pandemic influenza: hawaii preparedness & response

Disease Outbreak Control DivisionDisease Outbreak Control Division

Hawaii Department of HealthHawaii Department of Health

Pandemic Influenza:Pandemic Influenza:Hawaii Preparedness & Hawaii Preparedness &

ResponseResponse

Arrivals in Hawaii 2002-Arrivals in Hawaii 2002-20032003

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May0

100

200

300

400

500

600

700Thousands

Domestic International Total

Hawaii’s Resident Hawaii’s Resident PopulationPopulation

Hawaii’s Visitor PopulationHawaii’s Visitor Population

Rate of Death from Probable InfluenzaRate of Death from Probable Influenzaby Flu Season (October-April)by Flu Season (October-April)

Hawaii, 1914-1922Hawaii, 1914-1922

0

100

200

300

400

500

600

1914-15 1915-16 1916-17 1917-18 1918-19 1919-20 1920-21 1921-22

Flu Season Year

Dea

ths

per

100,

000

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillanceInfluenza surveillance

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

http://www.hawaii.gov/health/family-child-health/contagious-disease/pandemic-flu/fluplan.pdf

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Command and ControlCommand and Control• Incident Command System as applied to Incident Command System as applied to

Hawaii Dept of Health (HDOH)Hawaii Dept of Health (HDOH)

• HDOH as lead state agency in HDOH as lead state agency in medical/public health response supporting medical/public health response supporting State Civil DefenseState Civil Defense

• Establish roles and responsibilities of Establish roles and responsibilities of partner agenciespartner agencies

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillanceInfluenza surveillance

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Influenza SurveillanceInfluenza Surveillance• Early detectionEarly detection

• Components:Components:

– Routine surveillanceRoutine surveillance• SentinelSentinel• Illness cluster/absenteeismIllness cluster/absenteeism

– Enhanced surveillanceEnhanced surveillance• Port-of-entryPort-of-entry• Year-roundYear-round• Targeted testingTargeted testing

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillance: routine and Influenza surveillance: routine and pandemicpandemic

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Pandemic Influenza VaccinesPandemic Influenza Vaccines

• Pandemic vaccine availability likely Pandemic vaccine availability likely delayeddelayed

• May need multiple dosesMay need multiple doses

• Dependent upon Federal supplyDependent upon Federal supply

• Distribution via Strategic National Stockpile Distribution via Strategic National Stockpile (SNS) plan (SNS) plan

• Prioritization required – under debatePrioritization required – under debate

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillance: routine and Influenza surveillance: routine and pandemicpandemic

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Number of Antiviral Drug Number of Antiviral Drug Courses: Prophylaxis vs. Courses: Prophylaxis vs.

Treatment, USATreatment, USA

GroupGroup PopulationPopulation Number of coursesNumber of courses

Prophylaxis*Prophylaxis* Therapy**Therapy**

HCWsHCWs 11 m11 m 62 m62 m 4 m4 m

““Frontline” Frontline” hospitalhospital 3.2 m3.2 m 18 m18 m 1 m1 m

Public safetyPublic safety 2.3 m2.3 m 13 m13 m 1 m1 m

*Assumes 8-week prophylaxis*Assumes 8-week prophylaxis**Assumes 35% attack rate**Assumes 35% attack rate

93 m 93 m >>>>>>

6 m6 m

Modified from B. Schwartz, Modified from B. Schwartz, USPHSUSPHS

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Antiviral MedicationsAntiviral Medications• Antiviral resistanceAntiviral resistance

• Adequate dose and durationAdequate dose and duration

• Likely insufficient supplyLikely insufficient supply

• Stockpiling; federal assistance?Stockpiling; federal assistance?

• Prioritization requiredPrioritization required

• Distribution via SNS planDistribution via SNS plan

• Security necessarySecurity necessary

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillance: routine and Influenza surveillance: routine and pandemicpandemic

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & Quarantine/Social DistancingIsolation & Quarantine/Social Distancing

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Isolation, Quarantine,Isolation, Quarantine,Social DistancingSocial Distancing

• Isolation of Isolation of sicksick peoplepeople

• Quarantine of Quarantine of exposedexposed people people

• Social distancing for those Social distancing for those not yetnot yet exposed exposed

• All require adequate supplies for daily living All require adequate supplies for daily living and personal protectionand personal protection

• EnforcementEnforcement

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillance: routine and Influenza surveillance: routine and pandemicpandemic

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

Health Care DeliveryHealth Care Delivery

• Demand likely exceed capacityDemand likely exceed capacity

• Explore alternate facilities or home care Explore alternate facilities or home care optionsoptions

• Establish surge capacity for health care Establish surge capacity for health care personnelpersonnel

• Will require massive supplies Will require massive supplies

USAUSA Hospitalization Hospitalization ICU CareICU Care DeathsDeaths

Moderate Moderate 719,000719,000 107,850107,850 209,000209,000

SevereSevere 8,500,0008,500,000 1,300,0001,300,000 1,900,0001,900,000

USAUSA Hospitalization Hospitalization ICU CareICU Care DeathsDeaths

Moderate Moderate 0.25%0.25% 0.04%0.04% 0.07%0.07%

SevereSevere 2.93%2.93% 0.45%0.45% 0.66%0.66%

Hawaii Hawaii Hospitalization Hospitalization ICU CareICU Care DeathsDeaths

Moderate Moderate 3,4713,471 521521 1,0091,009

SevereSevere 41,03441,034 6,2766,276 9,1729,172

USA pop. = 290 m and Hawaii pop. = 1.4 (with visitors)

Hawaii Pandemic Influenza Hawaii Pandemic Influenza Preparedness & ResponsePreparedness & Response

• Command and controlCommand and control

• Influenza surveillance: routine and Influenza surveillance: routine and pandemicpandemic

• Pandemic influenza vaccinesPandemic influenza vaccines

• Antiviral medicationsAntiviral medications

• Isolation & quarantineIsolation & quarantine

• Health care deliveryHealth care delivery

• CommunicationsCommunications

Hawaii Preparedness & Response:Hawaii Preparedness & Response:

CommunicationsCommunications• CriticalCritical

• Establish contact with partners:Establish contact with partners:– Public health officialsPublic health officials– State agenciesState agencies– Federal, State, and Local governmentFederal, State, and Local government– Healthcare professionalsHealthcare professionals– BusinessesBusinesses– MediaMedia– PublicPublic

Summary PointsSummary Points

• Pandemic flu may easily reach Hawaii, a Pandemic flu may easily reach Hawaii, a globally popular travel destinationglobally popular travel destination

• Plans and policies should be establishedPlans and policies should be established

• Communication and collaboration are Communication and collaboration are criticalcritical

• Everyone must take responsibilityEveryone must take responsibility

Sources of InformationSources of Information• Questions for Hawaii Dept of Health Questions for Hawaii Dept of Health

fluinfo@doh.hawaii.govfluinfo@doh.hawaii.gov

• Hawaii Dept of HealthHawaii Dept of Health

http://www.hawaii.gov/health/family-child-health/conthttp://www.hawaii.gov/health/family-child-health/contagious-disease/communications/pandemicflu.htmlagious-disease/communications/pandemicflu.html

• Centers for Disease Control & Prevention:Centers for Disease Control & Prevention:http://www.cdc.gov/flu/pandemic/http://www.cdc.gov/flu/pandemic/

• US governmentUS governmenthttp://www.pandemicflu.gov/http://www.pandemicflu.gov/

• World Health OrganizationWorld Health Organizationhttp://www.who.int/topics/influenza/en/http://www.who.int/topics/influenza/en/