Pandemic Avian Influenza What Is It? How Can We Prepare For It?
Agenda • Brief overview of immune system • What is seasonal flu, and how does seasonal flu differ from pandemic flu? • What might we expect from an H5N1 pandemic? Business and public health impacts • History of influenza pandemics • Current status of H5N1 outbreaks • How can we prepare for, and minimize risks and impact of, an H5N1 pandemic?
(A)H5N1
What Is Seasonal Flu? • • • • •
RNA virus that attacks respiratory system Highly contagious (25 – 40 percent pop) Highly mutable Spread by coughing and sneezing Usually spread from person to person, through sometimes people become infected by touching something with flu viruses on it and then touching their mouth or nose • Most health adult may be able to infect others beginning 1-2 days before symptoms develop and up to 5 days after becoming sick • Most dangerous to the very young, the aged or infirm, pregnant. The immuno-compromised.
What is Pandemic Flu? • Global outbreak that occurs when a new virus “emerges” in the human population • Radically changed virus antigen that prevents immune system recognition • Very limited or no immune response • Spreads easily from person to person (H2H) worldwide • Significant disruption of socio-economic conditions Note: We are NOT currently experiencing a pandemic event
Pandemic Characteristics • Widespread impact – Extra-regional, probably world-wide • Not a physical disaster • Pandemic duration – Overall, est. 12-18 months long – Multiple waves of impact, with each wave being different, and with “lull” periods between individual local episodes • Advance notices – Probably some advance notice, but how long? – Area of origin, and abilities of local public health – Modern transport, and being infectious without showing symptoms, prevents effective quarantine
Seasonal Flu versus Pandemic Flu Seasonal Flu
Pandemic Flu
Follows annual predictable seasonal patterns
Occurs rarely (three times in 20th century) but regularly, over time
Some immunity built up from previous exposure
Little or no pre-existing immunity
Healthy adults usually not at risk for serious complications
Healthy people at very increased risk for serious complications
Average U.S. deaths approximately 36,000/yr
Number of US deaths could be high (significantly over 500,000)
Generally causes modest impact on society
May cause major impact on society
Manageable impact on domestic and world economy
Potential for severe impact on domestic and world economy
http://healthyamericans.org/reports/flu/FluBrochure.pdf
Human Bird Flu Symptoms • Can cause a range of symptoms in humans: – Includes “normal” seasonal flu symptoms • Fever, cough, sore throat, and muscle aches • Head ache and lethargy
– Symptoms not usually associated with seasonal flu • Eye infection – conjunctivitis • Severe viral pneumonia, leading to – Acute respiratory distress
• Potential for bleeding from respiratory and mucosal areas • Multi-organ failure
• Current mortality rate is over 50 percent of infected individuals. Global mortality and morbidity rates is an evolving area of research
Medical Protections • Tamiflu – Relenza – Limited manufacturing ability – Limited shelf-life, difficulty with stockpiling – Costs – Resistance is developing • Vaccinations – Long lead time to develop – “Old” chicken egg method – Antigenic shift/drift, “missing target” – Limited manufacturing ability – Costs
Public Health and Distribution Capability Limitations
History of Flu Pandemics
• Recurring over time: 2-3 times per century – Varying in intensity
• 1918 up to 100 million deaths – 5 – 10 percent of infected died – US: 3 percent overall mortality
• 2006 H5N1 – Approx 50 percent of infected die – Mortality rate may World Population: 1918 = 1.75B change as H5N1 – Pandemic trigger is H2H transmission
2006 = 6.5B
Pandemic Business Impact - Staffing • Primary business impact is on staffing levels: – Illness / incapacity • Suspected • Actual • Post-infectious
– Employees staying home to care for family • Ill family members • Children at home due to school closures
– Employees feeling safer at home – absenteeism – Staff volunteering in community • Staff panic and stress, decreased work efficiency
Possible Public Health – Medical Impacts • Insufficient medical facilities – beds, supplies labs • Insufficient trained medical staffing: – Doctors – Nurses – Incapacitation of medical staff due to pandemic illness • Disruptions of medical supply replacements • Disruptions of health-related transportation services • Triage versus treatment – Cancellation of non-essential medical services and testing • Insufficient end-of-life services: – Coffins and professional mortuary services – “Normal” burial areas and procedures • Issues with impact (inter) nationally, not just locally
H5N1: Current Status = Pandemic Alert
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208 infections world wide, may be significantly under-reported 115 deaths world wide, may be under-reported (55 percent M.R.) Bird to human (B2H) transmission primarily (x2 H2H), H5N1 is mutating, efficacy of B2H transmission seems to be increasing – Additional bird to non-human mammalian transmission occurring Risk of pandemic-enabling (H2H) mutation may be increasing
http://www.who.int/csr/disease/avian_influenza/phase/en/index.html
Inter-Agency Advisory On Pandemic Influenza Preparation, March „06 • FDIC, FDIC, OCC, Office Thrift Supervision • Advisory only: “Advises financial institutions and their service providers to consider this and similar threats in their response and contingency strategies.” • Directs recipients to other guidance-oriented web sites like pandemicflu.gov for details. No specific requirements, compliance dates, or financial support • National strategy doctrine: “Private sector should play an integral role in preparedness before a pandemic beings, and should be part of the national response.”