Pandemic Influenza Information for Federal Agencies Pandemic Influenza

Pandemic Influenza: Information for Federal Agencies Pandemic Influenza Seminar for Federal Agencies Federal Occupational Health a component of the U. S. Public Health Service Program Support Center Department of Health and Human Services 1

Pandemic Influenza: Information for Federal Agencies Seminar Objectives • To provide background information about pandemics • To provide basic medical information about influenza • To raise awareness about how your agency will prepare and respond to a possible pandemic • To provide a forum to ask questions and to understand agency issues and concerns “Once a pandemic virus emerges, it is too late to begin planning or to begin collaboration. There will only be a 20 -30 day window between emergence and pandemic. ” Dr. Klaus Stohr, WHO Global Pandemic Project 2

Pandemic Influenza: Information for Federal Agencies Agenda 1. 2. 3. 4. 5. Overview of Pandemics and Influenza National Strategy Planning and Response: What Agency Managers Can Do How FOH Can Help Questions and Answers: FOH Panel of Experts 3

Pandemic Influenza: Information for Federal Agencies Overview Pandemics and Human & Avian Influenza 4

Pandemic Influenza: Information for Federal Agencies Pandemic flu is front page news 5

Pandemic Influenza: Information for Federal Agencies Remember these? Swine Flu Toxic Shock Syndrome Legionnaires’ Disease Ebola Virus SARS Outbreak 1 6

Pandemic Influenza: Information for Federal Agencies Pandemic Influenza What is an influenza pandemic? 4 Global disease outbreak 4 A new influenza strain emerges 4 Causes serious illness to large populations worldwide Flu Pandemic of 1918 7

Pandemic Influenza: Information for Federal Agencies Avian Influenza or “Bird Flu” 4 Contagious viral disease of birds (rarely crosses the species barrier and infects humans) 4 Wild waterfowl (e. g. , ducks) likely natural reservoir of all influenza A viruses 4 Current H 5 N 1 outbreaks the most severe on record 4 Migratory birds appear to be spreading H 5 N 1 virus 4 Control of H 5 N 1 in poultry is very difficult and could take several years 8

Pandemic Influenza: Information for Federal Agencies Human Influenza 4 Has been a human adversary for hundreds of years 4 Annually in U. S. ~ 36, 000 deaths and 200, 000 hospitalizations from typical seasonal influenza 4 Vaccines are manufactured annually based on most common circulating strains 4 Flu virus mutations can happen slowly (virus “drift”) or suddenly (virus “shift”) 4 Virus “shift” allows little or no lead time to prepare a vaccine 9

Pandemic Influenza: Information for Federal Agencies Pandemic Influenza Basics Why is an influenza pandemic a greater concern than seasonal flu? 4 Little or no human immunity • Increased numbers /populations affected • More serious symptoms • Higher mortality 4 Scope and likely rapid spread of disease stretches capabilities of existing healthcare resources 4 High potential for economic and social disruption 10

Pandemic Influenza: Information for Federal Agencies Pandemic Influenza Basics Is a pandemic imminent? 4 Scientists believe it is only a matter of time 4 The timing/severity can’t be accurately predicted 4 The H 5 N 1 strain (avian flu virus) considered the most imminent threat 11

Pandemic Influenza: Information for Federal Agencies Historical Facts 4 Influenza pandemics have occurred for hundreds of years 4 Three pandemics in the 20 th Century • Spanish Flu (1918): 675, 000 Americans died, 40 -50 million deaths worldwide • Asian Flu (1957): 2 million deaths worldwide • Hong Kong Flu (1968): 1 million deaths worldwide 12

Pandemic Influenza: Information for Federal Agencies Current Facts 4“Bird flu” (H 5 N 1 strain) now spreading rapidly among birds; related to “Spanish flu” virus 4 Human infection has occurred primarily from direct contact with infected birds 4 To date, people infected with H 5 N 1 virus have shown a very high mortality rate 4 Most “conditions” for a pandemic have been met 13

Pandemic Influenza: Information for Federal Agencies Current Phase of Alert per WHO Global Influenza Preparedness Plan Inter-pandemic phase New virus in animals, no human cases Pandemic alert New virus causes human cases Pandemic Low risk of human cases 1 Higher risk of human cases 2 No or very limited human-tohuman transmission 3 Evidence of increased human-tohuman transmission 4 Evidence of significant human-tohuman transmission 5 Efficient and sustained human-to -human transmission 6 14

Pandemic Influenza: Information for Federal Agencies Other Facts 4 There is no sustained human-to-human transmission of H 5 N 1 influenza (currently no pandemic) 4 H 5 N 1 may never become a human pandemic virus 4>99% of Americans survived the 1918 flu pandemic, the deadliest influenza pandemic in recent history ~ 2. 5% mortality, which far exceeds the mortality rate for typical seasonal flu, which is ~ 0. 1% 4 Characteristics of the next pandemic strain are still unknown; can’t predict the mortality rate for an unknown strain 15

Pandemic Influenza: Information for Federal Agencies Reassuring Facts 4 Historically, pandemic influenza viruses have not retained high mortality rates such as those currently seen with H 5 N 1 4 For the past several years, public health authorities have been working to improve preparedness for a pandemic 4 There a number of things that individuals can do to reduce risks and decrease the effects of a pandemic 16

Pandemic Influenza: Information for Federal Agencies National Strategy for Pandemic Influenza November 2005 4 President requires federal departments and agencies to develop preparedness and response plans 4 Plan must take into account the potential impact of a pandemic on the federal workforce 4 Plan must be configured to support state, local and private sector efforts 17

Pandemic Influenza: Information for Federal Agencies How Public Health Authorities are Responding to the Pandemic Threat Flu Pandemic of 1918 18

Pandemic Influenza: Information for Federal Agencies World Health Organization (WHO) Recommendations 4 Strengthen national preparedness 4 Reduce opportunities for a pandemic virus to emerge 4 Improve the early warning system 4 Delay initial international spread 4 Accelerate vaccine development 4 Public Health authorities in countries with adequate resources should stockpile antiviral drugs for use at the start of a pandemic 19

Pandemic Influenza: Information for Federal Agencies U. S. Strategy Three pillars 1. Preparedness and Communication 4 Identify activities that should be undertaken before a pandemic 4 Communicate roles and responsibilities to all levels of government, segments of society and individuals 2. Surveillance and Detection 4 Ensure the earliest warning possible 3. Response and Containment 4 Limit the spread of disease 4 Mitigate the health, social and economic impacts 20

Pandemic Influenza: Information for Federal Agencies Influenza Vaccine 4 Vaccines designed for seasonal influenza will not protect against a pandemic virus 4 Vaccines that are effective against H 5 N 1 are being tested, but not yet available 4 Once pandemic strain is identified, vaccines unlikely to be available for several months 4 Current global production capacity falls far short of the demand expected during a pandemic 21

Pandemic Influenza: Information for Federal Agencies Drugs to Treat Influenza 4 Two drugs*, oseltamivir (Tamiflu) and zanamivir (Relenza) can reduce the severity and duration of seasonal influenza 4 Amantadine and rimantadine also available, but resistance has developed rapidly 4 The H 5 N 1 virus is currently susceptible to oseltamivir (Tamiflu) and zanamivir (Relenza) 4 It is critical that they be used judiciously to avoid emergence of resistance 4 Main constraints — cost and production capacity * Neuraminidase inhibitors class 22

Pandemic Influenza: Information for Federal Agencies and Pandemic Influenza Agency Planning Federal Occupational Health a component of the U. S. Public Health Service Program Support Center Department of Health and Human Services 23

Pandemic Influenza: Information for Federal Agencies Pandemic Preparedness 1. Does my agency have a Continuity of Operations Plan (COOP) with provisions for pandemic influenza? 2. Have managers and employees received pandemic influenza training? 24

Pandemic Influenza: Information for Federal Agencies COOP – Written Plan 4 Required for federal executive agencies (Presidential Decision Directive 67) 4 Defines essential functions that must continue under all circumstances (including pandemic influenza) 4 Prioritizes essential functions 4 Establishes staffing and resource requirements 4 Includes state and local government considerations 25

Pandemic Influenza: Information for Federal Agencies COOP – Pandemic Influenza Considerations 4 What will happen if 10%, 30% or 50% of your workforce is absent? 4 Are authorities, triggers, and procedures for activating and terminating COOP in place? 4 What is the emergency communications plan for pandemic conditions? 4 Can employees work from alternate locations? 4 Will a pandemic increase or decrease demands for agency services? 26

Pandemic Influenza: Information for Federal Agencies COOP – OPM Policy Considerations 4 Pending guidance on pandemic-specific policies for employee compensation and sick-leave absences 4 Flexible worksite (e. g. , telecommuting) 4 Flexible work hours (e. g. , staggered shifts) 4 Liberal annual and sick leave 27

Pandemic Influenza: Information for Federal Agencies COOP – Logistical Considerations 4 Will your agency provide infection control supplies such as Personal Protection Equipment (PPE)? 4 Will your agency provide hand-hygiene products, tissues and receptacles for their disposal? 4 Can your communications and information technology infrastructures support employee telecommuting and remote customer access? 4 Will you need medical consultation and advice for emergency response? 4 Would a pandemic adversely impact your security and security systems? 28

Pandemic Influenza: Information for Federal Agencies Education – Pandemic Influenza 4 Explain COOP and pandemic influenza components 4 Provide information regarding transmission, prevention, vaccines, and antivirals 4 Provide information and resources including the Employee Assistance Program (EAP) 4 Dispel common fears, anxiety, rumors, and misinformation 4 Practical drills and exercises 29

Pandemic Influenza: Information for Federal Agencies Education – Personal Protective Equipment 4 Exposure assessment considerations 4 Disposable gloves, outer clothing, shoe covers, eye protection, dust masks, etc. 4 Respiratory protection considerations (e. g. , written program, medical assessment, training, fit testing) 4 Disposal of PPE 30

Pandemic Influenza: Information for Federal Agencies Education – Basic Hygiene 4 Etiquette for sneezing, coughing and blowing nose 4 Frequent hand washing and use of antiseptic hand wash solution if water is unavailable 4 Keep hands away from face to prevent spread of germs to vulnerable eyes, nose, and mouth 4 Reduce/limit use of conference rooms, galleys, and common gathering spaces 4 Permissive vs. required sick leave 31

Pandemic Influenza: Information for Federal Agencies Education – Simple Concepts 4 Teach hygiene practices to children and reinforce regularly 4 Provide information about at-home care of ill employees and family members 4 Encourage seasonal flu shot to help prevent emergence of new flu strains 4 Eat well, exercise and practice healthy lifestyle 32

Pandemic Influenza: Information for Federal Agencies Worst-Case Planning Questions 4 If schools and daycare facilities are closed, who will take care of your employees’ children? 4 How will your employees travel if public transportation, planes, and trains are not operational? 4 Can your agency fulfill its mission if the building is shut down? 4 What will the impact be on you and your agency if banks, restaurants, grocery stores, etc. , are closed? 33

Pandemic Influenza: Information for Federal Agencies Use Resources to Help You Plan http: //www. pandemicflu. gov/ 34

Pandemic Influenza: Information for Federal Agencies and Pandemic Influenza Behavioral Health Concerns Federal Occupational Health a component of the U. S. Public Health Service Program Support Center Department of Health and Human Services 35

Pandemic Influenza: Information for Federal Agencies Catastrophic Events 4 Produce psychological effects 4 We can choose our own response – the only control we may have 4 Response management: • • Minimizes harm Supports safety May be primary to survival Aids in creating a new “normal” 36

Pandemic Influenza: Information for Federal Agencies EAP Preparedness Services Behavioral preparedness is essential because an emotionally-charged employee poses a safety hazard 37

Pandemic Influenza: Information for Federal Agencies How FOH Will Help 38

Pandemic Influenza: Information for Federal Agencies EAP Preparedness Services 4 Consultation on EAP COOP role 4 Consultation and coaching on traumatic incident preparedness 4 Stress and anxiety management training for first responders and employees 4 Manager training on maintaining calm and reducing anxiety at the workplace (Be Prepared) 39

Pandemic Influenza: Information for Federal Agencies Behavioral Health Strategies Suggestions for Management Leading in a Crisis – Reducing Employee Anxiety 4 Manage your own fear and uncertainty 4 Be considerate of employee concerns about families and friends 4 Communicate; repeat information 4 Be visible; assess how employees are doing 4 Schedule frequent briefings, even if no new information is available 40

Pandemic Influenza: Information for Federal Agencies Behavioral Health Strategies for All Employees Stay in Balance 4 Maintain focus on what you can control 4 Get involved in helping or social activities 4 Practice stress management 4 Engage in healthy self care activities 4 Maintain established routine 4 Contact the EAP if worry interferes with your life 41

Pandemic Influenza: Information for Federal Agencies EAP Response Services During 4 24/7 manager consultation on handling workplace stress and crisis issues 4 Critical Incident Stress Management (CISM) • Telephonic interventions • Stress management training • Debriefings as appropriate 4 Ongoing website updates and handouts 42

Pandemic Influenza: Information for Federal Agencies EAP Response Services During 4 Telephonic counseling and consultation when face-to-face is not possible (e. g. , quarantine) 4 Routing calls to alternate call centers if certain areas of the country are affected 4 Telephonic contact with designated staff counselor when offices are closed or during quarantine 43

Pandemic Influenza: Information for Federal Agencies EAP Response Services After 4 Coaching and education on post traumatic stress issues and how to create a new “normal” 4 Guidance for supervisors and employees on When Recovery is Ongoing 4 CISM services 4 Follow-up consultation; next steps 44

Pandemic Influenza: Information for Federal Agencies FOH Preparedness Services Employee Health Services 4 More than 270 onsite health clinics 4 General health promotion/disease prevention 4 Education • Specific pandemic awareness sessions in progress • Prevention strategies • “Cover Your Cough” Campaign 45

Pandemic Influenza: Information for Federal Agencies FOH Preparedness Services 4 Consultation Review of agency-specific Pandemic Influenza Response Plan 4 Medical Clearance Services Required medical evaluations for employees who use PPEs, such as respirators 4 Environmental Health Exposure assessment, risk analyses, respirator fit testing and training 4 Ongoing Information and Training • Future seminars/workshops • Pandemic website: www. foh. dhhs. gov 46

Pandemic Influenza: Information for Federal Agencies FOH Response Services Health Center Services 4 Disease/symptom tracking and surveillance 4 Vaccine/antivirals (if available) 4 Return-to-work screening Medical Consultation 4 Access to physicians and other medical experts 4 Current information on disease containment, risk reduction, etc. 47

Pandemic Influenza: Information for Federal Agencies What NOT To Do 4 Don’t stockpile antiviral medications 4 Don’t assume assistance will be available during a pandemic 4 Don’t purchase influenza prevention products or implement prevention strategies that are not approved by the FDA or public health authorities 4 Don’t assume that if an avian flu pandemic is avoided in the next year, the threat has passed 4 Don’t underestimate the likely global impact of a pandemic 48

Pandemic Influenza: Information for Federal Agencies SUMMARY - What To Do 4 Educate your employees about pandemics, influenza and prevention strategies 4 Plan for an influenza pandemic as part of COOP 4 Use planning resources: www. pandemicflu. gov 4 Update/communicate your plans 4 Manage stress, anxiety and fear 4 Know how FOH can help 49

Pandemic Influenza: Information for Federal Agencies Federal Occupational Health healthy bodies sound minds a safe place to work (800) 457 -9808 www. foh. dhhs. gov 50