PANDEMIC INFLUENZA M Rony Francois MD MSPH Ph

PANDEMIC INFLUENZA M. Rony Francois, MD, MSPH, Ph. D Secretary, Florida Department of Health Bill Tynan, M. D. T. R. Belcuore, MS

Overview Threat – Disease Characteristics – Pandemic Characteristics Preparedness – Surveillance – Resources Questions

Threat Pandemic Influenza – History 1918 1957 1968 – Frequency – Duration – Waves – Worldwide 40 – 50 million deaths 2 million deaths 1 million deaths ~ every 35 years 1 – 3, 4 – 8 weeks/wave 6 – 9 months, 3 months?

Threat Factors Affecting Outbreak Control – Attack rate 35% of population – Hospitalization rate 10% of cases – Case fatality rate ~2 - 50% – Asymptomatic, presymptomatic transmission ~30% - 50% – Reproduction number ~2 people – Serial interval ~2 – 4 days – Infectious period ~peaks day 2(1 -8) – Incubation period ~2 (1 – 4 days)

AVIAN FLU BY THE NUMBERS 0 - number of human and avian US cases 2 - reproductive value of single flu case 1 -5 days from exposure to illness Communicability: 1 -2 days before, 4 -5 days after onset of symptoms 1997 - year this virus appeared 250/115 -number of confirmed cases/dead 300, 000 - number of birds killed (est. )

What constitutes a Pandemic? 1. Highly virulent organism 2. Lack of human immunity to the organism 3. Ability to easily transmit from human to human H 5 N 1 has the first two but not the third (recent cases in Indonesia)

WHERE ARE WE TODAY? PREPAREDNESS SURVEILLANCE ANTIVIRALS VACCINE COMMUNICATION

Preparedness National Strategy 1. Stopping, slowing or otherwise limiting the spread of pandemic to the United States 2. Limiting the domestic spread of a pandemic, and mitigating disease, suffering and death 3. Sustaining infrastructure and mitigating impact to the economy and the functioning of society

Preparedness Florida’s Strategy – ESF 8 Emerging Event Team (EET) – Develop Florida Strategy for Pandemic Influenza – Engage entire emergency management system – Prepare gap analysis with WHO, HHS Plans – Review, update existing all-hazards plans – Develop communications strategy for WHO phases of disease to all stakeholder groups and the public

SURVEILLANCE Animals Alaska Wild Bird Testing Poultry Farm Protocol Humans Sentinel Physicians National Retail Monitoring System Five Biosafety Level 3 Laboratories Routine Disease Investigations

Commercial Poultry in Florida 13

OVERARCHING GOALS Push the epidemic curve to the right Reduce the “reproductive number” Minimize antiviral usage Minimize hospital burden Minimize morbidity/mortality while vaccine is developed

Effect of delaying the onset of the epidemic Delay three months No intervention Delay and contain Six months Pandemic starts Infection appears in Florida Vaccine available

RESPONSE & CONTAINMENT PHASE 6 CASE REPORTS LABORATORY SURGE CAPACITY ISOLATION QUARANTINE TARGETED ANTIVIRALS TARGETED PROPHYLAXIS TARGETED VACCINATIONS

THE LOG PHASE Individual case finding ceases Community Control Social Distancing Patient Management COOP Plans- do you have one?

COMMUNITY CONTROL Stay home if you are sick Innovative food purchasing Self Isolation Family Support Plans

SOCIAL DISTANCING Cessation of public meetings-technology can help here Church gatherings Theatres Sporting Events Closure of schools and child care Use of distance learning

PATIENT MANAGEMENT Home is the primary place to be Alternate treatment facilities Alternate housing

VACCINATION PHASE Who gets vaccinated first? Vaccination Issues Plan

COMMUNICATION Rumor control is critical Risk communication Internet Amplification Messenger and message

PANDEMIC FLU WEBSITES Centers for Disease Control & Prevention – http: //www. cdc. gov/flu/avian/index. htm Florida Department of Health – http: //www. doh. state. fl. us/ U. S. Department of Health & Human Services – http: //www. pandemicflu. gov/