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Pandemic Influenza Avian Influenza Maine Department of Health & Human Services Maine Center for Disease Control & Prevention (formerly Bureau of Health) Dora Anne Mills, M.D., M.P.H.

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"Pandemic Influenza & Avian Influenza..." Pandemic Influenza & Avian Influenza 101 Preparedness Efforts

1. Pandemic Influenza &     Avian Influenza 101

Influenza Seasonal influenza Avian influenza Pandemic influenza

All Influenza: RNA viruses Genetic engines A: Hemagglutinin Neuraminidase

Seasonal Influenza October – April Influenza Type A H3N2, H1N1, H1N2 Influenza Type B Vaccine

Avian Influenza (Bird Flu) Influenza A Domestic poultry – can be deadly High vs. low pathogenic Wild birds – carriers Virus in fecal droppings, saliva/nasal discharge

Recent Avian Influenza Outbreaks Affecting Humans 1997  H5N1  Hong Kong 1999  H9N2  Hong Kong 2003  H7N7  Netherlands 2004  H7N3  Canada 2004  H5N1  Southeast Asia

Pandemic Influenza Global outbreak Highly contagious Deadly

Recent Pandemics 1918 Spanish flu (H1N1) 5,000 deaths in Maine 500,00 in U.S. 40,000,000 worldwide 1957 Asian flu (H2N2) 70,000 deaths in U.S. 1-2,000,000 worldwide 1968  Hong Kong flu (H3N2) 34,000 deaths in U.S. 700,000 worldwide

Past Pandemic Influenza Estimates for Maine

H5N1 Detected in Asia since 1997 Deadly – 50% mortality in humans Transmitted birds to mammals and limited human to human Evolving quickly

H5N1 activity as of May 19, 2006 217 human cases In 58 countries 123 deaths Mortality rate = 57%

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2. Preparedness Efforts

A.  Avian Influenza      Preparedness

Detection Testing in: Migratory birds Poultry industry

Preparedness Planning Poultry workers Backyard flock owners Others – bird lovers, hunters

General Public Food safety Bird handling

B. Pandemic Influenza     Preparedness “Pan Flu”

Significant Issues for Pan Flu Planning Detection and Tracking Care for Isolated and Ill Vaccines and Antivirals Food and Other Support Basic Services and Economic Impact Communication Quarantine and Isolation

Pandemic Assumptions Attack rate of 25%-35% Duration of up to a year or more in 2 waves Each wave lasting 6-8 weeks in a community Healthcare system will be severely taxed if not overwhelmed

Social Disruption from Pandemic Influenza Absenteeism in essential sectors Health, law enforcement, food and fuel supplies, education Economic impact Psychological stress

2006 vs 1918 Advantages in 2006 Healthier population Better medical care Preparedness

Federal Preparedness

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Components of Federal Plan Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Antiviral Drugs Community Disease Control Travel-Related Risks of Disease Communications Workforce Support

Selected Components Vaccine Antivirals Community Disease Control

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Assumptions for Vaccination Two doses will be required Vaccine unavailable for 3-6 months Production will be 3-5 million doses (15 µg) per week à 10,000 doses per week in Maine

Vaccine Priority Groups Vaccine and  antiviral manufacturers Health care providers Those at high risk for severe disease Public health emergency response workers Key government leaders 400,000 in Maine

Recommendations for Vaccine and Antivirals may be modified based on: Virulence Transmissibility Drug resistance Geographic spread Age-specific attack rates Morbidity and mortality rates

Antivirals

Antivirals Adamantanes Amantadine Rimantadine Neuraminidase inhibitors Oseltamivir (Tamiflu) Zanamivir (Relenza)

Assumptions for Antivirals Resistance to adamantanes Neuraminidase inhibitors will be effective in decreasing morbidity and mortality Current national stockpile = 5 million courses; goal is 80 million courses ? Maine stockpile

Some Antiviral Priority Groups Patients admitted to hospital Infected health care workers and EMS providers Infected high-risk patients Infected pandemic responders and government decision-makers Exposed health care workers          Equals 40 million courses     (150,000 courses for Maine)

Cost of Antiviral Treatment 5-Day Course for an Adult Oseltamivir (Tamiflu) $72.10 Zanamivir (Relenza) $61.80

Personal Stockpiles of Antivirals Supply Effectiveness Resistance Equity Shelf life

Stockpiles of Antivirals Institutional State

Community Disease Control

Challenges to Containment Short incubation period of 1-5 days Infected people are contagious before they have symptoms Early symptoms are non-specific, delaying recognition

Goal of Community Disease Control To limit or slow spread of pandemic influenza Social Distancing

Containment Measures for Ill Individuals Patient isolation Management of contacts Contact tracing Contact monitoring Quarantine

Containment Measures For Groups of Exposed or At-Risk Persons Quarantine Containment measures for specific sites or buildings

Containment Measures For Communities Promotion of community-wide infection control measures Social distancing (snow days)

Unresolved Issues Role of airborne transmission Effectiveness of antivirals Coordination between states and countries

State of Maine Preparedness

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Overarching Roles of Major State Agencies Involved with Pandemic Influenza Response Planning Governor Incident Commander MEMA Coordinator of state’s planning and response to all emergencies Maine CDC Develops public health emergency response plans Strategy lead in state’s response to Pandemic Influenza Sits with Governor during public health emergencies Maine Department of Agriculture Develops response plans for zoonoses Strategy lead in state’s response to Avian Influenza Sits with Governor during animal health emergencies

What Has Maine Been Doing? 1997 – 2001 Two statewide Pan Flu Conferences Statewide Plan Two exercises 2001 – 2005 Post 9/11 Federal Funds Early Detection System Communication Systems Response System December, 2005 Pan Flu Conference

Maine’s Planning Efforts 2006 3-part process: Update Maine’s Pandemic Influenza Plan Development of sub-state Pandemic Influenza plans County plans Hospital plans Exercise and drills of the plans

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Overarching Framework Early detection Response systems Communications Training Exercises and drills

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Pandemic Preparedness Can Be Daunting! Need to:  Keep focused on the known  Be creative  Don’t wait for someone else

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Preparedness is Everyone’s Job – No one ever died of preparedness!

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