Pandemic Influenza: Hype or Reality?

Transcription

1 Pandemic Influenza: Hype or Reality? Leta Finch Executive Director, Higher Education Practice 2003 Arthur J. Gallagher & Co.

2 Objectives Review key characteristics of influenza, including differences between Pandemic and seasonal flu Avian and human flu Discuss likely modes of introduction Components of a Contingency Plan Effective risk communications

3 Sources World Health Organization Centers for Disease Control and Prevention State Departments of Health Various journal articles

4 What is a Pandemic? Pandemic (Greek: pan all + demos people ) is a an outbreak of an infectious disease that spreads globally or across a wide geographical area. Conditions of a pandemic: 1. The disease infects humans and causes serious illness 2. The disease spreads easily and in a sustained manner among humans

5 Contagious Viral Disease What is Influenza? Infects wide range of animals, but major reservoirs are wild birds Three types (A, B, C) Type A Commonly known as Avian Influenza Natural hosts are wild, migratory birds Also infects people, domesticated birds, pigs, horses, and other animals Can cause widespread death and disease among domestic birds and poultry Types B and C only circulate among humans

6 What is Avian Influenza? Influenza A usually only infect birds Birds, particularly migratory water birds, act as hosts by carrying viruses in their intestines and shedding them Most wild birds do not get sick, but can nonetheless spread the viruses

7 Avian Flu Caused by avian (bird) influenza viruses There are many more avian influenza A subtypes that occur naturally among birds than are transmissible to humans One avian subtype is H5N1, and some strains of H5N1are highly pathogenic (they sicken and kill birds) Currently, a severe strain of H5N1 is killing birds in Asia and parts of Europe Occasionally avian flu is transmitted from a bird to a human this is what has been occurring in Asia with H5N1

8 H5N1 Outbreak First isolated in wild birds in S. Africa in 1961 Appeared in Guangdong, China, in 1996 Almost exclusively spread through contact with infected birds, but limited evidence of human-tohuman transmission Now in Asia, Middle East, Europe and Africa

9 Process of Genetic Reassortment Avian Influenza Virus High mortality rate among birds, spreads rapidly Human Influenza Virus Spreads easily from human-to-human, low mortality rate Mutated (Novel) Virus Can easily spread human-to-human

10 Seasonal Flu Impact: ~ 36,000 deaths and 200,000 hospitalizations yearly in the United States Timing: Peak usually occurs December through March in North America

11 Cumulative Number of Confirmed Human Cases of Avian Influenza A/(H5N1) Reported to WHO as of 23 August 2006 Country 2003 Cases Deaths 2004 Cases Deaths 2005 Cases Deaths 2006 Cases Deaths Total Cases Deaths Azerbaijan Cambodia China Djibouti Egypt Indonesia Iraq Thailand Turkey Viet Nam Total Total number of cases includes number of deaths. WHO reports only laboratory-confirmed cases. Case fatality rate 59%

12 Avian Influenza triggers pandemics Spanish Flu (H1N1) 500,000+ deaths in the U.S., 50 million worldwide Asian Flu (H2N2) 2 million deaths worldwide Hong Kong Flu (H3N3) 750,000 deaths worldwide

13 Concern About H5N1 Influenza H5N1 is a Novel virus most people are susceptible and it is highly lethal in humans Currently the virus is endemic across a wide geographical area Large-scale avian infection results in significantly increased opportunities for infecting humans Repeated evidence of transmission to mammals Potential for emergence of human-to-human transmissible virus through mutation or genetic reassortment in pigs or humans

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15 A Pandemic Flu Outbreak is likely to Spread rapidly and span the globe in weeks or months due to global interconnectivity and travel Most likely will affect 15-30% of the population of any one country within weeks It will have great socio-economic impact and a significant impact on supply chains Not be easily contained or eradicated May begin any time of year and resurge in one or more waves, with a total duration of up to one year or more

16 Potential Vulnerability Points Medically underserved Homebound Disabled populations (blind/visually-impaired, deaf/hearing impaired, mobility impaired, mentally ill) Institutions (LTC facilities, prisons, state mental institutions) Populations with language barriers Marginalized populations including low-ses and those with no or minimal social networks

17 Effects of a Pandemic Hospitalized Low end of range: 10 per 100,000 High end of range: 8,000 per 100,000 Dead Low end of range: 1 per 100,000 High end of range: 1,000 per 100,000 Timing May begin any time of year and resurge in one of more waves, with a total duration of up to one year or more

18 Transmissibility (based on previous pandemics) Primarily transmitted though respiratory secretions 2 day average incubation period (time from infection to onset of symptoms) Virus can be transmitted ½ to 1 full day prior to symptom onset Highest risk for transmission will be during the first 2 days after symptom onset Children typically produce and shed the most virus and so would pose the greatest risk for transmission

19 Likely to Continue in Fall and Winter Last four years have shown: a drop-off in Spring and Summer a rise in cases in Fall and Winter High season in bird populations is October March Steady increase in cases in aquatic water birds since 2001

20 Government Surveillance & Business Action Influenza Monitoring Agencies WHO CDC PAHO HDs EU Monitoring Program Culling of Infected/Exposed Poultry Business Pandemic Contingency Planning

21 Stages of Pandemic Influenza Current Status of H5N1 Avian Influenza Inter-pandemic phase Low risk of human cases 1 New virus in animals, no human cases Higher risk of human cases 2 Pandemic alert Pandemic alert New virus causes human cases New virus causes human cases No or very limited human-to-human transmission 3 Evidence of increased human-to-human transmission Evidence of sustained human-to-human transmission 4 5 Pandemic Efficient and sustained human-to-human transmission 6

22 Inter-Pandemic Stage Spreading through migratory birds Little bird-to-human infection No known human-to-human infection Predominantly in rural areas Moderate social, economic, and political impact

23 Inter-Pandemic Stage 6 Planning Steps: 1. Establish a Pandemic Preparedness Team 2. Create contingency plan 3. Articulate duties and delegate responsibility 4. Educate employees about influenza and the organization s response plan 5. Communicate regularly as the threat heightens

24 Goals for Preparedness To minimize hospitalizations and deaths To preserve critical infrastructure To minimize social disruption

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26 Communication Plan

27 State Health Department Local Health Departments

28 Communication Plan HEALTH ALERT NETWORK (HAN) Continuous, high-speed internet connectivity and broadcast capacity to support emergency communication Provides a network of public health officials and other first-responders who are continuously connected to information vital to emergency and non-emergency public health practice.

29 Establish Communication Links - State PH Laboratory State PH Veterinarian State PH Preparedness Specialists State PH Immunization Program Manager Crisis Communication/Public Information Executive Decision Makers

30 Executive Steering Group Pandemic Preparedness Team Dept. Teams Dept. Teams Dept. Teams Dept. Teams

31 Communication Plan Appoint who will speak on behalf of the institution Determine what printed materials should be developed. Be prepared to send updates and alerts. Be sensitive to content, wording, and tone. Plan content and tone carefully Listen to the campus s concerns Be honest, frank, and open. Coordinate and collaborate with credible sources Speak clearly and with compassion

32 Communication Plan Messages will need to address Symptoms and transmission of influenza Geographic spread Current case counts Designated treatment sites Vaccine availability Information about canceled public events and meetings Quarantine laws and enforcement Need for volunteers

33 What will the workforce experience? Inter-Pandemic Phase Fear and anxiety Pandemic Phase Trauma, emotional numbness Post Pandemic Depression and low morale

34 Communication Plan Post Pandemic Communications Recovery time varies depending on the intensity of loss. Within reason, overlook dress codes, personal phone calls, allow time off for family matters. Be truthful about job security. Encourage talking Create situations for positive group events Be aware of signs that indicate need for professional help.

35 Communication Plan An informed population reduces disorder and improves effectiveness and efficiency in responding to a crisis.

36 Communication Plan The Centers for Disease Control and Prevention has issued Crisis and Emergency Risk Communication: By Leaders for Leaders

37 In Closing Like hurricanes, tsunamis, and earthquakes, pandemic influenza will happen. Dr. Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota

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39 Online Resources Overseas Security Advisory Council World Health Organization Centers for Disease Control and Prevention U.S. Government Pandemic Influenza Center U.S. Department of State Avian Influenza Fact Sheet (3/21/06)