Pandemic Flu


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Pandemic flu is a global outbreak of a new type of influenza (flu)

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  • These information is very helpful and instructive. Congratulations for a job well done. Keep up the good work.
    Shirley Mcfly. Tucson, AZ
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  • Pandemic Flu

    1. 1. Protecting Your Family and Workplace During Pandemic Atlanta Federal Safety Council November 7, 2006 L. Casey Chosewood, MD Director, Office of Health and Safety Centers for Disease Control and Prevention
    2. 2. Overview <ul><li>What is Pandemic? What is Avian Flu? </li></ul><ul><li>Seasonal Flu vs Pandemic </li></ul><ul><li>Lessons from Past Pandemics </li></ul><ul><li>Pandemic Control </li></ul><ul><li>Infection Control Basics </li></ul><ul><li>Preview of CDC’s Internal Workforce Protection Plan </li></ul><ul><li>Questions </li></ul>
    3. 3. What is a Pandemic? <ul><li>A Pandemic is a global disease outbreak. </li></ul><ul><li>Pandemic flu is a global outbreak of a new type of influenza (flu) </li></ul><ul><ul><li>People typically have no immunity against the new strain of flu. </li></ul></ul><ul><ul><li>Disease can then spread easily from person-to-person and can cause serious illness. </li></ul></ul><ul><ul><li>In a short time period, the disease can spread worldwide. </li></ul></ul>
    4. 4. What about Avian Flu? <ul><li>Avian Flu is an influenza infection affecting bird populations—may or may not cause human illness </li></ul><ul><li>Animals are the best reservoir for developing viruses. </li></ul><ul><li>Avian influenza types have been responsible for the last three human pandemics (1918, 1957, and 1968). </li></ul><ul><ul><li>A specific strain of avian influenza, H5N1, which presently exists in birds in over 16 countries has resulted in a large number of deaths in birds and </li></ul></ul><ul><li>Some fear that H5N1 will become the next pandemic flu strain </li></ul>
    5. 5. Human Infections with H5N1 Avian Flu <ul><li>As of October 31, 2006 </li></ul><ul><ul><li>WHO reports 10 countries have confirmed cases </li></ul></ul><ul><ul><li>Indonesia (55 ), Viet Nam (42 ) and Thailand (17) have most cases </li></ul></ul><ul><ul><li>256 persons have been infected </li></ul></ul><ul><ul><li>152 have died </li></ul></ul><ul><ul><li>Fatality rate: 59% </li></ul></ul>
    6. 6. <ul><li>Seasonal Flu is less severe than pandemic strains, partial immunity exists </li></ul><ul><li>Seasonal vaccine often prevents circulating strains </li></ul><ul><li>Globally: 250,000 to 500,000 deaths each year to flu </li></ul><ul><li>In the United States each year, seasonal flu causes: </li></ul><ul><ul><li>36,000 deaths </li></ul></ul><ul><ul><li>>200,000 hospitalizations </li></ul></ul><ul><ul><li>$37.5 billion in costs from influenza and pneumonia </li></ul></ul>Seasonal Flu vs Pan Flu
    7. 7. What is the onset time for pan flu? <ul><li>The typical incubation period for pan flu is 2 to 3 days. </li></ul><ul><li>A person may be shedding virus for up to 12 to 24 hours before s/he feels ill. </li></ul><ul><ul><li>However, at this stage, they typically do not have the symptoms of coughing or sneezing, so transmission will not yet be significantly elevated. </li></ul></ul><ul><li>The period of lost availability for those that are ill is 2 to 4 weeks. </li></ul>
    8. 8. How long will the pan flu epidemic last? <ul><li>Pandemic flu may occur in waves in different communities. </li></ul><ul><li>Each wave may last between 6 to 8 weeks; </li></ul><ul><li>The duration of the pandemic may last between 12 and 18 months overall. </li></ul><ul><li>It is estimated that absenteeism from pandemic flu will range from between 40 to 60%. </li></ul>
    9. 9. Recent 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
    10. 10. HHS Pandemic Influenza Focus <ul><li>Slow the spread to reduce incidence of illness and death </li></ul><ul><li>Use social distancing, targeted antiviral treatment, isolation and quarantine to buy time to increase: </li></ul><ul><ul><li>Antiviral supply </li></ul></ul><ul><ul><li>Vaccine availability </li></ul></ul>Weeks Impact Prepared Unprepared
    11. 11. Elements of Pandemic Control <ul><li>Infection control and prevention: </li></ul><ul><li>Reduce transmission from contact between infected and non-infected </li></ul><ul><li>Patient management and isolation: </li></ul><ul><li>Reduce contact between infected and non-infected </li></ul><ul><li>Contact management (e.g., quarantine): </li></ul><ul><li>Reduce contact between possibly-infected and non-infected </li></ul><ul><li>Community restrictions (e.g., school closures): </li></ul><ul><li>Reduce contact between groups that might contain infected individuals </li></ul>
    12. 12. History of Infection Control Precautions in the United States <ul><li>1877 Separate facilities </li></ul><ul><li>1910 Antisepsis and disinfection </li></ul><ul><li>1950- 60 Closure of Infectious disease and TB hospitals </li></ul><ul><li>1970 CDC presented “Isolation Techniques for use in Hospitals” </li></ul><ul><li>1980-90s Universal/Standard Precautions </li></ul>
    13. 13. Disease Transmission Leave original host Survive in transit Be delivered to a susceptible host Reach a susceptible part of the host Escape host defenses Multiply and cause tissue damage Pathogens:
    14. 14. Standard Precautions <ul><li>Constant use of gloves and handwashing (plus face-shields, masks or gowns if splashes are anticipated) for any contact with blood, moist body substances (except sweat), mucous membranes or non-intact skin. </li></ul><ul><li>Gloves are removed and discarded immediately after completion of a task. </li></ul><ul><li>Hands are washed every time gloves are removed. </li></ul>
    15. 15. Transmission-based Precautions Used in addition to Standard Precautions <ul><ul><li>Contact : Gloves, gown </li></ul></ul><ul><ul><li>Droplet : Adds splash protection, eye protection and/or face shield </li></ul></ul><ul><ul><li>Airborne : Adds respiratory protection and, ideally, other engineering controls </li></ul></ul>
    16. 16. Yes or No? <ul><li>Can influenza spread via contact route? </li></ul><ul><li>Can influenza spread via the droplet route </li></ul><ul><li>Can influenza spread via the airborne route? </li></ul>
    17. 17. Quick Review: How is pan flu likely to be transmitted? <ul><li>Influenza usually spreads from person to person through close contact via respiratory droplets from coughing, sneezing, or talking </li></ul><ul><li>Influenza can also be spread by touching something that contaminated with the virus. </li></ul><ul><ul><li>This can include items such as: </li></ul></ul><ul><ul><ul><li>Tabletops </li></ul></ul></ul><ul><ul><ul><li>Doorknobs </li></ul></ul></ul><ul><ul><ul><li>Computer keyboards and Telephone handsets </li></ul></ul></ul><ul><ul><ul><li>Cloth, tissues, paper or currency infected with the virus </li></ul></ul></ul><ul><ul><ul><li>Another person’s hands or mouth </li></ul></ul></ul>
    18. 18. Evidence for Benefits of Physical Separation <ul><li>Proximity of less than 3 feet has been associated with increased risk for transmission of infections via respiratory droplets. New Engl J Med 1982;307:1255-7 Am J Med 1948;4:690 </li></ul>*P=0.0001 for the difference 7% (5/71)* >102 cm 27% (20/73)* <102 cm Percentage of carriers or cases Distance between chairs
    19. 19. Potential for Contact Transmission <ul><li>Influenza virus can survive on surfaces at room temperature and moderate humidity: </li></ul><ul><ul><li>Steel and plastic: 24-48 hours </li></ul></ul><ul><ul><li>Cloth and tissues: 8-12 hours </li></ul></ul><ul><li>Virus could be transferred from steel to hands 24 hours after inoculation, but from tissue to hands for only 15 minutes. </li></ul>J Infect Dis 1982;146:47-51
    20. 20. Potential for Contact Transmission <ul><li>Influenza viruses are enveloped </li></ul><ul><li>Environmental cleaning may lower contact transmission risk </li></ul><ul><li>Effectively inactivated by: </li></ul><ul><ul><li>Detergents </li></ul></ul><ul><ul><li>Alcohol-based products (hand gels) </li></ul></ul><ul><ul><li>Bleach solutions </li></ul></ul><ul><ul><li>Household disinfectants </li></ul></ul>
    21. 21. Evidence for Benefits of Hand Hygiene <ul><li>Hand hygiene reduces the respiratory infections in healthcare and community settings. </li></ul><ul><li>Among Navy Recruits </li></ul><ul><li>Am J Prev Med 2001;21:79-83 </li></ul><ul><li>Hand washing program implemented at a Navy training center. </li></ul><ul><li>45% reduction in outpatient visits for respiratory illness. </li></ul><ul><li>Frequent hand washers had fewer respiratory illnesses. </li></ul>
    22. 22. Among Students in Residence Halls AJIC 2003;31:364-70 <ul><li>College dorms were randomized to having alcohol hand rubs in various locations vs. not. </li></ul><ul><li>Hand rub groups had: </li></ul><ul><ul><li>14.8%-39.9% reduction in respiratory illnesses </li></ul></ul><ul><ul><li>43% fewer sick days </li></ul></ul>
    23. 23. Stratifying Risk: How Likely Will I Be Infected? <ul><li>In Healthcare settings: </li></ul><ul><ul><li>++++ Aerosol generating procedures performed on influenza patients </li></ul></ul><ul><ul><li>++++ Resuscitation of a patient with influenza </li></ul></ul><ul><ul><li>(i.e., emergency intubation, CPR, etc.) </li></ul></ul><ul><ul><li>++/+++ Direct patient care for a symptomatic (ill) patient suspected to have influenza </li></ul></ul><ul><ul><li>++ Direct routine patient care for all other patients </li></ul></ul><ul><ul><li>++ Home care for a family member ill with influenza </li></ul></ul><ul><ul><li>++ Non-patient-care activities in a healthcare setting </li></ul></ul><ul><li>  </li></ul>
    24. 24. <ul><li>In the Community:                 </li></ul><ul><ul><li>+ Home care for a family member who is ill but not known to have influenza </li></ul></ul><ul><ul><li>+ Prolonged exposure within 3-6 feet to large numbers of individuals </li></ul></ul><ul><ul><li>+/- Brief exposure within 3-6 feet to large numbers of individuals </li></ul></ul><ul><ul><li>+/- Exposure within 3-6 feet to one or two individuals </li></ul></ul><ul><ul><li>~0 Being in a room alone </li></ul></ul>Stratifying Risk (continued)
    25. 25. Protecting the Workplace <ul><li>Prevent transmission within the workplace </li></ul><ul><ul><li>Optimize hand hygiene </li></ul></ul><ul><ul><li>Facilitate respiratory etiquette </li></ul></ul><ul><ul><li>Maintain good environmental hygiene </li></ul></ul><ul><li>Exclude sources of infection </li></ul><ul><ul><li>Consider a screening of and exclusion of individuals with fever or respiratory symptoms </li></ul></ul><ul><ul><li>Exclude individuals with ill household members </li></ul></ul>
    26. 26. What’s Included in the CDC Workforce Protection Plan ? <ul><li>Personal and Family Readiness </li></ul><ul><li>Keeping the Workplace Safe </li></ul><ul><li>Assuring the Safety of CDC Deployments </li></ul><ul><li>Managing Illness within the Workplace </li></ul><ul><li>Guidance for Supervisors and Managers </li></ul><ul><li>Mental Health and Resiliency During Pandemic </li></ul>
    27. 27. Personal and Family Readiness <ul><li>General Preparedness = Pandemic Preparedness </li></ul><ul><li>Family Emergency Plan Important </li></ul><ul><li>Pandemic Awareness Initiative: </li></ul><ul><ul><li>Seasonal and Pandemic Flu Pamphlets </li></ul></ul><ul><ul><li>“Flu Kit” Provided with Seasonal Vaccine </li></ul></ul><ul><ul><ul><li>Hand gel, tissues, waste bag </li></ul></ul></ul><ul><ul><li>“ Influenza Preparedness”: CDC Employee Guide </li></ul></ul>
    28. 28. Keeping the Workplace Safe <ul><li>Cough Etiquette </li></ul><ul><li>Hand Hygiene </li></ul><ul><li>Social Distancing </li></ul><ul><ul><li>Limiting Face to Face Meetings </li></ul></ul><ul><ul><li>Telecommuting and Teleconferencing </li></ul></ul><ul><ul><li>Lunch “To Go” </li></ul></ul><ul><li>Surface Cleaning and other Environmental Measures </li></ul><ul><li>Potential for Workplace Entry Screening </li></ul>
    29. 29. Managing Illness within the Workplace <ul><li>Have Workers Pay Attention to Your Own Body </li></ul><ul><li>Promote this--Stay Home if You Are Feeling Ill! </li></ul><ul><li>Supervisors, Managers and Team Leads Have a Role to Play </li></ul><ul><li>Onsite Occupational Health Clinics Can Offer Assistance </li></ul><ul><li>Know About and Use Appropriate Leave if Needed </li></ul><ul><ul><li> </li></ul></ul>
    30. 30. Guidance for Supervisors and Managers <ul><li>Stay Engaged in Pandemic Planning </li></ul><ul><li>Act Promptly if Illness Occurs Among Your Workforce </li></ul><ul><li>Understand and Apply Leave Policies </li></ul><ul><li>Consider Telecommute Options and Plan for Them in Advance </li></ul><ul><li>Cross-train Workers and Plan for a “3 Deep” Strategy </li></ul>
    31. 31. Mental Health and Resiliency During Pandemic <ul><li>Stay Connected to Those Around You </li></ul><ul><li>Optimize Your Current Level of Wellness </li></ul><ul><li>Find Hobbies, Sports, Pastimes or Activities that Make You Happy and Give Purpose </li></ul><ul><li>Remain Hopeful and Optimistic </li></ul>
    32. 32. Communicating with Your Workforce During the Pandemic <ul><li>Share information with staff on pandemic status through emails or periodic “town hall” conference calls </li></ul><ul><li>Set-up a hotline which provides current status and any specific directions to staff with critical or essential job functions </li></ul><ul><li>Provide communication/talking points to leaders and supervisors based on the specific stages of the pandemic </li></ul>
    33. 33. For More Information: Accurate and Up-to-Date Resources <ul><ul><li> (Government-wide pan flu site) </li></ul></ul><ul><ul><li> (CDC) </li></ul></ul><ul><ul><li> (Department of Homeland Security) </li></ul></ul><ul><ul><li> (World Health Organization) </li></ul></ul><ul><ul><li> (Red Cross) </li></ul></ul>
    34. 34. Acknowledgements <ul><li>Thanks goes to the following persons who have contributed to this presentation and to the development of the CDC Pandemic Workforce Protection Plan </li></ul><ul><ul><li>Dr. Mike Bell, Division of Healthcare Quality Promotion, Coordinating Center for Infectious Diseases, CDC </li></ul></ul><ul><ul><li>Dr. Eli Warnock, Medical Director of CDC’s Occupational Health Clinics </li></ul></ul><ul><ul><li>Dr. Marie Socha, Senior Health Scientist and Consultant to the CDC Office of Health and Safety </li></ul></ul>
    35. 35. QUESTIONS?