# Presentation: 399875

## Pandemic Flu: Could it Hit Job Corps?

**Gary Strokosch, MD,Regional Medical Consultant**
**Job Corps National Health and Wellness Conference**
**April 26, 2007**
**Denver, Colorado**

## Could a pandemic happen in the near future? What

- would be its impact at
- my JC center?

## Pandemic Flu(Global Disease Outbreak)

- New influenza virus emerges
- No immunity in the human population
- Causes serious illness
- Spreads easily person-to-person

## Pandemic Death Toll-Since 1900-

- _1918-1919_
- USA  >675,000 deaths
- Worldwide  >50,000,000 deaths
- _1957-1958_
- USA  >70,000 deaths
- Worldwide  >1-2,000,000 deaths
- _1968-1969_
- USA  >34,000 deaths
- Worldwide  >700,000 deaths

## THERE IS CURRENTLY NO PANDEMIC

***THERE IS CURRENTLY ***_***NO***_*** PANDEMIC***

## Additional Information Needed to Predict a Pandemic

- Virulence of the virus
- Disease transmissibility
- Clinical manifestation
- Drug susceptibility
- Risks to different age groups

## The Difference Between  Seasonal Influenza, Pandemic Influenza,   and Avian Influenza

## Seasonal Influenza

- Periodic outbreaks
- Respiratory illness
- Fall and winter in the US
- Outbreaks are limited geographically
- Some immunity to virus strains
- The very young, the elderly and those with health conditions most at risk for serious complications
- 5-20% of population sick with c. 36,000 deaths

## Human Infection

- Human flu virus refer to subtypes that spread widely among humans
- Those are H1N1, H1N2 and H3N2
- It is likely that some genetic parts came from birds
- H5N1 is one of the few to have crossed the species barrier and is the most deadly

## Pandemic Influenza

- Worldwide outbreak
- New strain of the virus
- Ability to infect humans
- Spread from person to person
- Healthy adults may be at risk for serious complications

## Avian Influenza Viruses

- Bird flu is caused by influenza A viruses that occur naturally among birds
- Hemagglutinin and neuraminidase proteins of the surface of the virus combine in different ways and produce subtypes of A
- All known subtypes of influenza A can be found in birds
- The H5N1 subtype is of current concern

## Avian Influenza	(Bird Flu)

- The virus infects wild birds and domestic poultry
- Since 1997 there have been a number of confirmed cases of human infection from bird flu viruses
- Divided into two groups:
- Low pathogenic
- Highly pathogenic

## Avian Influenza	(Bird Flu)

- Wild birds worldwide asymptomatically carry bird flu in the GI tract
- It is shed in their saliva, nasal secretions and feces
- Domesticated birds may get infected by direct contact or through contact with surfaces, water or feed that have been contaminated with the virus

## Avian Influenza	(Bird Flu)

- The low pathogenic form may go undetected and cause only mild symptoms such as ruffled feathers or a drop in egg production
- The highly pathogenic form may cause disease that affects multiple organs with mortality of 90-100% within 48 hours
- The H5N1 is highly pathogenic

## Avian Influenza	(Bird Flu)

- Since 2003, a growing number of human H5N1 cases have been reported
- More than half of the people have died
- Most are believed to have been caused by exposure to infected poultry
- There has yet been no sustained human to human transmission of the disease

## Slide 16

## Confirmed Cases of H5N1 in 2006

- 115 cases reported by WHO
- 79 deaths reported by WHO
- Indonesia accounted for 55 & 45
- Egypt accounted for 18 & 10
- China accounted for 13 & 8
- Turkey accounted for 12 & 4

## Prevention and Treatment of H5N1

- No vaccine available
- The virus must first emerge and be identified
- Some of the medications for flu virus should work for avian flu infection
- The current H5N1 in Asia is resistant to amantadine and rimantadine
- Oseltamavir and zanamavir would probably work, but studies need to be done

## Avian Influenza: Low Pathogenicity

- Occurs in wild birds and can spread to domestic birds
- Usually causes no signs of infection or only minor symptoms in birds
- Pose little threat to human health
- H5 & H7 strains have the potential to mutate into highly pathogenic strains and are, therefore, closely monitored

## Avian Influenza: High Pathogenicity

- Spreads rapidly
- High death rate in birds
- H5N1 strain is rapidly spreading in birds in some parts of the world

## H5N1 Avian Viral Strain

- One of the few strains to have crossed the species barrier
- One of the most deadly strains to infect humans
- Human cases have resulted from contact with infected poultry or surfaces contaminated with secretions/excretions from infected birds
- As of Feb. 2007 person-to-person spread limited to rare sporadic cases
- Little or no immunity to H5N1

## Influenza Spread Between People

- Spread by large droplets and aerosols
- To a lesser degree, spread by touching objects contaminated with flu virus
- Produced by cough, sneeze or talk
- Inoculation by direct contact with nose, mouth or eyes

## Pandemic Influenza Compared to Natural Disasters

- _WIDESPREAD:_ affecting multiple areas of the US and other countries at the same time
- _EXTENDED EVENT:_ multiple waves of outbreaks in the same geographic area
- _WAVES OF OUTBREAKS:_ may occur over a year of more

## Pandemic Influenza Exposure Categories at Work

- Very high exposure risk
- High exposure risk
- Medium exposure risk
- Lower exposure risk

## Very High Exposure Risk

- Healthcare employees performing aerosol generating procedures on known or suspected pandemic patients
- Healthcare or laboratory personnel collecting or handling specimens from known or suspected pandemic patients

## High Exposure Risk

- Healthcare delivery and support staff exposed to known or suspected pandemic patients
- Medical transport of known or suspected pandemic patients in enclosed vehicles
- Performing autopsies on known or suspected pandemic patients

## Medium Exposure Risk

- Employees with high frequency contact with the general population

## Lower Exposure Risk

- Employees who have minimal occupational contact with the general public and other coworkers

## JC Exposure Risk

- _Very high exposure risk staff_
- None
- _High exposure risk staff_
- Health and wellness staff
- Drivers that transport ill students in center vehicles
- _Medium exposure risk staff_
- Most of the non-health staff on center
- _Lower exposure risk staff_
- Few

## Disaster Plan Realities

- Prepare for reduced workforce
- Cross-train or develop ways to function in the absence of some of the staff
- Plan to be without some supplies
- Sick leave policy should not penalize employees for having to stay home
- Minimize exposure of employees

## Pandemic Flu Dilemma

- Reality would dictate planning for downsizing services because of the factors mentioned in last slide, but anticipate a surge in need for health and wellness services if ill students remain on center

## Control Measures

- Good hygiene
- Cough etiquette
- Social distancing
- Personal protective equipment
- Staying home from work

## Minimize Exposure of Employees

- Educate and train employees in proper:
- _Hand hygiene_ - frequent washing or sanitizing and avoid touching mouth, nose and eyes
- _Cough/sneeze etiquette_ - cover with a tissue or into upper sleeve
- _Social distancing techniques_ - separation of at least 6 feet and avoid shaking hands

## Minimize Exposure of Employees

- Personal protective equipment (PPE) will probably be limited to surgical masks.  They are used as a physical barrier to protect employees from hazards and also prevent contamination by the wearer, protecting other people against infection from the person wearing the mask.

## Minimize Exposure of Employees

- Keep work surfaces, telephones, computer equipment and other frequently touched surfaces and office equipment clean.
- Discourage employees from using other employees’ phones, desks, offices or other work tools and equipment.
- Minimize situations where groups of people are crowded together, such as in a meeting

## For More Information

- _[www.](http://www.pandemicflu.gov/)__[pandemicflu](http://www.pandemicflu.gov/)__[.](http://www.pandemicflu.gov/)__[gov](http://www.pandemicflu.gov/)_
- _[www.](http://www.cdc.gov/)__[cdc](http://www.cdc.gov/)__[.](http://www.cdc.gov/)__[gov](http://www.cdc.gov/)_

## National Job Corps Pandemic Influenza Planning

**Kelley J. Clark, MS, Sr. EHS Specialist**
**Tidewater, Inc. / National Office of Job Corps**

**Notes:**
Thank you

Good morning, my name is Kelley Clark.  I recently joined the National Office of Job Corps on the Tidewater contract as the new Sr. Environmental Health and Safety Specialist. 

I am here this morning to discuss the National Office of Job Corps’ pandemic flu planning efforts.  

## Agenda

- Information Notice No. 06-8
- National Job Corps Pandemic Planning Stages
- Job Corps Center Pandemic Planning
- Pandemic Influenza Resources
- National Job Corps Contacts

**Notes:**
I will briefly discuss the following topics: 

Copies of my presentation and the information notice have been provided for you.

## Information Notice No. 06-08 

- “Pandemic Influenza Preparedness for Job Corps Centers”
- Issued September 11, 2006
- Requires Centers to update emergency response plans to include:
- Strategies for evacuating sick students without spreading virus to others
- Strategies for preventing spread of virus on center
- Establishing relationships with local health departments
- Reporting virus outbreaks (significant incident) to National Office with information copy to Regional Office

**Notes:**
-Evacuation strategies should consider the availability of public transportation and local, State, or Federal travel restrictions.
-Strategies for preventing spread of virus on center should focus on personal hygiene, covering coughs, and encouraging the ill to stay at home.
-Point of contact for local health departments should have decision making authority such as the Center Director or his/her designee.
-Virus outbreaks will likely be reported through the news media. However, outbreaks occurring near Job Corps centers should be reported directly to the National and Regional Job Corps offices as quickly as possible via the SIR System.  

## Information Notice No. 06-08 (continued)

- Pre-planning to arrange for physicians or qualified health professional to confirm cases
- Reporting confirmed cases to local health department important to local response efforts

**Notes:**
-Centers should gather a list of physicians and/or qualified health professionals in the area to confirm cases of avian or seasonal flu.  Pandemic influenza outbreak will create  a tremendous burden on local health systems.  Centers must have several options available to facilitate diagnosis of virus.
-The number of confirmed cases of avian influenza in a particular area will greatly influence local response action.  Center’s should become familiar with local health department reporting procedures.

## Information Notice No. 06-08 (continued)

- The Job Corps Pandemic Influenza Planning Checklist has been provided to assist with preparing pandemic response plans
- Use the websites listed in Attachment B for planning guidance

**Notes:**
-The websites listed on Attachment B will provide more detail about pandemic influenza and its potential affects on the US.  

-The sample avian influenza plan from Carnegie Mellon will give you an idea about what your plans should look like.  Also, state and local governments and school districts are now posting their pandemic influenza plans on the internet.  It’s a good idea to download copies of plans for your area school districts and local government to become familiar with what their possible response actions will be.

-Your plans should change as new information becomes available.  It is important to stay informed and to participate in local planning sessions to the extent possible. 

## National Job Corps Pandemic Flu Planning

- Job Corps Pandemic Planning in 4 steps
- Step 1- Information Notice 06-8
- Step 2- Forthcoming Information Notice requesting quarterly updates and on-going discussions with other Federal agencies
- Step 3- Review of center pandemic flu status reports
- Step 4- Develop draft National Job Corps Pandemic Flu Response Guide

**Notes:**
-National Office of Job Corps will be addressing pandemic influenza planning for centers in four steps.  The fourth step will be the release of a pandemic influenza response guide. 
-Step I, has been completed.  You have copies of the information notices.
-Step II will take place following the conference.  Centers will be required to submit quarterly status reports on pandemic influenza planning efforts, which may include review of pandemic response plans.  
-The National Office will also continue to meet with other Federal agencies to get up to date information and guidance on Job Corps’ role in National Response actions (including the use of Job Corps facilities during pandemic) and to ensure the safety of Job Corps students and staff on center.  
-Step III, National Office will review and provide feedback on quarterly pandemic flu status reports.  From these reports, a national pandemic flu response guide will be prepared (Step IV).
-The proposed draft pandemic flu response guide will be a living document subject to change according to information that becomes available.  

## Job Corps Center Pandemic Planning

- Preliminary planning process can be done in 6 Steps:
- Evaluation of current emergency response plan
- Assemble a pandemic planning committee
- Identify essential center functions and personnel

**Notes:**
It is important  for Job Corps Center’s to begin planning for pandemic flu as soon as possible. Federal, State, and local governments response actions are based upon what is currently known about seasonal influenza and lessons learned from the past pandemics. Therefore, your plans must be flexible, resilient, and easily adaptable because little is known about the H5N1 virus type once a pandemic starts. 

Step 1- Best place to start is to thoroughly evaluate your center’s emergency response plan.  Determine if the plan can be adapted to pandemic flu response. The center’s safety committee or emergency response team should be engaged in pandemic response planning.
Step 2- Identify the key decision makers on center to begin pandemic flu response.  If your center already has an emergency response team, review the membership for pandemic flu purposes to ensure that Health Services is included. 
Step 3- If your center has an emergency response plan, essential center functions have been identified according to the nature of the emergency. Review essential functions in terms of pandemic flu response.  Certain functions may be more affected by a pandemic. Keep in mind that key personnel may be affected by illness so it is important to identify alternates for these individuals.

## Job Corps CenterPandemic Planning (continued)

- Establish the Chain-of-Command and appoint an “Incident Commander”.
- Establish the role of health services

**Notes:**
Step 4-Your center’s emergency response plan should have an established chain-of-command. An incident commander should be identified to coordinate and direct response and to advise the Center Director and the senior management staff.  There should be alternates for each member in the chain-of-command.  The influenza virus can strike anyone.  The incident commander, the Center Director or his/her designee should establish contact with State and local pandemic planning committees.  Participation in planning meetings and drills are important to the development of the center’s pandemic response plan.  Most importantly, State and local leaders will need to know who to contact on center to coordinate response actions that may involve center and/or center staff and students.

Step 5-The role of Health Services is an essential part of the pandemic flu response and should be clearly defined.  The size, location (urban or rural), available resources, affiliations and partnerships with other educational institutions, hospitals, or other agencies, and the demographics of the center staff and students will factor into the role of Health Services.  Health Services should be involved in determining which center staff and students should be first to receive anti-viral medications and/or flu vaccine when it becomes available.  

## Influenza Resources

- State and Local Government Planning & Response Activities, _[http://www.pandemicflu.gov/plan/states/index.html](http://www.pandemicflu.gov/plan/states/index.html)_
- State-by-State Pandemic Information
- State Pandemic Plans
- Antiviral Allocations by State
- State Contacts

**Notes:**
This web link should be one of many pandemic flu links added to you list of internet favorites.  You will find information critical to center response planning activities.  Visit this site often for up-to-date information about pandemic planning in your state.

## Influenza Resources

- The Centers for Disease Control and Prevention, “Interim Pre-Pandemic Planning Guidance, _[http://www.pandemicflu.gov/plan/community/index.html](http://www.pandemicflu.gov/plan/community/index.html)_
- The Centers for Disease Control and Prevention, Patient and Provider Education Materials, _[http://www.cdc.gov/flu/protect/covercough.htm](http://www.cdc.gov/flu/protect/covercough.htm)_
- The Centers for Disease Control and Prevention, Interim Guidance on Planning for the Use of Surgical Masks and Respirators in Health Care Settings During an Influenza Pandemic, _[http://www.pandemicflu.gov/plan/healthcare/maskguidancehc.html](http://www.pandemicflu.gov/plan/healthcare/maskguidancehc.html)_
- U.S. Food and Drug Administrations Center for Devices and Radiological Health, Personal Protective Equipment and Influenza Outbreaks, including Bird Flu (Avian Influenza) _[http://www.fda.gov/cdrh/ppe/fluoutbreaks.html](http://www.fda.gov/cdrh/ppe/fluoutbreaks.html)__)_

**Notes:**
The following websites contain information that you may find useful when preparing center specific response actions, preparing programs to prevent the spread of viruses on center, and obtaining PPE to control the spread of virus during a pandemic. 

-The CDC documents materials are downloadable and are not copy right restricted so you can make as many copies as you need.

-The guidance on use of surgical masks and respirators provides background information about influenza, control strategies, and PPE recommendations.

-The FDA guidance provides information about PPE and how it helps prevent the spread of infection.

## National Office of Job Corps Safety Contacts

- Marsha Fitzhugh, Team Leader, Division of IT and Program Support, (202) 693-3099
- Heather Edmonds, Environmental Health & Safety Specialist, (202) 693-3774
- Kelley Clark, Sr. Environmental Health & Safety Specialist, (202) 693-3089

**Notes:**
For more information regarding pandemic influenza response plan development, pandemic influenza status reporting or other safety questions, feel free to contact Marsha Fitzhugh, Heather Edmonds, or myself.

## QUESTIONS?

## Thank  You.