Pandemic Influenza. Bradford H. Lee, MD Nevada State Health Officer. Public Health: Working for a Safer and Healthier Nevada

Transcription

1 Pandemic Influenza Bradford H. Lee, MD Nevada State Health Officer EXHIBIT C Legislative Committee on Health Care Document consists of 29 slides. Entire document provided. Due to size limitations, pages provided. A copy of the complete document is available through the Research Library (775/ or library@lcb.state.nv.us). Meeting Date: December 13, 2005

2 Definitions Flu viral disease caused by virus family orthomyxoviridae Seasonal Flu annual human flu seen each year Avian flu flu typically seen in birds Epidemic attacking many people in a region at the same time Pandemic widespread epidemic (eg( continental or global spread)

3 Pan Flu Past and Future

4 Influenza Disease of swine, birds, horses and man Orthomyxoviridae (single strand RNA)

5 Pandemic Influenza Reassortment of RNA Two flu strains swap RNA A Shift occurs that allows the transmission from Avian to Human populations A Novel Virus in a Naïve Population

6 Potential Source of Shift DIRECT 15 HAs 9 NAs Non-human virus Human virus Source: CDC Influenza Branch Reassortant virus

7 A s s and B s, B H s H s and N sn Flu is classified by its RNA core Type A or Type B influenza Further classified by surface protein Hemagluttin (H) 15 subtypes known Neuraminidase (N) 9 subtypes known Only Type A had pandemic potential

8 Spreading the Flu Droplet spread Infectious Adults: 1 day prior to symptoms to about 5 days after onset Children and immunocompromised much longer Incubation 1 to 4 days Image Source: Human Biology, Starr and McMillan

9 Typical Flu Symptoms Fever (>102º F) Muscle and Joint Aches and Pains Dry Cough Runny Nose Sore throat GI symptoms in children and infants

10 Death from Flu Viral Pneumonia Rapid destruction of lung tissue Secondary bacterial pneumonia Disrupted lung tissue Body s s defense mechanisms impaired Encephalitis

11 Projected Numbers Typical Pandemic Attack Rate 15% to 35% 50% in CDC Deaths 89, ,000 Hospital Stays Outpatient Visits Additional Illness 314, , to 42 million 20 to 47 million TFAH 541,433 2,358, million

12 Ways to Stop Pan Flu When there is a novel virus Culling/vaccinating the bird flocks When person to person spread starts Quarantine/Isolation Antiviral medications Development of vaccine When there is widespread dissemination Antiviral medications Vaccine Social Distancing

13 Treatment Options Pandemic vaccine Minimum 5 month production time Needs chicken eggs and viral seed stock Antiviral Medications Neuraminidase Inhibitors Tamiflu and Relenza

14 Tamiflu - the drug of choice Prophylaxis Daily dosing for length of pandemic Not recommended option by CDC Treatment Twice daily dosing for 5 days Problem Only 2.3 million doses in SNS

15 Supportive Care Respiratory Hygiene/Cough Etiquette Hand washing/sanitizing Standard Precautions Droplet Precautions Supplemental Oxygen Antibiotics for Secondary Pneumonia

16 Response Plans WHO Pandemic Influenza Plan Draft HHS National Influenza Plan State and Local Influenza Plans

17 National Influenza Plan Intended to provide national, state and local guidance Acknowledges, but does not address Vaccine Manufacture and Distribution Antiviral Manufacture and Distribution Priority Group for Vaccine and Antivirals

18 NVAC/ACIP Joint Meeting Met 18th of July Made recommendations on Priority groups for vaccination Purchasing strategy for vaccination Priority groups for antivirals

19 Vaccination Priority Groups Tier 1 Higher Risk Groups >64 with a risk factor, 6m -64 y with 2+ risk factors Manufacturers of antivirals and vaccines Health Care Workers Key Gov t Officials Pregnant or taking care of child < 6m old Tier 2 Healthy seniors, 6 m-64 m y with 1 risk factor, critical infrastructure Tier 3 Health care decision makers, mortuary affairs, etc. Tier 4 - everybody else

20 Antiviral Priority Groups Treat hospitalized patients with influenza Treat HCWs including EMS who have direct patient contact Treat highest risk outpatients Treat pandemic health responders, etc. Treat other high risk outpatients Outbreak containment in closed setting (e.g. skilled nursing facility)

21 Antiviral Priority Groups Prophylaxis for HCW in ED, EMS, dialysis Treat pandemic societal responders and other HCW Treat other ill outpatients Prophylaxis for highest risk group Prophylaxis for other health care workers with patient contact

22 CDC Working Groups Developing detail for HHS plan Laboratory Surveillance Immunizations and Antivirals Hospital Preparedness Community Containment and Travel Psychosocial Issues Risk Communications

23 Antiviral Strategies Largest Unanswered Question SNS will be depleted Should state and/or local governments maintain a stockpile of antivirals?

24 Health Care Systems Alternate Care Sites Triage/Referral Points Neighborhood Emergency Health Centers Staffing Sustained Operations and Surge Capacity Volunteers, Retirees, etc. Medical Equipment Shortages Medication Shortages

25 Isolation/Quarantine Potentially useful early in outbreak Probably not useful after widespread person to person transmission established Prudent message Stay home when you re sick

26 Social distancing Reduces, but does not eliminate risk Closure of communal gatherings Churches, schools, sports venues, etc. Telecommuting Stockpiling supplies to stay at home Buys time

27 Masks? Recommendations from WHO N95 masks for health care workers Surgical masks to be considered for those who are ill Put in ER waiting rooms, etc. Tolerate use of surgical masks by the well

28 Avian Influenza Hype? H5N1, Phase 3 Since December Confirmed Cases 64 Confirmed Deaths Thailand, Vietnam, Cambodia, Indonesia and China H5N1 in Siberia, Kazakhstan, Turkey H5 in Romania Limited Person to Person Spread

29 Questions?