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Pandemic Influenza Avian Influenza. Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M.D., M.P.H. Pandemic Influenza & Avian Influenza 101 Preparedness Efforts. - PowerPoint PPT Presentation


  • Pandemic InfluenzaAvian InfluenzaMaine Department of Health & Human ServicesMaine Center for Disease Control & Prevention(formerly Bureau of Health)Dora Anne Mills, M.D., M.P.H.

  • Pandemic Influenza & Avian Influenza 101 Preparedness Efforts

  • 1. Pandemic Influenza & Avian Influenza 101

  • InfluenzaSeasonal influenza

    Avian influenza Pandemic influenza

  • All Influenza:RNA viruses Genetic engines A: Hemagglutinin Neuraminidase

  • Seasonal InfluenzaOctober April Influenza Type AH3N2, H1N1 Influenza Type B Vaccine

  • Avian Influenza (Bird Flu)Influenza A Domestic poultry can be deadlyHigh vs. low pathogenic Wild birds carriers Virus in fecal droppings, saliva/nasal discharge

  • Recent Avian Influenza Outbreaks Affecting Humans1997 H5N1 Hong Kong 1999 H9N2 Hong Kong 2003 H7N7 Netherlands 2004 H7N3 Canada 2004 H5N1 Southeast Asia

  • Pandemic InfluenzaGlobal outbreak Highly contagious Deadly

  • Recent Pandemics1918Spanish flu (H1N1)5,000 deaths in Maine500,00 in U.S.40,000,000 worldwide1957Asian flu (H2N2)70,000 deaths in U.S.1-2,000,000 worldwide1968 Hong Kong flu (H3N2)34,000 deaths in U.S.700,000 worldwide

  • Past Pandemic InfluenzaEstimates for Maine

  • H5N1Detected in Asia since 1997 Deadly 50% mortality in humans Transmitted birds to mammals and limited human to human Evolving quickly

  • H5N1 Activity as of September 29, 2006253 human cases (thru 10/13/06) In 58 countries 148 deaths Mortality rate = 58%

  • Human Infections and Human Deaths by H5N1 by Month, October 13, 2006

  • 2. Preparedness EffortsAvian Influenza PreparednessPandemic Influenza Preparedness

  • A. Avian Influenza Preparedness

  • DetectionTesting in: Migratory birdsPoultry industry

  • Preparedness PlanningPoultry workers Backyard flock owners Others bird lovers, hunters

  • General PublicFood safety Bird handling

  • B. Pandemic Influenza PreparednessPan Flu

  • Significant Issues forPan Flu PlanningDetection and TrackingCare for Isolated and IllVaccines and AntiviralsFood and Other SupportBasic Services and Economic ImpactCommunicationQuarantine and Isolation

  • Pandemic AssumptionsAttack rate of 25%-35% Duration of up to year or more in 2 waves Each wave lasting 6-8 weeks in community Healthcare system will be severely taxed, if not overwhelmed

  • Social Disruption fromPandemic InfluenzaAbsenteeism in essential sectors Health, law enforcement, food and fuel supplies, education Economic impact Psychological stress

  • 2006 vs 1918Advantages in 2006Healthier populationBetter medical carePreparedness

    Advantages in 1918Smaller populationLess travelMore self-reliance

  • Federal Preparedness


  • Components of Federal PlanSurveillanceLaboratory DiagnosticsHealthcare PlanningInfection ControlClinical GuidelinesVaccineAntiviral DrugsCommunity Disease ControlTravel-Related Risks of DiseaseCommunicationsWorkforce Support

  • Selected ComponentsVaccine Antivirals Community Disease Control

  • Vaccines

  • Assumptions for VaccinationTwo doses will be required Vaccine unavailable for 3-6 months Production will be 3-5 million doses (15 g) per week 10,000 doses per week in Maine

  • Vaccine Priority GroupsVaccine and antiviral manufacturers Health care providers Those at high risk for severe disease Public health emergency response workers Key government leaders

    400,000 in Maine

  • Recommendations for Vaccine and Antivirals may be modified based on:VirulenceTransmissibilityDrug resistanceGeographic spreadAge-specific attack ratesMorbidity and mortality rates

  • What You Can Do NowAnnual seasonal influenza vaccination Pneumococcal vaccination

  • Antivirals

  • AntiviralsAdamantanesAmantadineRimantadine Neuraminidase inhibitorsOseltamivir (Tamiflu)Zanamivir (Relenza)

  • Assumptions for AntiviralsResistance to adamantanes Neuraminidase inhibitors will be effective in decreasing morbidity and mortality Current national stockpile = 5 million courses; goal is 80 million courses ? Maine stockpile

  • Some Antiviral Priority GroupsPatients admitted to hospital Infected health care workers and EMS providersInfected high-risk patientsInfected pandemic responders and government decision-makersExposed health care workers

    Equals 40 million courses (150,000 courses for Maine)

  • Cost of Antiviral Treatment5-Day Course for an AdultOseltamivir (Tamiflu)$72.10 Zanamivir (Relenza)$61.80

  • Personal Stockpiles of AntiviralsSupply Effectiveness Resistance Shelf life

  • Stockpiles of AntiviralsInstitutional State

  • Community Disease Control

  • Challenges to ContainmentShort incubation period of 1-5 days Ability of persons with asymptomatic infection to transmit virus Early symptoms of illness are likely to be non-specific, delaying recognition

  • Goal of Community Disease ControlTo limit or slow spread of pandemic influenzaSocial Distancing

  • Containment Measures for Ill IndividualsPatient isolation Management of contactsContact tracingContact monitoringQuarantine

  • Containment Measures For Groups of Exposed or At-Risk PersonsQuarantine Containment measures for specific sites or buildings

  • Containment Measures For CommunitiesPromotion of community-wide infection control measures Social distancing (snow days)

  • Unresolved IssuesRole of airborne transmission Effectiveness of antivirals Coordination between states and countries

  • State of Maine Preparedness


  • Overarching Roles of Major State Agencies Involved with Pandemic Influenza Response PlanningGovernorIncident CommanderMEMACoordinator of states planning and response to all emergenciesMaine CDCDevelops public health emergency response plansStrategy lead in states response to Pandemic InfluenzaSits with Governor during public health emergenciesMaine Department of AgricultureDevelops response plans for zoonosesStrategy lead in states response to Avian InfluenzaSits with Governor during animal health emergencies

  • What Has Maine Been Doing?1997 2001Two statewide Pan Flu ConferencesStatewide PlanTwo exercises 2001 2005Post 9/11 Federal FundsEarly Detection SystemCommunication SystemsResponse SystemDecember, 2005 Pan Flu Conference

  • Maines Planning Efforts 20063-part process: Update Maines Pandemic Influenza Plan Development of sub-state Pandemic Influenza plans County plansHospital plans Exercise and drills of the plans

    September 20th Summit - 1,100 attended

  • Overarching FrameworkEarly detection Response systems Communications Training Exercises and drills

  • Emergency managementHealthcareMany stakeholders involvedMay-August 2006 plans draftedAugust 2006-2007 exercise for contact informationCounty Preparedness

  • 2006 Plans drafted 2007 Exercise plans for contact information

    Hospital Preparedness


  • Pandemic PreparednessCan Be Daunting!Need to: Keep focused on the known Be creative Dont wait for someone else

  • School Preparedness

  • School Preparedness - Maine200,744 enrolled in Maine elementary and secondary schools 66,000 enrolled in Maine post-secondary schools

  • Resources for School Pandemic Influenza Preparedness


  • Pandemic Flu K-12 Checklist FormatPlanning and Coordination Continuity of Student Learning and Core Operations Infection Control Policies and Procedures Communication Planning



  • Some Highlights of ACHA GuidelinesPlanning that allows employees to work from home Providing for ill students Addressing health and safety issues Addressing business continuity Making contingency plans for completion of courses

  • Some Highlights of ACHA Guidelines (contd)Testing and rehearsing the plans Identifying key members of the Pandemic Planning Committee Identifying appropriate channels of communication and chain of command Identifying the role of student health services Compiling a list of supplies that would be needed

  • Disaster Planning does not equal Public Health Emergency Planning.

  • Preparedness isEveryones Job No one ever died of preparedness!


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