Pandemic Planning: A Nation Prepared

Pandemic Planning:A Nation Prepared

U.S. Department of Health and Human Services

Mike Leavitt, Secretary

HHS Pandemic Influenza

Preparedness Planning

HHS Pandemic Influenza

Preparedness Planning

ADM John O. AgwunobiAssistant Secretary for Health

ADM John O. AgwunobiAssistant Secretary for Health

Pandemics Do Happen!

H1

H1H3

H2

H7*

H5*

H9*

1918Spanish

Influenza H1N1

1957Asian

Influenza H2N2

1968Hong Kong

Influenza H3N2

1980

1997

1915

*Avian Flu

2003 2004

1977

1996

2002

1925 1935 1945 1955 1965 1975 1985 1995 2005

2003-2006

1998

19992003

Planning Assumptions: Health Care

Moderate (1957-like) Severe (1918-like)

Illness 90 million (30%) 90 million (30%)

Outpatient medical care 45 million (50%) 45 million (50%)

Hospitalization 865,000 9, 900,000

ICU care 128,750 1,485,000

Mechanical ventilation 64,875 745,500

Deaths 209,000 1,903,000

• 50% or more of those who become ill will seek medical care• Number of hospitalizations and deaths will depend on the

virulence of the pandemic virus

Nations With Confirmed Cases H5N1 Avian Influenza (March 21, 2006)

Phases of a Pandemic: Where We Are Now

HHS Pandemic Influenza Plan

• Support 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 Lives

• Prevent or at least delay introduction into the

United States

– May involve travel advisories, exit or entry

screening

– For first cases, may involve isolation / short-

term quarantine of arriving passengers

HHS Pandemic Influenza Doctrine: Saving Lives

• Clearly communicate to the public

– Prepare people with information

– Encourage action steps to prepare now

– Provide updates when new information emerges

– Use trusted messengers

– Coordinate to ensure consistent messages

– Address rumors and inaccuracies

Challenges in Pandemic Vaccine Preparedness• Expand 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

Avian Influenza Vaccine Production

• Working with the National Institutes of Health– Current H5N1 Vaccine – 40 million doses being

produced– Second Clade 2 Avian Influenza vaccine

Antivirals and Medical Supplies: Influenza Treatments• Stockpile

– Tamiflu: 5+ million treatment courses in Strategic National Stockpile (SNS) with 12.4 million treatment courses ordered

– Tamiflu oral suspension: 97,000 courses in SNS with an additional 260,000 on order (arrival date to be determined)

– Relenza: 84,000 courses in SNS with 1.75 million treatment courses ordered

• Strategy– Procure 81 million courses of antivirals

• 6 million courses to be used to contain an initial U.S. outbreak

• 75 million courses to treat 25 percent of U.S. population

• Accelerate development of promising new antiviral candidates

Antivirals and Medical Supplies: Influenza Treatments $350 million appropriated in FY 2006 to upgrade

state and local response capacity for pandemic influenza

$100 million of the funding is scheduled to be awarded to all 50 states; 7 territories; Puerto Rico; Washington, D.C.; New York City; Chicago; and Los Angeles County and allocated according to a base + population formula

$250 million will be awarded later this year. Application for funding is supplemental to current cooperative agreements

State and Local Pandemic Influenza Planning Checklist

Community Leadership and Networking Surveillance Health System Partnerships Infection Control and Clinical Care Vaccine Distribution and Use Antiviral Drug Distribution and Use Community Disease Control and Prevention Communications Workforce Support

www.pandemicflu.gov

Complacency is the enemy of health protection!

Protecting American Agriculture34

Avian Influenza (AI) Preparedness and Response

Veterinary ServicesMarch, 2006

Protecting American Agriculture

Topics Covered

Avian Influenza OverviewUSDA’s AI Interventions

• Targeted surveillance• Border protection • Trade restrictions & OIE guidelines• Outreach & education• Preparedness & response


Avian Influenza Overview

Avian influenza (AI) - identified in the early 1900s

High pathogenic avian influenza (HPAI) – causes contagious illness, death in birds;

Low pathogenic (LPAI) causes mild to no illness

Vast majority of AI viruses found in birds do not represent a public health concern


Avian Influenza Overview (cont.)

Virus is characterized by H and N type (surface proteins).

144 different characterizations of the virus, based on 16 H types and 9 N types

AI viruses mutate easily; only H5 and H7 viruses have the potential to mutate from

an LPAI to an HPAI form.

AI viruses vary widely in pathogenicity from strain to strain. Therefore not all H5N1

viruses are infectious for people or pathogenic to poultry.

HA

PB1PB2PA

NPNAMANS

M2

Hemagglutinin Neuraminidase

M1

Matrix

Species Affected

Genetic Reservoirs

Intermixing

H1, H3

H1, H2, H3H3, H7

Commercial,LBMsOthers

H1-12H14-15

H1-2, 4-7,H9-13, 15-16

H10

H1, H3, H4, H7, H13

Other AquaticBirds?

H5N1


How is the virus spread among birds?

Direct contact between healthy and infected birds

Infected fecal matter

Can be found on surface of unwashed egg shells from

infected birds


Three HPAI Findings in U.S.

1924 – “Fowl Plague” affected live bird markets in the Northeastern U.S.

1983 – destruction of 17 million birds in PA

2004 – quickly contained and eradicated in TX


AI Surveillance

APHIS and States conduct surveillance through:

• National Poultry Improvement Plan (NPIP)• State and University laboratories• Export testing at slaughter• State movement requirements


AI Surveillance (cont.)

APHIS’ safeguarding system encompasses:• Targeted surveillance

• Cooperative efforts with States and Industry

• Outreach and education

• Trade restrictions

• Anti-smuggling programs


LPAI Surveillance and Control Plan

Federally-coordinated and State-assisted LPAI H5/H7 LPAI Control Program

Commercial poultry Live bird marketing system

Since 1986, APHIS and States have monitored live bird markets (LBMs) in Northeast U.S.


Surveillance: NPIP

Establishes standards for evaluation of poultry breeding stock and hatchery products

“Avian influenza free” certification for commercial companies

New LPAI program that will provide for H5 and H7 AI monitoring


Surveillance: NPIP (cont.)

New LPAI program that will provide for H5 and H7 AI monitoring

Program components: “AI monitored” program, surveillance specifications, and State LPAI

response and containment plans


LBMs – Surveillance

Uniform Standards published in 2004 provide guidelines for markets, dealers and producers:

• Licensing requirements and education

• Bird testing and recordkeeping

• Sanitation and biosecurity

• Surveillance and inspections

• LPAI positive facilities


LBMs – Surveillance (cont.)

States enforce LPAI program standards

Federal indemnification provided for participating States with positive diagnosis of H5 or H7 LPAI

APHIS initiated cooperative agreements with 21 States


LPAI Surveillance – National Animal Health Laboratory Network (NAHLN)

37 States participate in the network. NAHLN labs:• Provide laboratory services nationwide

• Provide laboratory data for reporting

• Respond to foreign animal disease outbreaks

• Focus on animal diseases


Border Protection & Risk of Introduction of Asian Strain of H5N1

USDA works closely with DHS to prevent smuggling of illegal poultry and poultry products.

USDA’s Smuggling Interdiction and Trade Compliance unit and DHS’ Customs and Border

Patrol actively monitor U.S. ports.

Legally imported birds from other countries are tested for AI.

Border Protection & Risk of Introduction of H5N1 Asian Strain of H5N1

• Genetic separation of H5 AI viruses between New & Old World• Asian birds rarely get off course and go to N. America• Risk from wild birds is low

Migratory Birds – Overlap of summer breeding grounds in Alaska, Northeast Canada


Trade Restrictions

USDA maintains trade restrictions on countries affected by H5N1:

Albania, Azerbaijain, Cambodia, Cameroon, People’s Republic of China, Egypt, France (VS defined restricted zone only), India, Indonesia, Iraq, Iran, Italy, Japan, Kazakhstan, Korea, Malaysia, Mongolia, Myanmar, Niger, Nigeria, Poland, Romania, Russia, Slovakia, Slovenia, Switzerland, South Korea, Taiperi China, Thailand, Turkey, Ukraine and Vietnam

Poultry and poultry products from those countries are strictly prohibited.

USDA works with trading partners and the World Organization for Animal Health (OIE) to maintain safe

trade.


World Organization for Animal Health (OIE) – Reporting and Guidelines

OIE guidelines state that:HPAI and all H5/7 LPAI must be reported to the OIE.

Poultry meat and table eggs do not transmit LPAI Trade in poultry and poultry products can continue despite a

finding of LPAI

Recommends certain health measures for the trade in poultry and poultry products based on risk and AI status

Compartmentalization allows countries to document separation based on biosecurity


Outreach & Education

USDA’s Biosecurity for the Birds Campaign is an extensive and far-reaching outreach initiative

designed to: Educate non-commercial poultry owners about the

signs of AI & other poultry diseases

Promote the importance of practicing biosecurity

Encourage rapid reporting of clinical signs of disease and/or unexpected deaths


USDA AI Web Sitewww.usda.gov/birdflu

Information about “Biosecurity for the Birds” programLinks to other Federal entities working on AIFact Sheets and other information resources

Q&A on AINews Releases

Technical Briefings


Preparedness in the Event of an Outbreak

Key is early detection and rapid responseUSDA maintains a comprehensive emergency

response structure: Partnerships with local, State, and Federal

organizations Integration with the National Response Plan Continual collaboration with HHS, DHS and other

Federal entities Diagnostic capabilities


Response to an Outbreak in Poultry

Guidelines

Stamping out

National Response Plan

First responders

Vaccines


Response for AI in Wild Birds

Manage wildlife threats

Assess risk wildlife poses to susceptible livestock and poultry

Containment, survey and surveillance, and population management


Questions?

Convention Center Floor Plan 2 – Exhibit Hall and Ballrooms

BREAK OUT SESSIONS ROOM LOCATIONS

Community/Volunteer Groups E 21B

Private Sector/Business E 21C

Schools K-12 E 21 A

Convention Center Floor Plan 1 – Exhibit Hall and Break out Sessions

BREAK OUT SESSIONS -- ROOM LOCATIONS

Assisted Living/Long Term Care E 10C

Colleges and Universities E 10D

Community/Volunteer Groups E 21B (see floor plan 2)

Fire/EMS E 11A

Healthcare E 10 A&B

Law Enforcement/Judiciary E 11C

Local Government E 11B

Private Sector/Business E 21C (see floor plan 2)

Schools K-12 E 21 A (see floor plan 2)

LUNCH Exhibit Hall B

Documents

Pandemic Planning: A Nation Prepared