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