1 north florida region domestic security task force setting the pace for florida's leadership...

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North Florida Region

Domestic Security Task Force

Setting the Pace for Florida's Leadership

11/292/05 Version 3.3

Pandemic Influenza Workshop

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Pandemic Influenza Workshop Objectives

Prior Planning Prevents Pandemic Pandemonium

• Raise awareness about impact of pandemic flu on the health care system and the community as a whole. • Increase understanding of the responsibilities of all community partners. • Determine the adequacy of current plans to address the range of anticipated events. • Identify gaps in coordination among community partners. • Promote planning continuity among all community partners.

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Education Format:

• Influenza Virus Characteristics

• History

• Surveillance

• Planning

Pandemic Influenza Workshop Format


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Exercise Format:

• Interactive Tabletop

• 3 Modules

•Prepare, Respond, Recover, Mitigate

• Hot Wash

• Action Plan


Pandemic Influenza Workshop Format

5Prior Planning Prevents Pandemic Pandemonium

Pandemic: An infectious disease epidemic that affects people worldwide or over an extensive geographical area.

Pandemic Definition

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Primitive “life” form

Only one function: Replication

Influenza Virus Characteristics


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Influenza Virus Infection


Stellenbosch University, Tygerberg, South Africa

Virus slips in RNA issues orders Viruses break out

High efficiency High mutation rate Confuses body defenses

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Virus Exchange Program

Wild Birds -- Chickens

Chickens -- Humans

Chickens -- Pigs

Pigs -- Humans

Humans -- Humans

Influenza Virus Characteristics


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H5N1 Outbreak in Birds12/2003 – 03/2006

Countries Affected (confirmed in poultry)

December 2003-March 2006 Source: World Health Organization

Cambodia China Indonesia Croatia Slovakia

Kuwait Japan Russia Kazakhstan Switzerland

Korea (Rep. of) Thailand Vietnam Ukraine Hungary

Romania Turkey Mongolia Malaysia Albania

Iraq* Nigeria Bulgaria Greece Poland

Italy Iran India Egypt Pakistan*

Austria Azerbaijan Germany France Serbia & Montenegro*

Bosnia* Laos* Slovenia Niger Burkina Faso

* - Only H5 confirmed, neuraminidase not determined

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Direct – Viral particles are contained in droplets resulting from an uncovered sneeze or cough.

Breathing them in can result in an infection.

Influenza Virus Transmission


During a sneeze, millions of tiny droplets of water, mucus, and virus particles are expelled at 200 mph.

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Indirect – Viral particles may survive for a short time on many surfaces (hands, door knobs, phones). Touching these surfaces may transmit infection through eyes, nose, or mouth.

Influenza Virus Transmission


What precaution do these transmissions suggest?

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History

“No disease the world has ever known even remotely resembles the great influenza epidemic of 1918. Presumed to have begun when sick farm animals infected soldiers in Kansas, spreading and mutating into a lethal strain as troops carried it to Europe, it exploded across the world with unequaled ferocity and speed. It killed more people in twenty weeks than AIDS has killed in twenty years; it killed more people in a year than the plagues of the Middle Ages killed in a century. Victims bled from the ears and nose, turned blue from lack of oxygen, suffered aches that felt like bones being broken, and died. In the United States, where bodies were stacked without coffins on trucks, nearly seven times as many people died of influenza as in the First World War.”


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History -- Images


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History – Some Statistics

Death Toll Worldwide: 40 - 100 Million

Death Toll US: 650,000

Normal Season Flu Death Toll: 36,000

Normal Sean Flu Hospitalizations: 200,000

Most Susceptible Population Age: 15-34

Number of Flu-Orphans in NYC: 21,000


I had a little bird

His name was Enza

I opened up the window

And Influenza

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History -- Pandemic Spread

• Exceptionally Virulent Strain

• New and Rapid Population Mixing (Training Camps)

• WWI Overseas Deployments

• Initial Lack of Communications (Sedition Act)

• Quarantine – None early on

• Weak Public Health Infrastructure


Liberty Bond Rally

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History – Other Pandemics

1957 Asian Flu -- US Deaths 69,800

1968 Hong Kong Flu – US Deaths 33,800

Pandemic Flu Scares:

1976 Swine Flu

1977 Russian Flu

1997 -1999 Avian Flu

Non-Flu Scare: SARS Multi-Country Outbreak


SARS Precautions

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Inter-Pandemic Period – Phases 1 and 2

Inter-Pandemic Period – Phases 1 and 2

•No new influenza virus•Develop plans and exercise them•Educate the public (throughout all phases)•Vaccinate public•Surveillance


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Pandemic Alert Period – Phase 3

The phase we are currently in

Pandemic Alert Period—Phase 3

•Human infection with a new subtype•No human to human spread

•Monitor the situation via surveillance systems and communication with Florida DOH•Communicate with community partners


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The phase we are currently in


• Pandemic Alert Period—Phase 3 Actions– Stockpile masks, hand-sanitizer, anti-virals– Nationally—encouraging the development of

vaccine– Nationally—develop more rapid testing

methods– State-Increase surge capacity of laboratories

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Human Cases of H5N1 Avian Flu 2003-2006

Country Total Cases Deaths

Indonesia 29 22

Cambodia 4 4

Thailand 22 14

Vietnam 93 42

China 15 10

Turkey 12 4

Iraq 2 2

Azerbaijan 7 5

Egypt 7 (4 initial confirmation only) 4

Jordan 2 (initial confirmation only)

Total 193 107

As of 04/04/06 Source: World Health Organization (laboratory confirmed cases)

55%

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• Pandemic Alert Period—Phase 4– Limited human to human transmission

• Isolate / treat the sick

• Vaccinate / treat close contacts

• Encourage self-quarantine

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• Pandemic Alert Period—Phase 5– Larger clusters but still localized– Adjust and maximize resources—questionable use of

points of distribution (drugs are trickling in)– If available deploy prototype vaccine

• Questionable use of points of distribution• Decision on who to vaccinate (ethics?)

– Assess staffing issues– Travel restrictions– Social distancing

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• Pandemic Period-Phase 6– Increased and sustained transmission– Alternative treatment sites– Ventilator decisions– State resources for aid– Continue risk management– Maintain surveillance, including deaths

• Morgue surge capacity• Funeral supplies may be limited

25Prior Planning Prevents Pandemic Pandemonium

• Sentinel physicians – how many are in your county?

• ESSENCE – influenza symptoms, patient load, etc.

• BIOSENSE – military hospitals• EpiCom• Vital Statistics – death rates• School absenteeism

Human Surveillance

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• Sentinel Physicians

• Hospitals

• County Health Departments

• Department of Health and Private Labs

• Department of Agriculture and Consumer Services

• Centers for Disease Control and Prevention (CDC)

• World Health Organization (WHO)

Communication! – Communication! – Communication!

Surveillance Partners


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Between Waves


• Between waves– Ensure staff recovery– Re-stock supplies/medications– Lessons learned to improve

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Current Situation -- Avian Flu – Phase 3:

• Bird to Human transmission still very rare

•Vaccine in development for birds for H5N1

•Vaccine in development for H5N1 for humans – this is not the same as a human to human virus we are planning for

• Human to Human transmission even more rare

•We can’t develop a vaccine until we know the human to human strain

• Will this be the “Big One”?

Influenza H5N1 – Avian Flu


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Request to Fund – National Strategy


DOH – 12/5/05

• Global surveillance $ 251 million• Vaccine technology $ 2.8 billion • Purchase medication • and vaccines $ 800 million• Vaccine for HHS $ 1.5 billion• Stockpile anti-virals $ 1.0 billion• Emergency preparedness $ 644 million• Total $ 7.1 billion

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The thing to Keep in Mind for Now:

Influenza H5N1 – Avian Flu


NOT Recommended.

31Pandemic Pandemonium

The Clock is Ticking….

We just don’t know what time it is.

Surveillance Urgency

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Pandemic Planning


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• We will have an epidemic soon of a strain of influenza to which none of us is immune.

• We will likely have only a short window between when the strain is clearly causing disease and when it starts causing widespread disease where we live.

• Vaccine likely won’t be available for 6 to 9 months after the epidemic starts.

• Supplies of anti-virals will be far less than needed for total-population coverage or even coverage of high-priority groups.

Planning Assumptions


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Predicted Morbidity Range for Palm Beach County

• 35% Attack Rate

Predicted Mortality Rate for Palm Beach County•5% of those infected



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Palm Beach Population 1.2 Million

Attack Rate 35% 420,000

Seeking Treatment 75% 315,000

Hospitalization Rate 10% 31,500

Mechanical Ventilation 7.5% 23,625

Fatality Rate 5% 21,000

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• Once the pandemic takes hold, we have to assume that there will be little to No Help from the national or state level – not just for days, but for weeks, and perhaps months.

• We have to assume that every county and every community will be pretty much on its own in an influenza pandemic.

• County Health Department will have ICS Lead.



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• When a vaccine first becomes available, who should get it?

• How should we use the limited supplies of antiviral medications? (Tamiflu – 10 doses in five days. Must be taken within 48 hours.)

• Given lack of vaccines and anti-virals, how do we approach reducing illness and death?

• What is the right balance among minimizing health burden, economic damage, and societal damage?

Planning Questions


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Can we hold the fort till we can get vaccine?

• The longer we can delay the onset of the epidemic in our community, the more illness we can prevent.

• This will require vigorously applying measures that have limited effectiveness and a strong and continuous, risk communication campaign directed to all of our citizens.

Planning – More Questions


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The placement of sick persons with specific infectious illness in separate rooms from those who are healthy. This is usually voluntary and may be at their own home or at a hospital

Planning – Isolation


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Usually voluntary, but the FDOH Secretary may declare a public health emergency and issue a quarantine order to separate and restrict movement of people who have been exposed to an infectious agent, and may therefore become infectious

Planning – Quarantine


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• Isolate the sickVoluntary or legally

mandated?

• Quarantine well, exposed persons

Voluntary or legally mandated?

• Limit personal interactionse.g., close schools and

day-care, stop large public gatherings

Planning – Options for Disease Prevention


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• Change social norms about self-quarantine, personal hygiene, shaking hands, and masks.

• Advise travel restrictions.

• Home management of uncomplicated influenza

-- Recognition of complications

-- Management of complicated patients

Planning – Behavioral Modification

Social Marketing


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• Stigmatization of vulnerable groups

• Equity in access to care and in application of isolation and quarantine

• Civil liberties balanced with effective disease control

• Potential for civil disorder and vigilante actions

• Trust in government and health care system institutions, especially if initial measures seem to fail

• Long-term stress and behavioral health

Planning – Social Issues


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• Cost of care and cost of providing preventive measures.

• Impact on essential services and general productivity of widespread illness – e.g., 10% of workforce out sick continuously for many weeks.

• Curtailment of business travel, shopping, and entertainment venues.

• Shipment of goods, including food, fuel, and essential supplies

Planning – Economic Issues


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• Lots and lots of issues and opportunities with risk communication

• Prompt, accurate, clear

• Acknowledge uncertainties

• Provide frequent updates as new info becomes available

• Manage the level of expectations

Planning – Communications Issues


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• For Unusual death in domestic birds call:

•USDA – Veterinary Services for Florida at

1-866-536-7593

•The Florida Department of Agriculture recommends that you contact your local agriculture extension at Broward County Fish and Game – Non-Game Division 561-625-5122 – Sharon Hood

•The Florida Dept of Agriculture / Division of Animal Industry can be reached at 850-410-0900

Communications

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QUESTIONS?


1 north florida region domestic security task force setting the pace for florida's leadership...

Documents

pandemic pandemonium

pandemic definition

impact of pandemic flu

planning continuity

virus particles

great influenza epidemic

humans humans

south africa virus