Johnson County Public Johnson County Public Health Health

Partnership for Emergency PlanningPartnership for Emergency Planning

January 19, 2006January 19, 2006

Influenza OverviewInfluenza Overview

Influenza “The Flu”Influenza “The Flu”

DescriptionDescription Viral infection that can Viral infection that can

make people of any age illmake people of any age ill Respiratory transmissionRespiratory transmission

SymptomsSymptoms FeverFever ChillsChills CoughCough Sore throatSore throat HeadacheHeadache Muscle achesMuscle aches

PreventionPrevention VaccinationVaccination Stay home if illStay home if ill

Influenza: Who, Where, Influenza: Who, Where, and When?and When?

Nearly everyone susceptible every yearNearly everyone susceptible every year Illnesses, hospitalizations, deaths Illnesses, hospitalizations, deaths Usually older, younger and those with chronic illnessUsually older, younger and those with chronic illness Influenza and complications (pneumonia)Influenza and complications (pneumonia) Most of us have some degree of immunity from Most of us have some degree of immunity from

repeated exposures!repeated exposures! EverywhereEverywhere

Can’t predict with certaintyCan’t predict with certainty SeasonalSeasonal

WinterWinter

Colds and Flu: The Colds and Flu: The DifferenceDifference The flu strikes suddenly, colds develop The flu strikes suddenly, colds develop

gradually and fever is unusualgradually and fever is unusual Influenza is seasonal (winter), colds are Influenza is seasonal (winter), colds are

present year roundpresent year round Flu has generalized symptoms, colds Flu has generalized symptoms, colds

are usually confined to upper are usually confined to upper respiratoryrespiratory

Only three types of virus cause the flu, Only three types of virus cause the flu, more than 200 cause coldsmore than 200 cause colds

Composition of the 2005-Composition of the 2005-2006 Influenza Vaccine2006 Influenza Vaccine

A/California/7/2004 (H3N2)A/California/7/2004 (H3N2)

A/New Caledonia/20/99 (H1N1)A/New Caledonia/20/99 (H1N1)

B/Shanghai/361/2002B/Shanghai/361/2002

Naming the Influenza VirusNaming the Influenza Virus

A /Fujian /411 /2002 (H3N2)A /Fujian /411 /2002 (H3N2)

Virustype

Geographic Origin

StrainNumber

Year of Isolation

VirusSubtype

Influenza AInfluenza A Seen in many animalsSeen in many animals Subtyped based on surface Subtyped based on surface

glycoproteins:glycoproteins: Hemagglutinins (H) Hemagglutinins (H) Neuraminidases (N)Neuraminidases (N)

Yearly epidemicsYearly epidemics H1, H2, H3H1, H2, H3 Mortality variesMortality varies

Responsible for known pandemicsResponsible for known pandemics

www.omedon.co.uk/influenza/ influenza/

Hemagglutinin

Neuraminidase

Influenza B and CInfluenza B and C Influenza BInfluenza B

Humans mostlyHumans mostly Not subtypedNot subtyped Less mortality than type ALess mortality than type A Associated with epidemics, not Associated with epidemics, not

pandemicspandemics

Influenza CInfluenza C Usually mild diseaseUsually mild disease

Drift vs. ShiftDrift vs. Shift

Antigenic DriftAntigenic Drift:: ‘‘A & B’A & B’ viruses viruses

Minor change, same Minor change, same subtypesubtype

Caused by genetic Caused by genetic mutationmutation

May result in May result in epidemicepidemic

Antigenic Shift:Antigenic Shift: ‘‘A’A’ Virus Virus Major change, new Major change, new

subtypesubtype Caused by change in Caused by change in

gene segments gene segments (genetic reassortment)(genetic reassortment)

May result in pandemicMay result in pandemic

Difference between Difference between Epidemic and PandemicEpidemic and Pandemic

Epidemic/outbreak: increase in cases in Epidemic/outbreak: increase in cases in a community clearly greater than what is a community clearly greater than what is normally expected.normally expected.

Pandemic: a global disease outbreak.Pandemic: a global disease outbreak.

Annual Flu Impact Annual Flu Impact NationallyNationally

5%-20% of the population gets the flu5%-20% of the population gets the flu

200,000 hospitalizations200,000 hospitalizations

36,000 deaths36,000 deaths

Potential Pandemic Potential Pandemic ImpactImpact

Potential impact of pandemic influenza:Potential impact of pandemic influenza: Attack rates up to 35%Attack rates up to 35% 89,000 to 207,000 deaths89,000 to 207,000 deaths >25% increased demand for inpatient >25% increased demand for inpatient

beds and assisted ventilationbeds and assisted ventilation 314,000 – 733,000 hospitalizations314,000 – 733,000 hospitalizations Up to $166 billion in direct medical costsUp to $166 billion in direct medical costs Significant social and economic disruptionSignificant social and economic disruption

www.cdc.gov/ncidod/eid/vol5no5/meltzer.htm

Pandemic InfluenzaPandemic Influenza

Experts believe that another pandemic is Experts believe that another pandemic is inevitable.inevitable.

There will be very little warningThere will be very little warning Outbreaks will probably occur simultaneously Outbreaks will probably occur simultaneously

throughout the US.throughout the US. The effect on individual communities will be The effect on individual communities will be

prolongedprolonged Healthcare workers will be at increased risk.Healthcare workers will be at increased risk.

2020thth Century Pandemics Century Pandemics

SpanishSpanish 19181918 H1N1H1N1 20 million 20 million deathsdeaths

AsianAsian 19571957 H2N2H2N2 70,000 70,000 deathsdeaths

Hong Hong KongKong

19681968 H3N2H3N2 34,000 34,000 deathsdeaths

AvianAvian 1997-20041997-2004 H5N1H5N1 Potential Potential pandemicpandemic

Pandemic InfluenzaPandemic Influenza

Pandemic Risk?Pandemic Risk?

Three conditions must be met:Three conditions must be met:

A new influenza virus subtype emerges;A new influenza virus subtype emerges;

It infects humans, causing serious illness;It infects humans, causing serious illness;

It spreads easily and sustainably among It spreads easily and sustainably among humanshumans

www.ukans.edu

http://www.riley.army.mil/OurPost/Maps.asp

http://hellokansascity.com/images/Liberty%20Memorial%201921.jpg

http://www2.okstate.edu/ww1hist

Slide from: http://www.pbs.org/wgbh/amex/influenza/index.html

Recognizing Avian Recognizing Avian InfluenzaInfluenza

Clinical Features of Avian Clinical Features of Avian (H5N1) Influenza(H5N1) Influenza

Influenza-like symptomsInfluenza-like symptoms

Eye infectionsEye infections

Encephalitis, MeningitisEncephalitis, Meningitis

Severe pneumonia or ARDSSevere pneumonia or ARDS

Internal bleeding and hemorrhagesInternal bleeding and hemorrhages

Avian (H5N1) InfluenzaAvian (H5N1) Influenza

Rapidly mutatesRapidly mutates Documented to cause severe disease in Documented to cause severe disease in

birds and humansbirds and humans Birds that survive infection shed virus in Birds that survive infection shed virus in

feces for weeks.feces for weeks. Has been passed from animals to Has been passed from animals to

humans rarely and Not EASILY.humans rarely and Not EASILY.

Courtesy of National Geographic October 2005

Courtesy of National Geographic October 2005

Courtesy of National Geographic October 2005

What Must Occur For H5N1 What Must Occur For H5N1 to Increase Transmissibility to Increase Transmissibility to Humans?to Humans?

““Reassortment”: genetic material is Reassortment”: genetic material is exchanged between human & avian exchanged between human & avian viruses during co-infection of a human or viruses during co-infection of a human or pig;pig;

““Mutation” which is a more gradual Mutation” which is a more gradual process. process.

HumanHuman virusvirus

HumanHuman virusvirus

ReassortantReassortantvirusvirus

ReassortantReassortantvirusvirus

Non-humanNon-humanvirusvirus

Non-humanNon-humanvirusvirus

Influenza Virus Reassortment (Shift)

16 HAs16 HAs9 NAs9 NAs

16 HAs16 HAs9 NAs9 NAs

DIRECTDIRECTDIRECTDIRECT

Pandemic Response:Pandemic Response:VaccineVaccine

Development Development ManufacturingManufacturing

6 – 8 month minimum for first batch6 – 8 month minimum for first batch Technical problems possibleTechnical problems possible

Distribution to state agenciesDistribution to state agencies 5 – 6 more months to produce all 5 – 6 more months to produce all

vaccinevaccine

AntiviralsAntivirals

Can reduce seasonal influenza:Can reduce seasonal influenza: Oseltamivir (Tamiflu)Oseltamivir (Tamiflu) Zanamivir (Relenza)Zanamivir (Relenza)

2 older drugs:2 older drugs: amantadineamantadine rimantadinerimantadine

Johnson County Public Johnson County Public Health Health Disease ContainmentDisease Containment

Surveillance/Surveillance/EpidemiologyEpidemiology Identify public health threatIdentify public health threat Disease Containment (DC) collaborates Disease Containment (DC) collaborates

with Health Officer, state and other with Health Officer, state and other appropriate agenciesappropriate agencies

Determine appropriateness for I or QDetermine appropriateness for I or Q Notify law enforcement/legal whether Notify law enforcement/legal whether

voluntary or mandatedvoluntary or mandated Information disseminationInformation dissemination

New Isolation and New Isolation and Quarantine Law Per HB Quarantine Law Per HB 22642264

The I&Q bill was passed as part of HB 2264The I&Q bill was passed as part of HB 2264 Signed into law on 4-12-05Signed into law on 4-12-05

Clarifies the local health officer’s authority to Clarifies the local health officer’s authority to order isolation and quarantine of infected order isolation and quarantine of infected persons or groupspersons or groups

Gives the local health officer the authority to Gives the local health officer the authority to order persons exposed to infectious disease to order persons exposed to infectious disease to seek medical evaluation or treatmentseek medical evaluation or treatment

Orders law enforcement officials to assist in the Orders law enforcement officials to assist in the execution or enforcement of health officer’s execution or enforcement of health officer’s ordersorders

Public Health OptionsPublic Health Options

Implement “Snow Day” restrictionsImplement “Snow Day” restrictions Close schools, daycare centers, etc.Close schools, daycare centers, etc. Cancel large public gatherings (concerts, theaters)Cancel large public gatherings (concerts, theaters) Minimize other exposures (markets, churches, travel Minimize other exposures (markets, churches, travel

restrictions)restrictions) Ask non-essential workers to stay homeAsk non-essential workers to stay home Consider additional measuresConsider additional measures

Distribution of surgical masks?Distribution of surgical masks? Temperature screening in public venuesTemperature screening in public venues Scaling back transportation servicesScaling back transportation services

What You Can DoWhat You Can Do

Report unusual events/absenteeismReport unusual events/absenteeism

Contact Health DepartmentContact Health Department

Business point of contact? Business point of contact?

What You Can DoWhat You Can Do

Educate staffEducate staff Develop and practice healthy habitsDevelop and practice healthy habits Be aware of your area…break chain of Be aware of your area…break chain of

transmissiontransmission Stay home if sickStay home if sick Family illnessFamily illness

Mouse1,676 Germs

per sq. in.

Keyboard3,295Germs

per sq. in.

Desktop20.961Germs

per sq. in.

80%80% of germs are of germs are transmitted transmitted by hands:by hands:

Hands spread germsHands spread germs

Germs cause illnessGerms cause illness

Illness cost moneyIllness cost money

Wash HandsWash Hands

When someone coughs or sneezes…..on youWhen someone coughs or sneezes…..on you After shaking someone’s handAfter shaking someone’s hand Each time you return to your deskEach time you return to your desk After you use the restroomAfter you use the restroom After using the water cooler or coffee potAfter using the water cooler or coffee pot Before you eat lunchBefore you eat lunch After going through your mailAfter going through your mail After touching moneyAfter touching money Whenever you need a refreshing break,Whenever you need a refreshing break, Before you go home for the dayBefore you go home for the day

Germiest Workplaces:-phones-desks

-computer keyboards-buses

-restrooms-day care centers

-escalators & elevators

Johnson County Public Johnson County Public Health Emergency Health Emergency ResponseResponse

Mass Prophylaxis Mass Prophylaxis Dispensing (MPD)Dispensing (MPD)

Epidemiology and Investigation have determined that there is Epidemiology and Investigation have determined that there is something going onsomething going on

They have notified appropriate agenciesThey have notified appropriate agencies Now what?Now what?

Is there something we can give?Is there something we can give? MedicationMedication VaccinationVaccination

Who is going to get these medications/vaccinations?Who is going to get these medications/vaccinations? Those Those *most* at risk *most* at risk based on Epidemiology and Investigationbased on Epidemiology and Investigation Priority ProphylaxisPriority Prophylaxis

Those providing support and assistance with Dispensing operationsThose providing support and assistance with Dispensing operations Critical InfrastructureCritical Infrastructure

Open Site Community Dispensing combined with Closed Site Open Site Community Dispensing combined with Closed Site DispensingDispensing

General Public General Public Dispensing only if deemed necessaryDispensing only if deemed necessary

New Concept for New Concept for Closed Site Dispensing of Closed Site Dispensing of MedicationsMedications

Health Department would contact the Business Health Department would contact the Business Point of Contact (BPOC) and notify them of Point of Contact (BPOC) and notify them of decision to Dispensedecision to Dispense

BPOC would receive appropriate forms and BPOC would receive appropriate forms and health information to distribute to staffhealth information to distribute to staff

MedicationsMedications For Dispensing of pills, BPOC would bring For Dispensing of pills, BPOC would bring

completed forms to designated Open Site completed forms to designated Open Site Forms would be processed and BPOC would be Forms would be processed and BPOC would be

provided the medications/prescriptions to take back provided the medications/prescriptions to take back to workers/familiesto workers/families

New Concept for New Concept for Closed Site VaccinationClosed Site Vaccination

Health Department would contact the Business Health Department would contact the Business Point of Contact (BPOC) and notify them of Point of Contact (BPOC) and notify them of decision to Dispensedecision to Dispense

BPOC would receive appropriate forms and BPOC would receive appropriate forms and health information to distribute to staffhealth information to distribute to staff

VaccinationVaccination For vaccination, Johnson County would coordinate For vaccination, Johnson County would coordinate

with the businesses to which sites/when with the businesses to which sites/when workers/families should bring completed forms to workers/families should bring completed forms to Open SitesOpen Sites

Business InterestBusiness Interest

If interested, please contact me to set up If interested, please contact me to set up a meeting/discussiona meeting/discussion

Process needs individualization and Process needs individualization and further discussion further discussion

QUESTIONS?QUESTIONS?

Contact InformationContact InformationNancy TauszNancy Tausz

Disease Containment DirectorDisease Containment Directornancy.tausz@jocogov.orgnancy.tausz@jocogov.org

913-826-1222913-826-1222

Ida NesmithIda NesmithDisease Containment Program ManagerDisease Containment Program Manager

ida.nesmith@jocogov.orgida.nesmith@jocogov.org913-826-1270913-826-1270

Liz TicerLiz TicerPublic Health Emergency CoordinatorPublic Health Emergency Coordinator

liz.ticer@jocogov.orgliz.ticer@jocogov.org913-477-8316913-477-8316