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Microbes100x

The National Strategy for Pandemic Influenza was announced by the President on May 3, 2006.  A summary of the strategy is provided here.

We have all seen or heard some of the recent discussions in the news and on TV regarding the potential for a worldwide flu pandemic. Scientists think that an avian virus known as H5N1 now spreading rapidly through wild bird populations and in some cases infecting poultry stocks has the potential to cause the next human influenza pandemic.

Below you'll find many frequently asked questions regarding the H5N1 virus that we've taken from the Center for Disease Control's (CDC) website. At the end of the article we include what we are doing locally to prepare for a pandemic, if one should occur.

For further information, please contact:

David Wetzel
Division Chief - Emergency Medical Services
wetzel@mydelraybeach.com
(561) 243-7414 - office
(561) 243-7461 - fax


Frequently Asked Questions

What is the avian influenza A (H5N1) virus also known as the "Bird flu" that has been reported in Africa, Asia, Europe, and the Near East? 

Influenza A (H5N1) virus ??" also called "H5N1 virus" ??" is an influenza A virus subtype that occurs mainly in birds, is highly contagious among birds, and can be deadly to them.

Outbreaks of avian influenza H5N1 occurred among poultry in eight countries in Asia (Cambodia, China, Indonesia, Japan, Laos, South Korea, Thailand, and Vietnam) during late 2003 and early 2004. At that time, more than 100 million birds in the affected countries either died from the disease or were killed in order to try to control the outbreaks. By March 2004, the outbreak was reported to be under control.

Since late June 2004, however, new outbreaks of influenza H5N1 among poultry and wild birds have been reported in countries in Africa, Asia, Europe, and the Near East.  Human cases of influenza A (H5N1) infection have been reported in Azerbaijan, Cambodia, China, Indonesia, Iraq, Thailand, Turkey, and Vietnam.

What are the risks to humans from the current H5N1 outbreak? 

H5N1 virus does not usually infect people, but more than 170 human cases have been reported. Most of these cases have occurred from direct or close contact with infected poultry or contaminated surfaces; however, a few cases of human-to-human spread of H5N1 virus have occurred.

So far, spread of H5N1 virus from person to person has been rare and has not continued beyond one person. Nonetheless, because all influenza viruses have the ability to change, scientists are concerned that H5N1 virus one day could be able to infect humans and spread easily from one person to another. Because these viruses do not commonly infect humans, there is little or no immune protection against them in the human population.

If H5N1 virus were to gain the capacity to spread easily from person to person, an influenza pandemic (worldwide outbreak of disease) could begin. No one can predict when a pandemic might occur. However, experts from around the world are watching the H5N1 situation in Asia and Europe very closely and are preparing for the possibility that the virus may begin to spread more easily from person to person.

How does H5N1 virus differ from seasonal influenza viruses that infect humans? 

Of the few avian influenza viruses that have crossed the species barrier to infect humans, H5N1 virus has caused the largest number of reported cases of severe disease and death in humans. In the current situation in Asia, more than half of the people infected with the virus have died.

Most cases have occurred in previously healthy children and young adults. However, it is possible that the only cases currently being reported are those in the most severely ill people and that the full range of illness caused by the H5N1 virus has not yet been defined.

Does the current seasonal influenza vaccine protect me from avian influenza?

No. Influenza vaccine for the 2005-06 season does not provide protection against avian influenza.

Is there a vaccine to protect humans from H5N1 virus?

There currently is no commercially available vaccine to protect humans against the H5N1 virus that is being detected in Asia and Europe. However, vaccine development efforts are taking place. Research studies to test a vaccine that will protect humans against H5N1 virus began in April 2005, and a series of clinical trials is under way. For more information about the H5N1 vaccine development process, visit the National Institutes of Health website.

What changes are needed for H5N1 or another avian influenza virus to cause a pandemic?

Three conditions must be met for a pandemic to start: 1) a new influenza virus subtype must emerge; 2) it must infect humans and causes serious illness; and 3) it must spread easily and sustainedly (continue without interruption) among humans. The H5N1 virus in Asia and Europe meets the first two conditions: it is a new virus for humans (H5N1 viruses have never circulated widely among people), and it has infected more than 100 humans, killing over half of them.

However, the third condition, the establishment of efficient and sustained human-to-human transmission of the virus, has not occurred. For this to take place, the H5N1 virus would need to improve its transmissibility among humans. This could occur either by "reassortment" or adaptive mutation.

Reassortment occurs when genetic material is exchanged between human and avian viruses during co-infection (infection with both viruses at the same time) of a human or pig. The result could be a fully transmissible pandemic virus??"that is, a virus that can spread easily and directly to humans. A more gradual process is adaptive mutation, where the capability of a virus to bind to human cells increases during infections of humans.

There is a tremendous amount of information located on the CDC and World Health Organization (WHO) websites.


Symptoms

Although human to human transmission of the H5N1 virus has occurred very rarely to date (3-06) the following symptoms have been found in those who have contracted the virus from infected birds.

In humans the avian flu can appear similar to other types of flu: fever, cough, sore throat, muscle aches, general malaise, upper respiratory infection, etc. In addition, there are signs and symptoms associated with the avian flu, specifically, including: conjunctivitis, pneumonia, acute respiratory distress and other life threatening complications.

Transmission

In the event that pandemic flu occurs, the transmission of a pandemic flu virus will spread like any other flu virus: in respiratory droplets caused by coughing or sneezing. Usually this spreads from person-to-person, although sometimes people become infected by touching something with flu viruses on it (i.e., unclean hands, telephones, pens, eating utensils, glasses, discarded tissues, door knobs, etc.) and then touching their mouth or nose.

Most healthy adults may be able to infect others beginning one day before symptoms develop and up to five days after becoming sick. The bottom line is the flu is a contagious respiratory illness. Practicing good personal protection techniques and using personal protection equipment (PPE) have to be the standard to reduce transmission of the virus as well as monitoring and protecting the first responder workforce.

Federal, State and Local Planning

There are large working groups meeting regularly to develop pre-pandemic plans that include monitoring wild bird populations and migrations. There is a system in place for monitoring poultry farms across the United States and Canada.

Strategic stockpiles of anti viral medications for use by first responders are being created.

Locally, the Palm Beach County Emergency Operations Center and The Palm Beach County Health Department are the lead agencies. They are holding planning sessions to address procedures for dead bird testing and disposal, points of distribution (POD's) for medications, public education etc.

The Delray Beach Fire-Rescue Department's EMS Division has started Department specific planning to include the following:

A specific Departmental Staff Member has been designated to be responsible for tracking and gathering the information from the local Health Department, CDC, professional contacts and media sources. That responsibility has been assigned to the Division Chief of Emergency Medical Services.

Arrange meetings with local hospital representatives to discuss the potential for a pandemic and coordinate preparations. (flu triage sites etc.)

Become familiar with the County and State Health Departments' plans for managing pandemic flu, the role of public safety in the plan and processes like quarantining and sheltering.

With the assistance of the Departmental Medical Director, review the Department's infectious disease policies. Make sure they are up to date and adequately address an epidemic or pandemic.

Review infection control policies and practices with all members of the Department. Something as simple as frequent hand washing can make a big difference in preventing the spread of an influenza outbreak.

Make sure we have procedures that provide for monitoring the workforce for signs and symptoms of the flu. These should include actions to be taken by supervisors if signs and symptoms are detected.

Have a contingency plan for staffing that incorporates high levels of absenteeism. We may see staffing shortages up to 40%.  Alternative shift schedules, similar staffing to what might be used during Hurricane incidents may be needed.

Provide the annual flu vaccine for all personnel and have a contingency plan for the use of antiviral drugs prophylactically. Encourage personnel to have their families get flu shots, as well.

Inventory and maintain adequate supplies of personal protective equipment, including, masks, gloves, tyvek suits, disinfectants, etc (3-5 months worth of supplies to be on hand and maintained).

Station and EMS response unit disinfection should be done frequently. Increase diligence on infection control procedures by all personnel.

EMS alternative protocols for transporting patients may be instituted.  (designated flu treatment centers)



DAVID WETZEL
Division Chief - Emergency Medical Services
wetzel@mydelraybeach.com
(561) 243-7414 - office
(561) 243-7461 - fax

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