myron pers 15 - Pandemic Exercise Pandemic Public Health...

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Unformatted text preview: Pandemic Exercise Pandemic Public Health Responses Public • Centers for Disease Control and Prevention Centers (CDC) (CDC) • World Health Organization (WHO) • Local public health offices • Private health providers & hospitals • Public education – individual and family Public preparedness preparedness Public Health Issues Public • • • • Surveillance and warning Prevention - immunization Quarantine Hospital and other medical surge capacities History of Pandemics History • Evidence of large scale pandemics – Evidence decreasing gene pool – “lost” civilizations decreasing • Black Death Black Death Black • 1347-1351 – killed up to one-third of the 1347-1351 population of Europe – one half to twopopulation thirds of the population of Iceland • 1330s – outbreak in China • 1347 on – outbreak in Cairo, Egypt, and 1347 spread to cities in Middle East, including Mecca Mecca Influenza (or Flu) Influenza • The flu is a contagious respiratory illness caused The by a virus. • It can cause mild to severe illness, and at times It can lead to death. • A person infected with the flu virus can transmit it person one-two days before they have symptoms. one-two • A person infected with the flu virus can transmit it person four-five days after symptoms start. four-five Influenza Spread Influenza Spread by contact with an infected person Spread through: through: • Sneezing • Coughing • Touching items recently contaminated by a Touching person with the flu virus person Influenza is a serious illness Influenza • Annual deaths: 36,000* • Hospitalizations: >200,000* * Average annual estimates during the 1990’s Average • Who is at greatest risk for serious complications? – – – – – persons 65 and older persons with chronic diseases infants pregnant women nursing home residents Influenza Types Influenza • Type A – Epidemics and pandemics – Animals and humans – All ages • Type B – – – Milder epidemics Humans only Primarily affects children Pandemic influenza: definition Pandemic • Global outbreak with: – – – Novel virus, all or most susceptible Transmissible from person to person Wide geographic spread Impact of Past Influenza Pandemics/Antigenic Shifts Pandemics/Antigenic Pandemic, or Pandemic, Antigenic Shift Antigenic 1918-19 (A/H1N1) 1957-58 1957-58 (A/H2N2) 1968-69 (A/H3N2) 1977-78 (A/H1N1) Excess Mortality Populations Populations Affected Affected Persons <65 years Persons Infants, elderly Infants, elderly Young (persons Young <20) <20) 500,000 70,000 70,000 36,000 36,000 8,300 8,300 Pandemic Waves Pandemic • Pandemics occur in multiple waves of Pandemics disease outbreaks disease • The first wave in a local area is likely to last The six to eight weeks six • The time between pandemic waves varies The and cannot be easily predicted. and Pandemic Severity Index Pandemic Category Potential Number Deaths Deaths 1 2 3 4 5 Less than 90,000 90,000 to 450,000 450,000 to 900,000 900,000 to 1.8 900,000 million million 1.8 million or 1.8 more Occurrences Occurrences Schools Seasonal Influenza Influenza Close Contact Not Recommended Recommended Limit Adult of Limit of Not Recommended 1957,1968 Consider up to 1957,1968 Consider Pandemics a Month None None None 1918 1918 Pandemic Consider up to a Month Consider up to a Month Recommended Recommended up to 3 Months Recommended up to 3 Months Consider up to Consider a Month Month Recommended up to 3 Months Recommended up to 3 Months Source: CDC, February 2007. As of August 23, 2009 As • • • Deaths = 556 Hospitalizations = 8843 Reporting States and Territories = 52 Not the same as seasonal influenza seasonal • The age groups affected by the pandemic are generally The younger. This is true for those most frequently infected, and especially so for those experiencing severe or fatal illness. • To date, most severe cases and deaths have occurred in To adults under the age of 50 years, with deaths in the elderly comparatively rare. This age distribution is in stark contrast with seasonal influenza, where around 90% of severe and fatal cases occur in people 65 years of age or older. ( older. Severe respiratory failure Severe • Clinicians from around the world are reporting a very Clinicians severe form of disease, also in young and otherwise healthy people, which is rarely seen during seasonal influenza infections. In these patients, the virus directly infects the lung, causing severe respiratory failure. Saving these lives depends on highly specialized and demanding care in intensive care units, usually with long and costly stays. The need for intensive care as the greatest burden on health services. Preparedness measures need to anticipate this increased demand on intensive care units, which could be overwhelmed by a sudden surge in the number of severe cases. severe Vulnerable groups Vulnerable • An increased risk during pregnancy is now consistently An well-documented across countries. • Data continue to show that certain medical conditions Data increase the risk of severe and fatal illness. These include respiratory disease, notably asthma, cardiovascular disease, diabetes and immunosuppression. Many of these predisposing conditions have become much more widespread in recent decades, thus increasing the pool of vulnerable people. Obesity, which is frequently present in severe and fatal cases, is now a global epidemic. WHO estimates that, worldwide, more than 230 million people suffer from asthma, and more than 220 million people have diabetes. have Higher risk of hospitalization and death hospitalization • Several early studies show a higher risk of hospitalization Several and death among certain subgroups, including minority groups and indigenous populations. In some studies, the risk in these groups is four to five times higher than in the general population. general • Although the reasons are not fully understood, possible Although explanations include lower standards of living and poor overall health status, including a high prevalence of conditions such as asthma, diabetes and hypertension. Implications for the developing world world • Such findings are likely to have growing relevance as the Such pandemic gains ground in the developing world, where many millions of people live under deprived conditions and have multiple health problems, with little access to basic health care. basic • As much current data about the pandemic come from As wealthy and middle-income countries, the situation in developing countries will need to be very closely watched. The same virus that causes manageable disruption in affluent countries could have a devastating impact in many parts of the developing world. parts Co-infection with HIV Co-infection • The 2009 influenza pandemic is the first to occur since the The emergence of HIV/AIDS. Early data from two countries suggest that people co-infected with H1N1 and HIV are not at increased risk of severe or fatal illness, provided these patients are receiving antiretroviral therapy. In most of these patients, illness caused by H1N1 has been mild, with full recovery. illness • On current estimates, around 33 million people are living with On HIV/AIDS worldwide. Of these, WHO estimates that around 4 million were receiving antiretroviral therapy at the end of 2008. 2008. 1918 Spanish Flu Pandemic Pandemic The Reference Point for The Future Pandemics Future Pandemic Vaccine Pandemic • Annual vaccine is trivalent (3 strains), Annual pandemic vaccine will be monovalent. pandemic • Production using current technologies Production would likely take 4-5 months may not be available before 1st pandemic wave available • There will be vaccine shortages initially • 2 doses may be necessary to ensure doses immunity immunity Influenza control: antiviral medications medications • Uses – Prophylaxis – Treatment • Issues – Limited supply – Need for prioritization (among risk groups and Need prophylaxis versus treatment) prophylaxis – Unlikely to markedly affect course of pandemic Influenza control: infection control control • influenza isolation precautions* – Private room or with other influenza patient – Negative air pressure room, or placed with Negative other suspected influenza cases in area of hospital with independent air supply hospital – Masks for HCW entering room – Standard droplet precautions (hand washing, Standard gloves, gown and eye protection) gloves, * 1994 Guidelines for Prevention of Nosocomial Pneumonia Infection control, cont’d Infection • Feasibility of these measures in a pandemic Feasibility setting is questionable, priorities should include: include: – Droplet transmission precautions (use of masks Droplet and hand hygiene) – Cohorting of influenza-infected patients Influenza control: other control measures measures • Education to encourage prompt self-diagnosis • Public health information (risks, risk avoidance, Public advice on universal hygiene behavior) advice • Hand hygiene • Face masks for symptomatic persons • School closures (?) • Deferring travel to involved areas Influenza control: quarantine Influenza • Challenges – – – short incubation period for influenza a large proportion of infections are asymptomatic clinical illness from influenza infection is non clinical specific specific • Not used during annual epidemics • Could potentially slow onset of a pandemic Could before sustained person-to-person transmission before has been established has Medical care during an influenza pandemic influenza • Surge capacity of the hospital system is Surge limited. limited. • Challenges: – – – Magnitude and duration Staff shortages Limited ability to call in external resources Limited Pandemic Influenza Preparedness and Response Plan Pandemic Prioritization for Immunization 1. Health care workers directly caring for patients (9 million) and drug plant Health employees (400,000); employees 2. High-risk patients over 65 with chronic conditions that increase risk of High-risk influenza; ages 6 months to 64 years with two such chronic conditions; people hospitalized in past year with influenza, pneumonia or a chronic condition (25 million); million); 3. Pregnant women and people in a household with infants or severely immunecompromised people (11 million); 4. Key government leaders and critical public health personnel (150,000); 5. Other patients at risk; all seniors; anyone with a chronic condition; and Other children 6 to 23 months of age (59 million); children 6. Other public health workers and public safety personnel, including utility and Other some transportation workers (8.5 million); some 7. Key government health decision-makers and funeral home workers (500,000); Key and and 8. Other Americans Triage in a Pandemic Low Priority Patients • People over 85 years old • Those with severe traumas, e.g., from car crashes, shootings, etc. • Severely burned patients over 60 • Those with mental impairments, e.g., advanced Alzheimer’s disease • Those with severe chronic disease, e.g., advanced heart failure, lung disease or poorly controlled diabetes Healthy Hygiene Healthy • Clean hands often – Wash with soap and water or – Clean with hand sanitizer • Cover mouth and nose when you sneeze or Cover cough and clean hands afterwards cough • Keep hands away from face • Stay away from people who are sick Prepare at Home Prepare • Plan now to care for yourself or loved ones Plan who get the flu. • Determine what supplies you will need to Determine provide care at home. provide • Plan how you will care for someone in your Plan household who becomes sick. household ...
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