Pandemic InfluenzaReadiness Update

Linda Johnson, MSN, RN, CIC

Pandemic Influenza Viruses

Year Subtype

1889 H2N?

1899 H3N8

1918 H1N1 “swine”

1957 H2N2 “Asian”

1968 H3N2 “Hong Kong”

1977 H1N1 “Russian”

? H5N1 Avian

Influenza

• Single-stranded, helcally shaped, RNA virus

• Basic antigen types A, B, and C

• Subtypes on type A are determined by surfaces antigens

• hemagglutinin (H) has a role in virus attachment to cells

• neuraminidase (N), has a role in virus penetration into cells

8 RNA strands

Membrane

Hemagglutinin

Neuraminidase

INFLUENZA VIRION

Influenza A

• Causes moderate to severe illness

• affects all age groups

• can infect some animals such as pigs and birds

• continually undergoing antigenic changes

Influenza

• Incubation period is 1-5 days (2)

• abrupt onset of fever sore throat and nonproductive cough, headache, myalgias.

• Severity of illness depends on prior exposure with clinically related variants

• case-fatality 0.5-1 per 1000 cases

Influenza

• Transmission is by droplet spread

• may also be spread by direct contact

• respiratory secretions shed virus for 5-10 days

• viremia does not occur

What are the symptoms of the Flu vs.

a common cold?• Symptoms of flu

• Fever (usually high)

• Headache (prominent)

• Extreme tiredness

• Dry cough

• Sore throat-sometimes

• Runny or stuffy nose-sometimes

• Muscle aches-usual and often severe

• Nausea, vomiting or diarrhea (more common in children)

• Symptoms of a cold

• Fever is rare or low grade

• Headache rare

• Extreme tiredness-not usual

• Cough- mild hacking

• Sore throat- common

• Congestion-common

• Muscle aches-slight

• Sneezing-usual

• Nausea and vomiting-rare

Complications of the flu

• Bacterial pneumonia

• Dehydration

• Worsening of chronic medical condition like diabetes or congestive heart failure

• Sinus or ear infections

H5N1 November, 2005

The Next Flu Pandemic?

• Exact timing impossible to occur

• Often do follow major antigenic shifts in flu virus

• Could be this flu season or several years away

• Ongoing preparation is key to readiness

Response to Influenza Pandemic

• Normal routines will be disrupted by a true pandemic.

• Health care system, campus and entire community affected– Influx of patients with acute health care

needs

– Elective medical care postponed

– Schools likely would close

– Daycares likely close

• Need for information management to prevent panic

UM Health Care Preparations

• Education

• Equipment

• Vaccine

• Anti-viral medication

• Bed Capacity

• Staffing

• Coordination of response

Education of UMHC Personnel

• Respiratory hygiene -clinic and front line staff

• Masks available for persons who come in coughing

• Tissues, hand sanitizer, and germicidal wipes available in all clinics

• Hand hygiene!!!• Do not allow staff to work sick

Equipment

• N-95 disposable respirators. – In event of pandemic it is very

unlikely to be able to get any additional masks.

– Requires fit testing.

• Ventilators – University Hospital- 74 ventilators –

30 in use on average day

– CRH 23 vents mostly infant

– Cache of 400 disposable vents

Bed Capacity

• Convert outpatient areas to inpatient wards (i.e. 7 West)

• If very high capacity needed, may need to convert non-medical buildings to inpatient care areas

• Tier 1 funding for bioterrorism - 2 trailers with supplies for 75 bed tent hospital each.

• Question of heat, water, oxygen, staff

Flu Vaccine

• Ample supply this year• Encourage all staff to receive flu vaccine• Unlikely to be effective against avian

influenza• Experimental avian flu vaccine may be

effective • If new strain, unlikely to have a vaccine for

several months after start of pandemic using traditional vaccine manufacturing methods

• Work on developing new methods which will allow vaccine to be produced on 4-6 weeks

Treatment

• Tamiflu may be effective against avian influenza.

• Drug made in Europe. Production plant being built in USA – Operational 2008?Not yet!

• Pharmaceutical stockpile- National stockpiles are in place- Missouri has some state and local stockpiles in limited quantities

Staffing Issues

• Many staff may be ill

• Staff afraid to come to work

• May need to temporarily reassign professional staff from non-patient care areas to patient care duties

• Emergency day care for children of staff

• All other hospitals struggling with similar issues - no temporary staff available

Coordination of Response

• Emergency Preparedness coordinator

• Works with campus and community resources – Prepare for wide variety of

possible disaster scenarios

– Assist in coordinating response of UMHC to actual disaster

Pandemic Influenza plan

• UMHC’s plan updated last in Aug 2008

• Follows DHSS’s national plan

• Part of the emergency operations plan

• Gives prioritization of antivirals and vaccine

Drills

• Oct 28, 2008 Alternate care site drill