1. PANDEMIC INFLUENZA
BACKGROUND AND GUIDANCE
FOR SCHOOLS

2. Influenza
• Respiratory infection
• Transmission: contact with respiratory secretions
from an infected person who is coughing and
sneezing
• Incubation period: 1 to 5 days from exposure to
onset of symptoms
• Communicability: Maximum 1-2 days before to 4-5
days after onset of symptoms
• Timing: Peak usually occurs December through
March in North America

3. Common Influenza Symptoms
• Rapid onset of:
– Fever
– Chills
– Body aches
– Sore throat
– Non-productive cough
– Runny nose
– Headache

4. Influenza is a serious illness
• Annual deaths: 36,000
• Annual hospitalizations: >200,000
• Total economic costs: $37.5B
• Who is at greatest risk for serious
complications?
– persons 65 and older
– persons with chronic diseases
– infants
– pregnant women
– nursing home residents

5. Definitions
• Epidemic: An increase in disease above
what is normally expected
• Pandemic: A worldwide epidemic

6. How Do Influenza Pandemics
Arise?
• Wild water fowl are natural reservoirs of
influenza
• They can spread the virus to domestic
birds

7. How Do Influenza Pandemics
Arise?
• When avian flu viruses experience sudden
changes in genetic structure
and
• Are capable of infecting humans
and
• Can reproduce and spread from person to
person efficiently

8. Why Be Concerned About
Pandemic Influenza?
• Influenza pandemics are inevitable: naturally recur at
more-or-less cyclical intervals
• Can cause:
– High levels of sickness and death
– Drastic disruption of critical services
– Severe economic losses
• There will be little warning time between the onset of
spread of a pandemic and its arrival in the U.S.
Outbreaks occur simultaneously in many areas
• Impacts will last for weeks to months and likely to
occur in successive waves
• Pandemics can disproportionately affect younger,
working-age people
• Current avian influenza outbreak in Asia

9. Timeline of Emergence of
Influenza A Viruses in Humans
Avian
Influenza
H9 H7
Russian
Influenza H5 H5
Asian H1
Influenza
Spanish H3
Influenza
H2 Hong Kong
Influenza
H1
1918 1957 1968 1977 1997 2003
1998/9

10. Influenza Pandemics 20th Century
Credit: US National Museum of Health and
Medicine
1918: “Spanish Flu” 1957: “Asian Flu” 1968: “Hong Kong Flu”
A(H1N1) A(H2N2) A(H3N2)
20-40 m deaths 1-4 m deaths 1-4 m deaths
675,000 US deaths 70,000 US deaths 34,000 US deaths

11. Planning Assumptions: Health Care
• 50% or more of those who become ill will seek medical care
• Number of hospitalizations and deaths will depend on the virulence
of the pandemic virus
Moderate (1957-like) Severe (1918-like)
Illness 90 million (30%) 90 million (30%)
Outpatient medical care 45 million (50%) 45 million (50%)
Hospitalization 865,000 9, 900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000

12. The 1918
Influenza
Pandemic

14. Chicken Little and the Sky is Falling
or The Next Major Disaster?
Which is it?

15. Current Outbreak:
Avian Influenza (H5N1)
• Began in fall, 2003.
• At least 252 confirmed human cases in
Asia, Africa and Europe
148 deaths in Asia and Africa
(World Health Organization, 10/06)
• Mammalian infection (cat, pig)
• No efficient person-to-person
transmission
• Isolated Human disease
• Case-fatality rate > 50%
• Outbreak spreading, not controlled

16. Current Avian Outbreaks

17. Clinical illness with H5N1 compared
with typical human influenza illness
• More severe illness in younger persons
• Primary viral pneumonia appears to be
more common and with rapid onset
• Incubation period may be longer 1-4+ days
(up to 14 days?)
• Duration of infectious period likely longer,
particularly in adults 1d. prior to 7d. after
(in adults; children ~longer)
Adapted from Guillermo Herrera, CDC, 2005

18. Pandemic Effects: Strain on
Resources
• Health care shortages
– Vaccine / Antivirals
– Hospital beds / equipment
– Masks
• Personnel shortages
• Disruption of essential society
functions
• Panic

19. Vaccines, Antivirals, and
Medical Supplies

20. Pandemic Influenza Vaccine
Questions
• When will it be available?
• How much will there be?
• Who will own it?
• Who should get it?
• How should it be delivered?

21. Treatment and Prevention:
Vaccine
• Vaccines takes 6-8 months to produce
following the emergence of a new virus
• Supplies will be limited, if available at all
– 2nd dose after 30 days will likely be required
– New vaccine safety and efficacy has
“unknowns”

22. Treatment & Prevention:
Antiviral Drugs
• Antiviral agents
– Effective in preventing illness
– Can prevent severe complications
– May not be effective against
pandemic virus
• Supplies will be limited
– Treatment over prevention

23. Nassau County Department of Health
Pandemic Influenza Preparedness Strategies
• Distribution Planning
– First Responder Prophylaxis
– Municipality operated PODs
– Employer operated PODs (regional)
– DOH operated PODs
– School operated PODs through municipalities

24. Points of Distribution
• Community based sites used to distribute
vaccines or medications to healthy citizens
• Would the schools be used?
• Municipalities will coordinate POD
planning within their communities.

25. Individual and Family
Preparedness
– We will have to take care of ourselves and those around
us.
– During a pandemic, public health will maximize resources
for the greatest impact on the population as a whole.
– Schools should communicate with local/ state public
health agencies and/or emergency responders about the
assets/services the districts could contribute to the
community.

26. Influenza Prevention:
What Can We Do?
Specific Recommendations
for Infection Control in
Schools and Workplaces:
Pandemic preparedness planning
Distribution of educational messages
and infection control guidance
Social distancing: people stay home when ill
Promotion of respiratory etiquette
 Provision of materials for respiratory hygiene/
etiquette: tissues and disposal receptacles

28. ISSUES FOR SCHOOL
DISTRICTS TO THINK ABOUT
• Absenteeism among children AND staff
• Resources limited: vendors, buses
• Role of school nurses
• Communication with parents and staff and community
• Advantages and disadvantages to closing schools
(amount of closure time)
• Working with local municipalities
• Implications with State aide
• Policies sending sick children home (isolation within the
school, masks, etc)
• Policies for allowing previously sick children to return to
schools

29. RESOURCES FOR SCHOOLS
Nassau County Health Department, with
direction from the New York State Health and
Education Departments, will provide guidance to
schools districts
• To create plans
• To create communication materials for students,
staff and parents
• To provide guidance for closing schools

30. Key Step for District Preparedness
• Incorporate the pandemic influenza plan
as an annex in the school district’s all
hazards plan.

31. COMMUNICATION
Before a Pandemic Hits
• Develop strong relationships with your
school communities
– Build confidence that information will be
distributed accurately and quickly
- Consider community meetings that describe
current plans in place

32. COMMUNICATION
Before a Pandemic Hits
• School Websites
• Lunch Menus
• PTAs
• Letters to the Community
• BOE Meetings
• Marquis
• Proactive

33. COMMUNICATION
Before a Pandemic Hits
• Establish relationship with Public Health
Officials early on
• Review/update procedures for
communicable disease reporting

34. Pandemic Influenza
“Don’t worry about it, it’s probably just a head cold.”

35. Acknowledgments
Presentation compiled and adapted from multiple slide
sets from the:
 Centers for Disease Control and Prevention
 HHS National Vaccine Program Office
 New York State Department of Health
 Connecticut Department of Health
 Kansas Department of Health
 Department of Defense
 Washington Department of Health