Preparing for Future Pandemic Influenza:

Lessons Learned from H1N1….Are We Ready For

Another Pandemic?

OBJECTIVESAt the end of this session, the learner will

be able to:▫Understand and explain the public health

implications of pandemic influenza▫Identify antiviral agents and understand

what is in the Strategic National Stockpile▫Describe mass prophylaxis▫Describe future preparedness plans for

Pandemic Influenza

OVERVIEW

•Seasonal vs. Pandemic Influenza•Pandemic is a global disease outbreak•Infectious diseases pose a public health

threat because they can be highly contagious and cause morbidity and mortality and also be utilized as an act of terrorism

20TH CENTURY FLU PANDEMICS

• 1918 – Spanish Flu

• 1957-1958 – Asian Flu

• 1968-1969 – Hong Kong Flu

• 2009-2010 – H1N1 Flu

IMPLICATIONS

•Main challenge is that health officials do not have the know when and where future pandemics will occur

•Management of pandemics require large stocks of antivirals, access to effective vaccines, resources and multidisciplinary and multisectoral approach

•LA Stats▫2238 lab confirmed cases▫>275,000 estimated cases

•Hospitalized: 641•Deaths: 48

PANDEMIC IN LOUISIANA (H1N1)

DISASTER MANAGEMENT CONTINUUM

Preparedness

Mitigation

Response

Recovery

Evaluation

Tener Goodwin Veenema, 2009

EMERGENCY SUPPORT FUNCTION 8

•Louisiana Department of Health and Hospitals (DHH)/Office of Public Health (OPH)-Emergency Support Function 8 is the lead agency in any pandemic influenza response within the state

•The Secretary of DHH under the advice of the State Health Officer has overall responsibility for the coordination, administration, implementation, receipt, distribution, and dispensing of assets

PUBLIC HEALTH• Infectious Disease Epidemiology- disease

surveillance and epidemiological investigation•Laboratory- testing samples from hospitals,

physician’s offices and conduct syndromic surveillance

•Bureau of Emergency Medical Services- provides transport/care, ensure consistent communication among EMS organizations, may assist in strike teams if needed for vaccination

PUBLIC HEALTH•Immunizations-provide vaccines,

immunization protocols and technical assistance

•Pharmacy- provide guidance on antivirals•Bureau Of Media and Communications-

provides media campaign for the general public; timely and accurate information

•Health Alert Network- network of communication systems used to distribute messages to federal, state, local agencies and community partners

PANDEMIC INFLUENZA PLANNING

•Vaccine of a new pandemic strain of influenza will not be available at the onset

•If the pandemic is more widespread and severe, individuals with severe acute respiratory failure will exhaust the available mechanical ventilator supply

•Antiviral medications that work may be in short supply

PUBLIC HEALTH EMERGENCY

•Severe Pandemic Influenza•Ethical Issues

▫Crisis Standards of Care▫Health professionals/non health professionals

may be called upon to temporarily perform tasks that are not routine and competence is limited

▫Quarantine and isolation▫Mass Care-Triage-Population focused care▫Routine operations of sickest first in ER could

result in use of resources on those who may be too sick to survive

VULNERABLE POPULATIONS

•Unsure who will be most vulnerable in a pandemic.

•Children are identified as part of the vulnerable population group

•Provisions for underinsured/uninsured•Planning is underway with community

outreach and other State agencies

BEHAVIORAL HEALTH IMPLICATIONS

•Preparing families in the event the school may be closed

•Consideration for children with special needs

•Encourage and support your coworkers•Staffing absences•Children in response to public health

threat/terrorist attack (Post Traumatic Stress Disorder, depression, anxiety disorders)

•Death of a student, teacher or family member

•Social disruption•Economic loss•Overwhelmed healthcare system•Staff or family members ill lead to cause

in absentism•Contigency plans

PREVENTING THE SPREAD OF INFLUENZA

•Community Mitigation▫Hand washing▫Respiratory hygiene and cough etiquette▫Stay at home when ill

•PPE

ANTIVIRAL AGENTS AND PANDEMIC FLU

• Antiviral Medications▫ are prescription medicines used

to treat/prevent influenza viruses▫ can make your illness milder and

make you feel better faster if taken within first 48 hours of illness

▫ extremely limited supply ▫ would be prioritized for high risk

groups ▫ May not work or be indicated in

most groups

Antiviral Medications

Oseltamivir (Tamiflu)•Suspension•Capsule

Zanamivir (Relenza)•Powder via inhaler

ANTIVIRAL AGENTS AND PANDEMIC INFLUENZA

• State Antiviral Cache consist of medications purchased by Louisiana for pandemic preparedness

• Strategic National Stockpile added antivirals in 2006. Amount is apportioned by population of the state

STRATEGIC NATIONAL STOCKPILE•Managed Inventory•Vaccines•Antivirals •CHEMPACK•Federal Medical Stations

EMERGENCY USE AUTHORIZATION (EUA)

•Used for medical and public health communities and is applicable for both civilian and military use.

•Fills the need for timely and practical medical treatment under emergency conditions and authorizes use of the best product available for treatment or prevention

•Used when a drug has not already been approved or it is not indicated for the specific use

INVESTIGATIONAL NEW DRUG (IND)

Investigational New Drug (IND)▫The FDA can permit treatment use of an

investigational drug during an investigational period when the drug is intended as therapy for a serious or immediately life-threatening condition and when no comparable or satisfactory alternative drug or therapy is available

MASS PROPHYLAXIS

•Capability to protect the health of the population through administration of critical interventions in response to a public health emergency in order to prevent the development of disease among those who are exposed or potentially exposed to public health threats

•Dispensing of antibiotics and/or vaccines to the community to prevent the development of disease in exposed individuals

MASS PROPHYLAXIS

•Public Health emergencies may require the dispensing of vaccines or medicine to the entire population

•Points Of Dispensing (PODs) are needed to reach populations in shorter time periods

•“Push” vs. “Pull”

Point of Dispensing (POD) sites•Location where medications/vaccines are provided to the

public to prevent disease during an emergency•Range from small clinics to very large facilities (school

auditoriums, civic centers, churches or large businesses)

FEDERAL LAWS

•Public Readiness and Emergency Preparedness (PREP) Act ▫authorizes the Secretary of HHS to issue a

declaration that provides immunity from tort liability except for willful misconduct for claims of loss regarding administration or use of countermeasures against chemical, biological, radiological and nuclear agents of terrorism, epidemics, and pandemics.

FEDERAL LAWS

•Isolation And Quarantine▫Title 42 US Code Section 264 gives the

Secretary of Health and Human Services responsibility for preventing the introduction, transmission, and spread of communicable diseases from foreign countries into the US and within the US and its territories/possessions

LOUISIANA STATE LAW

•Louisiana Revise Statutes and the Louisiana Administrative Code, June 2004, Public Health Code (5), Part 2: The Control of Disease ▫provides the Louisiana State Health Officer

with the authority to take actions to control diseases

LOUISIANA STATE LAW

•Louisiana Emergency Powers Act 2003 ▫grants the Louisiana State Health Officer,

Department of Health and Hospitals, and the Office of Public Health jurisdiction, control and authority to isolate or quarantine in order to prevent the spread of disease.

•Reinforce/initiate infection prevention and control measures

•Encourage flu vaccination •Share best practices•Hand washing signs in restrooms•Cleaning and disinfecting daily or when

there is visibly soiled areas (flu.gov)

•Review and revise existing pandemic plans

•Recognizing the signs/symptoms of influenza

•Alcohol based hand sanitizer when water is not available

USING ALTERNATIVE METHODS

•Shortage of medical supplies•Overwhelmed healthcare system•Decreased personnel•Limited number of ventilators•Shelter in place/Social distancing

LESSONS LEARNED

•School Campaign•Protocol needed for school nurses

administering vaccines•Expansion of vaccinators (Pharmacists)•Vaccine Rollout versus the H1N1

outbreak•Vaccine types led to confusion•Rumors about vaccine/Media frenzy•Needle supplies received were

appropriate for pediatrics

LESSONS LEARNED

•H1N1 After Action Plan revealed some school nurses were not comfortable administering vaccines

•H1N1 affected different age groups from seasonal most severe cases occurring in older children and adults <65 years of age

SKILLS

•Breakout session/Review of Medication techniques▫Arm injections▫Intranasal

AVAILABLE PRINTED MEDIA RESOURCES“How You Can Be Prepared

for a Flu Pandemic” Individual and Family Guide Spanish, English, Vietnamese

versions available Audio version available

through the State Library System

Braille version - Summer 2008 through the State Library System

AVAILABLE PRINTED MEDIA RESOURCES• Family Readiness Guides (also

online)• Get Ready, Stay Healthy!

▫ Pan Flu Brochure▫ Counter Cards (two-sided;

card stock)• “How You Can Be Prepared

for a Flu Pandemic”• Online Fact Sheets:

www.fighttheflula.com(click pandemic flu information)▫ Pandemic Flu: The Facts▫ Pandemics in the United

States

REFERENCES

• Centers for Disease Control and Prevention-www.cdc.gov

• www.flu.gov• US Department of Health and Human Services

(www.hhs.gov)• Louisiana Emergency Operations Plan• Louisiana DHH/OPH Pandemic Influenza

Guidance• Louisiana Office of Behavioral Health• Substance Abuse and Mental Health Services

Administration (SAMHSA)

REFERENCES

•Africa Influenza Preparedness Pandemic Plan, www.doh.gov.za

RESOURCES

•National Association of School Nurses•National Commission on Children and

Disasters•US Department of Education•American Academy of Pediatrics•Federal Emergency Management Agency

(FEMA)

FightthefluLA.com

“Doing the greatest good for the greatest number

with least amount of harm”

CONTACT INFORMATION

Sherhonda Harper, MHA, RN, PHN 7Statewide Nurse Consultant,Emergency Preparedness and ResponseDHH/OPH(225) 763-5740-OFFICE(225) 763-5727-FAX

QUESTIONS