Pandemic Flu CDC Perspective and Resources

Pandemic Flu:CDC Perspective and Resources : Pandemic Flu:CDC Perspective and Resources Adam L. Cohen, MD MPH Division of Healthcare Quality Promotion Centers for Disease Control and Prevention

Slide 2 : What is Pandemic Flu?

Slide 3 : But first, what is the Flu?

What is Influenza? : What is Influenza? “The flu” = acute febrile respiratory illness Caused by infection with an influenza virus Clinically Fever (=100.0 F) plus cough or sore throat Also headache, fatigue, body aches Range of symptoms differ by age Often confused with other illnesses “Viral illness”, “Cold”, “Stomach flu”

Virus family: Orthomyxovirus : Virus family: Orthomyxovirus Two surface proteins: Hemagglutinin (H) 15 types: H1 – H15 Neuraminidase (N) 9 types: N1 – N9 Influenza Virus

Transmission : Transmission Highly contagious Primarily person-to-person Incubation period: 1-4 days Infectious period may begin 1 day before symptom onset and last for 4-6 days

There are Three Types of Flu : There are Three Types of Flu Seasonal influenza A public health problem every year in humans Spread easily from person to person Avian influenza Devastating H5N1 global outbreak in poultry Rare but severe human infections Does not spread easily from person to person Pandemic influenza Appears in the human population periodically H5N1 is a likely candidate, but it is not a pandemic virus yet

Slide 8 : Previous Influenza Pandemics H1 H1 H3 H2 H7* H5* H9* 1918 Spanish Influenza H1N1 500k US deaths 1957 Asian Influenza H2N2 70k US deaths 1968 Hong Kong Influenza H3N2 34k US deaths 1980 1997 1915 *Avian Flu 2003 2004 1977 1996 2002 1925 1935 1945 1955 1965 1975 1985 1995 2005 2003-2006 1998 1999 2003

What would a pandemic look like in the U.S.? : What would a pandemic look like in the U.S.? Based on past pandemics,15-35% of the U.S. population may become clinically ill with influenza virus Preliminary estimates suggest 314,000 to 734,000 hospitalizations 18-27 million outpatient visits 89,000 - 207,000 deaths $71.3 - 166.5 billion economic impact

Healthcare Impact : Healthcare Impact High demand for services Estimated >25% increase in demand for inpatient beds, ICU beds, and ventilators for a mild pandemic Staff absenteeism 1957/58 (UK) 20% absenteeism rate; 1/3 of staff in one hospital was ill during peak Limited availability of critical resources

How would a pandemic happen? : How would a pandemic happen? Gene exchange between influenza A viruses Human or swine flu viruses can reassort with bird flu viruses in human or swine (co-infection) Human H3N2 Chicken H5N1 H5N2 influenza A H3N1 influenza A H5N1 influenza A

Slide 12 : Many H5N1-infected chickens Few H5N1-infected humans No human-to-human transmission

Slide 13 : Many H5N1-infected chickens Many H5N1-infected humans Moderately efficient human-to-human Reassort genes

Slide 14 : Elements of a pandemic: Many H5N1-infected humans Good human-to-human transmission

Why healthcare must prepare Lessons learned from SARS : Why healthcare must prepare Lessons learned from SARS Healthcare facilities will be critical areas during outbreaks of respiratory infections. They are essential in controlling outbreaks, despite being among the hardest hit by them. The outbreaks will stretch healthcare resources to their limits. Preparedness and response planning and testing must be done before the outbreak happens!

What will hospitalsneed to do? : What will hospitalsneed to do? Surveillance Infection Control Engineering Staffing Supplies and Equipment

Healthcare Logistics Issues : Healthcare Logistics Issues Prioritization of antivirals and vaccines Distribution and administration of antivirals Hotlines for triage to reduce burden on facilities Prioritization and allocation of medical equipment such as mechanical ventilators Selection of alternative care sites

Slide 18 : www.pandemicflu.gov www.cdc.gov/flu

Potential Toolsin Our Toolbox : Potential Toolsin Our Toolbox Our best countermeasure – vaccine – will probably be unavailable during the first wave of a pandemic Antiviral treatment may improve outcomes but will have only modest effects on transmission Antiviral prophylaxis will have more substantial effects on reducing transmission Infection control and social distancing should reduce transmission, but strategy requires clarification

Pandemic PlanPrevent or delay introductioninto the U.S. : Pandemic PlanPrevent or delay introductioninto the U.S. May involve travel advisories, exit or entry screening For first cases, may involve isolation / short-term quarantine of arriving passengers

Pandemic PlanSlow spread : Pandemic PlanSlow spread Antiviral treatment and isolation for people with illness Quarantine for those exposed Social distancing Vaccine when available Weeks Impact Prepared Unprepared

Pandemic PlanCommunicate to the public : Pandemic PlanCommunicate to the public Prepare people with information Encourage action steps to prepare now Provide updates when new information emerges Use trusted messengers Coordinate to ensure consistent messages Address rumors and inaccuracies

Pandemic PlanVaccine : Pandemic PlanVaccine Expand production of current vaccine Evaluate dose-sparing technology Accelerate development of modern (non-egg) vaccines Target new antigens

Pandemic PlanAntivirals : Pandemic PlanAntivirals Stockpile Oseltamivir (Tamiflu) Zanamivir (Relenza) Goal: quantity to treat 25% of the U.S. population Distribution Strategy Initial containment Treatment Prioritization – science and values, public engagement Preserve societal functioning Protect those most at risk New antiviral candidates

Funding : Funding $350 million for state and local response capacity $100 million has been awarded to All 50 states 7 territories; Puerto Rico; Washington, DC; New York City; Chicago; Los Angeles County Allocated according to a base + population formula $250 million to be awarded later this year

Network of Responsibilities : Network of Responsibilities Local - state - federal Domestic – international Public – private Multi-sector Non-partisan Animal – human Health protection – homeland security – economic protection www.pandemicflu.gov

Pandemic Influenza Checklists : Pandemic Influenza Checklists State and Local Business Preschool Schools (K-12) Colleges & Universities Faith-based & Community Organizations Travel Industry Physician Offices and Ambulatory Care Home Health Emergency Medical Services Have you thought about…?

Conclusions : Conclusions Preparedness, by definition, must occur before the event! A formal, preparedness plan is important for healthcare facilities to respond quickly and effectively. Plans must account for a variety of issues that will be encountered.

Conclusions : Conclusions Once developed, plans should be tested and refined. Perhaps the most important lesson learned from SARS is that healthcare facilities are capable of remarkable responses. We can help them, by promoting preparedness.

Slide 30 : Thank you