# Presentation: 665945

## Pandemic Influenza      Seminarfor Federal Agencies 

- Pandemic Influenza      Seminar***for ****Federal Agencies** *

- Federal Occupational Healtha component of the U.S. Public Health ServiceProgram Support CenterDepartment of Health and Human Services

## Seminar Objectives

**	****To provide background information about pandemics **
**	****To provide basic medical information about influenza**
**	****To raise awareness about how your agency will prepare ****	****and respond to a possible pandemic**
**	****To provide a forum to ask questions and to understand ****	****agency issues and concerns**
*“**Once a pandemic virus emerges, it is too late to begin planning or to begin collaboration. There will only be a 20-30 day window between emergence and pandemic.” *
- Dr. Klaus Stohr, WHO Global Pandemic Project

## Agenda

**Overview of Pandemics and Influenza **
**National Strategy **
**Planning and Response: *****What Agency Managers Can Do***
**How FOH Can Help**
**Questions and Answers: FOH Panel of Experts**

## Overview

*Pandemics and *
*Human & Avian Influenza*

## Pandemic flu is 

**front page news**

## Remember these?

- SARS Outbreak1

- Legionnaires’ Disease

- Toxic Shock Syndrome

- Ebola
- Virus

- Swine Flu

## Pandemic Influenza 

**What is an influenza pandemic?**
- Global disease outbreak
- A new influenza strain emerges
- Causes serious illness to large
-    	 populations worldwide

- Flu Pandemic of 1918

## Avian Influenza or “Bird Flu”

- Contagious viral disease of birds (rarely crosses the species barrier and infects humans)
- Wild waterfowl (e.g., ducks) likely natural reservoir of all influenza A viruses
- Current H5N1 outbreaks the most severe on record
- Migratory birds appear to be spreading H5N1 virus
- Control of H5N1 in poultry is very difficult and could take several years

## Human Influenza

- Has been a human adversary for hundreds of years
- Annually in U.S. ~ 36,000 deaths and 200,000 hospitalizations from typical seasonal influenza
- Vaccines are manufactured annually based on most common circulating strains
- Flu virus mutations can happen slowly (virus “drift”)or suddenly (virus “shift”)
- Virus “shift” allows little or no lead time to prepare a vaccine

## Pandemic Influenza Basics 

**Why is an influenza pandemic a greater concern than seasonal flu?**
- Little or no human immunity
- Increased numbers /populations affected
- More serious symptoms
- Higher mortality
- Scope and likely rapid spread of disease stretches capabilities of existing healthcare resources
- High potential for economic and social disruption

## Pandemic Influenza Basics 

- Pandemic Influenza Basics

**Is a pandemic imminent?**
- Scientists believe it is only a matter of time
- The timing/severity can’t be accurately predicted
- The H5N1 strain (avian flu virus) considered the most imminent threat

## Historical  Facts

- Influenza pandemics have occurred for hundreds of years
- Three pandemics in the 20th Century
- Spanish Flu (1918): 675,000 Americans died, 40-50 million deaths worldwide
- Asian Flu (1957): 2 million deaths worldwide
- Hong Kong Flu (1968): 1 million deaths worldwide

## Current Facts

- “Bird flu” (H5N1 strain) now spreading rapidly among birds; related to “Spanish flu” virus
- Human infection has occurred primarily from direct contact with infected birds
- To date, people infected with H5N1 virus have shown a very high mortality rate
- Most “conditions” for a pandemic have been met

## Current Phase of Alert per WHO Global Influenza Preparedness Plan

| 
Inter-pandemic phase

New virus in animals, no human cases | Low risk of human cases | 1 |
| --- | --- | --- |
|  | Higher risk of human cases | 2 |
| 
Pandemic alert

New virus causes human cases | No or very limited human-to-human transmission | 3 |
|  | Evidence of increased human-to-human transmission | 4 |
|  | Evidence of significant human-to-human transmission | 5 |
| Pandemic | Efficient and sustained human-to-human transmission | 6 |

## Other Facts

- There is no sustained human-to-human transmission of H5N1 influenza (currently *no pandemic)*
- H5N1 may never become a human pandemic virus
- >99% of Americans survived the1918 flu pandemic, the deadliest influenza pandemic in recent history
- 		~ 2.5% mortality, which far exceeds the mortality rate for typical 	seasonal flu, which is ~ 0.1%
- Characteristics of the next pandemic strain are still unknown; can’t predict the mortality rate for an unknown strain

## Reassuring Facts

- Historically, pandemic influenza viruses have not retained high mortality rates such as those currently seen with H5N1
- For the past several years, public health authorities have been working to improve preparedness for a pandemic
- There are a number of things that individuals can do to reduce risks and decrease the effects of a pandemic

## National Strategy for Pandemic InfluenzaNovember 2005

- President requires federal departments and agencies to develop preparedness and response plans
- Plan must take into account the potential impact of a pandemic on the federal workforce
- Plan must be configured to support state, local and private sector efforts

## How Public Health Authorities 

- are Responding to the Pandemic Threat

- Flu Pandemic of 1918

## World Health Organization (WHO) Recommendations

- Strengthen national preparedness
- Reduce opportunities for a pandemic virus to emerge
- Improve the early warning system
- Delay initial international spread
- Accelerate vaccine development
- Public Health authorities in countries with adequate resources should stockpile antiviral drugs for use at the start of a pandemic

## U.S. Strategy

**Three pillars**
**1. ****	****Preparedness and Communication**
- Identify activities that should be undertaken *before* a pandemic
- Communicate roles and responsibilities to all levels of government, segments of society and individuals
**2.  Surveillance and Detection**
- Ensure the earliest warning possible
**Response and Containment**
- Limit the spread of disease
- Mitigate the health, social and economic impacts

## Influenza Vaccine

- Vaccines designed for *seasonal** *influenza will not protect against a *pandemic* virus
- Vaccines that are effective against H5N1 are being tested, but not yet available
- Once pandemic strain is identified, vaccines unlikely to be available for several months
- Current global production capacity falls far short of the demand expected during a pandemic

## Drugs to Treat Influenza

- Two drugs*, **oseltamivir** (*Tamiflu*) and **zanamivir** (*Relenza*) can reduce the severity and duration of seasonal influenza
- Amantadine and rimantadine also available, but resistance has developed rapidly
- The H5N1 virus is currently susceptible to **oseltamivir** (*Tamiflu*) and **zanamivir** (*Relenza*)
***It is critical that they be used judiciously to avoid emergence of resistance***
- Main constraints — cost and production capacity
- * Neuraminidase inhibitors class

## Federal Agencies        and     Pandemic Influenza           Agency Planning 

- Federal Agencies        *and*     Pandemic Influenza      **     *****Agency Planning ***

- Federal Occupational Healtha component of the U.S. Public Health ServiceProgram Support CenterDepartment of Health and Human Services

## Pandemic Preparedness 

- Does my agency have a Continuity of Operations Plan (COOP) with provisions for pandemic influenza?
- Have managers and employees received pandemic influenza training?

## COOP – Written Plan

- Required for federal executive agencies (Presidential Decision Directive 67)
- Defines essential functions that must continue under all circumstances (including pandemic influenza)
- Prioritizes essential functions
- Establishes staffing and resource requirements
- Includes state and local government considerations

## COOP – Pandemic Influenza Considerations

- What will happen if 10%, 30% or 50% of your workforce is absent?
- Are authorities, triggers, and procedures for activating and terminating COOP in place?
- What is the emergency communications plan for pandemic conditions?
- Can employees work from alternate locations?
- Will a pandemic increase or decrease demands for agency services?

## COOP – OPM Policy Considerations 

- Pending guidance on pandemic-specific policies for employee compensation and sick-leave absences
- Flexible worksite (e.g., telecommuting)
- Flexible work hours (e.g., staggered shifts)
- Liberal annual and sick leave

## COOP – Logistical Considerations 

- Will your agency provide infection control supplies such as Personal Protection Equipment (PPE)?
- Will your agency provide hand-hygiene products, tissues and receptacles for their disposal?
- Can your communications and information technology infrastructures support employee telecommuting and remote customer access?
- Will you need medical consultation and advice for emergency response?
- Would a pandemic adversely impact your security and security systems?

## Education – Pandemic Influenza 

- Explain COOP and pandemic influenza components
- Provide information regarding transmission, prevention, vaccines, and antivirals
- Provide information and resources including the  Employee Assistance Program (EAP)
- Dispel common fears, anxiety, rumors, and misinformation
- Practical drills and exercises

## Education – Personal Protective Equipment

- Exposure assessment considerations
- Disposable gloves, outer clothing, shoe covers, eye protection, dust masks, etc.
- Respiratory protection considerations (e.g., written program, medical assessment, training, fit testing)
- Disposal of PPE

## Education – Basic Hygiene

- Etiquette for sneezing, coughing and blowing nose
- Frequent hand washing and use of antiseptic hand wash solution if water is unavailable
- Keep hands away from face to prevent spread of germs to vulnerable eyes, nose, and mouth
- Reduce/limit use of conference rooms, galleys, and common gathering spaces
- Permissive vs. required sick leave

## Education – Simple Concepts

- Teach hygiene practices to children and reinforce regularly
- Provide information about at-home care of ill employees and family members
- Encourage seasonal flu shot to help prevent emergence of new flu strains
- Eat well, exercise and practice healthy lifestyle

## Worst-Case Planning Questions

- If schools and daycare facilities are closed, who will take care of your employees’ children?
- How will your employees travel if public transportation, planes, and trains are not operational?
- Can your agency fulfill its mission if the building is shut down?
- What will the impact be on you and your agency if banks, restaurants, grocery stores, etc., are closed?

## Use Resources to Help You Plan

**http://www.pandemicflu.gov/**

## Federal Agencies        and     Pandemic Influenza           Behavioral Health Concerns

- Federal Agencies        *and*     Pandemic Influenza      **     *****Behavioral Health Concerns***

- Federal Occupational Healtha component of the U.S. Public Health ServiceProgram Support CenterDepartment of Health and Human Services

## Catastrophic Events

- Produce psychological effects
- We can choose our own response – the only control we may have
- Response management:
- Minimizes harm
- Supports safety
- May be primary to survival
- Aids in creating a new “normal”

## EAP Preparedness Services 

- 	Behavioral preparedness is essential because an emotionally-charged employee poses a safety hazard

## How FOH Will Help

- How FOH Will Help

## EAP Preparedness Services 

- Consultation on EAP COOP role
- Consultation and coaching on traumatic incident preparedness
- Stress and anxiety management training for first responders and employees
- Manager training on maintaining calm and reducing anxiety at the workplace (*Be Prepared)*

## Leading in a Crisis – Reducing Employee Anxiety

Manage your own fear and uncertainty 
Be considerate of employee concerns about families and friends
Communicate; repeat information
Be visible; assess how employees are doing
Schedule frequent briefings, even if no new information is available

- Manage your own fear and uncertainty
- Be considerate of employee concerns about families and friends
- Communicate; repeat information
- Be visible; assess how employees are doing
- Schedule frequent briefings, even if no new information is available

- Behavioral Health Strategies Suggestions for Management

## Behavioral Health Strategiesfor All Employees

**Stay in Balance**
- Maintain focus on what you can control
- Get involved in helping or social activities
- Practice stress management
- Engage in healthy self care activities
- Maintain established routine
- Contact the EAP if worry interferes with your life

## EAP Response Services During

- 24/7 manager consultation on handling workplace stress and crisis issues
- Critical Incident Stress Management (CISM)
- Telephonic interventions
- Stress management training
- Debriefings as appropriate
- Ongoing website updates and handouts

## EAP Response ServicesDuring

- 	Telephonic counseling and consultation when 	face-to-face is not possible (e.g., quarantine)
- 	Routing calls to alternate call centers if certain 	areas of the country are affected
- 	Telephonic contact with designated staff counselor 	when offices are closed or during quarantine

## EAP Response Services After

- Coaching and education on post traumatic stress issues and how to create a new “normal”
- Guidance for supervisors and employees on *When Recovery is Ongoing*
- CISM services
- Follow-up consultation; next steps

## FOH Preparedness Services

**Employee Health Services**
- More than 270 onsite health clinics
- General health promotion/disease prevention
- Education
- Specific pandemic awareness sessions in progress
- Prevention strategies
*“**Cover Your Cough”* Campaign

## FOH Preparedness Services

**Consultation**Review of agency-specific Pandemic Influenza Response Plan
**Medical Clearance Services**Required medical evaluations for employees who use  PPEs, such as respirators
**Environmental Health**Exposure assessment, risk analyses, respirator fittesting and training
**Ongoing Information and Training**
- Future seminars/workshops
- Pandemic website: _www.foh.dhhs.gov_

## FOH Response Services

**Health Center Services**
- Disease/symptom tracking and surveillance
- Vaccine/antivirals (if available)
- Return-to-work screening
**Medical Consultation**
- Access to physicians and other medical experts
- Current information on disease containment, risk reduction, etc.

## What NOT To Do

- Don’t stockpile antiviral medications
- Don’t assume assistance will be available during a pandemic
- Don’t purchase influenza prevention products or implement prevention strategies that are not approved by the FDA or public health authorities
- Don’t assume that if an avian flu pandemic is avoided in the next year, the threat has passed
- Don’t underestimate the likely global impact of a pandemic

## SUMMARY - What To Do

- Educate your employees about pandemics, influenza and prevention strategies
- Plan for an influenza pandemic as part of COOP
- Use planning resources: _[www.pandemicflu.gov](http://www.pandemicflu.gov/)_
- Update/communicate your plans
- Manage stress, anxiety and fear
- Know how FOH can help

## 
healthy bodies
            sound minds
                          a safe place to work

(800) 457-9808
www.foh.dhhs.gov

- healthy bodies
-             sound minds
-                           a safe place to work
- (800) 457-9808
- www.foh.dhhs.gov

- Federal Occupational Health