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Are We Ready? Influenza Pandemic Summit June 20, 2006 Sponsored by: Nuclear, Biological, Chemical (NBC) Public Health Workgroup Funded by: New York State Department of Health Influenza 101 What do WE need to know? Paula Calkins Lacombe, B.S. M.S. Director of Public Health Clinton County Health Department June 20, 2006 Outline Describe Seasonal Influenza Avian Influenza Pandemic Influenza Differences between cold and flu Factors In Emergence of Flu Pandemic Strategies to Reduce Impact Public Health Flu – What it is and is NOT The actual term for flu is influenza It is respiratory infection It is not a GI illness with vomiting, diarrhea It is not a cold Flu or Cold Is It a Cold or the Flu? Symptoms Cold Flu Fever Rare Characteristic, high (102-104°F); lasts 3-4 days Headache Rare Prominent General Aches, Pains Slight Usual; often severe Fatigue, Weakness Quite mild Can last up to 2-3 weeks Extreme Exhaustion Never Early and prominent Stuffy Nose Common Sometimes Sneezing Usual Sometimes Sore Throat Common Sometimes Chest Discomfort, Cough Mild to moderate; hacking cough Common; can become severe Complications Sinus congestion or earache Bronchitis, pneumonia; can be life-threatening Prevention None Annual vaccination; antiviral medicines - see your doctor Treatment Only temporary relief of symptoms Antiviral medicines - see your doctor Source: National Institute of Allergy and Infectious Diseases, National Institutes of Health, April 2001. Flu Viruses Three types of flu virus A,B,C ( A & B cause the most serious illness) Type A Many subtypes that cause most serious disease in humans Can cause human epidemics and pandemics Can sicken many other birds and mammals. chickens, ducks, geese, pigs, and horses Mutation Viruses routinely mutate Antigenic drift - small changes in the viruses Antigenic shift – occurs when rare, abrupt and major change in a type A virus that results in new subtype not previously found in humans (Novel virus) • If this new virus has the ability to spread easily to humans can lead to pandemic How is Flu Spread Close contact – spread by exposure to large respiratory droplets, direct contact, or near-range exposure to aerosols, within 3 feet. Little evidence of airborne transmission over long distances or prolonged periods of time (as is seen with M. tuberculosis). Influenza Infection Timeline British Columbia Ministry of Health Types of Influenza/Flu Seasonal Flu: Contagious respiratory illness caused by influenza viruses occurs every year Avian Flu: Bird flu is caused by avian influenza viruses; occurs naturally among birds. Pandemic Flu: Currently none. A flu pandemic is a global outbreak with a new influenza A virus that causes serious human illness and that spreads easily from person to person. Seasonal Influenza Seasonal influenza Outbreaks are predictable - seasonal patterns Occur annually- usually in winter People usually build up some immunity from previous exposure Most healthy adults – no serious complications Highest risk of complications – elderly and very young Vaccines are usually available Seasonal Influenza Average deaths in US per year 36,000 Modest impact on society Influenza A Virus AVIAN INFLUENZA Avian Flu Why all the concern? Subtype H5N1 is an influenza Type A Before 1997 only found in birds and few other animals Bird influenza viruses can mutate into a form which is easily transmitted human to human. This will represent a dramatic antigenic shift. Humans have no immunity to this virus thus the risk. Avian Flu Reassortment Mixing vessels Avian viruses & human viruses may also “reassort” in another animal and create a new virus Humans – with those who survive H5N1 Pigs get avian and human influenza If virus changes (New/Novel virus) and develops ability to spread human to human an influenza pandemic can begin June 6 – WHO (World Health Organization) 2004 Country 2005 2006 Total cases deaths cases deaths cases deaths cases deaths Azerbaijan 0 0 0 0 8 5 8 5 Cambodia 0 0 4 4 2 2 6 6 China 0 0 8 5 10 7 18 12 Djibouti 0 0 0 0 1 0 1 0 Egypt 0 0 0 0 14 6 14 6 Indonesia 0 0 17 11 32 26 49 37 Iraq 0 0 0 0 2 2 2 2 Thailand 17 12 5 2 0 0 22 14 Turkey 0 0 0 0 12 4 12 4 Viet Nam 29 20 61 19 0 0 93 42 Total 46 32 95 41 81 52 225 128 Why It is Spreading in Asia Large, dense population of people, poultry, and animals in close quarters Lifestyle Additional mammals involved Housecats in Netherlands Tigers in Thailand Pigs in China Avian Influenza Avian influenza (Bird Flu) is not the same as pandemic flu No one knows if this current avian virus (H5N1) will cause the next pandemic IF Bird Flu Arrives in the US… It does NOT mean that lots of people will get sick People who have gotten sick from bird flu had a lot of contact with sick birds and touched them with their bare hands Bird flu is easy for birds to catch, but hard for people to catch Bird Handling Advice Even in the absence of bird flu, you should not handle wild birds Many healthy birds can carry germs that can make people sick Wear gloves if you have to touch a wild bird, and wash your hands afterward PANDEMIC INFLUENZA Could it Happen, and What if it Does? What is a Pandemic Flu? A global influenza outbreak caused by a brand new (novel) flu virus Facts About a Flu Pandemic No immunity Occurs rarely no previous exposure 3x in 20th century not since 1968 Complications More severe symptoms With more frequent complications Can effect young and healthy people Facts About a Flu Pandemic Death toll high Health In US,1918 pandemic 675,000 systems Overwhelmed Vaccine Not available early on, not for 6-8 months Antivirals Limited supply of effective anitvirals Pandemic Flu Societal impact Widespread restrictions to travel Closings of schools, businesses Cancellation of large public gatherings Economy Potential for severe impact on domestic and world economy Assumptions Vaccine • Will not be available • Takes 6 – 8 months to produce • May need two doses Decreased Workforce • Plan 25 – 50% unavailable to work Time is our friend Timeline of Human Flu Pandemics Major pandemic The appearance of a new influenza strain in the human population Influenza Pandemics 20th Century Credit: US National Museum of Health and Medicine 1918: “Spanish Flu” A(H1N1) 1957: “Asian Flu” A(H2N2) 1968: “Hong Kong Flu” A(H3N2) 20 - 40 million deaths 1 - 4 million deaths 1 - 4 million deaths 675,000 US deaths 70,000 US deaths 34,000 US deaths Deja Flu - Similarities in 1918 Originated The in birds avian influenza virus we are seeing in Southeast Asia attacks humans similar to 1918; those with healthiest immune system are most susceptible 1918 Influenza Pandemic This May 29, 1919 photograph showed rows of tents that had been set up on a lawn at Emery Hill in Lawrence, Massachusetts where victims of the 1918 influenza pandemic were treated. Deja Flu - Similarities in 1918 1918 numbers extrapolated to today 1.7 million deaths in U. S. 30 – 384 million deaths worldwide Age projected deaths in U.S. < 5 years 233,000 15 – 24 years 214,000 25 – 34 years 378,000 35 – 44 years 268,000 > 65 years 426,000 From APIC News -Vol. 24 Issue 2- Preparing for the Next Pandemic by Michaie Osterholm, PHD, MPH, Director, Center for Infectious Disease Research and Policy Flu Pandemic Timeline • Past shown several waves of illness • Each wave lasts about six to eight weeks • Can be separated by 3 - 9 months Factors in Emergence of Flu Pandemic Microbial Host adaptation and change susceptibility to infection Climate and weather Changing ecosystems Factors in Emergence Economic development and land use Human demographics and behavior Technology and industry International travel and commerce Factors in Emergence Poverty War and social inequality and famine Lack of political will Breakdown of public health measures What Can We Do About It? Share Responsibility! Faith Communities Healthcare Delivery System Individual Local /State / Federal Public Health System Business Government & Workers Education, Law Enforcement, Emergency Services Planning Will Make A Difference Unprepared Impact Prepared Weeks Key Public Health Strategies to Reduce Impact Surveillance Monitor disease activity Coordination Local, state, and federal planning, systems and resources Key Public Health Strategies to Reduce Impact Utilize Limit exposure of cases (sick) Limit exposure of contacts to others Social Isolation and Quarantine Distancing Closing schools Reduce crowds and places where people gather Work from home Key Public Health Strategies to Reduce Impact An informed and responsive public Develop public education and communications to keep the public informed. Essential to minimizing the health effects Key Public Health Strategies to Reduce Impact Reduce stress on health care system Care for people at home or other facilities Protect limited assets – use effectively Empower people to do so Ethics – Discuss NOW! Hot lines, support services Keep people healthy Back to basics Respiratory Etiquette and Hand Hygiene Key Public Health Strategies to Reduce Impact Distribute vaccine rapidly when available Establish PODs – clinics Use antivirals effectively Protect limited asset Messages to Take Home Understand the facts about Influenza and a Pandemic Communicate what you have learned Integrate the messages and apply them to your setting Make plans Communicate, Cooperate, and Collaborate References References Animal Health Diagnostic Center Center for Infectious Disease Research and Policy Michigan State University’s College of Veterinary Medicine National Center for Food Protection and Defense Townsends, Inc. Wildlife Conservation Society WHO Global Influenza Preparedness Plan APIC News -Vol. 24 Issue 2 -Preparing for Pandemic Flu: Is Time Running Out British Columbia Ministry of Health Plans CDC and NYSDOH Presentations Speaker 1: Alfonso Torres Executive Director, Animal Health Diagnostic Center; and Associate Dean of Veterinary Public Policy, College of Veterinary Medicine, Cornell University Speaker 2: William Karesh Director, Field Veterinary Program, Wildlife Conservation Society Speaker 3: Spangler "Buzz" Klopp Corporate Veterinarian, Townsends, Inc. Speaker 4: Michael Osterholm Director, Center for Infectious Disease Research and Policy and Associate Director, National Center for Food Protection and Defense, University of Minnesota Speaker 5: Lonnie King Dean, College of Veterinary Medicine, Michigan State University