Pandemic Influenza Avian Influenza Maine Department of Health

Pandemic Influenza Avian Influenza Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M. D. , M. P. H.

1. Pandemic Influenza & Avian Influenza 101 2. Preparedness Efforts

1. Pandemic Influenza & Avian Influenza 101

Influenza Seasonal influenza Avian influenza Pandemic influenza

All Influenza: RNA viruses Genetic engines A: Hemagglutinin Neuraminidase

Seasonal Influenza October – April Influenza Type A H 3 N 2, H 1 N 1 Influenza Type B Vaccine

Avian Influenza (Bird Flu) Influenza A Domestic poultry – can be deadly High vs. low pathogenic Wild birds – carriers Virus in fecal droppings, saliva/nasal discharge

Recent Avian Influenza Outbreaks Affecting Humans 1997 H 5 N 1 Hong Kong 1999 H 9 N 2 Hong Kong 2003 H 7 N 7 Netherlands 2004 H 7 N 3 Canada 2004 H 5 N 1 Southeast Asia

Pandemic Influenza Global outbreak Highly contagious Deadly

Recent Pandemics 1918 Spanish flu (H 1 N 1) 5, 000 deaths in Maine 500, 00 in U. S. 40, 000 worldwide 1957 Asian flu (H 2 N 2) 70, 000 deaths in U. S. 1 -2, 000 worldwide 1968 Hong Kong flu (H 3 N 2) 34, 000 deaths in U. S. 700, 000 worldwide

Past Pandemic Influenza Estimates for Maine Illness Hospitalization Deaths Moderate (1957/1968) Severe (1918) 390, 000 5, 000 40, 000 1, 100 9, 100

H 5 N 1 Detected in Asia since 1997 Deadly – 50% mortality in humans Transmitted birds to mammals and limited human to human Evolving quickly

H 5 N 1 Activity as of September 29, 2006 253 human cases (thru 10/13/06) In 58 countries 148 deaths Mortality rate = 58%

Human Infections and Human Deaths by H 5 N 1 by Month, October 13, 2006

2. Preparedness Efforts A. Avian Influenza Preparedness B. Pandemic Influenza Preparedness

A. Avian Influenza Preparedness

Detection Testing in: Migratory birds Poultry industry

Preparedness Planning Poultry workers Backyard flock owners Others – bird lovers, hunters

General Public Food safety Bird handling

B. Pandemic Influenza Preparedness “Pan Flu”

Significant Issues for Pan Flu Planning Detection and Tracking Care for Isolated and Ill Vaccines and Antivirals Food and Other Support Basic Services and Economic Impact Communication Quarantine and Isolation

Pandemic Assumptions Attack rate of 25%-35% Duration of up to year or more in 2 waves Each wave lasting 6 -8 weeks in community Healthcare system will be severely taxed, if not overwhelmed

Social Disruption from Pandemic Influenza Absenteeism in essential sectors Health, law enforcement, food and fuel supplies, education Economic impact Psychological stress

2006 vs 1918 Advantages in 2006 Healthier population Better medical care Preparedness Advantages in 1918 Smaller population Less travel More self-reliance

Federal Preparedness

www. pandemicflu. gov

Components of Federal Plan Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Antiviral Drugs Community Disease Control Travel-Related Risks of Disease Communications Workforce Support

Selected Components Vaccine Antivirals Community Disease Control

Vaccines

Assumptions for Vaccination Two doses will be required Vaccine unavailable for 3 -6 months Production will be 3 -5 million doses (15 µg) per week 10, 000 doses per week in Maine

Vaccine Priority Groups Vaccine and antiviral manufacturers Health care providers Those at high risk for severe disease Public health emergency response workers Key government leaders 400, 000 in Maine

Recommendations for Vaccine and Antivirals may be modified based on: Virulence Transmissibility Drug resistance Geographic spread Age-specific attack rates Morbidity and mortality rates

What You Can Do Now Annual seasonal influenza vaccination Pneumococcal vaccination

Antivirals

Antivirals Adamantanes Amantadine Rimantadine Neuraminidase inhibitors Oseltamivir (Tamiflu) Zanamivir (Relenza)

Assumptions for Antivirals Resistance to adamantanes Neuraminidase inhibitors will be effective in decreasing morbidity and mortality Current national stockpile = 5 million courses; goal is 80 million courses ? Maine stockpile

Some Antiviral Priority Groups 1. 2. 3. 4. 5. Patients admitted to hospital Infected health care workers and EMS providers Infected high-risk patients Infected pandemic responders and government decision-makers Exposed health care workers Equals 40 million courses (150, 000 courses for Maine)

Cost of Antiviral Treatment 5 -Day Course for an Adult Oseltamivir (Tamiflu) $72. 10 Zanamivir (Relenza) $61. 80

Personal Stockpiles of Antivirals Supply Effectiveness Resistance Shelf life

Stockpiles of Antivirals Institutional State

Community Disease Control

Challenges to Containment Short incubation period of 1 -5 days Ability of persons with asymptomatic infection to transmit virus Early symptoms of illness are likely to be nonspecific, delaying recognition

Goal of Community Disease Control To limit or slow spread of pandemic influenza Social Distancing

Containment Measures for Ill Individuals Patient isolation Management of contacts Contact tracing Contact monitoring Quarantine

Containment Measures For Groups of Exposed or At-Risk Persons Quarantine Containment measures for specific sites or buildings

Containment Measures For Communities Promotion of community-wide infection control measures Social distancing (snow days)

Unresolved Issues Role of airborne transmission Effectiveness of antivirals Coordination between states and countries

State of Maine Preparedness

www. maineflu. gov

Overarching Roles of Major State Agencies Involved with Pandemic Influenza Response Planning Governor Incident Commander MEMA Coordinator of state’s planning and response to all emergencies Maine CDC Develops public health emergency response plans Strategy lead in state’s response to Pandemic Influenza Sits with Governor during public health emergencies Maine Department of Agriculture Develops response plans for zoonoses Strategy lead in state’s response to Avian Influenza Sits with Governor during animal health emergencies

What Has Maine Been Doing? 1997 – 2001 Two statewide Pan Flu Conferences Statewide Plan Two exercises 2001 – 2005 Post 9/11 Federal Funds • Early Detection System • Communication Systems • Response System December, 2005 Pan Flu Conference

Maine’s Planning Efforts 2006 3 -part process: 1. Update Maine’s Pandemic Influenza Plan 2. Development of sub-state Pandemic Influenza plans A. County plans B. Hospital plans 3. Exercise and drills of the plans 4. September 20 th Summit - 1, 100 attended

Overarching Framework Early detection Response systems Communications Training Exercises and drills

County Preparedness • Emergency management • Healthcare • Many stakeholders involved • May-August 2006 plans drafted • August 2006 -2007 exercise plans • www. maineflu. gov for contact information

Hospital Preparedness • 2006 Plans drafted • 2007 Exercise plans www. maineflu. gov for contact information

http: //www. fchn. org/healthreform/documents/fchn%5 Fpandemicfluplan. pdf

Pandemic Preparedness Can Be Daunting! Need to: Keep focused on the known Be creative Don’t wait for someone else

School Preparedness

School Preparedness - Maine 200, 744 enrolled in Maine elementary and secondary schools 66, 000 enrolled in Maine post-secondary schools

Resources for School Pandemic Influenza Preparedness

www. maineflu. gov www. pandemicflu. gov

Pandemic Flu K-12 Checklist Format Planning and Coordination Continuity of Student Learning and Core Operations Infection Control Policies and Procedures Communication Planning

http: //www. pandemicflu. gov/plan/schoolchecklist. pdf

www. acha. org

Some Highlights of ACHA Guidelines Planning that allows employees to work from home Providing for ill students Addressing health and safety issues Addressing business continuity Making contingency plans for completion of courses

Some Highlights of ACHA Guidelines (cont’d) Testing and rehearsing the plans Identifying key members of the Pandemic Planning Committee Identifying appropriate channels of communication and chain of command Identifying the role of student health services Compiling a list of supplies that would be needed

Disaster Planning does not equal Public Health Emergency Planning.

Preparedness is Everyone’s Job – No one ever died of preparedness!