Preparing for Future Pandemic Influenza:

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Preparing for Future Pandemic Influenza:. Lessons Learned from H1N1.Are We Ready For Another Pandemic?. OBJECTIVES. At the end of this session, the learner will be able to: Understand and explain the public health implications of pandemic influenza - PowerPoint PPT Presentation

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Responding to Future Pandemic Influenza:

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 influenzaIdentify antiviral agents and understand what is in the Strategic National StockpileDescribe mass prophylaxisDescribe future preparedness plans for Pandemic Influenza

OVERVIEWSeasonal vs. Pandemic InfluenzaPandemic is a global disease outbreakInfectious 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 terrorism320TH CENTURY FLU PANDEMICS1918 Spanish Flu

1957-1958 Asian Flu

1968-1969 Hong Kong Flu

2009-2010 H1N1 Flu

4IMPLICATIONSMain 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 Stats2238 lab confirmed cases>275,000 estimated cases

Hospitalized: 641Deaths: 48PANDEMIC IN LOUISIANA (H1N1)

DISASTER MANAGEMENT CONTINUUMTener Goodwin Veenema, 2009EMERGENCY SUPPORT FUNCTION 8Louisiana 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 stateThe 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 HEALTHInfectious Disease Epidemiology- disease surveillance and epidemiological investigationLaboratory- testing samples from hospitals, physicians offices and conduct syndromic surveillanceBureau of Emergency Medical Services- provides transport/care, ensure consistent communication among EMS organizations, may assist in strike teams if needed for vaccination

PUBLIC HEALTHImmunizations-provide vaccines, immunization protocols and technical assistancePharmacy- provide guidance on antiviralsBureau Of Media and Communications-provides media campaign for the general public; timely and accurate informationHealth Alert Network- network of communication systems used to distribute messages to federal, state, local agencies and community partners PANDEMIC INFLUENZA PLANNINGVaccine of a new pandemic strain of influenza will not be available at the onsetIf the pandemic is more widespread and severe, individuals with severe acute respiratory failure will exhaust the available mechanical ventilator supplyAntiviral medications that work may be in short supply11PUBLIC HEALTH EMERGENCYSevere Pandemic InfluenzaEthical IssuesCrisis Standards of CareHealth professionals/non health professionals may be called upon to temporarily perform tasks that are not routine and competence is limitedQuarantine and isolationMass Care-Triage-Population focused careRoutine operations of sickest first in ER could result in use of resources on those who may be too sick to survive 12VULNERABLE POPULATIONSUnsure who will be most vulnerable in a pandemic.Children are identified as part of the vulnerable population groupProvisions for underinsured/uninsuredPlanning is underway with community outreach and other State agencies

BEHAVIORAL HEALTH IMPLICATIONSPreparing families in the event the school may be closedConsideration for children with special needsEncourage and support your coworkersStaffing absencesChildren in response to public health threat/terrorist attack (Post Traumatic Stress Disorder, depression, anxiety disorders)Death of a student, teacher or family member

Social disruptionEconomic lossOverwhelmed healthcare systemStaff or family members ill lead to cause in absentismContigency plansPREVENTING THE SPREAD OF INFLUENZACommunity MitigationHand washingRespiratory hygiene and cough etiquetteStay at home when illPPE

16ANTIVIRAL AGENTS AND PANDEMIC FLUAntiviral Medicationsare prescription medicines used to treat/prevent influenza virusescan make your illness milder and make you feel better faster if taken within first 48 hours of illnessextremely limited supply would be prioritized for high risk groups May not work or be indicated in most groupsAntiviral MedicationsOseltamivir (Tamiflu)SuspensionCapsuleZanamivir (Relenza)Powder via inhaler

17ANTIVIRAL AGENTS AND PANDEMIC INFLUENZAState Antiviral Cache consist of medications purchased by Louisiana for pandemic preparednessStrategic National Stockpile added antivirals in 2006. Amount is apportioned by population of the state

18STRATEGIC NATIONAL STOCKPILEManaged InventoryVaccinesAntivirals CHEMPACKFederal Medical Stations

19EMERGENCY 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 use20INVESTIGATIONAL 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

21MASS PROPHYLAXISCapability 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 threatsDispensing of antibiotics and/or vaccines to the community to prevent the development of disease in exposed individuals

22MASS PROPHYLAXISPublic Health emergencies may require the dispensing of vaccines or medicine to the entire populationPoints Of Dispensing (PODs) are needed to reach populations in shorter time periodsPush vs. PullPoint of Dispensing (POD) sitesLocation where medications/vaccines are provided to the public to prevent disease during an emergencyRange from small clinics to very large facilities (school auditoriums, civic centers, churches or large businesses)

24FEDERAL LAWSPublic 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 LAWSIsolation And QuarantineTitle 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.26LOUISIANA STATE LAWLouisiana 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 LAWLouisiana 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 practicesHand washing signs in restroomsCleaning and disinfecting daily or when there is visibly soiled areas (flu.gov)Review and revise existing pandemic plans Recognizing the signs/symptoms of influenzaAlcohol based hand sanitizer when water is not available

USING ALTERNATIVE METHODSShortage of medical suppliesOverwhelmed healthcare systemDecreased personnelLimited number of ventilatorsShelter in place/Social distancingLESSONS LEARNEDSchool CampaignProtocol needed for school nurses administering vaccinesExpansion of vaccinators (Pharmacists)Vaccine Rollout versus the H1N1 outbreakVaccine types led to confusionRumors about vaccine/Media frenzyNeedle supplies received were appropriate for pediatrics

LESSONS LEARNEDH1N1 After Action Plan revealed some school nurses were not comfortable administering vaccinesH1N1 affected different age groups from seasonal most severe cases occurring in older children and adults

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