.
Infection Control Considerations for Specific Settings
The infection control guidance in the previous section is also applicable in each of the
following settings.
Home Care

The use of respiratory hygiene, hand hygiene, cough etiquette, and droplet and
contact precautions are recommended, as possible.
Symptomatic patients who do not require hospitalization should not go to work,
school, childcare centers or other public areas until 14 days after the onset of
symptoms. During this time, the infection prevention recommendations below
should be used to minimize the potential for transmission:

Physically separate the patient with influenza from non-ill persons living in
the home. If more than one person in the home has influenza, all ill persons
can share the same room. Ideally, the patient(s) with influenza should have
his or her (or their) own room with windows that open to increase air
circulation.

The patient should cover his or her mouth and nose with a facial tissue when
coughing or sneezing; wear a surgical mask when uninfected persons enter
the room; or, if unable, uninfected persons should wear a N95 respirator
when entering the room.

When travel outside the home is necessary for a patient (e.g., for medical
care), the patient should cover his or her mouth and nose when coughing and
sneezing, and wear a mask.
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

One person in the home should be the designated caregiver and all others
should limit contact to the extent possible.

Follow general infection control measures described above.
Caregivers should:

Wear disposable gloves when in contact with the ill person’s blood or bodily
fluids—including respiratory secretions or items such as disposable tissues
contaminated with respiratory secretions—and the immediate environment.
Gloves should be removed and discarded immediately after activities
involving contact with blood or body fluids, and hand hygiene should be
performed. Gloves are not intended to replace proper hand hygiene.

Wash hands with soap and water after gloved and ungloved contact with the
ill person’s blood or body fluids—including respiratory secretions or items
such as disposable tissues contaminated with respiratory secretions—and the
ill person’s immediate environment. If soap water is not immediately
accessible, and hands are not visibly soiled with respiratory secretions, blood
or other bodily fluids, then alcohol-based hand hygiene products can be used
after removing gloves. Gloves should never be washed or reused.

Unwashed dishes and utensils should not be shared. Wash dishes and
utensils with warm to hot water and any commercial detergent after each use.
Disposable plates or eating utensils are not necessary.

Clean and disinfect environmental surfaces in the kitchen, bathroom and
bedroom at least daily with a household cleaner diluted and used according to
manufacturer’s instructions. Bleach, if used, should be diluted one part
bleach to 10 parts water. A fresh solution should be mixed daily.

Linens should not be shared between household members until they have
been washed. Wash clothes, bed linens and towels in water at any
temperature, using any commercial laundry product, and dry at an
appropriate fabric temperature. Gloves should be worn when handling soiled
linens.

Dispose of surgical masks and waste soiled with respiratory secretions, blood
or other bodily fluids as normal household waste.

Any rented, non-disposable medical or respiratory equipment should be
placed in a plastic bag and labeled contaminated prior to their return.
Schools and Daycare Providers

Keep sick students, teachers and other workers away from school or daycare
while ill.

If there will be a lag time between when a potentially infectious person is
identified and when he or she can leave school, move him or her to a separate and
well-ventilated room during the waiting period.

Promote respiratory hygiene, cough etiquette and hand hygiene as for any
respiratory infection.
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
Routine environmental cleaning is adequate.
Workplace (See also Non-pharmaceutical Interventions)

Keep sick workers away from the workplace while ill and potentially infectious—
generally up to 14 days from onset of illness. This may be revised to a shorter
period once more is known about the virus.

If there will be a lag time between when a potentially infectious person is
identified and when he or she can leave the workplace, move him or her to a
separate and well-ventilated room during the waiting period.

Promote respiratory hygiene, cough etiquette and hand hygiene as for any
respiratory infection.

Routine environmental cleaning is adequate.
Jails, Correctional Facilities and Locked Wards
Jails, correctional facilities or other locked wards represent unique settings in which
crowding, barrack-style living and freedom of mobility may increase transmission of
influenza. Special care should be taken to identify infectious inmates as early as
possible.

To the extent possible, house inmates in three groups: ill, exposed and those who
are neither.

Keep ill inmates in a well-ventilated room or rooms physically separate from the
remainder of the population.

Avoid allowing jail staff assigned to the ill inmates to float or have any contact
with the second or third groups.

Promote respiratory hygiene, cough etiquette and hand hygiene as for any
respiratory infection.

Once a pandemic is established, considering using masks for all inmates and staff.

Routine environmental cleaning is adequate.
Law Enforcement
Law enforcement personnel—particularly those who may have contact with or
transport ill people, or those who have been potentially exposed to pandemic flu—
should follow law enforcement’s standard procedures for infection control, implement
PPE protocol per departmental policy, and use patrol cars with plastic dividers that
separate officers from suspects or passengers. Follow the infection control guidelines
above—including those for the workplace—in addition to the following:

If contact between infected and uninfected cannot be avoided (e.g., during
transport in a car), place a surgical or procedure mask over the nose and mouth of
the ill person, and open the windows to increase air circulation.

For workers uncertain of potential exposure, wear a surgical or procedure mask
when in close contact or in an enclosed area (less than 3 feet) with a potentially
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infectious person. Change the mask when it becomes moist, washing hands with
soap and water or an alcohol-based hand rub after discarding the mask. Wear
gloves if there is contact with respiratory secretions and discard gloves
immediately after use, washing hands or using an alcohol-based hand rub.

Law enforcement vehicles should be equipped with masks and alcohol hand
sanitizer.
Pre-Hospital Care Situations (Emergency Medical Services/Ambulance Drivers, Etc.)
For ambulance drivers or others who may transport ill patients or suspected cases of
pandemic flu, implement usual standard protocol, in addition to the following:

Screen patients requiring emergency transport for symptoms of influenza.

Follow standard and droplet precautions when transporting symptomatic patients.

Once pandemic influenza has been identified in the community, use N95
respirators for all patient transport.

If possible, place a surgical or procedure mask on the patient to contain droplets
expelled during coughing. If this is not possible (e.g., such action would further
compromise respiratory status or be difficult for the patient to wear), have the
patient cover his or her mouth and nose with tissue when coughing, or use the
most practical alternative to contain respiratory secretions.

Oxygen delivery with a non-rebreather facemask can be used to provide oxygen
support during transport. If needed, positive-pressure ventilation should be
performed using resuscitation bag-valve mask.

Unless medically necessary to support life, aerosol-generating procedures (e.g.,
mechanical ventilation) should be avoided during pre-hospital care.

Optimize the vehicle’s ventilation to increase the volume of air exchange during
transport. When possible, use vehicles that have separate driver and patient
compartments that can provide separate ventilation to each area.

Notify the receiving facility that a patient with possible pandemic influenza is
being transported.

Follow standard operating procedures for routine cleaning of emergency vehicles
and reusable patient care equipment.
8.1.3 General Guidelines for Healthcare Settings (Hospitals,
Health Centers, Etc.)
In addition to the above guidelines, healthcare facilities are encouraged to implement
additional precautions.
Standard Precautions
These precautions should be observed in all patient care interactions, and are designed
to reduce the risk of transmission of microorganisms from both recognized and
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unrecognized sources of infection within healthcare facilities. The precautions apply
to blood and all bodily fluids except sweat regardless of whether or not they contain
visible blood, non-intact skin and mucous membranes. All healthcare facilities and
providers must ensure:

Barriers are used to protect the skin and mucous membranes of the healthcare
worker from contact with the blood and/or bodily fluids of the patient(s).

Availability of PPE, including gowns, gloves, masks and eye protection (see PPE
section below).

Availability of hand washing/hand sanitization stations.
Airborne Precautions
These measures are designed to limit the spread of microorganisms that are small (5
μm or less). Because of their small size, these microorganisms may remain in the air
for long periods of time. Microorganisms carried in this manner can be dispersed
widely by air currents and may be inhaled by a susceptible host in the same room or
over a longer distance, depending on environmental factors. All healthcare facilities
and providers must ensure:

Negative pressure, where available, is utilized in rooms where these patients are
housed.

Protective masks used by personnel are N95 respirators.
Contact Precautions
These measures are designed to limit the transmission of microorganisms that are
spread by skin-to-skin contact or physical transfer of the microorganisms via
unwashed hands or certain inanimate objects in the patient care environment.
All healthcare facilities and providers will ensure PPE utilized include gloves, gowns
for direct contact, and masks if splashing or aerosolization of secretions is anticipated
(see PPE section below).
Droplet Precautions
These measures are designed to limit the transmission of organisms contained in the
droplets generated from the infected person during coughing, sneezing and talking,
and during the performance of certain procedures such as suctioning and
bronchoscopy. These droplets are generally large and are propelled a short distance
through the air and either land directly on the conjunctiva, nasal mucosa or mouth of
another person, or on surfaces where they can contaminate the hands of another
person. The unwashed contaminated hands will spread the pathogen when they touch
the conjunctive, nasal mucosa or mouth of another. Because droplets do not remain
suspended in the air, special air handling and ventilation are not required to prevent
droplet transmission; that is, droplet transmission must not be confused with airborne
transmission. All healthcare facility and providers will ensure:

A N95 respirator and protective eyewear are utilized.
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
PPE includes gloves for direct contact and gowns, if soiling is anticipated.
8.2 Personal Protective Equipment
8.2.1 Overview
During an influenza pandemic, masks and respirators, used in combination with other
NPIs when close contact with someone who has pandemic influenza is expected, may
help reduce the spread of influenza.
A risk assessment to determine necessary PPE and work practices to avoid contact
with blood or bodily fluids will help customize standard precautions to the healthcare
setting of interest. Standard precautions include the use of gloves and facial (e.g.,
nose, mouth and eye) protection by healthcare workers when providing care to
coughing or sneezing patients.
In suggesting the use of these PPEs, CUPHD will follow the IDPH, HHS, OSHA and
CDC interim recommendations based on the best judgment of public health experts
who relied in part on information about the protective value of masks in healthcare
facilities.
Employees whose work involves close contact with humans or animals known or
suspected to be infected with certain types of flu or pandemic influenza must be
provided appropriate PPE. Employees providing direct care to patients known or
suspected of being infected with pandemic influenza, or those employees working
directly with animals known or suspected of being infected with influenza, should use
full barrier PPE.
Full barrier PPE includes:

Respirator at least as protective as a NIOSH-certified N95 respirator*

Gown

Gloves

Eye protection (e.g., face shield or goggles)
Although most employees outside of healthcare or animal control settings will not
need PPE, the need for PPE by employees whose regular duties involve possible
contact with infected humans or animals will be evaluated on a case-by-case basis.
*Respirators should be used in the context of a complete respiratory protection
program as required by OSHA. This includes pre-use medical evaluation, training and
fit testing, as well as seal-checking at time of use to ensure appropriate respirator
selection and use. To be effective, respirators must seal properly to the wearer's face.
Detailed information on respiratory protection programs is available at the following
sites:
http://www.osha.gov/SLTC/etools/respiratory/
http://www.health.state.mn.us/divs/idepc/dtopics/infectioncontrol/rpp/index.html
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8.2.2 Assorted Personal Protective Equipment
Differences between Surgical Masks and Respirators
Although some disposable respirators look similar to surgical masks, it is important
that healthcare workers understand the significant functional difference between
surgical masks and disposable respirators.
Surgical Masks
Surgical masks are not designed to prevent inhalation of airborne contaminants. Their
ability to filter small particles varies greatly and cannot be assured to protect
healthcare workers against airborne infectious agents. Instead, their underlying
purpose is to prevent contamination of a sterile field or work environment by trapping
bacteria and respiratory secretions that are expelled by the wearer (i.e., protecting the
patient against infection from the healthcare worker). Surgical masks are also used as
a physical barrier to protect the healthcare worker from hazards such as splashes of
blood or bodily fluids. Surgical masks should be used once and then thrown away.
When both fluid protection (e.g., blood splashes) and respiratory protection are
needed, a surgical N95 respirator can be used. This respirator is approved by the FDA
and certified by NIOSH.
Respirators
A respirator (e.g., an N95 or higher filtering face piece respirator approved by
NIOSH) is designed to protect people from breathing in very small particles that might
contain viruses. Healthcare workers use respirators when taking care of patients with
diseases that can be spread through the air.
N95 means the filter on the respirator screens out 95 percent of the particles (0.3
microns and larger) that could pass through. To be most effective, these types of
respirators need to fit tightly to the face so that the air is breathed through the filter
material. Fit testing is the usual method for assuring proper fit in workplaces where
respirators are used. Respirators are not designed to form a tight fit on people with
small faces (e.g., children) or people with facial hair. Men who have beards need to
shave before using a respirator.
N95 and higher respirators are less comfortable to wear than facemasks because they
are more difficult to breathe through. Like surgical masks, most N95 respirators
should be worn only once and then discarded.
Particulate respirators can be divided into several types:

Disposable or filtering face piece respirators, in which the entire respirator face
piece is comprised of filter material. It is discarded when it becomes unsuitable
for further use due to excessive breathing resistance (e.g., particulate clogging the
filter), unacceptable contamination/soiling or physical damage.

Reusable or elastomeric respirators, in which the face piece is cleaned, repaired
and reused, but the filter cartridges are discarded and replaced when they become
unsuitable for further use.
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
Powered air-purifying respirators, in which a battery-powered blower pulls
contaminated air through filters, and then moves the filtered air to the wearer.
All respirators used by employees are required to be tested and certified by NIOSH,
which uses very high standards to test and approve respirators for occupational uses.
NIOSH-certified particulate respirators are marked with the manufacturer’s name, part
number, protection provided by the filter (e.g., N95) and “NIOSH.” This information
is printed on the face piece, exhalation valve cover or head straps. If a respirator does
not have these markings, and does not appear on one of the following lists, it has not
been certified by NIOSH.
A list of all NIOSH-certified disposable respirators is available at
http://www.cdc.gov/niosh/npptl/respirators/disp_part/particlist.html.
NIOSH also
maintains a database of all NIOSH-certified respirators regardless of respirator type
(the Certified Equipment List), which can be accessed at the following site:
http://www.cdc.gov/niosh/celintro.html
Goggles/Face Shields
The HHS Pandemic Influenza Plan does not recommend the use of goggles or face
shields for routine contact with patients with pandemic influenza; however, if sprays
or splatters of infectious material are likely, it states that goggles or a face shield
should be worn as recommended for standard precautions.
If a pandemic influenza patient is coughing, any healthcare worker who needs to be
within three feet of the infected patient is likely to encounter sprays of infectious
material. Eye and face protection should be used in this situation, as well as during
the performance of aerosol-generating procedures.
Facemasks are loose fitting, disposable masks that cover the nose and mouth. These
include products labeled as surgical, dental, medical procedure, isolation and laser
masks. Facemasks help stop droplets from being spread by the person wearing them.
They also keep splashes or sprays from reaching the mouth and nose of the person
wearing the facemask. They are not designed to protect the person wearing it against
breathing in very small particles. Facemasks should be used once and then discarded.
Gloves
HHS recommends the use of gloves made of latex, vinyl, nitrile or other synthetic
materials as appropriate, when there is contact with blood and other bodily fluids,
including respiratory secretions. HHS further suggests:

There is no need to double-glove.

Gloves should be removed and discarded after patient care.

Gloves should not be washed or reused.

Hand hygiene should be performed after glove removal.
Because glove supplies may be limited in the event of pandemic influenza, other
barriers such as disposable paper towels should be used when there is limited contact
8-12
Champaign-Urbana Pandemic Annex
MITIGATION STRATEGIES
with respiratory secretions, such as handling used facial tissues. Hand hygiene should
be practiced consistently in this situation.
Indications for, and limitations of, glove use include the following:

Hand contamination may occur as a result of small, undetected holes in
examination gloves.

Contamination may occur during glove removal.

Wearing gloves does not replace the need for hand hygiene.

Failure to remove gloves after caring for a patient may lead to transmission of
microorganisms from one patient to another.
Gowns
Healthcare workers should wear an isolation gown when it is anticipated that soiling
of clothes or uniform with blood or other bodily fluids—including respiratory
secretions—may occur. HHS states that most routine pandemic influenza patient
encounters do not necessitate the use of gowns. Examples of when a gown may be
needed include procedures such as intubation or when closely holding a pediatric
patient.
Isolation gowns can be disposable and made of synthetic material, or reusable and
made of washable cloth.
Gowns should be the appropriate size to fully cover the areas requiring protection.
After patient care is performed, the gown should be removed and placed in a laundry
receptacle or waste container, as appropriate. Hand hygiene should follow.
Additional Personal Protective Equipment Instructions
Materials Management/Equipment Availability
Agencies must ensure that appropriate PPE is available for employee and patient use.
As the pandemic widens, shortages can be anticipated. Agencies must maintain
constant inventory oversight of basic infection control equipment, including gloves,
N95 masks, gowns, waste disposal bags, alcohol-based hand gel and antiseptic hand
wash, tissues and the like. Shortages in other materials are also anticipated. Consider
whether work procedures can be modified to avoid the need for PPE during a
pandemic. Agencies should assess their expected service delivery needs during a
pandemic and consider the current recommended personal protection guidelines. If
personal protection is expected to be necessary during a pandemic, agencies should
follow any applicable OSHA regulations and make arrangements in advance to
evaluate, train and equip employees with the appropriate PPE. Employees that are
issued PPE are required to wear the equipment.
Agencies that have a clear need for PPE during a pandemic (e.g., direct care of
individuals ill with influenza or other critical services where PPE is required) should
consider the gradual stockpiling of nonperishable PPE.
Champaign-Urbana Pandemic Annex
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Section 8
Employees Instruction
Employee education will need to focus on appropriate PPE as well as proper donning
and doffing sequence. Information on immunization and medications used for
prophylaxis as well as review of all isolation precautions will also be needed.
Educational offerings will likely need to be repeated and perhaps revised every three
to six months. To maintain employee interest, it will be necessary to develop different
types of presentations that can be rotated and sent out to remote sites (e.g. ambulatory
care centers).
Patient Education
Handouts will need to be developed on many topics, including infection prevention
and control in a home setting. Instruction on patient home care and self-care will be
critical because of the expected surge in patients and overcrowding of healthcare
facilities. Non-critical patients should be encouraged not to come to hospitals or
healthcare centers. Information and fact sheets on immunization and prophylactic
medications will also be needed.
Other recommended actions include:

Plan education for all levels of employees on newly developed policies as well as
influenza

Promote influenza vaccination for all employees

Institute “Cover your Cough” signage

Develop strategies to provide masks, tissues and appropriate disposal containers
in emergency departments and ambulatory care sites

Strongly encourage immunization and provide healthcare workers with
immunization free of charge

Reinforce existing policies for respiratory hygiene, isolation precautions and hand
hygiene

Educate healthcare workers to facilitate rapid identification of potential cases of
influenza due to a novel strain with pandemic potential

Increase surveillance for flu-like illness

Assess current levels of N95 mask availability and begin to consider some
stockpiling

Develop teaching handouts to address issues related to home care of patients with
influenza, antiviral medication, influenza vaccine declination forms and symptom
diaries

Maintain close contact with CUPHD and other healthcare infection control and
prevention practitioners in Champaign County

Conduct frequent review of current literature to ensure that the most recent
recommendations have been considered in the development of any policies,
procedures, or patient and employee management recommendations
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Champaign-Urbana Pandemic Annex
MITIGATION STRATEGIES
Signage and Policy Implementation
Daily rounds will be needed to ensure that signs are posted in necessary locations and
in a variety of languages. Waiting areas will need to have a supply of tissues and/or
masks as well as appropriate disposal containers.
Patient Management
As more patients present for care, the number of negative pressure isolation rooms
will not be adequate. Thought must be given to housing patients in designated areas.
The optimal characteristics for a designated area would include:

Ability to create negative pressure rooms within this area

Ability to limit access to the area

Room for storage/stockpiling of supplies

Ability to house more than one person within the room
Criteria for placing patients on this floor, as well as assigning staff to this floor, will
need to ensure that patients have documented illness with the pandemic influenza, and
staff will need to have received full immunization. Administration will need to
consider whether assignment to these areas will be voluntary or mandatory.
Nutrition, Laundry and Environmental Services
At this time, there is no recommendation regarding the use of disposable dishes and
eating utensils. Standard precautions should be observed when handling dishes and
utensils used by patients with influenza. Laundry should also be handled using
standard precautions. No additional precautions are recommended at this time.
Cleaning and disinfection of environmental surfaces are important infection control
measures in healthcare facilities. In addition to routine daily environmental
decontamination, healthcare personnel should perform more frequent disinfection of
commonly touched surfaces in patient rooms and common areas. All rooms should be
terminally cleaned after discharge.
Postmortem Care
Standard precautions should be followed when caring for deceased persons. If
autopsy or other procedures are performed on a person suspected or known to have
died from pandemic influenza, a Personal Air Purifying Respirator (PAPR) should be
utilized.
8.2.3 Pandemic Response Period
General
During the peak of the pandemic it may be necessary to establish a triage center
outside of the entrance to the emergency department or health center. This area would
need to be staffed and equipped to screen patients and direct them to an appropriate
Champaign-Urbana Pandemic Annex
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Section 8
treatment area. Separate areas will be needed for persons with influenza-like
symptoms and persons needing to be seen for other healthcare issues.
Patients should be managed according to all previously outlined precautions.
Additionally, a secure method to transition patients out of the hospital and into
alternate care sites and/or home care will be needed.
The goal of infection prevention and control in the alternate care sites will be to limit
the transmission of virus within and out of the site. Sites are expected to have staffing
mixes (healthcare professionals and volunteers) and no special air handling capacities,
so strict attention must be paid to respiratory etiquette, hand hygiene, droplet and
contact precautions. Whenever possible, symptomatic persons awaiting examination
and diagnosis should be masked and separated from those persons being seen for other
reasons.
During this period, infection prevention and control activities will be focused on:

Participation in any daily meetings regarding bed utilization and patient
management

Enforcing all infection prevention and control recommendations

Meeting all requirements regarding reporting to local, state and federal agencies
as required by law

Facilitating patient transfer when needed

Daily rounds to ensure that all cases are reported and appropriate infection
prevention measures are in place

Provision of immunization and/or prophylactic medication to all hospital and
health center employees

Monitoring employee sick calls and employees who have received either
vaccination and/or prophylaxis

Serving as a clearinghouse for current information and treatment guidelines, and
distributing educational materials as needed

Frequent assessment of supplies—work in close collaboration with materials
management and pharmacy

Attending all countywide meetings as required

Assisting and facilitating discussions regarding patient care and resource
allocation
Nutrition, Laundry and Environmental Services
Although no recommendation exists for the use of disposable utensils and dishes, it
may be necessary to utilize them as the pandemic spreads and the potential for
shortages increases within the nutrition services departments. Laundry should
continue to be handled using standard precautions until such time as additional
precautions are recommended. As the pandemic spreads there may be shortages or
delay in laundry delivery and creative alternatives may be needed. Cleaning and
8-16
Champaign-Urbana Pandemic Annex
MITIGATION STRATEGIES
disinfection of environmental surfaces are important infection control measures in
healthcare facilities. In addition to routine daily environmental decontamination,
healthcare personnel should perform more frequent disinfection of commonly touched
surfaces in patient rooms and common areas. All rooms should be terminally cleaned
after discharge.
Postmortem Care
Standard precautions should be followed when caring for deceased persons.
Autopsies will likely not be done and there may be large numbers of bodies requiring
storage. It may be necessary to have an alternative morgue set up.
Human Resources
As the pandemic progresses, manpower will be stretched and it will likely become
necessary to utilize volunteer physicians and nurses and to cross-train employees to do
alternate jobs. All individuals will need specific infection control training to ensure
policies and procedures are followed.
Employee Health
During a pandemic, employee health strategies will be in effect. As the pandemic
peaks, methods will need to be developed to screen healthcare workers for influenzalike illness at the start of their shift. Additionally, it will be necessary to establish
return-to-work criteria for employees.
8.2.4 Post-Pandemic (Recovery) Period
Continue infection control activities per normal operations.
8.3 Non-Pharmaceutical Intervention
8.3.1 Overview
According to the CDC, it is highly unlikely that the most effective tool for mitigating a
pandemic (i.e., a well-matched pandemic strain vaccine) will be available when a
pandemic begins. This means that we must be prepared to face the first wave of the
pandemic without a vaccine and potentially without sufficient quantities of influenza
antiviral medications. In addition, it is not known if current influenza antiviral
medications will be effective against a future pandemic strain.
With that caution as a planning assumption, it is clear that a combination of
pharmaceutical and NPIs, during the duration of the pandemic, must be used to reduce
the number of persons infected. NPIs may help reduce the number of infected persons
by reducing contact between infected and uninfected persons. Reducing the number
of persons infected will, in turn, lessen the need for healthcare services and minimize
the impact of a pandemic on the economy and society.
Champaign-Urbana Pandemic Annex
8-17
Section 8
NPIs refer to measures that attempt to slow introduction of disease and subsequent
transmission until more definitive public health measures (e.g., antivirals and vaccine)
are available. The major goals of promoting the use of NPIs are to:

Delay the increase of cases in order to “buy time” for production and distribution
of a well-matched pandemic strain vaccine

Decrease the pandemic peak (the highest number of cases at a given time)

Reduce the total number of cases, thus reducing illness and death

Decrease demand for medical services at the peak of the epidemic and throughout
the epidemic wave

Protect health workers and first responders to ensure the well-being of the
Champaign County community
CUPHD will make decisions about which NPIs should be used carefully, recognizing
that there will be consequences of the interventions, such as increased workplace
absenteeism related to child-minding responsibilities if schools dismiss students and
childcare programs close.
8.3.2 Non-Pharmaceutical Intervention Community Control
Measures
No intervention short of mass vaccination of the public will dramatically reduce
transmission when used alone. Mathematical modeling of pandemic influenza
scenarios in the U.S., however, suggests that pandemic mitigation strategies utilizing
multiple NPIs may decrease transmission substantially and that even greater
reductions may be achieved when such measures are combined with the targeted use
of antiviral medications for treatment and prophylaxis. Recent preliminary analyses of
cities affected by the 1918 pandemic show a highly significant association between the
early use of multiple NPIs and reductions in peak cases.
These measures are to be initiated early, before explosive growth of the epidemic, and,
in the case of severe pandemics, should be maintained consistently during an epidemic
wave in a community. CUPHD will consider the following NPIs, depending on the
phase and severity of the pandemic:

Isolation and treatment (as appropriate) with influenza antiviral medications of all
persons with confirmed or probable pandemic influenza. Isolation may occur in
the home, healthcare setting or alternate care site, depending on the severity of an
individual’s illness and/or the current capacity of the healthcare infrastructure.

Voluntary home quarantine of members of households with confirmed or
probable influenza case(s). Consider combining this intervention with the
prophylactic use of antiviral medications, providing that sufficient quantities of
effective medications exist and that a feasible means of distributing them is in
place.

Social distancing for children/students, such as dismissal of students from
school—including public and private schools, as well as colleges and
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Champaign-Urbana Pandemic Annex
MITIGATION STRATEGIES
universities—and school-based activities, in addition to closure of childcare
programs. This should be coupled with protecting children and teenagers through
social distancing in the community to achieve reductions of out-of-school social
contacts and community mixing.

Use of social distancing measures to reduce contact between adults in the
community and workplace (e.g., cancellation of large public gatherings, and
alteration of workplace environments and schedules to decrease social density and
preserve a healthy workplace to the greatest extent possible without disrupting
essential services).

Travel restrictions to reduce contact between Champaign County residents and
travelers arriving at Willard Airport and bus and train stations from outside the
area, state or country.

Promotion of individual infection control measures, such as hand hygiene and
cough etiquette, and use of PPE such as masks or respirators by first responders
and health workers to limit the spread of the disease.

Public education, which will reduce the demand for medical services throughout
the epidemic.

Measures to assist essential services to continue operating.
Enforcement of Isolation, Quarantine, Social Distancing and Travel
Restrictions
The CUPHD Public Health Administrator has broad authority to act to protect the
health and welfare of the community. Based on the SARS experience in 2003, it is
anticipated that individuals will comply with social distancing orders such as isolation
or quarantine. In rare instances, it may be necessary to enforce isolation or quarantine
orders.
To prepare law enforcement to respond to a pandemic, CUPHD will:

Inform law enforcement about Health Officer authority to order isolation,
quarantine and social distancing measures

Establish mechanisms of communication between CUPHD and law enforcement

Instruct law enforcement on PPE should they be called upon to enforce isolation,
quarantine or social distancing measures

Request law enforcement assistance with any of the following:

Enforce isolation and quarantine orders

Assist to provide security at private and public hospitals

Provide perimeter security at isolation/quarantine alternate care sites

Provide security (escort) for physicians, EMS personnel, ambulance
personnel, other care providers or support personnel, as required

Conduct area evacuations and secure evacuated areas
Champaign-Urbana Pandemic Annex
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Section 8

Evacuate and secure public assembly venues when social distancing is
required by Public Health Order or other declaration
8.3.3 Criteria for Determining Community Control Measures
Actual decisions about how to protect the public before an effective vaccine is
available and/or when limited pharmaceuticals are available will be based on a
complex number of factors present at the time of the pandemic. In addition to the
severity and phase of a pandemic, the following factors will help guide health officials
on which NPIs should be used.

Ethical considerations

Impact of the NPIs on society as a whole, on specific subpopulations, the
healthcare delivery system and critical infrastructure

Benefits of the interventions

Available resources

Feasibility of success based on such things as the community’s ability and
likelihood to comply

Direct and indirect costs

Common sense

The public’s perspective of the protective measures

Guidance and coordination with IDPH and neighboring counties
As was presented in the Introduction, the CDC has developed the PSI to introduce
categories of pandemic intensity, similar to the system used to measure hurricane
strength. The following table presents recommended NPIs within the context of the
PSI.
Table 8-1
Non-Pharmaceutical Intervention Recommendations Based on Pandemic Severity Index
PSI
Interventions by Setting
Home
Voluntary isolation of ill at home (adults and
children); combine with use of antiviral
treatment as available and indicated
Voluntary quarantine of household
members in homes with ill persons (adults
and children); consider combining with
antiviral prophylaxis if effective, feasible and
sufficient quantities
School
Child Social Distancing
8-20
1
2 and 3
4 and 5
Recommend
Recommend
Recommend
Generally Not
Recommended
Consider
Recommend
Champaign-Urbana Pandemic Annex
MITIGATION STRATEGIES
PSI
- Dismissal of students from schools and
school-based activities and closure of child
care programs
- Reduce out-of-school social contacts and
community mixing
Workplace/Community
Adult Social Distancing
- Decrease number of social contacts (e.g.,
encourage teleconferences and alternatives
to face-to-face meetings)
- Increase distance between persons (e.g.,
reduce density in public transit, workplace)
- Modify, postpone or cancel selected public
gatherings to promote social distance (e.g.,
postpone indoor arena events, theater
performances)
- Modify workplace schedules and practices
(e.g., telework, stagger shifts)
Champaign-Urbana Pandemic Annex
Generally Not
Recommended
Consider
< 4 weeks
Recommend <
12 weeks
Generally Not
Recommended
Consider
< 4 weeks
Recommend <
12 weeks
Generally Not
Recommended
Consider
Recommend
Generally Not
Recommended
Consider
Recommend
Generally Not
Recommended
Consider
Recommend
Generally Not
Recommended
Consider
Recommend
8-21
Section 9
RISK COMMUNICATION
9.1 Overview
Risk communication and public education play a vital role in pandemic flu
preparedness and response. Strong risk communication and public outreach activities
help build trust, confidence and cooperation, and support effective preparedness and
response efforts.
Dissemination and sharing of timely and accurate information will be one of the most
important facets of the pandemic response. Instructing the public and partners in
actions they can take to minimize their risk of exposure, or actions to take if they have
been exposed, will reduce the spread of the pandemic and may also serve to reduce
anxiety and unnecessary demands on vital services.
This section will help guide and prepare the CUPHD in communicating key messages
to the general public, the news media, healthcare providers and other partners and
stakeholders (e.g., first responders, law enforcement, local government, schools and
businesses) before, during and after a pandemic influenza.
9.1.1 Coordination
The CUPHD PIO will—in consultation with the CUPHD Public Health Administrator,
the Infectious Disease and Management Division staff, the IDPH and the CDC, as
appropriate—identify public health issues and concerns that will need to be addressed
or may need to be addressed through public information messages regarding pandemic
influenza, as well as identify affected target audiences for messages.
CUPHD will also coordinate, as appropriate, dissemination of information with the
County PIO and Champaign County EMA (see the Champaign County EOP for more
information).
9.1.2 Risk Communication Principles
In all emergency communication efforts, CUPHD will make every effort to adhere to
risk communication and ethics principles:

Be first, be right and be credible. Balance the public’s “need to know” in a timely
manner with the need to ensure that information is accurate.

Engage the public in a manner that allows non-expert citizens to combine
technical facts with their values.

Provide enough information to create “transparency” so that the public
understands how decisions are made, who is making the decisions, and where the
resources are going.
Champaign-Urbana Pandemic Annex
9-1
Section 9
9.1.3 Risk Communication Planning Assumptions and
Considerations

An influenza pandemic will generate intense and sustained demand for
information from the public, healthcare providers, policy makers and the news
media.

Informing healthcare providers and the public about influenza disease and the
course of the pandemic, the ability to treat mild illness at home, and the
availability of antivirals and vaccine will be important to ensuring appropriate use
of medical resources. It will also help to avoid possible panic or overwhelming of
vaccine delivery sites.

Effective communication with community leaders and the media is important to
maintain public awareness, avoid social disruption and provide information on
evolving pandemic response activities. Spokespersons need to acknowledge the
anxiety, distress and grief people will experience during a major public health
crisis such as a pandemic.

Communication efforts will be directed to rapid sharing of appropriate, up-to-date
information on the progression of the outbreak, the possible disruptions to
routines and events, and contingency measures.

The public must be provided as much information as possible to help them
understand that uncertainty is part of the process and that answers may change as
new information and science becomes available.

Emergency communication is approved by the CUPHD Public Health
Administrator or the Administrator’s designee.

All government and non-government resources will use a single source of
information on Champaign County’s position regarding the emergency.

Federal partners at the CDC and HHS will provide regular updates regarding the
pandemic.

Local information will be provided to IDPH through existing reporting systems
from local sources, such as local health departments, hospitals, physician’s offices
and schools.

Coordination of release of information among federal, state and local health
officials is critical to avoid confusion that can undermine public trust, raise fear
and anxiety, and impede response measures.
9.1.4 Vulnerable Population Considerations
CUPHD is committed to providing healthcare services to those in need and most
vulnerable, and actively seeks to do so. Including vulnerable populations and the
organizations that serve them in pandemic flu risk communication planning is
consistent with CUPHD’s mission to improve the health, safety and well-being of the
community through prevention, education, collaboration and regulation.
9-2
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION
The following issues will be taken into consideration as preparedness and response
actions are implemented:

Key messages delivered in multiple languages (e.g., English and Spanish, and
others as resources allow)

Key messages delivered using multiple communication modes

Key messages delivered through grassroots mechanisms (e.g., community- and
faith-based) to people who are homeless, geographically or culturally isolated

Key messages delivered to people who are homebound, including those with
services (e.g., Senior Transportation, First Call for Help) and without services
9.1.5 Desired Outcomes
Provide timely and accurate pre-event information to the public about pandemic
influenza, pandemic influenza preparedness and actions, and CUPHD plans.
During a pandemic event, provide the most current and accurate information,
including what is happening, what is being done and what people can do to protect
themselves.
9.2 Communications Infrastructure
CUPHD will use a range of communication methods, as appropriate, to notify
CUPHD staff, health providers, first responders, partners, stakeholders, the public and
the media of changes in pandemic flu stages, and recommend actions, such as the use
of PPE and social distancing.
9.2.1 Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Test local communication systems through training, drills and exercises to ensure
that local and statewide communications are functional

Establish and maintain health provider contact information

Maintain fax and email contact list for media

Maintain fax and email contact list for CBOs

Maintain contact list for business and industry partners, schools and colleges, day
care providers, organizations that serve vulnerable populations, etc.
9.2.2 Pandemic Response Period
During a pandemic, CUPHD will follow WHO, HHS, CDC and IDPH guidance to
issue recommendations locally, and will:
Champaign-Urbana Pandemic Annex
9-3
Section 9

Use CUPHD communication methods to notify hospitals, public and private
healthcare providers, first responders, other appropriate PIOs, and other public
and private sector partners and stakeholders of the change in pandemic stage

Implement contingency plans, if any, for obtaining critical hardware, software or
personnel to expand communication systems if needed for a pandemic

Maintain ongoing communication with healthcare providers, first responders, and
all partners and stakeholders, including posting information on the CUPHD
website
9.2.3 Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in after action reports (AARs)

Return to Interpandemic/Pandemic Alert Period activities
9.3 Communicating with the General Public
9.3.1 Message Development
Messages are developed with key CUPHD staff and are approved by the CUPHD
Public Health Administrator or the Administrator’s designee, and, as appropriate, with
the IDPH. CUPHD also will coordinate, as appropriate, with the Champaign County
EMA.
During the course of pre-event activities and especially during a pandemic influenza
event, messages and other information will be updated and customized.
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Develop key messages for printed materials, public presentations and the media

Provide a solid foundation of information upon which future actions can be based

Develop key messages to address CUPHD activities, including planning efforts,
as well as avian or swine influenza education, pandemic influenza and general
preparations
Pandemic Response Period
During this period, CUPHD will:

Update and further develop key messages as the situation warrants

Develop messages to be used primarily for communicating key actions to the
general public through the media

Post materials to the CUPHD website as they are developed
9-4
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Return to Interpandemic/Pandemic Alert Period activities
9.3.2 Public Education and Awareness Campaign
The public is more likely to respond and cooperate more readily if they are involved in
the discussions and planning for pandemic influenza; have general knowledge of the
situation; are aware of the issues and concerns that are to be addressed; and understand
their individual roles and responsibilities. Planning checklists for individuals and
families, workplace, schools, healthcare providers, and community and faith-based
organizations have been created and are posted on the CDC pandemic flu web page
(http://www.pandemicflu.gov/plan/checklists.html).
Interpandemic/Pandemic Alert Period
During this period, CUPHD will conduct a public education and awareness campaign
as resources allow. Key messages are used in the various components of the
campaign, which is directed at the general public and conducted in both English and
Spanish.
Pandemic Response Period
During this period, CUPHD will:

Continue and increase public education and awareness campaign as resources
allow. Key messages are used in the various components of the campaign, which
is directed at the general public and conducted in both English and Spanish

Use pandemic flu information materials available in Amharic, Arabic, Chinese,
Farsi, Russian and Vietnamese on the CDC’s pandemic flu website
(www.pandemicflu.gov)

Update current materials and develop new materials as the situation warrants.
Updated materials will be posted as they are developed to the CUPHD website,
the Health Emergency Information Line (HEIL), etc.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Return to Interpandemic/Pandemic Alert Period activities
9.3.3 Message Dissemination
Depending on resources, the following tools may be used to disseminate the message:
Champaign-Urbana Pandemic Annex
9-5
Section 9

Educational materials on pandemic flu

Media campaigns

Bill inserts

Web postings

Phone scripts

Radio ads and Public Service Announcements (PSAs)

Print ads

Theater and mall signs

Bus shelters, bus interior signs and bus boards

Billboards

Television ads

Emergency alerts such as ChampCoPrepares.com

Speakers bureau

Collateral materials/handouts

Special events/venues such as health fairs, public meetings, etc.

Direct mail

HEIL, if created
9.4 Working with the Media
9.4.1 Communicating with the Media
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Develop a packet of materials for the media, including CUPHD materials as well
as approved outside materials. These materials include samples of public
education materials, and guidelines for planning and personal protection.

Hold informational meetings with the media to educate them on Champaign
County preparedness activities, pandemic influenza and their role in helping
CUPHD educate the public on the pandemic threat.
Pandemic Response Period
During this period, CUPHD will communicate regularly with media to disseminate
updated public information and risk communication materials about pandemic flu as
part of ongoing media outreach through press releases, web postings, media interviews
and press conferences.
9-6
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective action steps identified in AARs

Update materials as needed

Return to Interpandemic/Pandemic Alert Period activities
9.4.2 Spokesperson Training
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Identify, train and drill CUPHD and other county spokespersons on specific
pandemic influenza risk communications

Conduct an informational training with healthcare provider PIOs and appropriate
members of the county’s PIOs
Pandemic Response Period
During this period, CUPHD will distribute to spokespersons updated public
information and risk communication materials about pandemic flu as part of ongoing
public outreach.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed

Return to Interpandemic/Pandemic Alert Period activities as appropriate
9.5 Coordinating with Healthcare Public Information
Officers
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Maintain a hospital PIO contact list

Provide the hospital PIOs with pandemic influenza materials and updates
Pandemic Response Period
During this period, CUPHD will:
Champaign-Urbana Pandemic Annex
9-7
Section 9

Communicate regularly with hospital PIOs about CUPHD activities as well as any
new developments regarding avian, swine and/or pandemic flu. Healthcare PIO
information will be communicated primarily through email and fax, as
appropriate

Provide updated public information and risk communication materials about
pandemic flu regularly as part of ongoing public outreach
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed

Return to Interpandemic/Pandemic Alert Period activities as appropriate
9.6 Communicating with Key Partners
The CUPHD PIO provides support to CUPHD staff and programs that are primarily
responsible for outreach, coordination and content development with key partners and
stakeholders. These key partners include the Champaign County Board, businesses,
local governments, Parkland College and the University of Illinois at UrbanaChampaign, community-based and faith-based organizations, Champaign County
Corner, county government, emergency medical services and pre-hospital responders,
fire services, Champaign County legal/court system, law enforcement agencies, local
healthcare system, mental health facilities, news media, University of Illinois-Willard
Airport, local transit and area schools.
Interpandemic/Pandemic Alert Period
During this period, CUPHD will:

Maintain contact lists for business and industry partners, schools and colleges,
day care centers, organizations that serve vulnerable populations, etc.

Make existing materials available for distribution. Key partners may use these
materials for distribution to employees, customers, clients, vendors, students, etc.
Post all information to the CUPHD website.
Pandemic Response Period
During this period, CUPHD will distribute regularly, as part of ongoing public
outreach, updated information and risk communication materials about pandemic flu.
Post-Pandemic (Recovery) Period
During this period, CUPHD will:

Take appropriate corrective steps identified in AARs

Update training and materials as needed
9-8
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION

Return to Interpandemic/Pandemic Alert Period activities as appropriate
9.7 Risk Communication/Public Education Strategies
and Key Messages
CUPHD will use the following communication strategies as appropriate to notify
providers, first responders, partners, stakeholders, the public and the media of changes
in pandemic flu stages, and inform them of recommended actions to prepare for,
prevent, respond to and recover from pandemic flu. Based on federal and state
guidance, and in consultation with the CUPHD Public Administrator and CUPHD
Infectious Disease Division, the CUPHD PIO will perform public education activities
and disseminate information on recommended actions to the public, such as the use of
PPE, school dismissal or closures, and other risk reduction measures.
9.7.1 Interpandemic/Pandemic Alert Period
Strategy
The CUPHD PIO and staff will prepare to respond to a pandemic through the
following activities and strategies:

Conduct community education and media campaigns on pandemic flu, disease
prevention and CUPHD preparedness activities.

Work with schools, child care providers, law enforcement and volunteer
organizations (e.g., American Red Cross) to coordinate pandemic flu
preparedness and response plans.

Maintain and update the pandemic flu plan components as needed, including fact
sheets, media contact lists and website.

Create and maintain a pandemic preparedness page on the CUPHD website.

Create and update pandemic flu messages to be activated when needed on the
HEIL.

Designate and train appropriate pandemic spokespersons.

Develop pandemic flu materials for advice nurses and staff should a Health
Emergency Call Center be created.

Educate CUPHD staff about pandemic flu planning, preparedness and response.
Key Messages

General public education about pandemic flu.

What to consider when preparing for a pandemic (home, business, etc.).

Champaign County and CUPHD is planning for the event of pandemic influenza.
Champaign-Urbana Pandemic Annex
9-9
Section 9

Planning is not just a government issue. Every resident and business must take
responsibility to prepare themselves, their families and their business for
pandemic influenza.

Practice good hygiene habits such as hand washing and covering coughs and
sneezes with a tissue or sleeve to prevent the spread of germs.

Promote seasonal flu and pneumonia vaccination.

Encourage residents to
ChampCoPrepares.com.
sign
up
for
local
emergency
alerts
on
9.7.2 Pandemic Response Period
Strategy
During this period, communicating information to the public in a timely and accurate
manner will be essential to ensure compliance with health directives. CUPHD will
use a variety of strategies to communicate with partners and the public to provide
appropriate messages. To get information out quickly, CUPHD will use a number of
redundant communications methods, including the following:

If created, update the HEIL on a regular basis as appropriate.

Activate Health Emergency Call Center, as needed.

Modify and update written materials (e.g., fact sheets, materials for schools) as
needed.

Post documents intended for electronic distribution on CIPHD website.

Provide press releases, web postings, media interviews and press conferences for
media on a timely basis.

Implement public information campaigns by creating PSAs to air on local cable
and satellite television, as well as broadcast media.

Provide advice nurses, call center staff and any phone answerers with latest
pandemic flu information on prevention, treatment, etc.

Alert schools, child care providers, law enforcement and other local public and
private agencies of the need to activate their own pandemic flu response plans.

Provide risk communication guidance to hospitals in Champaign County.

Disseminate guidelines on influenza precautions for workplaces, healthcare
facilities, schools, jails and prisons, public safety agencies and individuals.

Provide internal information to employees through the Intranet, All Staff email
messages, the media and other mechanisms.

Communicate with partners and stakeholders (including Champaign County
Board) and keep them updated, including if and when school and child care
closures or dismissals are needed.
9-10
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION

Coordinate messages with appropriate agencies, such as the Champaign County
EMA, IDPH, CDC and law enforcement agencies.

Identify contact person (and backup person) for communication with IDPH
communication staff.

Use PIO mutual aid as necessary; however, be aware that in a pandemic every
county across the U.S. will be hit at approximately the same time. Relying on
mutual aid will likely be a risky strategy.

Staff the PIO position at the Champaign County EOC and/or Joint Information
Center (JIC) as needed.
Key Messages

Projected severity of the novel virus.

Current surveillance information.

Travel alert information received from the state and/or CDC.

Provide updates about Champaign County, Illinois State and federal response
activities.

Announce the availability of a telephone hotline and website updates.

Update public about critical services that are still available.

Disseminate information about how to stop the spread of the disease. These
should be risk reduction tips and other instructions to the general public,
healthcare providers, first responders, and partners and stakeholders, and should
include the importance of hand washing, social distancing and other NPIs, as
appropriate.

Offer suggestions on how to care for sick family members.

Provide information about isolation and quarantine.

Declare school and business closures as necessary.

Provide updates on the availability/status of antiviral medications and/or vaccines.

Provide information on how and where to get antiviral medications and/or
vaccines, if available.

Communicate with and update healthcare providers on:

Pandemic flu status

Screening

Infection control

Reporting

Treatment

Lab protocols
Champaign-Urbana Pandemic Annex
9-11
Section 9


Vaccine/antiviral status and priority groups
Provide updated guidance on infection control, health monitoring and precautions
to businesses, schools and the general public.
9.7.3 Post-Pandemic (Recovery) Period
Strategy
A pandemic flu is predicted to come in waves; the recovery period may be delayed by
several waves. CUPHD’s goal is to return CUPHD services to normal as quickly as
possible. Recovery period activities will include:

Return website to normal function

Deactivate communication tools specifically activated for the pandemic. These
may include HEIL and the Health Emergency Call Center

Have the public, media and key partners prepare AARs on how well CUPHD
performed during the pandemic event; correct deficiencies identified in the AARs

Update fact sheets and appropriate materials

Evaluate media coverage

Return to Interpandemic/Pandemic Alert Period activities
Key Messages

Officially declare the pandemic over and summarize the impact on the county and
the county’s preparedness and response efforts.

Announce the deactivation of any communication tools specifically activated for
the pandemic.

Continue messages on importance of hygiene to prevent flu and other illnesses.

Continue messages to promote seasonal flu and pneumonia vaccinations.

Provide information regarding community resources and strategies for
psychosocial effects.
9.8 Risk Communication Guidance for Hospitals
9.8.1 Risk Communication Strategies
Pandemic influenza risk communication strategies are a critical and necessary
component of pandemic influenza preparedness and response. Hospitals will play an
important role in providing vital information to the public, healthcare providers and
hospital staff before, during and after a pandemic to help ensure people respond
9-12
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION
appropriately to outbreak situations and follow public health measures. To ensure that
this information is consistent, accurate and timely, it is critical that hospitals
coordinate pandemic flu messages with CUPHD.
The CUPHD PIO will collaborate with Champaign County’s PIO, taking the lead in
development of public health and medical risk communication materials for release to
the public, business community, schools and critical infrastructure, including
healthcare facilities. Hospital PIOs should initiate and maintain a close working
relationship with the CUPHD PIO, if they have not already done so.
Information regarding a pandemic and the planning for it is coming from a variety of
sources. The federal government provides background information and frequent
updates for healthcare professionals through the CDC’s website at
www.pandemicflu.gov/. Additionally, the CDC provides information through their
Emergency Communication System. The IDPH is tasked by the Governor to
coordinate public health, medical emergency and risk communication messages for the
state. In that role, IDPH will provide background information and frequent updates
for healthcare professionals. To reduce the likelihood of conflicting or confusing
messages across the healthcare system, every effort should be made to coordinate
media content between CUPHD and hospitals. This is true during both the
Interpandemic/Pandemic Alert Period and the Pandemic Response Period.
Interpandemic/Pandemic Alert Period
During the Interpandemic/Pandemic Alert Period, it is important for hospitals to
establish methodologies for assuring that the most current information is being
received from and provided to the CUPHD PIO.
Information received should be shared with appropriate individuals within the
organization, such as healthcare providers, other staff, patients and partners. Hospitals
are encouraged to include risk communication strategies in their hospital pandemic
plan. Preparations for implementing the following strategies are recommended.
External Communication

The CUPHD PIO will maintain a single source of contact with each hospital.
Current contact information should be provided by each hospital, and a plan
developed to ensure the information is updated, as needed.

Hospital PIOs should consider participating in a PIO network.

Hospitals should prepare or use messages provided by the CUPHD PIO for use in
call centers, websites, hotlines, recorded messages, etc. These messages should
be differentiated for patients, community and employees.

Hospitals should identify and train individuals who may be expected to support
the hospital PIO or serve as the hospital spokesperson during periods where there
is increased communication flow related to pandemic flu.
Champaign-Urbana Pandemic Annex
9-13
Section 9
Internal Communication

Hospitals will develop mechanisms for sharing pandemic flu planning with
employees.

Hospitals will develop frequently asked questions or use those provided by
CUPHD, which target hospital personal, differentiating them for patients and the
community.
Pandemic Response Period
During the Pandemic Response Period, hospital PIOs are encouraged to:

Maintain a single source of contact with the CUPHD PIO, ensuring this
information is updated, as needed

Use established mechanisms for external communication with the media and a
PIO network

Determine how to keep administrators, personnel, patients and visitors informed
of the ongoing impact of pandemic influenza on the facility and the community

Ensure capacity for increases in communication flow related to the pandemic flu

Establish communication with any area JIC as appropriate, if activated. The
Champaign County EOC may open a JIC
9.8.2 Education and Training
Each hospital is encouraged to develop an education and training plan that addresses
the needs of staff, patients, family members and visitors. Hospitals will need to assign
responsibility for coordination of the pandemic influenza education and training
program and identify training materials—in different languages and at different
reading levels, as needed—from HHS agencies, IDPH and CUPHD, and professional
associations.
The following guidelines, taken from the HHS Pandemic Influenza Plan, provide a
basis for inclusion of education and training in the hospital’s pandemic influenza plan.
CUPHD and/or IDPH will provide current information that should be used in
developing education and training content.
Interpandemic/Pandemic Alert Period
Each hospital is encouraged to develop a plan to provide staff education. Staff
education should include infection control strategies for influenza, including
respiratory hygiene/cough etiquette, hand hygiene, standard precautions, droplet
precautions and airborne precautions (see also the section on Infection Control and
Prevention Guidelines for Healthcare Settings).
Hospital-specific topics for staff education should include:

Policies and procedures for the care of pandemic influenza patients, including
how and where pandemic influenza patients will be located
9-14
Champaign-Urbana Pandemic Annex
RISK COMMUNICATION

Pandemic staffing contingency plans, including how the facility will deal with
illness in personnel

Policies for visitation

System for reporting suspected cases of infection caused by novel influenza
strains during the Interpandemic/Pandemic Alert Period to CUPHD

Measures to protect family and other close contacts from secondary occupational
exposure
Hospitals should also:

Establish a schedule for training/education of clinical staff and a mechanism for
documenting participation. Use annual infection control updates/meetings,
Medical Grand Rounds and other educational venues as opportunities for training
on pandemic influenza

Cross-train clinical personnel—including outpatient healthcare providers—who
can provide support for essential patient-care areas (e.g., emergency department,
ICU, medical units)

Train intake and triage staff to detect patients with influenza symptoms and to
implement immediate containment measures to prevent transmission

Create a mechanism for supplying social workers, psychologists, psychiatrists and
nurses with guidance for providing psychological support to patients and hospital
personnel during an influenza pandemic. Hospitals should also provide
psychological-support training to appropriate individuals who are not mental
health professionals (e.g., primary-care clinicians, leaders of community and
faith-based organizations)

Develop a strategy for “just-in-time” training of non-clinical staff who might be
asked to assist clinical personnel (e.g., help with triage, distribute food trays,
transport patients), students, retired health professionals and volunteers who
might be asked to provide basic care (e.g., bathing, monitoring of vital signs) and
other potential in-hospital caregivers (e.g., family members of patients)
Education of patients, family members and visitors should:

Ensure that patients and others know what they can do to prevent disease
transmission in the hospital, as well as at home and in community settings.

Identify and use language-specific and reading-level appropriate materials,
provided by CUPHD, IDPH and CDC for educating patients, family members and
hospital visitors during an influenza pandemic. Develop a plan for distributing
information to all persons who enter the hospital.

Identify staff to answer questions about procedures for preventing influenza
transmission.
Champaign-Urbana Pandemic Annex
9-15
Section 9
Pandemic Response Period
Hospitals will implement the mechanisms created to distribute updated informational
and educational materials to hospital visitors and the patient community on an ongoing
basis. It will be essential that the hospital PIO maintain regular contact with the
CUPHD PIO to ensure that the hospital receives the most updated pandemic flu
guidance and that the assigned Education and Training staff receive the most current
information to use in their training.
Training and education should be ongoing and incorporate information on the
following:

Disease prevention precautions

Home self-care information

The need to either postpone non-critical appointments or procedures or provide
alternative ways for patients to be seen for non-urgent needs

The need to advise the public to only use the emergency department for true
medical emergencies
9-16
Champaign-Urbana Pandemic Annex
Section 10
MAINTENANCE OF ESSENTIAL SERVICES
One of the critical needs during a flu pandemic will be to maintain essential
community services. With the possibility that 25 to 35 percent of the workforce could
be absent due to illness, it may be difficult to maintain adequate staffing for certain
critical functions. There is the possibility that services could be disrupted if
significant numbers of public health, law enforcement, fire and emergency response,
medical care, transportation, communications and public utility personnel are unable
to carry out critical functions due to illness.
Government agencies and private businesses, particularly those that provide essential
services to the public, must develop and maintain continuity of operations plans and
protocols that address the unique consequences of a pandemic.
Local EMAs in Champaign County will lead continuity of government planning and
preparedness within their jurisdictions, with technical support provided by CUPHD.
Local EMAs in Champaign County will also participate in and support logistical and
non-medical infrastructure planning with hospital facilities within their jurisdictions.
CUPHD will develop continuity of operations plans that address the following, at a
minimum:

Line of succession for the agency

Approval of continuity of operations plans by the Champaign Urbana Board of
Health

Identification of mission essential services and priorities

Procedures for the reassignment of employees to support public health functions
essential during a public health emergency

Redundancy of mission critical communication and information systems

Physical relocation of critical CUPHD functions
Maintenance of Essential Services by Period
During Interpandemic/Pandemic Alert Period

All divisions and sections in CUPHD will develop plans for maintaining essential
services during a pandemic.

The PIO will continue to educate government agencies, non-profit organizations
and businesses that provide essential community services about the need for
continuity planning in advance of a pandemic.
Champaign-Urbana Pandemic Annex
10-1
Section 10
During Pandemic Response Period

CUPHD will update its essential services plans and request that its community
partners update their plans.

The Public Health Administrator will determine the appropriate time to
implement CUPHD continuity of operations plans and protocols, and will advise
community partners to implement their plans as needed.
10-2
Champaign-Urbana Pandemic Annex
Section 11
PLAN DEVELOPMENT AND MAINTENANCE
11.1
Plan Development
The CUPHD Public Health Administrator will direct the development of and approve
the Pandemic Plan. The CUPHD Public Health Administrator may be assisted by
such individuals as the Administrator directs.
11.2
Distribution
Once approved, the Pandemic Plan will be distributed to the following:

IPHD

All divisions within CUPHD

Champaign County EMA

Stakeholders, partner agencies and organizations, and other pertinent individuals
and programs within Champaign County

Health departments/districts of neighboring counties

The website
11.3
Review and Update

This Plan will be updated based on the deficiencies identified in AARs from
actual pandemic situations or exercises, when there are changes in pandemic
threats, resources and capabilities, or when there is a change in agency structure.

This Plan must be revised or updated by a formal change at least every five years.
The responsibility for coordinating the revision of the Plan rests with the CUPHD
Public Health Administrator.
Champaign-Urbana Pandemic Annex
11-1
Section 12
ACRONYMS AND ABBREVIATIONS

AAR
After Action Report

ACIP
Advisory Committee on Immunization Practices

CBO
Community-Based Organization

CDC
Centers for Disease Control and Prevention

CFR
Case Fatality Ratio

CUPHD
Champaign-Urbana Public Health District

EMA
Emergency Management Agency

EMS
Emergency Medical Services

EOC
Emergency Operations Center

EOP
Emergency Operations Plan

Flu
Influenza

H
Hemagglutinin

HEIL
Health Emergency Information Line

HHS
United States Department of Health and Human Services

IDPH
Illinois Department of Public Health

JIC
Joint Information Center

N
Neuraminadase

NIOSH
National Institute for Occupational Safety and Health

NPI
Non-Pharmaceutical Intervention

NVAC
National Vaccine Advisory Committee

OSHA
Occupational Safety and Health Administration

PAPR
Personal Air Purifying Respirator

PEP
Post-Exposure Prophylaxis

PIO
Public Information Officer

Plan
The Champaign-Urbana Public Health District Pandemic
Influenza Plan

PPE
Personal Protective Equipment

PSA
Public Service Announcement

PSI
Pandemic Severity Index
Champaign-Urbana Pandemic Annex
12-1
Section 12

SNS
Strategic National Stockpile

WHO
World Health Organization
12-2
Champaign-Urbana Pandemic Annex