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Pandemic Influenza Public Health – Seattle & King County Pandemic Influenza The influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world. Alfred W. Crosby America’s Forgotten Pandemic The Influenza of 1918 Cambridge University Press, 1989 Trends in Infectious Disease Mortality in the United States During the 20th Century Armstrong, GL. JAMA. 1999 Jan 6;281(1):61-6. Pandemic Influenza 1918 Influenza Pandemic • 20-40 million persons died worldwide, possibly more • Death rate 25 times higher than previous epidemics • 500-650,000 deaths in the U.S.: Ten times as many Americans died of flu than died in WW I • The epidemic preferentially affected and killed younger, healthy persons • The epidemic was so severe that the average life span in the U.S. was depressed by 10 years Pandemic Influenza Percentage of Influenza Deaths by Age Group, 1917-1918 70 60 Percent 50 40 1917 1918 30 20 10 0 <10 10-20 20-30 30-40 40-50 50-60 >60 Age Crosby. Influenza in America, 1977 2003-4 Outbreak of Highly Pathogenic Avian (HPAI) Influenza A (H5N1) in Asia W.H.O. Official Says Deadly Pandemic Is Likely if the Asian Bird Flu Spreads Among People By KEITH BRADSHER and LAWRENCE K. ALTMAN HONG KONG, Nov. 29 - A pandemic of human influenza could kill up to 100 million people around the world in a worst case, a World Health Organization official said Monday, significantly raising the agency's earlier estimates of the potential number of deaths in such a catastrophe. Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia • WHO: H5N1 poses a considerable human public health risk – Widespread, outbreak not controlled – Mutates rapidly, propensity to acquire new genes – Increasing host range – Directly infects humans • To-date, at least 60 human cases with 44 deaths from Vietnam, Thailand, Cambodia • No sustained person-to-person transmission • Outbreak not controlled Phases of an Influenza Pandemic Phase Level Definition 0 0 Inter-Pandemic Period: Annual epidemics with 3-4 circulating influenza strains worldwide 0 1 0 2 Initial Report of New Strain in Humans: Novel virus reported; no clear evidence of person-to-person spread or outbreak activity. Novel Virus Alert: Infection in >2 humans confirmed; ability to spread and cause severe disease questionable. 0 3 1 Human Transmission Confirmed: Person-to-person transmission confirmed or new virus found in several countries; at least one outbreak lasting > 2 weeks Confirmation of Onset of Pandemic: Efficient person-toperson spread with outbreaks in >1 country and evidence of severe morbidity and mortality Phases of an Influenza Pandemic Phase Definition 2 Regional and Multi-Regional Epidemics: Outbreaks and epidemics in multiple countries around the world 3 End of First Pandemic Wave: Influenza activity stops in initially affected regions and continues elsewhere 4 Second or Later Waves: 2 or more waves of infection are expected to occur within 3-9 months of initial outbreak 5 End of Pandemic: Infection rates return to pre-pandemic levels, no more large scale “waves” of infection expected. May take 2 or more years. Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia "We at WHO [the World Health Organization] believe that the world is now in the gravest possible danger of a pandemic…" Dr. Shigeru Omi, the WHO's Western Pacific Regional Director, 23 February 2005 Pandemic Influenza Potential Impact of Pandemic Influenza in the U.S. • • • • • • • Cannot predict the severity or exact onset of a pandemic Up to 200 million persons infected 38-89 million persons clinically ill 18-42 million persons require outpatient care 314,00-733,000 persons hospitalized 89,000-207,000 deaths Economic cost estimated at $71-$166 billion Pandemic Influenza Estimated Range of Deaths and Outpatient Medical Visits Due to Pandemic Influenza in King County by Attack Rate* Attack Rate 25% 35% Deaths 578-1,905 809-2,666 Outpatient Medical Visits 178,512-333,315 249,916-466,642 Estimates based on past pandemics suggest demand for inpatient beds and assisted ventilation may increase by 25%** *Based on CDC’s FluAid pandemic modeling software ** CDC. National Pandemic Influenza Preparedness Plan Pandemic Influenza Pandemic Influenza – Unique Challenges • Large proportion of population ill and seeking medical care • Long duration: weeks – months • Disruption of vital community services • Outbreaks may occur simultaneously in many areas of the U.S., limiting shifts of human and material resources that occur with other disasters Pandemic Influenza Potential Impact of Pandemic Influenza in the U.S. • Vaccine and antiviral drugs will be in short supply 6-8 month lag-time needed for vaccine availability • Healthcare workers and other first responders will be at higher risk of exposure and illness than the general population • Healthcare system will be overwhelmed • Risk of sudden shortages of key personnel in critical community services: police, fire, power/utilities, transportation, air traffic controllers, etc. Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia "I think what we're concerned about is looking at what's going on in Asia right now with avian flu, and a very big worry that this is statistically a time bomb ticking" "This is a very ominous situation for the globe…" “..the most important threat we are facing right now." Dr. Julie L. Gerberding, Director, Centers for Disease Control & Prevention Pandemic Influenza Key Components of Pandemic Preparedness • Command and control: Decision-making and coordination, including communication among/between responders • Surveillance: Recognition & reporting of cases, monitoring impact on community • Vaccine and antiviral drug management • Healthcare system preparedness: delivery of medical care • Maintenance of essential services: Community emergency response, provision of social services • Outbreak containment measures: travel restrictions, school closings, isolation & quarantine • Public communication Pandemic Influenza Potential Community Measures to Decrease Transmission • • • • • • • • Travel advisories/limit travel to affected areas Limit large public gatherings; close schools Encourage telecommuting Limit availability of public transportation Hand hygiene, respiratory hygiene/cough etiquette Screening travelers from affected areas* Quarantine of exposed persons* Education to allow early identification and isolation of cases* * Note: Some measures may be most useful early in outbreak and with strains that are not efficiently transmitted Public Health – Seattle & King County Pandemic Influenza Preparedness Planning Legal Authorities • State law grants to the Health Officer broad authority to take measures necessary to protect public health – “The local health officer, acting under the direction of the local board of health . . . shall . . . control and prevent the spread of any dangerous, contagious or infectious diseases that may occur within his or her jurisdiction.” RCW 70.05.070(3).. • The Health Officer’s powers are not contingent on a proclamation of an emergency by the Executive or Governor. Public Health – Seattle & King County Pandemic Influenza Preparedness Planning Legal Authorities During a pandemic flu outbreak, the Health Officer will evaluate the need for: – community outbreak containment and response measures – Temporary reorganization of medical services (cancellations of elective hospital admissions and redirection of available resources) Pandemic Influenza Planning Goals • Limit sickness and death • Maintain continuity of essential services • Minimize social disruption • Reduce economic losses Pandemic Influenza Preparedness Activities Underway • Educating and informing: – First Responders – Emergency Managers – Elected Leaders • Coordinating with hospitals and health care providers Pandemic Influenza Preparedness Activities Underway • Identifying protective measures that may be necessary and the circumstances for their use • Enhancing capabilities to rapidly vaccinate large populations • Enhancing our capabilities to communicate information to the public Pandemic Influenza Preparedness Key Steps for Local Governments Business Continuity Planning 1. Prioritize critical functions – Life, Health, Safety (Police, Fire, EMS, Public Health, Hospitals) – Identify functions that support life, health and safety actions (Communications, data management, facility operation, payroll) – Identify functions that are critical to the mission of an agency Pandemic Influenza Preparedness Key Steps for Local Governments Business Continuity Planning 2. Identify staff needed to carry out critical functions 3. Identify functions that could be suspended 4. Build depth through cross training 5. Plan for alternative work schedules 6. Explore telecommuting capabilities – large scale Pandemic Influenza Preparedness Key Steps for Local Governments • • • Ensure local emergency managers coordinate with Public Health and local hospitals Engage local businesses and large employers – Educate, inform, support Involve elected leaders - identify actions they may take in response to a pandemic event Pandemic Influenza Preparedness - Next Steps • Focus on health system resiliency and expanded capacity • Support business continuity planning • Brief elected leaders • Conduct training and exercises