Linking Pandemic Influenza Preparedness with Bioterrorism Vaccination Planning

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1 Linking Pandemic Influenza Preparedness with Bioterrorism Vaccination Planning APHA Annual Meeting San Francisco, California Lara Misegades, MS Director of Infectious Disease Policy November 18, 2003

2 Overview Influenza pandemic background Planning efforts to date ASTHO checklist Mass vaccination lessons and unique issues Conclusions

3 Influenza Respiratory infection Spread through contact with infected person 1 to 5 days from exposure to onset of symptoms Characterized by sudden onset of Fever Chills Muscle aches Sore throat Cough Runny nose Headache

4 The Influenza Virus Influenza A and B regional and widespread epidemics Influenza C mild illness, sporadic cases, minor outbreaks

5 Virus Changes Antigenic Drift small changes in type A and B that account for the differences in annual influenza Antigenic Shift - a new subtype of influenza A that emerges through recombination of human and animal antigens

6 The (1918 Spanish Influenza) epidemic killed, at a very, very conservative estimate, 550,000 Americans in ten months; that s more Americans than died in combat in all the wars of this century, and the epidemic killed at least 30 million in the world and infected the majority of the human species. - Alfred W. Crosby Influenza 1918, The American Experience

7 Pandemic Influenza History 1918: Spanish flu At least 500,000 U.S. fatalities 1957: Asian flu 69,800 U.S. fatalities 1968: Hong Kong flu 33,800 U.S. fatalities Next Pandemic flu? Estimated 89, ,000 U.S. fatalities

8 Pandemic Flu Planning to Date National planning efforts National Influenza Plan pending HHS approval CDC Flu-AID assessment tool CDC Pandemic Flu: Planning Guide for State and Local Officials State efforts CSTE/CDC forum for development and review of state plans 35 states drafting plans, 12 states completed draft plans (Nov 2002) Preparedness grants States are using lessons learned from bioterrorism planning to address pandemic influenza preparedness

9 Preparedness Lessons Learned Anthrax West Nile Smallpox program SARS Monkeypox

10 ASTHO Pandemic Flu Checklist for State Health Officials

11 Checklist Sections Legal and Policy Issues Authority Vaccination/Antivirals Laboratory/Surveillance Surge capacity Risk Communications

12 Mass Vaccination My state has Determined how adverse vaccine side effects will be documented Compiled a list of healthcare workers and institutions that will assist in mass vaccination Identified ways to secure and protect a limited vaccine supply and other essential medicines and supplies Developed and tested a plan for mass vaccination

13 Lessons Learned from Smallpox Public education and buy-in Strategic National Stockpile coordination Contraindication screening Surge capacity Liability coverage for manufactures and vaccinators Injury Compensation Pre-designation of vaccine clinic locations IND and informed consent Vaccination documentation Vaccine data systems Adverse event tracking

14 ASTHO Survey In the event there is a smallpox outbreak anywhere in the world my state could effectively vaccinate its entire population in 10 days. April 25, Responders October 15, Responders 5% 40% 45% 50% 60% Yes No No Response Last Updated 10/31/03

15 How is Pandemic Influenza Different?

16 Availability of Vaccine Smallpox Strategic National Stockpile Novel influenza strain and time required to produce vaccine means limited or possibly no vaccine available at the beginning of the pandemic need to identify priority groups Pandemic Flu

17 Immunogenicity of Vaccine Smallpox One dose May require two doses, a tracking system, and recall capacity Pandemic Flu

18 Mass Vaccination Distribution Smallpox Known: Federally purchased, delivered through Strategic National Stockpile, and distributed by public health emergency response Unknown: Will federal, state or private agencies be responsible for the procurement and distribution of vaccine? Pandemic Flu

19 Clarifying Pandemic Vaccine Roles State Federal Local Manufacturers Private Providers

20 Prolonged Event Smallpox Once contained, will most likely not resurge with any predictability Pandemic cycles: may be a second or third round of severe influenza cases occurring 3-9 months after the initial outbreak Pandemic Flu

21 Epidemiology & Burden of Illness Smallpox Most likely focal or multi-focal Affecting numerous locations simultaneously, can t rely on federal assistance or other jurisdictions Pandemic Flu

22 Advance Warning Smallpox No advance warning But vaccine available and effective postexposure May have weeks to months But vaccine manufacturing process may take 6-8 months Pandemic Flu

23 Annual Influenza Smallpox Last naturally acquired case in 1977 Existing vaccination programs are in place to help decrease the significant morbidity and mortality due to annual influenza Pandemic Flu

24 Vaccine Risk Communications Why is vaccination so important during a pandemic? Are there vaccine side effects/dangers? Why is a vaccine shortage likely at the beginning of a pandemic? In the event of a vaccine shortage during the early months, what specific priority groups will be vaccinated first? Where can I get the vaccine? How can the public best protect itself during the early months before adequate vaccine is available? Does the public still need to be vaccinated after the first wave of cases seems to be over?

25 Global SARS Epidemic Lessons Public health nurse skill set very useful Mental health issues - for families, patients, and the clinical and public health community Prior coordination between clinical community and public health is essential Prioritization of other public health and health care services Need to address stigmatization of individuals Economic loss

26 State Pandemic Flu Planning Today Move toward all hazards planning with an annex for specific events Use of a common planner, or coordinating planners Building on SNS, smallpox, and SARS plans Exercising plans - Pandemic Table Top Revisiting old plans in new context of preparedness planning

27 Conclusions Most experts agree that another flu pandemic is imminent Need to be prepared for a range of pandemic situations Plans can build on experience with annual influenza, pandemic influenza history, and existing preparedness planning efforts

28 Acknowledgements ASTHO Infectious Disease Policy Committee Helen Fox Fields, ASTHO Senior Director, Infectious Disease Claire Hannan, ASTHO Senior Director, Immunization CDC NCID and NIP

Pandemic Influenza Preparedness and Response

Pandemic Influenza Preparedness and Response US Department of Health and Human Services Bruce Gellin, MD, MPH Director, National Vaccine Program Office The pandemic influenza clock is ticking. We just