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Pandemic Influenza
Stephen Prior: Executive Director, NSHPC & NCCIA
Is your state prepared to prevent or minimize
the human morbidity and mortality, the social
disruption, and the economic consequences
caused by an influenza pandemic?
Pandemic Influenza
No location is safe or immune
A problem characterized by uncertainty & urgency
Avian H5N1 in Asia
• Continuing presence in Asia since 1996
– Documented direct avian to human transmission, Hong Kong,1997
• Enzootic and epizootic of unprecedented size and complexity
– 9 countries with ongoing outbreaks (most recently Kazakhstan)
– 3 countries now free of disease
• Ongoing human cases with high case fatality, mostly in
healthy children and young adults
• Ongoing evolution of the virus’ antigenic, genetic and
functional properties
• No sustained human-to-human transmission to date
Why are We Concerned?
• Increasing countries/areas with avian influenza
– Uncertainties on progress of control
• Ongoing human infection with avian H5N1
– Limited implementation of protective measures
• Co-Circulating human influenza viruses
– Risk of genetic reassortment leading to pandemic strain
• Majority of human population would have no immunity
Overall Goals of Pandemic
Preparedness and Response
First, to minimize serious illness and overall deaths, and
second to minimize societal disruption and economic losses
that would result from an influenza pandemic.
The Satchel Paige Theory
It ain’t what you don’t know
that will hurt you the most –
It’s what you think you know
that just ain’t so
Uncertainties & Their Impact
• When will it happen?
• Where will it occur?
• Disease features?
• Infectivity/Transmission
• Morbidity/Mortality
• Effectiveness of control measures?
• Medical
• Non-medical
‘Uncertainty’ will fuel fears
Psychosocial/psychological impact will be pronounced fueled by:
• Lack of medical certainty and solutions
• Costless, rapid transmission of information lacking context.
The Reality of the Threat from Avian (Bird) Flu
Pre-pandemic Phase (WHO Phase 3)
Pandemic
• Respond
• Recover
Pre-Pandemic
• Prevent
• Contain
WHO September 2005: The risk is great and persistent. Our early warning
system is weak and hampered by an evolving threat. Reductions in
morbidity & mortality will be impeded by inadequate medical supplies.
Deaths Among
Healthy Adults
• Influenza deaths usually
among youngest &
oldest (V versus W)
• Rates during 1918
– Infants & over 40 ~2-10fold higher
– 10-20 yrs old:
20-100-fold higher
– 20-30 yrs old
20-180-fold higher
Comparison with SARS
SARS
Influenza
Control
Incubation
period
Average 5 days
Average 2 days
Harder
Infectious
period
Peaks day 10
Peaks day 2
Harder
Droplet>>airborne
Droplet>airborne
Harder?
Age
distribution
Adults
Children/young
adults (Unknown)
Unclear
Attack rate
Low (variable)
High
Harder
Transmission
Pandemic Influenza Response will
need to be Multi-Faceted
Communication
Command & control
Risk communication
Non-clinical responses
Medical Management
Clinical response
Antivirals
Vaccination
Travel & trade restrictions
Hygiene
Surveillance
Infection control
Epidemiology
Social distance
Legal & ethical
Public policy
Coordination will be an enormous challenge
Elements of the WHO Checklist
Essential
Command & control
Communication
Public health measures
Clinical management
Essential services
Desirable
Vaccines
Antivirals
Key Strategies and Planning Components
• Rapid detection, monitor spread and assess impact
– Surveillance and lab testing protocols
• Reduce spread and impact
–
–
–
–
–
–
Border measures
Public health measures and infection control
Vaccines
Antivirals
Maintaining health services
Emergency and social services
• Maintain public awareness
– Risk communication