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Introduction to Pandemic Influenza
Introduction to Pandemic Influenza
Public Health emergencies and international disaster response
Public Health emergencies and international disaster response
ObjectivesObjectives
• To understand the pattern of infectious disease outbreaks
• To understand the historical significance and impacts of pandemic influenza outbreaks
• To learn the WHO protocols and guidelines for combating infectious diseases
• To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics
• To understand the pattern of infectious disease outbreaks
• To understand the historical significance and impacts of pandemic influenza outbreaks
• To learn the WHO protocols and guidelines for combating infectious diseases
• To understand the steps in the process of identifying, responding to, and recovering from pandemic influenza pandemics
World Health Organization Phases of a Pandemic
World Health Organization Phases of a Pandemic
• WHO has six phases for a pandemic that are under review following the H1N1 pandemic
• Each Phase has specific activities recommended to governments
• Each phase has communication recommendations
• International Health Regulations of 2005• Novel virus and severity of the virus must be
linked in new phase release
• WHO has six phases for a pandemic that are under review following the H1N1 pandemic
• Each Phase has specific activities recommended to governments
• Each phase has communication recommendations
• International Health Regulations of 2005• Novel virus and severity of the virus must be
linked in new phase release
EpidemiologyEpidemiology
• Incubation period about 1 to 4 days
•2-3 days for H1N1, 2-8 days for H5N1
• Infective for about 5 to 7 days
•up to 2 weeks in high-risk individuals
• Infectious up to 24 hours BEFORE symptoms
• May be asymptomatic (30 - 50%)
How do we identify infected
individuals
How do we identify infected
individuals Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg
SARS
5 to 7 days
1 to 2 weeks
When symptomatic
All ill
Clinical FeaturesClinical Features
Fever (3 - 7 days)
Dry cough
Loss of appetite
Weakness
Blocked nose
Muscle aches
Sore throat
Headache
Lethargy (2 weeks)
Pneumonia
Runny nose
High Risk PopulationsHigh Risk Populations
• Schools– Children have longer viral shedding period– Greater opportunities for spread
• Military facilities– Close living quarters– Field hygiene
• Incarcerated– Prisons– Mental facilities
• Elderly care facilities
• Schools– Children have longer viral shedding period– Greater opportunities for spread
• Military facilities– Close living quarters– Field hygiene
• Incarcerated– Prisons– Mental facilities
• Elderly care facilities
Who is a “close contact”?Who is a “close contact”?
• People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.
• People who came within 1 meter of shared space with a confirmed or suspect case patient beginning 1 day before onset of symptoms through 14 days after onset of symptoms.
Picture: http://www.molecularlab.it/public/news/_20050916_influenza_aviaria_polli.jpg
Droplet PrecautionsDroplet Precautions
• Prevent infection by large droplets from– Sneezing– Coughing– Talking
• Examples– Neisseria meningitidis– Pertussis– Influenza– Avian influenza (probable)
• Prevent infection by large droplets from– Sneezing– Coughing– Talking
• Examples– Neisseria meningitidis– Pertussis– Influenza– Avian influenza (probable)
Rapid ResponseRapid Response• Strong Surveillance systems will provide the
opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response
• Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS
• Logistical support and trained personnel• A Risk Communication Plan and support
from the local authorities• Plan for 6 weeks of support for 10,000
people
• Strong Surveillance systems will provide the opportunity to “Contain” a virus or bacteria before it can spread; Two weeks response
• Launching a Containment Operation to seal off a geographically defined area requires a PRE-DEFINED DECISION-MAKING PROCESS
• Logistical support and trained personnel• A Risk Communication Plan and support
from the local authorities• Plan for 6 weeks of support for 10,000
people
Rapid Containment Cannot Be “Business as Usual”
Rapid Containment Cannot Be “Business as Usual”
“When is it too late to contain?”
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Societal ImpactsSocietal Impacts
• School closures• Air transportation and general movement of
goods• Potential Border Closures (Tourism decline)• Economic slow down • Health system overload from flu patients
– Care for normal sick is reduced– Supplies and staff become over burdened
• School closures• Air transportation and general movement of
goods• Potential Border Closures (Tourism decline)• Economic slow down • Health system overload from flu patients
– Care for normal sick is reduced– Supplies and staff become over burdened
Sustaining Essential ServicesSustaining Essential Services• Planning estimates are that 40% of the work
forces will be affected• Essential services will deteriorate slowly
– Health services (patient care and Public Health)– Water and Sanitation– Food and agriculture production– Power (fuel and power grids)– Communications– Banking and finance– Transportation– Rule of law (police, courts, prisons, and national
security
• Planning estimates are that 40% of the work forces will be affected
• Essential services will deteriorate slowly– Health services (patient care and Public Health)– Water and Sanitation– Food and agriculture production– Power (fuel and power grids)– Communications– Banking and finance– Transportation– Rule of law (police, courts, prisons, and national
security
Non-Pharmaceutical Interventions
Non-Pharmaceutical Interventions
• Infection controls• Voluntary isolation of sick people• Voluntary quarantine of healthy contacts• School closures• Social distancing• Travel restrictions• Mask use• Hand washing
• Infection controls• Voluntary isolation of sick people• Voluntary quarantine of healthy contacts• School closures• Social distancing• Travel restrictions• Mask use• Hand washing
Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months
Current Seasonal Influenza Vaccine Production Timeline: 6 - 9 months
Enough eggs? Strain selection? Adjuvants? Repeat doses? Expiration?
Potential Strategies to Decrease the Impact of a Pandemic
Potential Strategies to Decrease the Impact of a Pandemic
• Prevent or delay introduction, slow spread
• Decrease illness and death
– Vaccine when available
– Antiviral treatment and isolation for people with illness
– Non-pharmaceutical interventions
• Prevent or delay introduction, slow spread
• Decrease illness and death
– Vaccine when available
– Antiviral treatment and isolation for people with illness
– Non-pharmaceutical interventions
Weeks
Impact
Prepared
Unprepared
SummaryCombating a Pandemic; the
three keys to success
SummaryCombating a Pandemic; the
three keys to success
• Knowledge of the virus is critical– Mutations and movement– Laboratory testing capabilities (Field and Lab
testing)
• Vaccines (6-9 months)– Development– Manufacturing– Distribution
• Non-Pharmaceutical interventions– Population compliance or non-compliance
• Knowledge of the virus is critical– Mutations and movement– Laboratory testing capabilities (Field and Lab
testing)
• Vaccines (6-9 months)– Development– Manufacturing– Distribution
• Non-Pharmaceutical interventions– Population compliance or non-compliance
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