Pandemic Flu

A pandemic is a global disease outbreak. A flu pandemic occurs when a new influenza virus emerges for which people have little or no immunity, and for which there is no vaccine. The disease spreads easily person-to-person, can cause serious illness, and can sweep across the country and around the world in very short time.

It is difficult to predict when the next influenza pandemic will occur or how severe it will be. Wherever and whenever a pandemic starts, everyone around the world is at risk. Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.

Health professionals are concerned that the continued spread of a highly pathogenic avian H5N1 virus across eastern Asia and other countries represents a significant threat to human health. The H5N1 virus has raised concerns about a potential human pandemic because:

• It is especially virulent

• It is being spread by migratory birds

• It can be transmitted from birds to mammals and in some limited circumstances to humans, and like other influenza viruses, it continues to evolve.

Since 2003, a growing number of human H5N1 cases have been reported in Asia, Europe, and Africa. More than half of the people infected with the H5N1 virus have died. Most of these cases are all believed to have been caused by exposure to infected poultry. There has been no sustained human-to-human transmission of the disease, but the concern is that H5N1 will evolve into a virus capable of human-to-human transmission.

Vaccination and Treatment for H5N1 Virus in Humans

There currently is no commercially available vaccine to protect humans against H5N1 virus that is being seen in Asia, Europe, and Africa. A vaccine specific to the virus strain causing the pandemic cannot be produced until a new pandemic influenza virus emerges and is identified.

The U.S. Department of Health and Human Services (HHS), through its National Institute of Allergy and Infectious Diseases (NIAID), is addressing the problem in a number of ways. These include:

• The development of pre-pandemic vaccines based on current lethal strains of H5N1 (The Food and Drug Administration has approved a vaccine based on an early strain of the H5N1 virus that is not commercially available, but is being added to the Strategic National Stockpile.)

• Collaboration with industry to increase the Nation's vaccine production capacity

• Seeking ways to expand or extend the existing supply

• Doing research in the development of new types of influenza vaccines.

Studies done in laboratories suggest that some of the prescription medicines approved in the United States for human influenza viruses should work in treating avian influenza infection in humans. However, influenza viruses can become resistant to these drugs, so these medications may not always work. Additional studies are needed to demonstrate the effectiveness of these medicines.

The H5N1 virus that has caused human illness and death in Asia is resistant to amantadine and rimantadine, two antiviral medications commonly used for influenza. Two other antiviral medications, oseltamavir and zanamavir, would probably work to treat influenza caused by H5N1 virus, but additional studies still need to be done to demonstrate their effectiveness.

For more information about H5N1 drug and vaccine development, see http://www.pandemicflu.gov/vaccine/index.html

Stay Healthy

Will the seasonal flu shot protect me against pandemic influenza?

• No, it won't protect you against pandemic influenza. But flu shots can help you to stay healthy.

• Get a flu shot to help protect yourself from seasonal flu.

• Get a pneumonia shot to prevent secondary infection if you are over the age of 65 or have a chronic illness such as diabetes or asthma. For specific guidelines, talk to your health care provider or call the Centers for Disease Control and Prevention (CDC) Hotline at 1-800-232-4636.

• Make sure that your family's immunizations are up-to-date.

Take common-sense steps to limit the spread of germs. Make good hygiene a habit.

• Wash hands frequently with soap and water.

• Cover your mouth and nose with a tissue when you cough or sneeze.

• Put used tissues in a waste basket.

• Cough or sneeze into your upper sleeve if you don't have a tissue.

• Clean your hands after coughing or sneezing. Use soap and water or an alcohol-based hand cleaner.

• Stay at home if you are sick.

It is always a good idea to practice good health habits.

• Eat a balanced diet. Be sure to eat a variety of foods, including plenty of vegetables, fruits, and whole grain products. Also include low-fat dairy products, lean meats, poultry, fish, and beans. Drink lots of water and go easy on salt, sugar, alcohol, and saturated fat.

• Exercise on a regular basis and get plenty of rest.

How Does Seasonal Flu Differ From Pandemic Flu?

Seasonal Flu

Outbreaks follow predictable seasonal patterns; occurs annually, usually in winter, in temperate climates

Usually some immunity built up from previous exposure

Healthy adults usually not at risk for serious complications; the very young, the elderly and those with certain underlying health conditions at increased risk for serious complications

Health systems can usually meet public and patient needs

Vaccine developed based on known flu strains and available for annual flu season

Adequate supplies of antivirals are usually available

Average U.S. deaths approximately 36,000/yr

Symptoms: fever, cough, runny nose, muscle pain. Deaths often caused by complications, such as pneumonia.

Generally causes modest impact on society (e.g., some school closing, encouragement of people who are sick to stay home)

Manageable impact on domestic and world economy

Pandemic Flu

Occurs rarely (three times in 20th century - last in 1968)

No previous exposure; little or no pre-existing immunity

Healthy people may be at increased risk for serious complications

Health systems may be overwhelmed

Vaccine probably would not be available in the early stages of a pandemic

Effective antivirals may be in limited supply

Number of deaths could be quite high (e.g., U.S. 1918 death toll approximately 675,000)

Symptoms may be more severe and complications more frequent

May cause major impact on society (e.g. widespread restrictions on travel, closings of schools and businesses, cancellation of large public gatherings)

Potential for severe impact on domestic and world economy

Epidemic/Pandemic Preparedness Plan

The following personnel are identified as having key roles in initiating epidemic/pandemic emergency procedures:

Administrative: Director of Operations, Senior Home Support Business Director

Nursing: Director of Nursing Services

Supervisor: Supervisor of Senior Home Support

The Business Director/Director of Nursing is responsible for monitoring the influenza conditions for the area. These conditions can be monitored at www.cdc.gov/flu/weekly/fluactivity.htm. The Business Director, in conjunction with the Director of Nursing, will decide when and how the epidemic/pandemic plan will be initiated. Once the decision has been made to implement the plan the following steps will be put into action:

1. All home health care workers will be notified by the office staff that the plan is operational and that all workers need to report to the main office to pick up a sufficient supply of vinyl gloves and face masks.

2. When workers pick up supplies, informational material regarding universal precautions, the epidemic/pandemic plan and other pertinent information regarding the current situation will be distributed. Workers who do not pick up gloves, masks and information will not be used in the work force.

3. Administrative staff will contact clients prior to a home visit to determine whether persons in the household have an influenza-like illness.

If clients or family members with pandemic influenza are in the home, the Nursing Director will consider several options including:

• Postponing nonessential services

• Assigning a worker who is not at increased risk for complications of pandemic influenza to care for the client

• Home healthcare providers who enter homes where there is a person with an influenza-like illness will follow the recommendations for standard and droplet precautions. When there is a known risk of influenza workers will don a surgical or procedure mask upon entry into the home. These precautions will be followed when there is a possibility that others in the household may be infectious.

The Director of Nursing will be in communication with the local Hospitals to determine if a vaccine is available. If the vaccine becomes available the staff of Senior Home Support will be vaccinated in the following priority order:

1. Director of Nursing

2. RNs and other nursing staff

3. Home Health Care Aides

4. Administrative Personnel

Care of “At risk” clients:

“At risk” clients are those clients who have been identified as being particularly vulnerable (see general information). When the epidemic/pandemic plan is initiated those clients deemed at risk will take priority over lesser risk clients. The Supervisor/Administrator will make every attempt to have workers report for duty on a continual basis. If possible, workers who are at the lowest risk (i.e. workers who have already had the flu and are no longer considered contagious or who have been vaccinated) will work with at risk clients.

In the event that there is not a sufficient work force to attend to these clients, the Administrator/Director of Nursing will take the following steps:

If the client is care managed, a call will be placed to the care management facility for further instructions.

“At risk” clients will be contacted on a daily basis to assess the clients situation The administrative staff will contact immediate family members and inform them of the situation. If the client does not have family in the area the Administrator/Director of Nursing will contact the Red Cross or First Responders (police, fire and EMT) and request a wellness check. Alternative arrangements will be made to move the client to safety, working within the epidemic/pandemic plans of the local community.

Assignment of Staff:

In all cases, an employee must be in good physical health before coming in contact with clients and/or other Senior Home Support employees. Employees with signs and/or symptoms of influenza will not be permitted to work unless authorized by a physician or the Director of Nursing.

While the Pandemic/Epidemic plan is operational Employees are required to report to the main office any symptoms that are out of the ordinary. The Director of Nursing will make the decision whether or not the worker will be permitted to proceed with home visits or will be temporarily removed from the work force.

Failure by employees to report to their supervisor that they have, or have been exposed to a communicable disease will be considered negligent and subject to appropriate disciplinary action.

Office based employees will also report incidents of infectious/communicable disease to their supervisor who must abide by the Senior Home Support Infection Control Policy in determining appropriateness of reporting to work.

Care of deceased clients:

In the event that a worker reports to the home of a client who has died of influenza or other natural causes the worker will immediately call the home office. The worker will be instructed to not touch or move the body, but wait for first responders if they are available to come to the home within an hour. If first responders cannot come to the home within 1 hour the worker will be instructed to leave the home, ensure that the home is locked, and bring the key to the main office.

The home office will contact:

1. County first responders as designated by the county epidemic/pandemic plan. The home office will insure that the first responders have access to the home when they arrive.

2. Family members or client guardian if applicable.

For more information:

http://www.pandemicflu.gov/

http://www.kalcounty.com/php/pandemic.htm

The Great Influenza The Epic Story of the 1918 Pandemic by John M. Barry