influenza – what in the world do you need to know? kristine a. smith, m.a
TRANSCRIPT
What is Influenza? Acute, febrile respiratory
illness affecting nose, throat, bronchial tubes and lungs
Epidemics caused by influenza viruses A and B(Type C uncommon in people; no epidemics)
Occurs worldwide, causing considerable morbidity (illness) and mortality (death) each year
Symptoms appear rapidly
Symptoms
Fever, dry cough, sore throat, muscle aches/pain, headache, lack of energy, possibly runny nose
Fever and body aches for 3-5 days
Cough and lack of energy - 2 weeks
Symptoms similar to other upper respiratory diseases such as adenovirus, rhinovirus, parainfluenza, legionellosis, etc.
How You Get the Flu?
Typical incubation: 2 days
Range: 1-4 days Viral shedding
Can begin 1 day before symptom onset
Peak shedding first 3 days of illness
Correlates with temperature
Subsides after 5 days in adults, can be 10+ days in children
Transmission is Transmission is predominately droplet predominately droplet spreadspread
The Burden of Seasonal Influenza
Globally: 250,000 to 500,000 deaths each year
In the United States each year: 36,000 deaths >200,000 hospitalizations $37.5 billion in economic costs from influenza
and pneumonia
How Influenza Viruses Change?
Antigenic Drift: Small changes in virus over time New strains appear and replace older strains May not be recognized by antibodies to older strains
Antigenic Shift: Abrupt, major change (reassortment) Results in novel strain or new subtype Can cause pandemic influenza
What is an Influenza Pandemic ?
A global influenza outbreak Caused by a brand new (novel) flu virus Most severe occur with changes in both surface proteins Viruses can be isolated at any time of year
Because it is a new virus, few or no people would be immune
Many people would get sick in every part of the world
Asia is the source of many outbreaks because swine, birds and humans live under the same roof, providing opportunity for viral mixing
Influenza Pandemics 20th Century
A(H1N1) A(H2N2) A(H3N2)1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
20-40 m deaths
675,000 US deaths
1-4 m deaths
70,000 US deaths
1-4 m deaths
34,000 US deaths
Credit: US National Museum of Health and Medicine
Timeline of Emergence of Timeline of Emergence of Influenza A Viruses in HumansInfluenza A Viruses in Humans
1918 1957 1968 1977 19971998/9
2003
H1
H1
H3H2
H7H5H5
H9
SpanishInfluenza
AsianInfluenza
RussianInfluenza
AvianInfluenza
Hong KongInfluenza
If a Pandemic Happens: What to expect…
At the peak of a moderate pandemic influenza outbreak (i.e. 35% attack rate, 6 week duration), New York State (excluding New York City) can expect: 14,916 influenza-related hospital admissions per week 3,728 influenza-related deaths per week
2,609 deaths in the hospital
Influenza patients will most likely utilize: 63% of hospital bed capacity 125% of intensive care capacity 65% of hospital ventilator capacity
Will Avian Flu Cause the Next Pandemic?
No one knows!
The H5N1 virus could change to spread more easily among humans-but it might not.
It could “swap genes” with another animal virus, or with a human flu virus
Avian Influenza
The H5N1 strain of avian influenza (bird flu) is present in birds in many countries across several continents. Bird flu is NOT the same as pandemic flu
Some human cases of avian influenza have also occurred Cases occurred after close contact with infected birds No sustained person to person transmission
Human death rate is high >57%
H5N1 Outbreak: December 2003 –July 20, 2006 Laboratory confirmed human cases:
231 human cases
133 human deaths
Case fatality rate 57 percent
Cases occurred in countries with endemic infection of poultry
Nearly all human cases had poultry/bird exposure
No sustained person-to-person transmission identified
No influenza A viruses with human and avian genes detected yet
Source: World Health Organization
Situation Report: Avian Influenza
Widespread prevalence in migratory birds; broad host range
Continued outbreaks among domestic poultry
Mammalian infection (cats, pigs, etc.) - lethal
Virus is evolving
Sporadic human cases (>190 reports to date)• Most in young and healthy, Case-fatality 57%• Rare person-to-person transmission
Sustained and rapid person-to-person transmission
WHO Pandemic Phases
Interpandemic Interpandemic periodperiod
Phase 1: Phase 1: No new influenza virus subtypes in No new influenza virus subtypes in human; subtype that has caused human human; subtype that has caused human infection may be present in animalsinfection may be present in animals
Phase 2: Phase 2: As above, but circulating animal As above, but circulating animal subtype poses substantial risk of human subtype poses substantial risk of human diseasedisease
Pandemic Pandemic alert periodalert period
Phase 3: Phase 3: Human infection w/ new subtype, no Human infection w/ new subtype, no human-to-human (HTH) spread, or rare spread human-to-human (HTH) spread, or rare spread to close contactto close contact
Phase 4: Phase 4: Small clusters w/ limited HTH Small clusters w/ limited HTH transmission, highly localized spread, transmission, highly localized spread, suggesting virus not well adapted to humansuggesting virus not well adapted to human
Phase 5: Phase 5: Larger clusters, but HTH spread still Larger clusters, but HTH spread still localized, virus increasingly better adapted to localized, virus increasingly better adapted to humans, but not yet fully transmissiblehumans, but not yet fully transmissible
Pandemic Pandemic periodperiod
Increased and sustained transmission in Increased and sustained transmission in general populationgeneral population
NYSDOH Planning Process
Original plan drafted using internal DOH workgroups – August 2004
Based on federal DHHS August 2004 pandemic plan
NYSDOH revised plan and incorporated recent guidance issued in the updated DHHS November 2005 plan
Additional workgroup members added from:
Local health departments
Hospitals and hospital associations
NYSDOH plan: www.health.state.ny.us
Federal plan: www.pandemicflu.gov
Current Status of NYS Planning
With the Disaster Preparedness Commission (DPC) agencies, SEMO is coordinating development of a State pandemic plan that will become an annex of the State’s Comprehensive Emergency Management (“All Hazards”) plan
Local Health Departments are developing county-specific plans—due date August 30, 2006
Hospitals and Regional Resource Centers are planning for surge capacity
Pandemic preparedness town meetings, regional partner meetings, regional media forums are being held
Extensive Training is Underway
NIMS training for emergency responders
Point of Dispensing (POD) training for Local Health Departments
Laboratory specimen collection and submission training
Informatics training for key partners using HIN, HPN, HERDS
Multiple tabletop and functional exercises held: ProtEX NY state POD
exercise, November 2005 2006 versions Nov. 9 in
NYC, Syracuse
CDEx full functional exercise, June 2006 (more than 200 agencies participated)
Public Health Emergency Preparedness -
A Shared Responsibility! Local – state – federal Domestic –
international Public – private Multi-sector Animal – human Health protection –
homeland security – economic protection
Healthcare
DeliverySystem
Federal Partners
Education System
Businesses & Workers
Local/State/Federal Public HealthSystem
Businesses, school systems, community infrastructure providers, and other employers should develop plans for continuity of essential operations and modified operation with a significantly reduced workforce
25 to 30% of persons may become ill during a 6 to 8 week outbreak An additional 10% of the workforce may be absent due to illness of a
family member Others may stay home due to a fear of becoming infected
General Infection Control Assumptions in a Pandemic
Core prevention and control measures (e.g., vaccination and antivirals) will not be available or will be limited
We must prepare for that!
Individual Infection Control Strategies
Respiratory hygiene/cough etiquette and hand hygiene are effective strategies to stop the spread of germs
We should make good hygiene a habit now
What is Respiratory Hygiene/Cough Etiquette?
Cover mouth/nose when sneezing or coughing If no tissue, use elbow instead of hands
Use tissues and dispose of appropriatelyPerform hand hygiene after contact with
respiratory secretionsDistance yourself from others
(more than 3 feet)
What is Hand Hygiene?
Traditional hand washing Soap and hot water Minimum of 20 seconds
(the time it takes to sing “Happy Birthday” twice)
Alcohol based hand rubs Acceptable means to disinfect/sanitize EXCEPT
when hands are visibly soiled
Did You Ask About Masks?
Recommended for: Health care workers with
direct patient contact
Those at high risk for complications of influenza
Symptomatic persons
Contacts of ill persons
More About Masks
Benefit of wearing masks by well persons in public settings has not been established Persons may choose to wear a mask as part of an
individual protection strategy that includes respiratory hygiene/cough etiquette, hand hygiene, and social distancing
If you wear a mask, keep your hands away from your face!
Clean your hands each time you touch your mask!
Isolation and quarantine: reduces influenza transmission by separating infected persons from uninfected persons, and exposed persons from non-exposed persons
Isolation of ill persons will be valuable during all phases of pandemic influenza
Quarantine of those exposed to ill persons is justified when there are a limited number of cases
Individual or GroupInfection Control Strategies
Work or School Based Infection Control Strategies
Respiratory hygiene/cough etiquette, hand hygiene Stay away if ill (staff stay home, students do not go
to classes) Encourage self-reporting of illness that develops Active screening for
illness in staff/students Send staff/students home
(with mask) if ill
Community-Based Infection Control Strategies
Social distancing Snow days, voluntary self-
shielding Cancellation of public events
concerts, sports events, movies, plays
Closure of schools and workplaces office buildings, shopping malls
Closure of recreational facilities community swimming pools, youth
clubs, gymnasiums
Individual and Family Preparedness is Crucial!
We might have to take care of ourselves and those around us
How many would be ready?
Family Preparedness Checklist
To plan for a pandemic Store a supply of food
and water Have non-prescription
drugs and other health supplies on hand
Get involved in your community
Start now to limit the spread of germs and prevent infection Hand hygiene Respiratory hygiene Stay home if sick
Parents need to model behavior!
Questions
Contact Information:
(518) 486-1642
Additional Resources: Contact your local health department Websites – www.nyhealth.gov or www.pandemicflu.gov