Joint Hearing House Committees on Public Health,

Agriculture & Livestock, & Culture, Recreation & Tourism

February 13, 2007

“Avian/Pandemic Influenza—Texas Prepares”

David Lakey, MDCommissioner, Texas Department of State

Health Services

Emergency Preparedness and Pandemic Influenza

• The “unthinkable” events can and do happen

• Texas has been building a new emergency preparedness infrastructure

• Need an “ all-hazards” approach– Manmade Disasters (Bioterrorism)

– Natural Disasters (Hurricanes)

– Natural Infectious Disease Disasters (Flu pandemics)

• Flu pandemics have unique characteristics, but still need to be part of an “ all-hazards” plan

Definitions• Seasonal flu occurs annually from late fall through spring.

– CDC reports annual deaths numbering ~40,000

• Avian Influenza (bird flu) occurs in wild birds, but does not kill them; they spread it as they migrate

– Virus is deadly when it infects poultry– Few human deaths, mostly through direct

contact with poultry

• Pandemic influenza is a worldwide influenza epidemic

Recorded Influenza Pandemics

1918-19 Pandemic Flu

• Highest number of known flu deaths– More than 500,000 U.S. deaths

– 20 to 50 million deaths worldwide

• Many died within the first few days after infection

• Nearly half of those who died were young healthy adults

Lessons from 1918• The unthinkable does happen

• Pandemic worse than natural disasters- prolonged and progressive

• Planning is different

• You do not have time to start planning after the pandemic starts

Other 20th Century Influenza Pandemics

• 1957-58 Asian Flu – 70,000 deaths in the United States – First identified in China in late Feb 1957– Spread to the US by June 1957

• 1968-69 Hong Kong Flu– 34,000 deaths in the United States– First detected in Hong Kong in early 1968 – Spread to the US later that year

• 1976 Swine Flu– The pandemic that did not happen

Why the Concern Now?• All influenza viruses have the ability to change

– H5N1 virus may one day change to become easily transmitted between humans

• H5N1 – Avian Flu is increasing around the world in birds/chickens, & has expanded its host range to include cats, tigers & leopards

• The death rate for humans is over 60% • 1918 (H1N1) Flu and H5N1 are the only “Kissing

Cousins” among the 169 known Avian Flu viruses• World is “overdue” for a pandemic

– 32 Pandemics in the last 400 years• Countries are not prepared for a Pandemic

Does H5N1 Meet the Requirements for a Pandemic?

• 3 Requirements to become a Pandemic– A new virus to which humans are not immune

Yes– Virus causes severe human illness or death Yes– Virus spreads easily human-to-human No

H5N1 has 2 of the 3 today

WHO Pandemic Alert PhasesCurrent Phase Of Alert is a 3 in the World Health Organization Global Influenza Preparedness Plan

Inter-Pandemic Phase Low risk of human cases 1

New Virus in animals, no human cases

Higher risk of human cases 2

Pandemic alert No or very limited human-to-human transmission 3

New virus causes human cases

Evidence of increased human-to-human transmission

4

Evidence of significant human-to-human transmission

5

Pandemic Efficient and sustained human-to-human transmission

6

3

Are we LESS at Risk in 2007?• Advances in Medical Care

– Antibiotics, IV fluids, ventilators

• Greater ability to do surveillance, confirm diagnosis of flu

• Rapid means of communications – internet, TV, radio, email

• More effective personal protective equipment• Fewer people living in each household and

more rooms.

Are We More At Risk Today?• More international travel & trade• Increased population density• Little surge capacity in health care • Greater reliance on health professionals• More elderly & immuno-compromised

people • Today’s society not used to rationing,

sacrifice • “Just-in-time” ordering means limited

supplies of food, medicine & other critical items

SARS – Toronto – 2003

• 352 cases put hospitals in surge capacity

• All unnecessary hospital services shut down

• Churches and schools shut down• Tourism and conventions near zero

for two years.

Pandemic Influenza: Unlike any other challenge

• Possible global reach within weeks

• Likely impact measured in months, not weeks

• Expected to come in waves

• No state, region or community is likely to be unaffected

Disasters Pandemics

• Widespread geographic impact

• Occur in 6 week to 2 month waves

• Invisible evidence• Human casualties

predominate• State/federal response

limited• Widespread economic

crisis

• Limited in scope to a certain area

• Limited in time from minutes to days

• Visible evidence • Material casualties

predominate• Local material aid &

state/federal response• Localized economic

impact

A Pandemic will Affect all Sectors

• Up to 50% of the population may be absent at any given time

–Employees will stay home to care for loved ones

–Employees will stay home if schools & daycare facilities close

• Delivery of food & fuel will be impacted

• Companies should plan for continuity of operations in a radically different climate

Keys to Successful Preparation in Texas

• All hazards planning– Texas Homeland Security Strategic Plan

• Training & exercises– Planning alone is insufficient

• Integration at all levels– Local officials must be effectively supported at regional, state & national levels

• Early detection– Statewide monitoring

– Adequate lab capacity

Leadership Across State Agencies

• Office of the Governor

• Division of Emergency Management

• Texas Animal Health Commission

• Department of Agriculture

• Texas Education Agency

• HHSC/DSHS

DSHS & Pandemic Flu

• DSHS has primary responsibility for coordinating pandemic flu prevention, detection, response & recovery.

• DSHS is also responsible for coordinating state health & medical services

Texas Preparations• Statewide planning summits with broad

stakeholder participation–Pandemic Influenza Conference (12/05)–State Pandemic Summit with Sec. Leavitt (3/06)

• Expert panels including scientists, ethicists, consumer representatives, attorneys & faith-based organizations

• Business sector planning summits• State-level planning across key state agencies• Rapid investment of federal funds for pandemic flu

planning at state, regional & local levels– 90% of federal funds passed to regions & locals

Planning Progress• Original Pandemic Influenza Plan (posted on web

10/24/05)• Public Pandemic Influenza Plan (posted on web 12/06)• Under Review

– Appendix 7 to Annex H – Pandemic Influenza Plan Operating Guidelines

(PIPOG)– DSHS Concept of Operations Plan

• Due 3/1/07– State Pandemic Influenza Operations Plan – Antiviral allocation, distribution, and storage plan – Community Mitigation (Non-Pharmaceutical

Intervention)

DSHS Zoonosis Control

• Coordinate with Texas Animal Health Commission during outbreaks of avian flu

• Coordinate with TPWD regarding wild bird surveillance

• Provide recommendations for protection of inspectors & production facility workers related to avian flu

Local Achievements and Progress

• Plan development

• Exercises

• Enhanced regional collaboration through regional cooperation relating to use of federal funds

• Enhanced local participation in state planning

El Paso

San AntonioHouston

Austin

Tyler

DallasFt. Worth

Lubbock

Harlingen

Laredo

El PasoEl Paso

San AntonioSan AntonioHoustonHouston

AustinAustin

TylerTyler

DallasDallasFt. Worth

LubbockLubbock

Harlingen

Laboratories with Rapid H5 Flu Testing

Conventional Public Health Strategies

• Personal hygiene (clean hands, cover cough, contain germs)

• Closure of schools

• Cancellation of public events

• Isolation & quarantine

• Vaccinations & antivirals

Pandemic Influenza Vaccines

• Vaccines stimulate antibody production that provides long-term protection

• Current H5N1 vaccine in development is mismatched, but expected to provide some cross-over protection– Should be available in limited quantities before a pandemic

of H5N1

• Specific vaccine will be developed after the virus changes to become easily transmitted between humans– Should be available in limited quantities by the second

wave

• Cost & funding mechanisms to be determined

Antiviral Medications for Influenza

• If given within 48 hours of exposure or before exposure antivirals may:– Prevent disease– Antivirals may prevent disease only while

medication is taken – no long term protection• If given within 48 hours of symptoms

antivirals may:– Reduce length of illness by 1-2 days– Prevent severe complications

Antivirals will not cure disease

Antivirals

• Purchased of small cache of 144,622 courses• Texas allotment of the current Federal

Strategic National Stockpile is 3.3 million courses

• Current option to purchase 2.3 million courses at federal government subsidized rate– DHHS contract opened to other governmental

entities to purchase antivirals at subsidized price

• Developed antiviral target group guidelines

• Pandemic flu could last longer & cost more lives than any other threat

• Improving our efficacy against seasonal flu may be the single best way to reduce our risk in the event of a pandemic

– Universal seasonal flu vaccinations for all Texans could reduce the severity of disease in a pandemic

• Partnerships are critical to our success, not only federal state & local, but also public & private

• Integrated planning & exercises are essential• Preparation is vital, early detection is critical

Concluding Thoughts