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  • 1.Mid-Peninsula Citizens Preparedness Committee Pandemic InfluenzaPreparation and Response:A Citizens Guide Version 1.5November 2007 Written bySarah Booth & Kelsey Hills-Evans

2. This Guide is for you! It was written so that you can educate yourself,your family, and your community about pandemic influenza.The Guide covers many subjects,so please refer to the Appendices for quick-reference information and essential lists.We hope this Citizens Guide will help you stay safe, aware and healthy! 3. Table of ContentsLicensing - iii Acknowledgments - ivForeword - v Chapter 1:An Introduction to Pandemics - 1Chapter 2: Prevention and Preparation - 14 Chapter 3: Response - 26Chapter 4: Communication and Volunteering - 36 Chapter 5: Recovery and Waves - 42Bibliography - 46Version 1.5 4. ii Table of Contents (Continued) Appendix - 47A. World Health Organization and Pandemic Phases - 48B. World Health Organization Advice for Travelers - 49C. Items to Stockpile for an Influenza Pandemic - 50D. Items for Treatment of Severe Influenza - 51E. Homemade Oral Rehydration Solution - 52F. Possible Roles for Community Volunteers - 53G. Example: Home Patient Medical Record - 54H. Overview of Influenza Surveillance in the United States - 55I. A Doctors Letter during the Height of the 1918 Pandemic - 57Glossary - 59 Version 1.5 5. iii Creative Commons License Deed AttributionShareAlike 3.0 United StatesYou are free to:Share: to copy, distribute, display, and perform the workRemix: to make derivative worksUnder the following conditions:Attribution: You must attribute the work in the manner specified by the author orlicensor (but not in any way that suggests that they endorse you or your use of thework).Share Alike: If you alter, transform, or build upon this work, you may distribute theresulting work only under the same, similar or a compatible license.For any reuse or distribution, you must make clear to others the license terms of this work.The best way to do this is with a link to the website where you found this document.Any of the above conditions can be waived if you get permission from thecopyright holder.Apart from the remix rights granted under this license, nothing in this licenseimpairs or restricts the authors moral rights.This work is licensed under the Creative Commons AttributionShare Alike 3.0United States License. To view a copy of this license, visithttp://creativecommons.org/licenses/bysa/3.0/us/ or send a letter to CreativeCommons, 171 Second Street, Suite 300, San Francisco, California, 94105, USA.Version 1.5 6. iv AcknowledgmentsConceived, Supported and Sponsored byJane and Peter CarpenterAlso Sponsored byMid-Peninsula Citizens Preparedness CommitteeLead Advisors Peter Carpenter Dennis Israelski, MDSamuel Perry Special Acknowledgment for Selected Medical Information and Content Grattan Woodson, MD, FACP Special Assistance Provided by Douglas G. DeVivo, Ph.D.Tessa AndermanKenneth Dueker, JDMaya Guendelman Kathleen SextonChristine Chang Denise Caruso Graphics and DesignGlenda Lee Editing Luke BeckmanDemi Rasmussen Use Doctrine This manual is meant to be a guide for many citizens in its present form, but we encourage individuals, communities, and organizations to revise and adapt it to their individual needs and cultures, and to translate it into other languages. We ask that such revisions reference the original document and remain in the public domain. Revisions should be posted on fluwikie.com so thatthose derivates will be widely available. To check for current updates to this manual, please visithttp://www.fluwikie.com/pmwiki.php?n=Consequences.VersionHistoryCorrections and Additional AcknowledgmentsIf you wish to correct an error in this manual or if you find material for which the original author or source is notproperly acknowledged (an increasingly common and unavoidable problem in the age of multiple postings and of extracts that do not retain identification of the original source), please document your concern and email it to PandemicPrepAndResponse@gmail.com.Version 1.5 7. v Foreword by Dr. David L. Heymann Assistant Director-GeneralWorld Health OrganizationMost public health specialists from around the worldRecent examination of records from the years 1918believe that there will be another human influenza1919 in many cities across the United States haspandemic, a pandemic caused by an avian influenza shown that communities that put into practice socialvirus that can cause human illness and has mutated to distancing measures, such as closure of schools anda form that spreads from person to person. Such a public gathering places before infections were firstrandom event has occurred three times during thedetected, were able to maintain lower levels ofpast century, causing three different influenza infection than others. Those persons at greatest riskpandemics.were those who lived closely together in confinedspaces, such as men serving in the military.Since 2003 three major classes of avian influenzavirusH5, H7 and H9have caused sporadic humanDuring the inter-pandemic period since 1968, sixinfections and, because of the instability of the levels of alert for pandemic influenza have beeninfluenza virus, any one of these viruses is thought to defined by the World Health Organization in orderbe capable of mutating in such a way as to cause ato best describe the pandemic risk: Phases 1 and 2,human pandemic. Presently the most widespread ofduring which no new influenza virus is infectingthese viruses is the H5N1 avian influenza virus, or humans: and Phases 3 to 6 when there is humansimply H5N1. Since an H5N1 outbreak in chickens ininfection with a new influenza virusPhase 3 whenHong Kong was first reported to infect humans inthere is no human to human transmission to Phase 61997, the H5N1 virus has spread in poultrywhen there is increased and sustained transmissionpopulations throughout Asia, the Middle East and to of the new influenza virus in human populations.some parts of Africa and Europe causing a pandemicThe world is currently at phase 3a new (avian)of influenza in chickens and occasional human influenza virus, H5N1, that occasionally infectsinfections in persons who have come into contacthumans and causes severe illness, but that is notwith infected chickens. Since 2003 there have beencapable of sustained human-to-human transmission.more than 300 reported human infections withH5N1, all having caused severe illness, and with an Should the H5N1 virus mutate in such a way that itoverall death rate of more than 60%.can readily transmit from human to human in alimited geographic area, a collective internationalTwo of the three influenza pandemics of the pastresponse would be made in an attempt to containcenturyone that occurred from 19571958 and onethe outbreak by stopping human to humanin 19681969are still in the memory of manytransmission. The objective of such a containmentpersons living today. These pandemics spread rapidlyactivity would be to encircle the focus of humanthroughout the world, causing severe illness in infection by using an antiviral medicine, and/or apersons of all ages, massive absenteeism from schoolvaccine (should one be available), in all persons withand the workplace, and an estimated 2.5 million the potential of exposure to the H5N1 virus. Such adeaths, mostly in persons over the age of 60. The containment activity would be conducted under thethird pandemicthat of 19181919caused anInternational Health Regulations (2005), anestimated 40 million deaths in persons of all ages. international law that requires countries to workArticles published in scientific and medical journals oftogether collectively in assessing and responding tothe time speak of severe illness and death, with aany public health emergency of internationalbreakdown of routine health and mortuary services inconcern, such as the current threat of an H5N1almost all major cities, closure of public gatheringpandemic.places, and quarantine and isolation of those infectedor exposed to infected persons in an attempt to stop(continued)the spread of infection.Version 1.5 8. Foreword viThe International Health Regulations (2005) camecommerce and trade to health care, policeinto effect on 15 June 2007, four years after the enforcement and many other day-to-day activities.outbreak of Severe Acute Respiratory Syndrome Though efforts are being undertaken to increase(SARS). The worldwide response to SARS, which influenza vaccine production capacity so thatwas led by the World Health Organization where Ienough vaccine would be available to preventwork as head of the Communicable Diseaseinfection, and antiviral medications are beingProgramme, permitted development of control stockpiled nationally and internationally, the risk ofstrategies using information collected in real time bya pandemic remains, though lack of predictabilityepidemiologists working in all affected countries.precludes quantification of that risk.Within five months the SARS outbreak was fullycontained using these strategies, and the virus Pandemic Influenza Preparation and Response: A Citizensdisappeared from human populations. Though aGuide, this manual, describes possible consequencespandemic of influenza could not be contained usingof an influenza pandemic, and makes it clear thatthe same strategies, an attempt at early containmentindividuals and families can and must know what towould require early detection with a focus on do should a pandemic occur. It also describes howhuman-to-human transmission, and effective use of those with this knowledge can help to educateantiviral drugs and/or a vaccine to fence-ring theothers in the simple measures that will mitigate andoutbreak and prevent further spread. Becauselimit the negative impact of an influenza pandemiccontainment has never before been tried as aon the worlds communities. Public healthmeasure to prevent or slow the spread of an authorities throughout the world agree that theinfluen

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