Pandemic Influenza Planning Update Your County Department of Health Spring 2006.

Pandemic Influenza Pandemic Influenza Planning UpdatePlanning Update

Your CountyYour County

Department of HealthDepartment of Health

Spring 2006Spring 2006

OverviewOverview

• Seasonal InfluenzaSeasonal Influenza

• Avian InfluenzaAvian Influenza

• Pandemic InfluenzaPandemic Influenza

• What we are doing to prepareWhat we are doing to prepare

Influenza

InfluenzaInfluenza

• Respiratory infectionRespiratory infection

• Spread through coughing, sneezingSpread through coughing, sneezing

• 1 to 5 days from exposure to onset of 1 to 5 days from exposure to onset of symptomssymptoms

• Spread 1 day Spread 1 day before illnessbefore illness up to 7 up to 7 days afterdays after

• Seasonal influenza traditionally occurs Seasonal influenza traditionally occurs October through AprilOctober through April

Influenza SymptomsInfluenza Symptoms

• Rapid onset of:Rapid onset of:– FeverFever– ChillsChills– Body achesBody aches– Sore throatSore throat– Non-productive coughNon-productive cough– Runny noseRunny nose– HeadacheHeadache

Seasonal InfluenzaSeasonal Influenza

• 36,000 deaths nationally every year; 36,000 deaths nationally every year; 800-1000 in MN 800-1000 in MN

• Vaccine availableVaccine available

• High risk for complications include:High risk for complications include:– Very youngVery young

– Very oldVery old

– Fragile immune systemsFragile immune systems

– Pregnant womenPregnant women

AVIAN INFLUENZAAVIAN INFLUENZA

Avian Influenza (“Bird Avian Influenza (“Bird Flu”)Flu”)• Birds of all species thought to be Birds of all species thought to be

susceptiblesusceptible

• Two formsTwo forms

– MildMild

– SevereSevere

• Signs and SymptomsSigns and Symptoms

– Mild: ruffled feathers, reduced egg productionMild: ruffled feathers, reduced egg production

– Severe: extremely contagious, rapidly fatal, Severe: extremely contagious, rapidly fatal, case fatality rate ~ 100%case fatality rate ~ 100%

Avian Influenza - H5N1 Avian Influenza - H5N1 Infection in HumansInfection in Humans

• Remains an avian flu strainRemains an avian flu strain

• Living quarters are close to animalsLiving quarters are close to animals

• TransmissionTransmission

– Contact with manureContact with manure

– Handling chickensHandling chickens

– Walking through live poultry marketsWalking through live poultry markets

Avian Influenza - H5N1Avian Influenza - H5N1Why do we care?Why do we care?• Spreading among birds quickly and across Spreading among birds quickly and across

countriescountries

• Jumping hosts (across animal groups)Jumping hosts (across animal groups)

• High case fatality rate among people (141 High case fatality rate among people (141 documented cases, 73 deaths) documented cases, 73 deaths) as of February 2006as of February 2006

• Mutating little by littleMutating little by little

• Has potential to mutate dramatically into a Has potential to mutate dramatically into a human strainhuman strain

PandemicPandemic

• PandemicPandemic– Widespread infectionWidespread infection– No immunity within a populationNo immunity within a population

• EpidemicEpidemic– Localized to one populationLocalized to one population– Low immunity within the populationLow immunity within the population

Prerequisites for a Prerequisites for a PandemicPandemic

• A “new” virus transmitted to A “new” virus transmitted to humans (no immunity within the humans (no immunity within the community)community)

• Virus must be able to cause Virus must be able to cause illness in humansillness in humans

• Virus must be able to pass Virus must be able to pass easily from human to humaneasily from human to human

Could the H5N1 be the Could the H5N1 be the cause of the next flu cause of the next flu pandemic?pandemic?• Possibly…Possibly…

but so far the virus cannot pass but so far the virus cannot pass easily from human to humaneasily from human to human

World Health World Health Organization Organization Influenza Pandemic Influenza Pandemic PhasesPhases Interpandemic PeriodInterpandemic Period

Novel subtypes in animals but not Novel subtypes in animals but not humanshumans

Phase 1Phase 1

Circulating subtypes in animals Circulating subtypes in animals posing threat to humansposing threat to humans

Phase 2Phase 2

Pandemic Alert PeriodPandemic Alert Period

Novel subtypes in humans, but no Novel subtypes in humans, but no human-to-human transmissionhuman-to-human transmission

Phase 3Phase 3

Limited human-to-human Limited human-to-human transmissiontransmission

Phase 4Phase 4

Localized clusters of human casesLocalized clusters of human cases Phase 5Phase 5

Pandemic PeriodPandemic Period

Increased and sustained Increased and sustained transmission in the general transmission in the general population on a large scalepopulation on a large scale

Phase 6Phase 6

Current Pandemic Flu Current Pandemic Flu Planning AssumptionsPlanning Assumptions

Attack rate Attack rate

(30%)(30%)1,544,000 cases in MN1,544,000 cases in MN

Hospitalization rate Hospitalization rate

(1 to 10+% of cases)(1 to 10+% of cases)15,000 to 172,000 15,000 to 172,000 hospital patients in MNhospital patients in MN

Case-fatality rate Case-fatality rate

(.2 – 2% of cases) (.2 – 2% of cases) 3,600 to 32,900 deaths 3,600 to 32,900 deaths in MNin MN

Local ImpactLocal Impact

• Insert local numbers on this slideInsert local numbers on this slide

Federal, State, Local Federal, State, Local PlansPlans

General All HazardsGeneral All Hazards Pandemic FluPandemic Flu

genergeneralal

National Response National Response Plan (NRP)Plan (NRP)

The National The National Strategy for Strategy for Pandemic Influenza Pandemic Influenza (White House)(White House)

healthhealth ESF #8: Public Health ESF #8: Public Health and Medical Servicesand Medical Services

HHS Pan Flu PlanHHS Pan Flu Plan

genergeneralal

MEOPMEOP HSEM’s Pan Flu PlanHSEM’s Pan Flu Plan

healthhealth MDH All Hazards PlanMDH All Hazards Plan MN Public Health MN Public Health Pan Flu PlanPan Flu Plan

genergeneralal

Local All Hazards Local All Hazards PlansPlans

Local Pan Flu PlanLocal Pan Flu Plan

healthhealth Health component of Health component of All Hazards PlansAll Hazards Plans

LPH Pan Flu PlanLPH Pan Flu Plan

Fed

er

al

Sta

te

Loc

al

Protective ActionsProtective Actions

• Governor is state decision makerGovernor is state decision maker– Close schoolsClose schools– Cancel large gatheringsCancel large gatherings– Encourage people to limit exposure Encourage people to limit exposure

to othersto others– Assure continuation of infrastructureAssure continuation of infrastructure– Make decisions about use of limited Make decisions about use of limited

resourcesresources

Goals of MN PlanningGoals of MN Planning

• Maintain the elements of the Maintain the elements of the community infrastructure necessary community infrastructure necessary to carry out pandemic responseto carry out pandemic response

• Minimize social disruption and Minimize social disruption and economic losseconomic loss

• Reduce morbidity Reduce morbidity • Minimize mortalityMinimize mortality• Stay flexible as the situation unfoldsStay flexible as the situation unfolds

Goals of Regional and Goals of Regional and Local PlanningLocal Planning

• Limit the spread of diseaseLimit the spread of disease

• Create & test plansCreate & test plans

• Integrate non-health entities in planningIntegrate non-health entities in planning

• Establish community stockpiles & Establish community stockpiles & distribution systemsdistribution systems

• Identify spokespersonsIdentify spokespersons

• Provide effective public educationProvide effective public education

Goals of Regional and Goals of Regional and Local Planning (cont)Local Planning (cont)

• Maintain community Maintain community infrastructureinfrastructure

• Minimize social disruptionMinimize social disruption

• Reduce morbidity/mortalityReduce morbidity/mortality

• Response is community based, Response is community based, and flexibleand flexible

PartnershipsPartnershipsOur health department is working Our health department is working with:with:

• Homeland Security and Emergency Homeland Security and Emergency ManagementManagement

• County and city emergency managersCounty and city emergency managers

• SchoolsSchools

• Law enforcement/militaryLaw enforcement/military

• Voluntary organizationsVoluntary organizations

• Regional hospital coalitionRegional hospital coalition

• ClinicsClinics

• Emergency Medical ServicesEmergency Medical Services

• MediaMedia

Health & Medical PlanningHealth & Medical Planning

• __ County, Tribal and City Public __ County, Tribal and City Public • Health AgenciesHealth Agencies• ___Hospitals ___ Clinics___Hospitals ___ Clinics• Emergency ManagementEmergency Management• Emergency Emergency

Medical Medical ServicesServices

• Other Other Community Community partners partners Insert your regional mapInsert your regional map

Local and Regional Public Local and Regional Public Health PlanningHealth Planning

• Education Education

– Businesses, schools, clinics, community groupsBusinesses, schools, clinics, community groups

– Community stakeholdersCommunity stakeholders

• TrainingsTrainings

– Infection control education for law Infection control education for law enforcement, first respondersenforcement, first responders

– Psychological First AidPsychological First Aid

– CommunicationCommunication

– Drills/Exercises Drills/Exercises

Working with community Working with community partners partners to addressto address• Disease surveillanceDisease surveillance• Clinical issuesClinical issues• LaboratoryLaboratory• Infection controlInfection control• Health care planningHealth care planning• Vaccine and antiviral agentsVaccine and antiviral agents

Working with community Working with community partners partners to address (cont)to address (cont)• Community disease control and Community disease control and

preventionprevention• CommunicationsCommunications• Animal health collaborationAnimal health collaboration• Care of the deceasedCare of the deceased• Legal issuesLegal issues• Ethical issuesEthical issues

Localize this slideLocalize this slide

• Of the following series (29-40) of Of the following series (29-40) of slides we suggest you select 2-3 slides we suggest you select 2-3 that are relevant to your regional that are relevant to your regional and/or local planning efforts, and and/or local planning efforts, and are reflected in your previous are reflected in your previous slide.slide.

Disease SurveillanceDisease Surveillance

• Tracking influenza Tracking influenza disease on disease on ongoing basisongoing basis• Maintain high Maintain high alert for H5N1alert for H5N1• Monitor activity Monitor activity in other in other countriescountries

Wash-ing-ton

Lake

Cook

Le Sueur

Rice Goodhue

NoblesRock Jackson Martin Faribault FreebornMower

Fillmore Houston

WinonaOlmsted

DodgeSteeleWasecaBlue Earth

WatonwanCottonwoodMurrayPipestone

Nicollet

Wabasha

DakotaScott

Chisago

Isanti

Brown

Sibley

Carver

Hennepin

WrightMeeker

Kandiyohi

Renville

Redwood

Sherburne

LyonLincoln

Yellow Medicine

Lac Qui Parle

Swift

Big Stone

PopeStevensTraverse

Chippewa

Stearns

Benton

Carlton

Pine

Kanabec

MilleLacs

Aitkin

Crow Wing

Morrison

CassHubbard

Wadena

Todd

DouglasGrant

OttertailWilkin

BeckerClay

ClearWater

MahnomenNorman

Red Lake

PenningtonPolk

Beltrami

Marshall

Itasca

Koochiching

Lakeof theWoods

RoseauKittson

St. Louis

McLeod

71Ram-sey

Anoka

Hennepin

1

2

1

1

1

4

1

1

1

1

1

1

1

1

1

1

1

3

1

1

1

Sentinel Site Locations

N=27

Clinical IssuesClinical Issues

• Clinicians will question Clinicians will question travel history and travel history and poultry exposure on poultry exposure on influenza-like casesinfluenza-like cases• Clinicians will report Clinicians will report critical influenza in critical influenza in young, healthy young, healthy individualsindividuals• Developing Developing treatment and treatment and care protocols care protocols

LaboratoryLaboratory

• Developing capacity for rapid testing and confirmation

• Statewide network Statewide network ofof clinical clinical laboratories

• Monitoring Monitoring agriculturalagricultural testing testing

• Sharing Sharing informationinformation quickly quickly

• Connection to CDCConnection to CDC

Infection ControlInfection Control

• What are What are effective effective measures?measures?

• Maintaining Maintaining stockpiles of stockpiles of suppliessupplies

• Reuse, disposalReuse, disposal

• Air handlingAir handling

• Handwashing!!Handwashing!!

Health Care PlanningHealth Care Planning

• Hospitals in 8 regionsHospitals in 8 regions working together working together

• Predicting and Predicting and managingmanaging surge in demand surge in demand

• Protecting workers andProtecting workers and patients patients

• Off-site care facilitiesOff-site care facilities

• Home careHome care

• Minnesota Responds, Minnesota Responds, Medical Reserve Corps Medical Reserve Corps

Vaccine and Antiviral Vaccine and Antiviral AgentsAgents

• Strategic NationalStrategic National Stockpile system Stockpile system

• Mass dispensing clinicsMass dispensing clinics

• Vaccine for preventionVaccine for prevention

• Antivirals potentially Antivirals potentially forfor prevention and prevention and treatmenttreatment

• Get neededGet needed material/supplies to material/supplies to thethe public quickly public quickly

Community Disease Community Disease Control and PreventionControl and Prevention

• Respiratory hygieneRespiratory hygiene

• Business continuationBusiness continuation

• School closingSchool closing

• Limit interaction of Limit interaction of peoplepeople

• Home careHome care

• Isolation and Isolation and quarantinequarantine

CommunicationsCommunications

• Need many ways toNeed many ways to reach people reach people

• Consistent, Consistent, understandable, understandable, complete messages complete messages

• Reaching non-EnglishReaching non-English speakers speakers

• Hotlines, web, TV, Hotlines, web, TV, community community organizationsorganizations and many other and many other meansmeans

Animal Health Animal Health CollaborationCollaboration

• Animal health leaders Animal health leaders andand industry are planning industry are planning forfor bird outbreak bird outbreak

• Protecting poultry Protecting poultry workersworkers

• Disposal of birdsDisposal of birds

• Economic impactEconomic impact

Care of the DeceasedCare of the Deceased

• Manage death Manage death certificatescertificates

• Mortician collaborationMortician collaboration

• Cremations and Cremations and burialsburials

• Safe, compassionateSafe, compassionate

• Limit interactionLimit interaction

Legal IssuesLegal Issues

• Governor’s Governor’s authorityauthority to manage an to manage an emergency emergency

• Liability issuesLiability issues

• Being able to Being able to move move quickly quickly

• Licenses, sharingLicenses, sharing resources resources

• Isolation andIsolation and quarantine quarantine

Ethical IssuesEthical Issues

• What if there’s not What if there’s not enoughenough __________? Who should __________? Who should getget the limited supply? the limited supply?

• Antivirals – treatment orAntivirals – treatment or prevention? prevention?

• Economic impact of Economic impact of closing aclosing a business or limiting business or limiting interactioninteraction

• Does response change Does response change withwith length of event? length of event?

• Reduced types of health Reduced types of health carecare because of increased because of increased demanddemand

Priority Activities for Priority Activities for 20062006

• Review the federal plan and plans Review the federal plan and plans from other statesfrom other states

• Update and expand state plansUpdate and expand state plans• Support planning by othersSupport planning by others• Education and training Education and training • Public educationPublic education• Exercising!Exercising!

Business PlanningBusiness Planning

• Forecast and allow for absencesForecast and allow for absences• Modify the frequency of face-to-Modify the frequency of face-to-

face contactface contact• Encourage annual flu shotsEncourage annual flu shots• Evaluate access to healthcareEvaluate access to healthcare• Identify employees and key Identify employees and key

customers with special needscustomers with special needs

Is Is Your CountyYour County Ready? Ready?

• More today than yesterdayMore today than yesterday• More tomorrow than todayMore tomorrow than today• Continuing processContinuing process• Requires everyone to participateRequires everyone to participate

– State and local governmentState and local government– BusinessesBusinesses– Faith-based and community Faith-based and community

organizationsorganizations– Individuals/familiesIndividuals/families

Recommended Web SitesRecommended Web Sites

www.health.state.mn.uswww.health.state.mn.us

www.hsem.state.mn.uswww.hsem.state.mn.us

www.ready.govwww.ready.gov www.pandemicflu.govwww.pandemicflu.gov

www.fema.gov/areyoureadywww.fema.gov/areyouready

www.ed.gov/emergencyplanwww.ed.gov/emergencyplan

www.weprevent.org/usa/cover.pdfwww.weprevent.org/usa/cover.pdf