{[ promptMessage ]}

Bookmark it

{[ promptMessage ]}

INTRO PANDEMIC FLU - Objectives Introduction to Pandemic...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: Objectives Introduction to Pandemic Flu Planning Joan M. Culley, PhD, MS, MPH, RN, CWOCN Culley PhD MS MPH RN CWOCN • • • Describe the difference between seasonal flu, Avian flu and a pandemic Discuss the SC pandemic emergency plan plan Apply principles of influenza immunization to practice Revised August 2010 1 2 Flu Terms Defined • Bird flu - commonly used to refer to Avian flu – Infect birds, including chickens, other poultry and wild birds such as ducks Flu Terms Defined • Pandemic flu - virulent human flu that causes a global outbreak, or pandemic, of serious illness – Because there is little natural immunity, the disease can spread easily from person to person – Currently there is no pandemic flu • Avian flu (AI) - caused by influenza viruses that occur naturally among wild birds – Low pathogenic AI is common in birds and causes few problems – Highly pathogenic H5N1 is deadly to domestic fowl, can be transmitted from birds to humans, and is deadly to humans – There is virtually no human immunity and human vaccine availability is very limited 3 • Seasonal (or common) flu - a respiratory illness that can be transmitted person to person – Most people have some immunity, and a vaccine is available 4 Influenza Viruses • The flu is a highly contagious respiratory illness caused by RNA virus • It can cause mild to severe illness, and at times can lead to death • Every year in the United States, on average: – 5% to 20% of the population gets the flu – More than 200,000 people are hospitalized from flu complications – About 36,000 people die from flu • Range from 1976 and 2006 (3,000 to a high of about 49,000 people) 1976 Transmission of Influenza • Some people, such as older people (>70), young children (<2 years), and people with certain health conditions (such as asthma, diabetes, or heart disease), are at high risk for serious flu complications 5 6 Unclassified 1 Transmission of Influenza • Spread through large droplets (droplet transmission) that directly contact the nose, mouth or eyes • Droplets are produced when infected people cough, sneeze or talk, sending the relatively th large infectious droplets and very small sprays (aerosols) into the nearby air and into contact with other people • infectious particles (aerosols) traveling in the air approximately 6 feet 7 Transmission of Influenza • Large droplets can only travel a limited range – People should limit close contact (within 6 feet) with others • To a lesser degree, human influenza is spread by touching objects contaminated with influenza viruses and then transferring the infected material from the hands to the nose, mouth or eyes • Influenza may also be spread by very small infectious particles (aerosols) traveling in the air 8 Transmission of Influenza • Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5 days after becoming sick ft • Isolation from the onset of symptoms to 24 hours after the fever has subsided Symptoms of Flu • Fever (not everyone with flu will have a fever) • Cough • Core throat • Runny or stuffy nose • Body aches • Headache • Chills • Fatigue • Sometimes diarrhea and vomiting 9 10 Naming Influenza Viruses Complications Complications of Flu • • • • • Bacterial pneumonia Ear infections Sinus infections Dehydration Worsening of chronic medical conditions, such as congestive heart failure, asthma, or diabetes • Three types: influenza A, B and C • Influenza A and B cause seasonal epidemics • Influenza C causes a milder respiratory illness not thought to cause epidemics • Sub-type - named for the broad classes of the hemagglutinin hemagglutinin (HA) or neuraminidase (NA) surface or neuraminidase (NA) surface proteins sticking through the viral envelope – There are 16 HA sub-types (designated H1 - H16) – There are 9 NA sub-types (designated N1 - N9) • Only those containing the H1, H2, H3, H5, H7 and H9 and the N1, N2 and N7 surface proteins infect humans 11 12 Unclassified 2 Naming Influenza Viruses • H5 subtype is considered a candidate for a new subtype for broad human infectivity (Pandemic form) – Example A/H5N1 or influenza A/H3N2 A/H5N1 or influenza A/H3N2 Influenza A and B • Subtypes of A – H1N1 – H3N3 • Subtypes of B – None • Viruses mutate readily and within subtypes there may be many genetic variants, called strains • Influenza A (H1N1) and (H3N2) and Influenza B are included in each year’s influenza vaccine • Influenza vaccine does not protect against C 13 14 Pandemic Influenza Pandemic Influenza 15 16 Pandemic Influenza Pandemic Influenza • Could produce a public health emergency more daunting than any other type of naturally occurring, accidental, or terroristinstigated event • Could affect essentially every community in the nation almost simultaneously (within the space of a few weeks) • Could be more severe than the influenza pandemic of 1918 17 18 Unclassified 3 Pandemic Influenza • Could result in 25% or more of the population experiencing life-threatening illness and/or being forced to dispense with normal activities to care for victims • Response activities within each affected community not only will need to be sustained for several months, generally with little or no outside help but also might be generally with little or no outside help, but also might be degraded due to substantial influenza-induced absenteeism • Coping with degraded functioning in virtually every aspect of society could be so demanding as to preclude the initiation of significant recovery activities for many months Pandemic Influenza • Influenza pandemics are recurring phenomena • The prevailing uncertainty is not whether the world will experience another influenza pandemic but rather when the next one will occur and how severe it will be • Thorough preparedness is imperative 19 20 Case Fatality Rate (CF) • Ratio of deaths within a designated population of people with a particular condition, over a certain period of time – E.g. 9 deaths per 10,000 people at risk per year. This means that within a given year, out of 10,000 people formally diagnosed with a disease, 9 died. History of Pandemics • 1918-1919 - “Spanish Influenza” (“The Great Pandemic”) • 1957-1958 - milder “Asian Flu” • 1968-1969 - milder “Hong Kong Flu” • 1976 - pandemic threats “Swine Flu” • 1977 – pandemic threat “Russian Flu” • 1997 ongoing pandemic threat (A/H5N1) “Avian Flu” • 1999 ongoing pandemic threat (A/H9N2) “Bird Flu” • 2009-2010 pandemic A(H1N1) “Swine Flu” 21 22 Pandemic of 1918 Spanish Flu (H1N1) • In the waning months of the First World War, a lethal virus known as the Spanish flu (influenza A, subtype H1N1), swept the United States, Europe and Asia in three convulsive waves • The pandemic claimed up to 100 million victims, 100 most of whom succumbed to severe respiratory complications associated with rapidly progressing pneumonia • Many died within days of the first symptoms Pandemic of 1918 • Mostly killed young adults • 99% of deaths occurred in people under 65 year of age • More than half of the deaths occurred in adults 20-40 years of age • 25 million world wide killed in the first 25 weeks of the pandemic • Case Fatality Rate 2-3% • Age groups most affected – young adults • HIV/AIDS killed 25 million in its first 25 years 23 24 Unclassified 4 Pandemic of 1957 Asian Flu (H2N2) • Originated in China • Infection rates highest among school children, young adults, and pregnant women • Elderly had highest rates of death • Second wave developed in 1958 with 70,00 deaths in US • Case fatality rate <0.2% • Mortality world wide 1-4 million 1• Age group most affected - children • • • • • • Pandemic of 1968-1969 Hong-Kong Flu (H3N3) First detected in Hong Kong Those > 65 most likely to die Case fatality rate <0.2% Mortality world wide 1-4 million 1Age groups mostly affected – all ages Returned in 1970 and 1972 and circulates today • 34,000 died in US 26 25 1976 Swine Flu Threat • First identified at Fort Dix and labeled ‘killer flu’ • Though to be related to Spanish Flu • Never moved outside of Fort Dix 1977 Russian Flu Threat (H1N1) • Caused epidemic disease in children and young adults (<23 years) worldwide • Similar to other viruses that circulated Similar to other viruses that circulated prior prior to 1957 – thought to have caused immunity and protection • Not considered a true pandemic because it mostly affected children 27 28 • Virus moved directly from chickens to people rather than having infected pigs as an intermediate host • All chickens (1.5 million) were slaughtered in Hong Kong • Did not easily spread from person to person after the slaughter • Few hundred infected in Hong Kong with 6 deaths • In 1999 a subtype A/H9N2 caused illnesses in two Hong Kong Children • This remains an ongoing concern 29 1997- 1999 Avian Flu Threat (H5N1) 2006 Avian Flu Threat (H5N1) 30 Unclassified 5 Recent Avian Strain (H5N1) Replicates profusely within the first 24 hours, causing severe damage to respiratory tissues while sending the host’s innate immune response into a lethal overdrive, reminiscent of the trajectory of the original 1918 virus 31 How Does Bird Flu Spread? • Infected birds shed flu virus in their saliva, nasal secretions, and feces • Susceptible birds become infected when they have contact with contaminated excretions or surfaces that are contaminated with excretions • It is believed that most cases of bird flu infection in humans have resulted from contact with infected poultry or contaminated surfaces 32 Avian Avian Strain H5N1 • Not readily communicable between humans but since 2003 has infected 404 people in 15 countries and killed 254 • Forced the destruction of more than 300 million birds as it the destruction of more than 300 million birds as it spread to 61 countries in Asia • Primarily in Vietnam, Thailand, China, Egypt and Indonesia, • Mortality rate for those stricken with highly pathogenic avian influenza (HPAI) H5N1 is 63 percent • Should a series of modifications allow the virus to pass from person to person, the consequences for humankind could be catastrophic 33 Avian Strain H5N1 • It is feared the H5N1 virus could kill millions in a pandemic if it ever mutated to transmit efficiently among people • There are currently two drugs, Roche's (ROG.VS) Tamiflu and GlaxoSmithKline Plc's (GSK.L) Relenza, which experts hope can be used to fight H5N1 • Growing drug resistance of some H5N1 strains have led researchers to try to design new drugs 34 The Perfect Storm • Unlike typical seasonal flu which poses the greatest threat to juveniles, elderly and those with compromised immunity; the 1918 flu reserved the worst of its wrath for healthy young adults with robust immune systems • In the case of the avian H5N1 virus, statistics of the case of the avian H5N1 virus statistics of human fatalities reveal a similar trend • In both cases, the highly pathogenic strains replicate rapidly and induce a massive transcription of genes associated with the innate immune response, the body’s first line of defense for combating viral challenges 35 Pandemic of 2009-2010 Swine Flu (H1N1) • First detected in US in April 2009 • Origins traced to Mexico • Spreads efficiently from person-toefficiently from person person • Guadruple ressortant virus – Contains two genes from flu viruses that normally circulate in pigs – Avian genes and human genes 36 Unclassified 6 CDC Influenza Updates • http://www.cdc.gov/h1n1flu/updates/ us/#totalcases • www.Flu.gov – Comprehensive information for professionals and lay people World Health Organization Pandemic Phases 20102009-2010 37 38 (WHO) Global Influenza Preparedness Plan Defines Stages of a Pandemic Interpandemic period • Phase 1 – No new influenza virus subtypes detected in humans – An influenza virus subtype causing human infection may be influenza virus subtype causing human infection may be present in animals – If present in animals, the risk of human infection or disease is considered to be low. Stages of a Pandemic Pandemic alert period • Phase 3 – Human infection(s) with a new subtype but no human-tohuman spread, or at most rare instances of spread to a close contact. • Phase 4 – Small cluster(s) with limited human-to-human transmission but spread is highly localized, suggesting that the virus is not well adapted to humans • Phase 2 – No new influenza virus subtypes detected in humans – a circulating animal influenza virus subtype poses a substantial risk of human disease 39 • Phase 5 – Larger cluster(s) but human-to-human spread still localized, suggesting that the virus is becoming increasingly better adapted to humans but may not yet be fully transmissible (substantial pandemic risk) 40 Stages of a Pandemic • Phase 6 – Pandemic: increased and sustained transmission in general population Eleven Key Areas of Pandemic Influenza Planning and Response • post-peak period, pandemic disease levels postin most countries with adequate surveillance in most countries with adequate surveillance will will have dropped • post-pandemic period, influenza disease postactivity will have returned to levels normally seen for seasonal influenza – It is expected that the pandemic virus will behave as a seasonal influenza 41 SOURCE: U.S. Department of Health and Human Services (2005). Unclassified 7 Very High Exposure Risk • Healthcare employees (doctors, nurses, dentists) performing aerosol-generating procedures on known or suspected pandemic patients • Healthcare or laboratory personnel collecting or handling specimens High Exposure Risk • Healthcare delivery and support staff exposed to known or suspected pandemic patients (doctors, nurses, and other hospital staff that must enter patients’ rooms). • Medical transport of known or suspected pandemic patients in enclosed vehicles (emergency medical technicians) • Performing autopsies on known or suspected pandemic patients (morgue and mortuary employees) 43 44 Medium Exposure Risk • Employees with high-frequency contact with the general population (schools, high population density work environments, and some high volume retail) Lower Exposure Risk (Caution) • Employees who have minimal occupational contact with the general public and other coworkers (office employees) employees) 45 46 Community Mitigation Strategies Strategies used to: • Decrease the spread of influenza may reduce the number of people infected before vaccines are available before vaccines are available – Social Distancing – Surveillance and Epidemiology – Infection Control – Patient Care and Treatment – Vaccination – Antiviral Drugs 47 Social Distancing Strategies • Isolation - separates or restricts movement or activities of ill persons with contagious disease to prevent transmission to others • Quarantine - restricts movement and activities or separates well persons believed to have been exposed to infection, to prevent possible transmission to others 48 Unclassified 8 Social Distancing Strategies • Minimizing contact with others – Staying home with upper respiratory flu-like flusymptoms – Using stairs instead of crowded elevators – Canceling non-essential face-to-face nonface-tomeetings (teleconferencing, e-mails) e– Alternate work options (working from home, staggered work schedules) – Alternate classes schedules (web-based) (web– Staying (6’) away from others when meeting Social Distancing Strategies – Avoiding shaking hands, hugging, kissing – Closing residence halls – Canceling or reducing the number of classes, public activities, social gatherings – Closure of schools and non-essential nonactivities 49 50 Social Distancing Strategies • Voluntary isolation (or mandated by SC Department of Health and Environmental Control (DHEC) (DHEC) – Ill students, faculty and staff stay at home Ill st fac and staff sta at home or or residence halls Surveillance and Epidemiology How often a disease occurs in different groups of people and why • Pandemic Surveillance – Laboratory surveillance • • • • Detect and confirm influenza cases rapidly Establish the extent of spread of a disease Asses severity of the disease Monitor changes in the pandemic virus – Antiviral resistance 51 52 Surveillance and Epidemiology • Pandemic Surveillance – Disease surveillance • Early warning system to detect increase in influenzainfluenza-like illness in a community • Monitor impact on health and well-being well(morbidity and mortality) • Track trends in influenza activity and identify population severely affected • Track trends in influenza related absences Infection Control • Facility and environmental controls • Administrative controls • Personal protective equipment and safe work practices Surggen.mp4 Surggen.mp4 53 54 Unclassified 9 To Help Stop The Spread Of Germs • Cover your mouth and nose with a tissue when you cough or sneeze • If you don't have a tissue, cough or sneeze into your upper sleeve not your hands your upper sleeve, not your hands • Put your used tissue in the waste basket • Clean your hands after coughing or sneezing • Wash with soap and water or • Clean with alcohol-based hand cleaner 55 Work Practice Controls • Providing resources and a work environment that promotes personal hygiene • Provide tissues, notouch trash cans, hand soap, hand sanitizer, disinfectants and disposable towels for employees to clean their work surfaces 56 CDC Guidance for Recommendations for Facemask and Respirator Protection • http://www.cdc.gov/h1n1flu/masks.htm Facemask • N95 Respirator Protects against breathing in against breathing in very small particle aerosols Not recommended for children or people who have facial hair. Requires fit testing • In community and home settings, the use of facemasks and respirators generally are not recommended • See CDC recommendations 57 58 Engineering Controls Include • Installing physical barriers, such as clear plastic sneeze guards • Installing a drive-through window for customer service service • In some limited healthcare settings, for aerosol generating procedures, specialized negative pressure ventilation may be indicated 59 Administrative Controls Administrative controls include controlling employees' exposure by scheduling their work tasks in ways that minimize their exposure levels • Developing policies that encourage ill employees/students to stay at home without fear of any reprisals • Discontinuation of unessential travel to locations with high of unessential travel to locations with high illness transmission rates • Practices to minimize face-to-face contact between employees such as e-mail, websites and teleconferences, flexible work arrangements such as telecommuting or flexible work hours • Home delivery of goods and services 60 Unclassified 10 Patient Care/Treatment • Surveillance and epidemiology of the virus • Communication regarding risk, severity and progression of the pandemic and progression of the pandemic • Provide care • Reduce spread • Protect and support Types Types of Influenza Vaccine • Trivalent Inactivated Influenza vaccine (TIV) – Injected into the muscle of the upper arm or thigh – Used for people 6 months of age or older, including healthy people, those with chronic medical conditions, and pregnant women • Live, Intranasal Influenza vaccine (LAIV) Li (LAIV) • Given as a nasal spray • Used for healthy people 2-49 years of age who are not 2pregnant (persons who do not have an underlying medical condition that predisposes them to influenza complications • Vaccine reduces the likelihood of becoming ill with influenza or transmitting influenza to others 61 62 Types Types of Influenza Vaccine • High Dose Seasonal Influenza Vaccine Specifically Intended for People Ages 65 and Older – 180 micrograms (mcg) of influenza virus hemagglutinin (HA) which is made up of 60 mcg of each of the three influenza virus strains – non-serious adverse events were more nonfrequent compared with Fluzone. Fluzone. • Pain, redness and swelling at the injection site and headache, muscle aches, fever and malaise Influenza prevention and control recommendations...
View Full Document

{[ snackBarMessage ]}