HHS Pandemic Influenza Preparedness Planning Julie Louise Gerberding, MD, MPH.

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  • HHS Pandemic Influenza Preparedness Planning Julie Louise Gerberding, MD, MPH

  • The Burden of InfluenzaSeasonal InfluenzaGlobally: 250,000 to 500,000 deaths each year In the United States each year:36,000 deaths>200,000 hospitalizations $37.5 billion in economic costs from influenza and pneumoniaPandemic InfluenzaAn ever-present threat

  • Seasonal Influenza PreparednessPandemic Influenza Preparedness

  • Pandemics Do Happen! H1H1H3H2H7*H5*H9*1918SpanishInfluenza H1N11957AsianInfluenza H2N21968Hong KongInfluenza H3N2198019971915*Avian Flu 2003 2004 1977199620021925193519451955196519751985199520052003-2006199819992003

  • H5N1 Influenza Severe Pneumonia - Vietnam 2004Hien TT et al., New England J Med 2004;350:1179-1188DAY 5 DAY 7 DAY 10

  • Planning Assumptions: Health Care 50% or more of those who become ill will seek medical careNumber of hospitalizations and deaths will depend on the virulence of the pandemic virus

    Moderate (1957-like)Severe (1918-like)Illness90 million (30%)90 million (30%)Outpatient medical care45 million (50%)45 million (50%)Hospitalization865,0009, 900,000ICU care128,7501,485,000Mechanical ventilation64,875745,500Deaths209,0001,903,000

  • Pandemic Strain Emergence: Direct InfectionAvian ReservoirAvian virus

  • Pandemic Strain Emergence: Reassortment of Influenza A VirusesAvian ReservoirAvian virusHuman virus

  • Addressing Local Practices

  • Situation Report: Avian InfluenzaWidespread and spreading prevalence in migratory birds; broad host range Continued outbreaks among domestic poultry Mammalian infection (cats, pigs, etc.) lethal Virus is evolving Sporadic human cases (>140 reports to date)Most in young and healthyCase-fatality 50%Rare person-to-person transmissionSustained and rapid person-to-person transmission

  • HHS Pandemic Influenza PlanSupport the National Strategy for Pandemic Influenza

    Outlines planning assumptions and doctrine for health sector pandemic preparedness and response

    Public Health Guidance for State and Local Partners

    11 Supplements with detailed guidance

  • HHS Pandemic Influenza Doctrine:Saving LivesA threat anywhere is a threat everywhere! Quench first outbreaks: detect and contain where it emerges, if feasibleInternational collaborations Frontline detection and response; rapid laboratory diagnosis Isolation / quarantine / antiviral prophylaxis / social distancing / animal culling

  • HHS Pandemic Influenza Doctrine: Saving LivesPrevent or at least delay introduction into the United StatesMay involve travel advisories, exit or entry screeningFor first cases, may involve isolation / short-term quarantine of arriving passengers

  • HHS Pandemic Influenza Doctrine: Saving LivesSlow spread, decrease illness and death, buy timeAntiviral treatment and isolation for people with illnessQuarantine for those exposedSocial distancingVaccine when availableLocal decisions WeeksImpactPreparedUnprepared

  • HHS Pandemic Influenza Doctrine: Saving LivesClearly communicate to the publicPrepare people with information Encourage action steps to prepare nowProvide updates when new information emergesUse trusted messengers Coordinate to ensure consistent messages Address rumors and inaccuracies

  • Our Health Protection Preparedness SystemA NETWORK of Shared Responsibility!

    Local - state - federal Domestic internationalPublic privateMulti-sectorNon-partisanAnimal humanHealth protection homeland security economic protection

  • Countermeasures: Vaccines, Antivirals, andMedical Supplies

    Strategic National Stockpile

  • Vaccine Production and Use: U.S Seasonal Influenza

  • Antivirals and Medical Supplies: Influenza TreatmentsStockpileTamiflu: 4.3 million courses in Strategic National Stockpile with an additional 1 million courses by end of January 2006 StrategyProcure 81 million courses of antivirals6 million courses to be used to contain an initial U.S. outbreak75 million courses to treat up to 25 percent of U.S. population Accelerate development of promising new antiviral candidates

  • Overcoming Challenges to Pandemic VaccineExpand production of current (egg-based) vaccine Evaluate dose-sparing technology (adjuvants, intramuscular vs. intradermal route)Accelerate development of modern (non-egg) vaccines Target new antigens

  • State and Local Pandemic Influenza Planning ChecklistCommunity Leadership and NetworkingSurveillanceHealth System PartnershipsInfection Control and Clinical CareVaccine Distribution and UseAntiviral Drug Distribution and UseCommunity Disease Control and PreventionCommunicationsWorkforce Support

  • Pandemic Influenza ChecklistsState and LocalBusinessPreschoolSchools (K-12)Colleges & UniversitiesFaith-based & Community Organizationswww.pandemicflu.gov

    Physician Offices and Ambulatory CareHome HealthEmergency Medical ServicesTravel Industry

  • Health Protection at the Frontline: Local, County, and State Public Health Departments

  • Seasonal Influenza PreparednessPandemic Influenza PreparednessPreparing for a pandemic now will mean: Lives saved during seasonal influenzaModern seasonal influenza vaccine for all who need itNew antiviral drugs for prevention and treatmentCommunity health protection from other threatsPeace of mind

  • Complacency is the enemy of health protection!www.cdc.gov


    We know that healthier people who enter the healthcare system have better outcomesFor example, if their diabetes is controlled


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