Pandemic Flu Presentation


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  • Pandemic Flu Presentation

    1. 1. City of Worthington Pandemic Flu Initiative
    2. 2. Course Goal <ul><li>Is to provide Worthington’s business leaders with education on the subject of pandemic influenza and its effect on our community, enabling him or her to effectively plan and prepare for an outbreak of pandemic influenza </li></ul>
    3. 3. Pandemic Influenza Planning and Preparedness Pandemic Influenza — The Threat Presented by: Chris Craig FF/NREMT-P City of Worthington Division of Fire
    4. 4. Objectives Describe the historical aspects associated with the last great pandemic — Spanish Flu Identify the factors associated with the cause of pandemics Identify the distinctions among various pandemics Identify the current peril associated with pandemic influenza
    5. 5. Understanding Pandemics
    6. 6. Pandemic Disease—Old Nemesis Rather than New Threat <ul><li>Pandemic disease is not a new threat </li></ul><ul><li>National Strategy for Pandemic Influenza (NSPI) — November 2005 </li></ul><ul><li>Department of Health and Human Services (HHS) Pandemic Influenza Plan — November 2005 </li></ul><ul><li>NSPI Implementation Plan released by the Homeland Security Council — May 2006 </li></ul>NSPI
    7. 7. Endemic, Epidemic, and Pandemic Defined <ul><li>Endemic — A disease that occurs at a high rate in a given population </li></ul><ul><li>Epidemic — An outbreak of new cases of a disease in numbers that exceed what is expected </li></ul><ul><li>Pandemic — An epidemic that spreads worldwide </li></ul>Malarious Area
    8. 8. Pandemics Throughout History <ul><li>Plague of Justinian — 541 A.D. </li></ul><ul><li>The Black Death — 1347-1350 </li></ul><ul><li>Typhus or camp fever — 15 th and16 th centuries </li></ul><ul><li>Smallpox — 16 th to 18 th centuries </li></ul>The Roof Rat
    9. 9. Influenza and Its Cause
    10. 10. Influenza and Its Cause <ul><li>The flu is a viral respiratory disease that occurs throughout the world every winter </li></ul><ul><li>Responsible for 35,000 deaths each year in the United States </li></ul><ul><li>Most fatalities from seasonal flu are children and the elderly and those with debilitating medical conditions </li></ul>Assisted Living
    11. 11. Influenza and Its Cause (continued) <ul><li>Influenza pandemics — frequency </li></ul><ul><ul><li>Occur about every 30 years, or about three times each century </li></ul></ul><ul><ul><li>New strain of flu not recognized by the immune systems of the population </li></ul></ul><ul><ul><li>Rapidly spread worldwide </li></ul></ul>
    12. 12. Influenza and Its Cause (continued) <ul><li>Influenza pandemics — statistics </li></ul><ul><ul><li>May have higher mortality rates and higher rates of infection </li></ul></ul><ul><ul><li>One in three pandemics may be particularly lethal </li></ul></ul><ul><ul><li>Pandemics often occur in two or three distinct waves </li></ul></ul><ul><ul><li>Second wave — usually the most deadly </li></ul></ul><ul><ul><li>Third wave — the least deadly </li></ul></ul>Infant in Incubator
    13. 13. Influenza and Its Cause (continued) <ul><li>Flu pandemics of the 20 th Century </li></ul><ul><li>1918 — Spanish Flu </li></ul><ul><ul><li>The Great Pandemic </li></ul></ul><ul><ul><li>Killed 675,000 Americans and up to 100 million people world wide </li></ul></ul><ul><li>1957 — Asian Flu </li></ul><ul><ul><li>Killed 70,000 in the United States </li></ul></ul><ul><li>1968 — Hong Kong Flu </li></ul><ul><ul><li>Killed 35,000 in the United States </li></ul></ul>Cautious Ballerinas — SARS
    14. 14. The Spanish Flu Pandemic of 1918
    15. 15. The Spanish Flu Pandemic of 1918 <ul><li>Killed more people than any other disease in history </li></ul><ul><li>Caused more deaths than WWI, WWII, the Korean War, and the Vietnam War combined </li></ul><ul><li>Unusually high attack rates among young and otherwise healthy adults (soldiers) </li></ul>Doughboys - 1918
    16. 16. The Spanish Flu Pandemic of 1918 (continued) <ul><li>Arose in February 1918 and spread rapidly throughout the spring </li></ul><ul><li>First wave disappeared in the early summer </li></ul><ul><li>Second wave appeared in August 1918 </li></ul>Masked Citizens - 1918
    17. 17. The Spanish Flu Pandemic of 1918 (continued) <ul><li>The first wave </li></ul><ul><ul><li>Unusually high mortality rate was not clearly recognized </li></ul></ul><ul><ul><li>Influenza was not a reportable disease early in 1918 </li></ul></ul><ul><ul><li>Communication was not optimal to enable tracking of the disease </li></ul></ul><ul><ul><li>Wartime conditions made information sharing difficult </li></ul></ul>Tent Hospitals — 1918
    18. 18. The Second Wave <ul><li>Mutation: </li></ul><ul><ul><li>Flu viruses mutate very readily and frequently </li></ul></ul><ul><ul><li>New variation of the virus may not be recognized by a population’s immunity </li></ul></ul><ul><ul><li>New variation may be more deadly or less deadly than the previous variation </li></ul></ul><ul><ul><li>New variation may be more or less contagious </li></ul></ul>Influenza Virus Particles
    19. 19. The Second Wave (continued) <ul><li>Reappeared in late August 1918 </li></ul><ul><li>Appeared almost simultaneously in multiple cities around the globe </li></ul><ul><li>Had mutated to an exceptionally lethal variation </li></ul>Military Loss — 1918
    20. 20. America’s Forgotten Pandemic, page 65 The Second Wave (continued)
    21. 21. The Second Wave (continued) America’s Forgotten Pandemic, page 65
    22. 22. America’s Forgotten Pandemic, page 65 The Second Wave (continued)
    23. 23. America’s Forgotten Pandemic, page 65 The Second Wave (continued)
    24. 24. America’s Forgotten Pandemic, page 65 The Second Wave (continued)
    25. 25. The Second Wave (continued) <ul><li>Over 90% of the deaths occurred during the second wave </li></ul><ul><li>Had significant effect on the war effort in combatant countries </li></ul><ul><li>Not a single United States troop transport ship was sunk during the entire war, but thousands died from the flu en route to Europe </li></ul>Loading Ambulance — 1918
    26. 26. The Second Wave (continued) <ul><li>Second wave would strike 30% to 50% of the world population: </li></ul><ul><ul><li>10% of those developed a massive pneumonia </li></ul></ul><ul><ul><li>60% of those died </li></ul></ul><ul><li>Death sometimes occurred in 24 hours or less </li></ul>Funeral — 1918
    27. 27. Impact on Life in America
    28. 28. Impact on Life in America
    29. 29. <ul><li>Impact on Life in America (continued) </li></ul>
    30. 30. Impact on Life in America (continued) Deaths from pneumonia and influenza in U.S. in 1892 and 1918 pandemics (Massachusetts numbers)
    31. 31. Seattle Daily Times Archives Impact on Life in America (continued) Camp Funston, Kansas Emergency Hospital Courtesy of National Museum of Health and Medicine
    32. 32. Iowa State Gymnasium Tent Hospital Impact on Life in America (continued) Wartime Poster 1918 Courtesy of National Museum of Health and Medicine
    33. 33. Factors Causing Pandemics
    34. 34. Factors Causing Pandemics <ul><li>Zoonotic diseases — Caused by an infectious agent that can be transmitted between, or shared by, animals and humans </li></ul><ul><li>Avian influenza is a zoonotic disease </li></ul><ul><li>Zoonotic organism may mutate to allow direct human-to-human transmission </li></ul>Zoonotic Cycle
    35. 35. Factors Causing Pandemics (continued) <ul><li>Human immune system may not be prepared to fight off a new zoonotic organism </li></ul><ul><li>Viruses rapidly and frequently mutate to new forms that may not be recognized by the human immune system </li></ul>Bird Flu Collage
    36. 36. Factors Causing Pandemics (continued) <ul><li>Rate of transmission </li></ul><ul><li>Severity of the illness — Some diseases kill so rapidly that there is minimal opportunity for the spread of the disease (Ebola) </li></ul><ul><li>Overall health of a population </li></ul><ul><li>Ease of travel </li></ul>Birds to Live Market
    37. 37. Factors Causing Pandemics —Conditions Favoring a Pandemic <ul><li>A new Influenza A virus arising from a major genetic change (i.e., an antigenic shift) </li></ul><ul><li>A susceptible population with little or no immunity </li></ul><ul><li>A virus that is transmitted efficiently from person to person </li></ul><ul><li>A virulent virus with the capacity to cause serious illness and death </li></ul>
    38. 38. Lesser Pandemics of the Twentieth Century
    39. 39. Lesser Pandemics of the Twentieth Century Asian Flu — 1957 — H2N2 Hong Kong Flu — 1968 — H3N2 Gargling Broth - 1957 Vaccine Production - 1968
    40. 40. Swine Flu —1976 <ul><li>Initial cases suggested possible re-emergence of the 1918 virus </li></ul><ul><li>Nationwide immunization program initiated </li></ul>1976 Swine Flu Vaccine Program
    41. 41. Swine Flu — 1976 (continued) <ul><li>40 million Americans were vaccinated before the program was discontinued because of deaths and illness attributed to the vaccine </li></ul><ul><li>No other reported deaths from the Swine Flu itself </li></ul>President Ford — 1976
    42. 42. Spanish Flu Differences <ul><li>1957 (Asian Flu H2N2) and </li></ul><ul><li>1968 (Hong Kong Flu H3N2) attacked mostly the very young, the old, and the debilitated </li></ul><ul><li>1918 (Spanish Flu) attacked all age groups but killed a disproportionately large percentage of young adults </li></ul>Doughboys — 1918
    43. 43. Spanish Flu Differences (continued) <ul><li>Asian and Hong Kong Flu viruses arose through reassortment (mixing) of the genetic material between avian and human viruses </li></ul><ul><li>Spanish Flu virus seems to have been a pure avian virus that developed the unique capability to infect humans and to spread easily by human-to-human contact </li></ul>Reassortment
    44. 44. Spanish Flu Differences —Causes of Death <ul><li>In a typical flu season, and during the lesser pandemics, most deaths are due to secondary bacterial pneumonias </li></ul><ul><li>In the 1918 pandemic, many deaths were due to an exceptionally lethal primary viral pneumonia </li></ul>Pneumonia
    45. 45. The Current Situation
    46. 46. <ul><li>Antibiotic development </li></ul><ul><li>Critical care advances </li></ul><ul><li>Surveillance </li></ul><ul><li>Detection </li></ul><ul><li>Diagnosis </li></ul>The Current Peril —Status of Infectious Diseases in the Late 20 th Century Advanced Critical Care
    47. 47. The Current Peril —Trends in Emerging Diseases <ul><li>Legionnaires' Disease — 1976 </li></ul><ul><li>HIV/AIDS — 1978 </li></ul><ul><li>Antibiotic-resistant TB </li></ul><ul><li>Nipah Virus — 1997 </li></ul><ul><li>SARS — 2003 </li></ul>
    48. 48. Influenza Mortality <ul><li>Treatment of the rapidly progressive severe viral pneumonia is still suboptimal </li></ul><ul><li>Mortality rates from influenza seem to be rising </li></ul><ul><li>The treatment capabilities for influenza is not all that different from 1918 </li></ul>Bacterial Pneumonia
    49. 49. Influenza Mortality (continued) <ul><li>Growing numbers of cancer survivors on drugs with immunosuppressant properties </li></ul><ul><li>40 million persons living with HIV/AIDS </li></ul><ul><li>Millions on various steroids that suppress the immune system </li></ul>Cancer Survivors
    50. 50. Flu Morbidity and Mortality <ul><li>An average year — 36,000 deaths in US </li></ul><ul><li>Mostly affects people over 65 years old </li></ul><ul><li>Epidemics occur in winter months </li></ul><ul><li>Peaks in hospitalization and death related to influenza occur week five to week 10 </li></ul>Seasonal Nature of Flu
    51. 51. World Population Growth
    52. 52. World Population Growth <ul><li>1918 world population 1.8 billion — 104 million in the United States </li></ul><ul><li>2006 world population exceeds 6 billion — 290 million in United States </li></ul>World Population Growth
    53. 53. World Population Growth (continued) <ul><li>Reported deaths from the 1918 flu range from 20 million to 100 million worldwide — 675,000 known deaths in the United States </li></ul><ul><li>A pandemic of similar lethality, based on population growth alone, could yield fatalities ranging from 67 million to 333 million — 1.6 million in the United States </li></ul><ul><li>Avian influenza (H5N1) case fatality rate has been 53% consistently </li></ul>
    54. 54. World Population Growth —Travel Patterns <ul><li>Travel was relatively primitive in 1918 </li></ul><ul><li>Rapid worldwide travel, particularly by air, may allow more rapid spread of a pandemic </li></ul>Travel in 1918 Travel Today
    55. 55. Possibility Versus Probability <ul><li>World Health Organization (WHO) assures us that there will be another pandemic </li></ul><ul><li>Unknown when it will occur </li></ul><ul><li>Unknown what the organism will be </li></ul><ul><li>Unknown how severe the next pandemic will be </li></ul><ul><li>Difficulty preparing for these unknowns </li></ul><ul><li>Comparison to bioterrorism threat and planning </li></ul>WHO Logo
    56. 56. Medical Response Capability <ul><li>United States hospital capacities decreasing </li></ul><ul><li>United States Intensive Care Unit (ICU) beds decreasing </li></ul><ul><li>Insufficient numbers of mechanical ventilators </li></ul><ul><li>Staffing shortages </li></ul><ul><li>Minimal surge capacity </li></ul><ul><li>Public reliance on EMS( 911) and Emergency rooms for Primary Medical Care </li></ul>Hospital Ward
    57. 57. Key Points About Pandemics <ul><li>Pandemic Influenza is a significant threat </li></ul><ul><li>Nature and extent of next pandemic is unpredictable </li></ul><ul><li>History of previous pandemics, particularly the 1918 Spanish Flu, can provide useful information for today’s planners </li></ul><ul><li>Many factors affect the nature and extent of a pandemic </li></ul><ul><li>Each pandemic somewhat distinct </li></ul>Influenza Virus
    58. 58. Influenza
    59. 59. Influenza <ul><li>What is influenza? </li></ul><ul><li>What causes it? </li></ul><ul><li>What are Types A, B, and C? </li></ul><ul><li>How much does it affect us normally? </li></ul><ul><li>Bird flu is not pandemic influenza </li></ul>Influenza Virus Particles
    60. 60. Influenza (continued) <ul><li>Essential Terminology </li></ul><ul><ul><li>Common (seasonal) flu </li></ul></ul><ul><ul><li>Avian (bird) flu </li></ul></ul><ul><ul><li>Pandemic flu </li></ul></ul>Virions
    61. 61. Types of Influenza Virus <ul><li>Orthomyxoviruses </li></ul><ul><li>Three main types </li></ul><ul><ul><li>Type A — Multiple species </li></ul></ul><ul><ul><li>Type B — Humans </li></ul></ul><ul><ul><li>Type C — Humans and swine </li></ul></ul>Influenza Virus Particles
    62. 62. Types of Influenza Virus — Influenza Virus A <ul><li>Multihost pathogen </li></ul><ul><ul><li>Humans </li></ul></ul><ul><ul><li>Avian Influenza </li></ul></ul><ul><li>Most virulent group </li></ul><ul><li>Classification by surface antigens into subtypes </li></ul><ul><ul><li>Hemagglutinin (H or HA) </li></ul></ul><ul><ul><li>Neuraminidase (N or NA) </li></ul></ul>Cross Section of Influenza Virus
    63. 63. Types of Influenza Virus — Influenza Virus B <ul><li>Mostly humans </li></ul><ul><li>Common </li></ul><ul><li>Less severe than A </li></ul><ul><li>Epidemics occur less often than A </li></ul><ul><li>Human seasonal vaccine </li></ul><ul><ul><li>Two strains of type A </li></ul></ul><ul><ul><li>One strain of type B </li></ul></ul>Influenza B Virus
    64. 64. H5N1 What do the numbers and letters mean ?
    65. 65. Influenza Virus A <ul><li>Surface antigens and subtypes </li></ul><ul><ul><li>15 HA and nine NA </li></ul></ul><ul><ul><ul><li>All in aquatic birds </li></ul></ul></ul><ul><ul><li>Hemagglutinin (HA) </li></ul></ul><ul><ul><ul><li>Sites for attachment to infect host cells </li></ul></ul></ul><ul><ul><li>Neuraminidase (NA) </li></ul></ul><ul><ul><ul><li>Remove neuraminic acid from mucin and release from cell </li></ul></ul></ul>Influenza A Virus
    66. 66. Genetic Variability Mixing Scenario Source: CDC Influenza Branch
    67. 67. How is it spread?
    68. 68. The Flu Virus as a Contagion <ul><li>One of the most infectious pathogens </li></ul><ul><li>Transmission: Droplets, aerosol, and contact </li></ul><ul><li>Survive off the host for 48 hours! </li></ul><ul><li>Peak transmission in United States </li></ul><ul><li>Many strains circulating </li></ul>Sneeze Profile
    69. 69. The Flu Virus as a Contagion (continued) Incubation Symptomatic (Sick) Recovering Work, etc. Work/Home/Hospital Back to work, etc Day 0 Day 11 Day 4 Day 15 DANGER OF INFECTION Day 2 Infectious (Shedding Virus)
    70. 70. Flu Morbidity and Mortality (continued) Annual Peak of Influenza Cases
    71. 71. Avian Influenza
    72. 72. Avian Influenza <ul><li>Sometimes referred to as bird flu </li></ul><ul><li>Caused by Type A influenza virus </li></ul><ul><li>LPAI and HPAI </li></ul><ul><li>HPAI can be devastating to poultry industry </li></ul><ul><li>Containment is difficult </li></ul>Containing HPAI in Japan
    73. 73. Avian Influenza — Animal Transmission <ul><li>Initial source of infection </li></ul><ul><ul><li>Other poultry, migratory waterfowl, pet birds </li></ul></ul><ul><li>Spread by aerosol, shared drinking water, fomites </li></ul><ul><li>Virus in respiratory secretions and feces </li></ul><ul><li>Virus present in eggs but eggs unlikely to survive and hatch </li></ul>Migratory Birds
    74. 74. Pandemic Influenza and H5N1 <ul><li>Previously considered nonpathogenic for humans </li></ul><ul><li>1997 — Hong Kong </li></ul><ul><ul><li>18 humans infected, six died </li></ul></ul><ul><ul><li>H5N1 virus linked to outbreak in live bird market and area farms </li></ul></ul><ul><li>2003 — The Netherlands </li></ul><ul><ul><li>83 confirmed cases in humans, one death H7N7 strain </li></ul></ul>H5N1 Strain of Type A
    75. 75. Pandemic Influenza and H5N1 — Human Transmission <ul><li>2004-2005 — Southeast Asia </li></ul><ul><li>79 cases, 49 deaths </li></ul><ul><ul><li>Vietnam, Thailand, Cambodia </li></ul></ul><ul><li>H5N1 strain </li></ul><ul><li>Within the vicinity of poultry outbreaks </li></ul><ul><li>No sustained human-to-human transmission </li></ul>Bird Flu”in Asia
    76. 76. Avian Flu Human-to-Human Transmission <ul><li>Bird Flu — Current Situation </li></ul><ul><li>Death Rate over 50% </li></ul><ul><li>Spreading globally </li></ul><ul><li>Not in North America </li></ul><ul><li>Role of migratory birds — evident </li></ul><ul><li>Sustained human-to-human transmission not yet a factor </li></ul>Cases H5N1
    77. 77. BREAKOUT SESSION <ul><li>Business Impacts </li></ul><ul><li>Seasonal Influenza/Prevention </li></ul>
    78. 78. Workforce Absenteeism <ul><li>How will my business: </li></ul><ul><li>Maintain essential operations and services if 40 percent or more of all workers are out sick or choose to stay home to avoid exposure? </li></ul><ul><li>Maintain essential operations when well workers choose or are forced to stay home? </li></ul><ul><li>Maintain essential operations when community outbreaks last 6-8 weeks, with multiple waves strike in a calendar year? </li></ul><ul><li>Bolster the depth of reserves for essential workers at all levels? </li></ul><ul><li>Ensure family and child care support for essential workers? </li></ul><ul><li>Provide delegations of authority and orders of succession for workers? </li></ul>
    79. 79. Geographic Dispersion and Rapid Spread <ul><li>How will my business: </li></ul><ul><li>Maintain essential operations and services when necessary resources are not available? </li></ul><ul><li>Ensure sufficient essential resources are available at each work site? </li></ul><ul><li>Ensure that their planning takes into account the people and businesses that depend them for supplies and services? </li></ul><ul><li>Afford to cross-train nonessential personnel for essential functions? </li></ul><ul><li>Afford to stockpile adequate levels of essential reserve materials? </li></ul>
    80. 80. Time Duration and “Waves” <ul><li>How will my business: </li></ul><ul><li>Ensure essential functions over a six to eight week pandemic wave? </li></ul><ul><li>Ensure recovery from a first wave, while preparing for possible subsequent waves over the course of a calendar year? </li></ul><ul><li>Define breaking points when a portion or all basic and essential functions begin to fail? </li></ul>
    81. 81. Mobility and Travel <ul><li>How will my business: </li></ul><ul><li>Ensure continuity despite significant delays in, and restrictions on moving personnel and materials? </li></ul><ul><li>Withstand a lengthy quarantine for all traveling personnel? </li></ul><ul><li>Ensure continuity of overseas operations if U.S. personnel abroad return to protect their families and/or seek better healthcare? </li></ul>
    82. 82. Supply Chain and Delivery Networks <ul><li>How will my business: </li></ul><ul><li>Ensure continuity when worker absenteeism and movement restrictions delay or stop their supply and delivery chains? </li></ul><ul><li>Ensure adequate visibility of their entire essential supply and delivery chain in order to uncover potential impacts on second and third order manufacturers and supplies? </li></ul><ul><li>Define the breaking points when movement restrictions affect a portion or all of the functions of a business? </li></ul><ul><li>Ensure all essential business partners in the supply chain are equally well prepared for a pandemic? </li></ul>
    83. 83. Health Care Delivery and Public Health <ul><li>How will my business: </li></ul><ul><li>Ensure the healthcare and public health support for workers and their families? </li></ul><ul><li>Know when their workers and their families have contracted a the virus? </li></ul><ul><li>Know how to protect their employees and families when seemingly healthy individuals are spreading the disease? </li></ul><ul><li>Protect workers from others who, while infected, do not feel ill or exhibit any symptoms? </li></ul>
    84. 84. National Economic Disruption <ul><li>How will my business: </li></ul><ul><li>Ensure economic viability at each phase of the pandemic? </li></ul><ul><li>Prepare and respond when other businesses around us are failing? </li></ul>
    85. 85. Security Risks and Social Stability <ul><li>How will my business: </li></ul><ul><li>Ensure the security of its workers and families from home to work? </li></ul><ul><li>Ensure the security of their workplace operations and supplies? </li></ul><ul><li>Ensure security up and down our supply and delivery chains? </li></ul>
    86. 86. What can be done now for prevention?
    87. 87. Seasonal Influenza Prevention Measures <ul><li>Get yourself and you workers vaccinated against seasonal flu! </li></ul><ul><li>Wash hands frequently with soap and water! </li></ul><ul><li>Cover you mouth and nose when you cough or sneeze! </li></ul><ul><li>Put used tissues in a waste basket </li></ul><ul><li>Clean your hands after coughing or sneezing. </li></ul><ul><li>Use soap and water or alcohol based hand cleaner. </li></ul><ul><li>Stay home if you are sick </li></ul>
    88. 88. Summery <ul><li>Seasonal flu kills 36,000 people every year! </li></ul><ul><li>Lost work time due to seasonal flu leads to millions in lost revenue. </li></ul><ul><li>A sick workforce is less productive than a well one. </li></ul><ul><li>Remember the flu is a virus, whether it is pandemic or seasonal the same prevention strategies work to limit the spread. </li></ul><ul><li>If we can reduce the spread of seasonal flu, we can limit the impact of a pandemic. </li></ul><ul><li>If we work together we can “ flatten the curve ”, reduce the spread/ severity of the flu, and possibly avoid an economic disaster. </li></ul>