# Presentation: 760418

## Douglas A. Holt, MDDirector, Hillsborough County Health DepartmentKelly Granger, MPH, CHES Pandemic Influenza Coordinator, Hillsborough County Health Department

## Expert Opinion

- A pandemic is inevitable
- Possibly H5N1 (Avian Influenza)
- May be muted or catastrophic
- Viral illness affecting people, pigs, and birds

## Disease Description

- Severe influenza pandemics are one of the greatest threats to the public's health
- Would be a worldwide epidemic due to it being a new strain of influenza
- Develop in two ways:
- Wild birds are reservoirs for all influenza viruses
- All influenza viruses experience frequent, subtle changes to their genetic structure

## Avoiding Influenza

- Wash hands frequently
- Cover mouth when coughing or sneezing
- Stay home if flu symptoms appear
- Thoroughly wash eating utensils
- Avoid close contact with other family members

## Cycles of the Asian H5N1 Virus in Animals and Humans

- Waterfowl

- Waterfowl

**Notes:**
H5N1 outbreaks have been reported in domestic pigs. Not clear whether the virus jumped from wild birds or poultry.

H5N1 cases in people currently are dead-end infections -- infected people don't infect other people.  It is not known when or whether that will change.  

## Why H5N1 is of Particular Concern

**Traditional belief of antigenic shift leading to pandemics of human influenza**

**H5NI influenza is able to infect humans directly**

- ?

**Notes:**
Most recent pandemic was in China in 1968-69 when its population was 790 million. Today it is 1.3 billion. 1968 # pigs in China was 5.2 million. Today it is ???

- Source: World Health Organization Web site, www.pandemicflu.gov

## Potential Future Situation: Florida Example

- All communities in Florida would likely be affected at the same time
- Each community will have to deal with the pandemic primarily on their own
- Based on the conservative estimate of a 25% attack rate, Hillsborough County would experience 3,691 influenza-related hospital admissions and 725 influenza-related deaths over an 8 week outbreak

## 3-Step Strategy for Pandemic Influenza

- Preparedness and Communication
- Surveillance and Detection
- Response and Containment

## Preparedness

- Recent statewide Influenza Summit
- Existing plan dated March 2004
- Draft White Paper September 2005
- Draft Influenza Pandemic Annex to Department of Health Emergency Operations, Version 9
- Finalizing Hillsborough County Pandemic Flu Plan

## Communication

- Public Health and Healthcare System
- Government and First Responders
- Essential Services
- Business Leadership
- The Public

## Surveillance and Detection

- Sentinel Physician Practices
- Influenza culture specimens received, positive results, at state Public Health Lab
- Syndromic Tracking and Reporting System (STARS)
- Influenza activity level by county
- www.pandemicflu.gov

## Response and Containment

- Non-pharmaceutical interventions will be key
- Isolation of sick persons
- Quarantine
- Antiviral drugs may be useful for prophylaxis or treatment
- Vaccine trials are underway

- Commercial Poultry in Florida

**Notes:**
We have plenty of commercial poultry (chickens, geese, ducks, turkeys) in Florida -- introduction of a strain of highly pathogenic avian influenza into those flocks would be a major economic disaster, requiring vigorous control measures including depopulating affected flocks. 

## Pandemic Influenza and Schools

- Collaboration with local school board
- Potential for social distancing measures, such as school closure
- Need for discussion NOW
- Challenge of case identification

## Planning Assistance for Schools

- _[http://www.pandemicflu.gov/plan/schoolchecklist.html](http://www.pandemicflu.gov/plan/schoolchecklist.html)_
- Four general planning sections (K-12)
- 		- Planning & coordination
- 		- Continuity of student learning & core 		operations
- 		- Infection control policies & procedures
- 		- Communications planning

## Planning and Coordination

- Communicate with local health department
- Become familiar with county plan
- Assist with surveillance activities (student absenteeism)
- Plan to assist with surge capacity needs (schools used in alternative ways)

## Continuity of Student Learning and Core Operations

- Develop & practice scenarios
- Develop alternate types of instruction (web-based, mailed lessons, local TV, etc.)
- Update or develop continuity of operations plan to keep essentials functions up

## Infection Control Policies and Procedures

- Develop infection control policies in conjunction with health department
- Establish good hygiene practices among students and staff NOW
- Establish sick leave policies relating to a pandemic
- Plan for ways to transport ill students

## Communications Planning

- Develop and test platforms for communications (telephone trees, hotlines, dedicated websites, etc.)
- Update communication plans
- Identify spokespersons and ensure language, cultural and reading level appropriateness of messages
- Disseminate factually correct information

## What Local Government and Businesses Can Do

- Identify pandemic coordinator or team
- Identify essential employees and services
- Train the workforce
- Develop and plan for scenarios that may result in an increase or decrease in product demand
- Plan for potential financial impact
- Plan on travel impact
- Establish an emergency communications plan

## What Individuals and Families Can Do

- Have a supply of food and water
- Have a supply of your regularly prescribed medications
- Have supply of non-prescription medications
- Have a family plan to care for loved ones if they are sick
- Volunteer to help with emergency response

## Questions?

- (813) 307-8015 x 6326
- kelly_granger@doh.state.fl.us