pandemic planning: community working together get informed / be prepared
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Pandemic Planning: Community Working Together
GET INFORMED / BE PREPARED
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Objectives
Review of Influenza Virus and Illness, H5N1 avian influenza (“bird flu”)Pandemic Influenza Planning assumptions and principles
National (Health and Human Services, or HHS)TennesseeKnox County
Local Pandemic planningIndividual Pandemic planning
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Local Pandemic Planning
Six groupsFaith based/CommunityHealthcareBusinessMediaMortuarySchools/daycare
You are here*
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Why Plan?Evidence suggests… all communities would be severely impacted when a civilian disaster produces more than 120 casualties. Therefore, >120 casualties considered a major MCI- Mass Casualty Incident.In MCI, without Internal Disaster planning, estimated 40% business will fail.For social cohesion in a crisis to occur, planning and communication need to occur now.
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The Pandemic Influenza Cycle
Rapid transmission with worldwide outbreaks; multiple waves of disease over a 2 year period.Occurrence of cases outside the usual season.High attack rate for all age groups, with high mortality rates, esp for young adultsCycles 10-40 years. Last pandemic was mild, 1968 (35 years ago)
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Situation Report: Avian InfluenzaWidespread prevalence in migratory birds; broad host range
Continued outbreaks among domestic poultry
Mammalian infection (cats, pigs, etc.) - lethal
Virus is evolving
Sporadic human cases (>190 reports to date)
•Most in young and healthy, Case-fatality 50%
•Rare person-to-person transmission
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7
Avian Flu not yet Pandemic Flu, but current outbreaks for H5N1 Avian Flu in poultry and birds are the largest that have ever been documented.
H5N1 Influenzaand Pandemic Preparedness
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Will H5N1 become the next pandemic?
Impossible to know if or when
If not H5N1, then another will come
The prudent time to plan is now
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HHS Objectives: Pandemic Planning and Response
Primary objective:
Minimize sickness and death
Secondary objectives:
Preserve functional society
Minimize economic disruption
There is not complete consensus on the proper order of these objectives
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Assumptions about Disease Transmission
No one immune to virus; 30% of population will become ill
Most will become ill 2 days (range 1-10) after exposure to virus
People may be contagious up to 24 hours before they know they are sick
People are most contagious the first 2 days of illness
Sick children are more contagious than adults
On average, each ill person can infect 2 or 3 others (if no precautions are taken)
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Medical Burden in Tennessee (pop. 6 million) (HHS Plan Estimates)
Characteristic Moderate (0.2%)
Severe (2%)
Illness (30%) 1.8 million 1.8 million
Outpatient Care
900,000 900,000
Hospitalization 17,300 198,000
ICU Care 2,575 29,700
Mechanical Ventilation
1,300 14,850
Deaths 4,180 (0.2%) 38,060 (2%)*HHS recommends that states plan for severe scenario
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Medical Burden in Knox County2005 Knox County Population est. 396,741
Characteristic
Moderate (0.2%)
Severe (2%)
Illness (30%) 119,000
119,000
Outpatient care
59,500
59,500
Hospitalization
1,190
11,900
ICU (15% hosp pts)
180
1,800
Mechanical ventilators (50% ICU pts)
90
900
Deaths 240
2,380
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Preparing for a Pandemic in Knoxville
Federal Plan: Local and Self-reliance is keyLocal groups to develop Internal Disaster Plan
SurveillanceCommunicationsInfection ControlOccupational IssuesVaccine/Antiviral access
Public Health responsibility to educate and facilitate PanFlu planningPreparation by families and individuals essential
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Influenza Virus: How it spreads
Close contact (<6 feet) with sick person who is coughing or sneezing
Touching a surface contaminated by respiratory secretions and getting the virus into mouth, nose or eyes.
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Community Disease Control:Early Stage Isolation and Quarantine
Initial Objective: slow spread of disease Isolation vs. QuarantineLegal measures possible but will rely on voluntary cooperationHousing, health care, psychological, spiritual, food needs must be met for those on isolation/quarantine
Once beyond initial cases, shift strategy to “stay home when you are sick”
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Influenza Containment Strategy: Community Response
Basic ActivitiesSurveillance; quarantine of early casesPublic information and educationPromote “respiratory hygiene” and hand washing
Enhanced ActivitiesFocused measures to increase social distanceCommunity-wide measures to increase social distance
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Community Disease Control:Community Wide Measures
Reduce Social Contact :Canceling large gatherings, mass transit, schools
Decision based on location of flu activity:Outbreak not local: gatherings >10,000 cancelledOutbreak in local/neighboring county: >100
School closings determined by State Commissioner of Health/Board of Education.
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Vaccine or Antivirals??
Flu Vaccine Production minimum 6 month process:
Growing eggs (93 million!)
HHS priority groups1. Military and
Vaccine manufacturers 2. Healthcare workers with
direct patient care 3. Persons at highest risk
for complicationsTwo doses needed for protection
TamifluAnti-viral agent, currently in short supplyCould be used in one area of world to contain first human outbreakResistance describedShould be used within 48 of infectionHHS priority groups: military and hospitalized patientsTamiflu ≠ Preparedness
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Guidance for PlanningBecause resources will be limited…
Contingency planning should include:
Planning for absenteeism: ~40%Hygiene products and
education in the workplaceSupply shortagesHome offices for critical personnelSick leave policies compatible with state recommendations
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Planning to be away…Plan for childcare in the event schools close
Arrangements made for eldercare, pet care Discuss/develop plan with employer how you might work at home
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Guidance for Personal /Family Planning
Personal protection: Hand hygiene and respiratory etiquetteSurgical masks: proven effective for
droplet precautions
Pneumococcal vaccination of those for whom it is recommended
Stockpiling: One to three week essential water, food, supplies, medicines
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Surveillance Here at KCHDA traditional influenza responsibility of the Department of Health:
Sentinel health care providersER visitsSchool absenteeism911 calls
CDC is planning additional national surveillance activities: hospitals and states will assist upon request
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For those at work:Surveillance– Develop screening for employees with flu-like symptoms
Develop sick leave policy specific for panflu
Determine when ill employee may return to work
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Internal and External Communication networks
Detailed communications planning needed:Internal- Ensure employees know panflu policy, communications plan, their specific role, esp in surge capacity/
External- Point of contact with Health Department
Access to Public Health education via media, internet, phone bank
Coordinate with like organizations to develop/coordinate emergency plans
Communicate with other organizations affected by yours
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Infection ControlHand Hygiene
Frequent washing60%-95% alcohol-basedsanitizer
Environmental cleaning1:10 bleach solutionEPA registered disinfectant
Gloves & surgical masks. Face shields/goggles for specialized procedures
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Workforce Support
Psychological and physical strain on personnel responding in emergency situationPsychological stress for families Plan for your staff to have adequate
SleepFoodAccess to psychological and spiritual support