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Pandemic Flu

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

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