What Is an Influenza Pandemic?

A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide.

Historically, the 20th century saw 3 pandemics of influenza:

·                     1918 influenza pandemic caused at least 500,000 U.S. deaths and up to 40 million deaths worldwide

·                     1957 influenza pandemic caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide

·                     1968 influenza pandemic caused about 34,000 U.S. deaths and 700,000 deaths worldwide

Characteristics and challenges of a pandemic

1.      Rapid Worldwide Spread

·          When a pandemic influenza virus emerges, its global spread is considered inevitable.

·          Preparedness activities should assume that the entire world population would be susceptible.

·          Countries might, through measures such as border closures and travel restrictions, delay arrival of the virus, but cannot stop it.

 

2.      Health Care Systems Overloaded

·          Most people have little or no immunity to a pandemic virus. Infection and illness rates soar. A substantial percentage of the world’s population will require some form of medical care.

·          Nations unlikely to have the staff, facilities, equipment and hospital beds needed to cope with large numbers of people who suddenly fall ill.

·          Death rates are high, largely determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the effectiveness of preventive measures.

·          Past pandemics have spread globally in two and sometimes three waves.

 

 

3.      Medical Supplies Inadequate

·          The need for vaccine is likely to outstrip supply.

·          The need for antiviral drugs is also likely to be inadequate early in a pandemic.

·          A pandemic can create a shortage of hospital beds, ventilators and other         supplies. Surge capacity at non-traditional sites such as schools may be created to cope with demand

·          Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines.

 

4.      Economic and Social Disruption

·          Travel bans, closings of schools and businesses and cancellations of events could have major impact on communities and citizens.

·          Care for sick family members and fear of exposure can result in significant worker absenteeism.

 

Communications and Information are Critical Components of Pandemic Response

Education and outreach are critical to preparing for a pandemic. Understanding what a pandemic is, what needs to be done at all levels to prepare for pandemic influenza, and what could happen during a pandemic helps us make informed decisions both as individuals and as a nation. Should a pandemic occur the public must be able to depend on its government to provide scientifically sound public health information quickly, openly and dependably. For additional information on pandemic influenza visit: www.pandemicflu.gov  

What would be the Impact of a Pandemic?

A pandemic may come and go in waves, each of which can last for six to eight weeks.

An especially severe influenza pandemic could lead to high levels of illness, death, social disruption, and economic loss. Everyday life would be disrupted because so many people in so many places become seriously ill at the same time. Impacts can range from school and business closings to the interruption of basic services such as public transportation and food delivery.

Pandemics Death
Toll Since 1900

1918-1919
U.S.... 500,000+
Worldwide... 40,000,000+
1957-1958
U.S.... 70,000+
Worldwide... 1-2,000,000
1968-1969
U.S.... 34,000+
Worldwide... 700,000+

A substantial percentage of the world's population will require some form of medical care. Health care facilities can be overwhelmed, creating a shortage of hospital staff, beds, ventilators and other supplies. Surge capacity at non-traditional sites such as schools may need to be created to cope with demand.

The need for vaccine is likely to outstrip supply and the supply of antiviral drugs is also likely to be inadequate early in a pandemic. Difficult decisions will need to be made regarding who gets antiviral drugs and vaccines.

Death rates are determined by four factors: the number of people who become infected, the virulence of the virus, the underlying characteristics and vulnerability of affected populations and the availability and effectiveness of preventive measures

Avian Influenza in Birds

Wild birds worldwide carry avian influenza viruses in their intestines, but usually do not get sick from them. Avian influenza is very contagious among birds and can make some domesticated birds, including chickens, ducks, and turkeys, very sick and kill them.

Infected birds shed influenza virus in their saliva, nasal secretions, and feces. Domesticated birds may become infected with avian influenza virus through direct contact with infected waterfowl or other infected poultry, or through contact with surfaces (such as dirt or cages) or materials (such as water or feed) that have been contaminated with the virus.

Avian influenza infection in domestic poultry causes two main forms of disease that are distinguished by low and high extremes of virulence. The "low pathogenic" form may go undetected and usually causes only mild symptoms (such as ruffled feathers and a drop in egg production). However, the highly pathogenic form spreads more rapidly through flocks of poultry. This form may cause disease that affects multiple internal organs and has a mortality rate that can reach 90-100%, often within 48 hours. The H5N1 virus is highly pathogenic.

Human Infection with Avian Influenza Viruses

"Human influenza virus" usually refers to those subtypes that spread widely among humans. There are only three known A subtypes of influenza viruses (H1N1, H1N2, and H3N2) currently circulating among humans. It is likely that some genetic parts of current human influenza A viruses originally came from birds. Influenza A viruses are constantly changing, and other strains might adapt over time to infect and spread among humans.

The risk from avian influenza is generally low to most people, because the viruses do not usually infect humans. H5N1 is one of the few avian influenza viruses to have crossed the species barrier to infect humans, and it is the most deadly of those that have crossed the barrier.

Most cases of H5N1 influenza infection in humans have resulted from contact with infected poultry (e.g., domesticated chicken, ducks, and turkeys) or surfaces contaminated with secretion/excretions from infected birds.

So far, the spread of H5N1 virus from person to person has been limited 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.

In the current outbreaks in Asia, Europe, and Africa, more than half of those infected with the H5N1 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.

Symptoms of avian influenza in humans have ranged from typical human influenza-like symptoms (e.g., fever, cough, sore throat, and muscle aches) to eye infections, pneumonia, severe respiratory diseases (such as acute respiratory distress), and other severe and life-threatening complications. The symptoms of avian influenza may depend on which virus caused the infection.

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, a 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 very closely and are preparing for the possibility that the virus may begin to spread more easily and widely from person to person.

  

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 pandemic vaccine 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, collaboration with industry to increase the Nation's vaccine production capacity, and seeking ways to expand or extend the existing supply. We are also 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.

 

 Frequently Asked Questions About

 Pandemic Influenza

1.      What is an influenza pandemic?

A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide.

2.      How do pandemic viruses occur?

New influenza viruses emerge as a result of a process called antigenic shift, which causes a sudden and major change in influenza A viruses. These changes occur when proteins on the surface of the virus combine in new ways as a result of mutation or exchange of genetic material between multiple influenza viruses. If such changes result in a new influenza A virus subtype that can infect humans and spread easily from person to person, an influenza pandemic can occur.

3.      Is a pandemic imminent?

Many scientists believe it is a matter of time until the next influenza pandemic occurs. However, the timing and severity of the next pandemic cannot be predicted. Influenza pandemics occurred three times in the past century — in 1918-19, 1957-58, and 1968-69.

4.      Why is there concern about the H5N1 avian influenza outbreak in Asia and other countries?

Although it is unpredictable when the next pandemic will occur and what strain may cause it, the continued and expanded spread of a highly pathogenic—and now endemic—avian H5N1 virus across eastern Asia and other countries represents a significant threat.

Avian H5N1 influenza infection in humans was first recognized in 1997 when this virus infected 18 people in Hong Kong, causing 6 deaths. Concern has increased in recent years as avian H5N1 infections have killed large numbers of poultry flocks and other birds in Asia, Europe, and Africa. Since 2003, more than 100 human H5N1 cases have been reported in Azerbaijan, Cambodia, China, Egypt, Indonesia, Iraq, Thailand, Turkey, and Vietnam, and more than half have died.

The H5N1 virus has raised concerns about a potential human pandemic because:

o                    The H5N1 virus is widespread in poultry in many countries in Asia and has spread to Europe and Africa;

o                    The virus has been transmitted from birds to mammals and in some limited circumstances to humans;

o                    Wild birds and domestic ducks have been infected without showing symptoms and become carriers of viral infection to other domestic poultry species;

o                    There a few cases of human-to-human transmission have been reported; and

o                    Genetic studies confirm that H5N1 influenza viruses, like other influenza viruses, are continuing to evolve.

 

5.      Is influenza A (H5N1) virus the only avian influenza virus of concern regarding a pandemic?

Although H5N1 probably poses the greatest current pandemic threat, other avian influenza A subtypes also have infected people in recent years. For example, in 1999, H9N2 infections were identified in Hong Kong; in 2002; and 2003, H7N7 infections occurred in the Netherlands and H7N3 infections occurred in Canada. These viruses also have the potential to give rise to the next pandemic.

6.      Will H5N1 cause the next influenza pandemic?

Scientists cannot predict whether an avian influenza (H5N1) virus will cause a pandemic. That is why we are focusing on comprehensive public health efforts — increasing surveillance monitoring for outbreaks, international cooperation, antiviral and vaccine stockpiles and building more robust capacity for vaccine production — that will help protect us no matter what pandemic strain emerges or where.

7.      Why won't the annual flu vaccine protect people against pandemic influenza?

Influenza vaccines are designed to protect against a specific virus, so a pandemic vaccine cannot be produced until a new pandemic influenza virus emerges and is identified. Even after a pandemic influenza virus has been identified, it could take at least 6 months to develop, test and produce vaccine.

8.      How much time does it take to develop and produce an influenza vaccine?

The influenza vaccine production process is long and complicated. Traditional influenza vaccine production for the U.S. relies on long-standing technology based on chicken eggs. This production technology is labor-intensive and takes 9 months from start to finish.

The flu vaccine production process is further complicated by the fact that influenza virus strains continually evolve. Thus, seasonal flu vaccines must be modified each year to match the strains of the virus that are known to be in circulation among humans around the world. As a result of this constant viral evolution, seasonal influenza vaccines cannot be stockpiled year to year.

The appearance of an influenza pandemic virus would likely be unaffected by currently available flu vaccines. Researchers are making and testing possible H5N1 vaccines now.

Large amounts of vaccine cannot be made before knowing exactly which virus will cause the pandemic. It could then take up to 6 months before a vaccine is available and in only limited amounts at first. Research is underway to make vaccines more quickly.

9.      How many influenza vaccine manufacturers have production facilities in the United States?

Currently, Sanofi Pasteur and Medimmune have influenza vaccine production facilities in the United States, although only Sanofi Pasteur's entire production process is based in this country.

HHS has made the establishment and expansion of U.S.-based manufacturing facilities for influenza vaccine a key component of its strategy to improve the security of the influenza vaccine supply.

10.  How will vaccine be distributed if a pandemic breaks out?

Most likely, the federal government will work with manufacturers, distributors and states and the states will develop distribution plans at the local level. States are developing and improving plans to distribute a vaccine rapidly. These plans build on experience gained from other emergencies.

In addition, influenza vaccine makers already have systems in place to distribute vaccine. Tens of millions of doses of seasonal influenza vaccine are shipped every year, and during past shortages, vaccine makers have responded to urgent situations.

Fairness in vaccine distribution and use during a pandemic is important. Protecting people at high risk and protecting essential day-to-day services are also important considerations.

11.  What age groups are most likely to be affected during an influenza pandemic?

Although scientists cannot predict the specific consequences of an influenza pandemic, it is likely that many age groups would be seriously affected. Factors to consider include the following:

o                    Few if any people would have immunity to the virus

o                    The virus could spread rapidly.

o                    An influenza pandemic could temporarily disrupt activities important to overall public health, the economy, and essential community services.

 

12.  What is the difference between a vaccine and an antiviral?

Vaccines are usually given as a preventive measure. Currently available viral vaccines are usually made from either killed virus or weakened versions of the live virus or pieces of the virus that stimulate an immune response to the virus. When immunized, the body is then poised to fight or prevent infection more effectively.

Antivirals are drugs that may be given to help prevent viral infections or to treat people who have been infected by a virus. When given to treat people who have been infected, antiviral medications may help limit the impact of some symptoms and reduce the potential for serious complications, especially for people who are in high risk groups.

13.  How would antivirals be used?

Antivirals may help prevent infection in people at risk and lessen the impact of symptoms in those infected with influenza. It is unlikely that they would substantially modify the course or effectively contain the spread of an influenza pandemic.

A number of antiviral medications (antivirals) are approved by the U.S. Food and Drug Administration to treat and sometimes prevent flu. At this time, Tamiflu® and Relenza® are the most likely antivirals to be used in a pandemic. There are efforts to find new drugs and to increase the supply of antivirals. If everyone follows the recommended uses of antivirals there will be more available for those who need it most.

14.  What other strategies will help protect Americans?

In the event of a pandemic, certain public health measures may be important to help contain or limit the spread of infection as effectively as possible. The following actions could include:

o                    Treating sick and exposed people with antivirals,

o                    Isolating sick people in hospitals, homes, or other facilities,

o                    Identifying and quarantining exposed people,

o                    Closing schools and workplaces as needed,

o                    Canceling public events, and

o                    Restricting travel.


In addition, people should protect themselves by:

o                    Getting seasonal flu shots,

o                    Washing hands frequently with soap and water,

o                    Staying away from people who are sick, and

o                    Staying home if sick.

 

15.  How many people would die in a pandemic?

The consequences of an influenza pandemic are difficult to predict. Pandemics occurred three times in the past century. The most recent (1968) was the mildest and killed about 34,000 people in the United States. The most severe influenza pandemic in the past century occurred in1918 and killed about 500,000 Americans and up to 40 million people worldwide.

16.  Could terrorists spread the avian influenza viruses to create a worldwide pandemic?

Experts believe it highly unlikely that a pandemic influenza virus could be created by terrorists. Developing a pandemic influenza virus would require extraordinary scientific skill as well as sophisticated scientific equipment and other resources.

17.  What is the Government doing now to prepare for a pandemic flu outbreak?

Federal, State, and local health agencies are making plans to prepare for, respond to, and contain an outbreak of pandemic flu. HHS activities to prepare for a pandemic flu include:

o                    Supporting Federal, State, and local health agencies' efforts to prepare for and respond to a pandemic flu outbreak;

o                    Working with the World Health Organization (WHO) and other nations to help detect and contain outbreaks;

o                    Developing a national stockpile of antiviral drugs to help treat and control the spread of disease;

o                    Supporting the manufacture and testing of possible vaccines, including finding more reliable and quicker ways to make large quantities of vaccines; and

o                    Working with other Federal agencies to prepare and to encourage communities, businesses, and organizations to plan for a pandemic influenza outbreak.

 

18.  How many state and local governments are prepared for a pandemic outbreak?

Funding from CDC's Public Health Preparedness Cooperative Agreements has allowed state and local health agencies to enhance the capacity of their public health systems to respond to public health threats, including pandemic influenza.

All states have emergency plans for responding to an influenza pandemic. All states have reviewed their public health legal authorities pertaining to isolation and quarantine. States are in various phases of updating regulations and legislation after reviewing their current authorities. CDC's Public Health Law program is cataloging all state quarantine authorities.

As part of planning for smallpox, all states have developed plans for mass immunization. In the past 12 months, all states conducted exercises to test components of their smallpox plans and 46 conducted exercises related to components of their pandemic influenza plan. Exercises such as these allow states and communities to identify weaknesses and take corrective action.

19.  How would pandemic flu affect communities and businesses?

If an influenza pandemic occurs, many people could become sick at the same time and would be unable to go to work. Many would stay at home to care for sick family members. Schools and businesses might close to try to prevent disease spread. Large group gatherings might be canceled. Public transportation might be scarce. These are examples of challenges that local communities, schools, civic organizations, and businesses will have to work together on to plan for a pandemic response.

 

What can we do now?

 

Planning & Response Activities

Pandemic planning requires that people and entities not accustomed to responding to health crises understand the actions and priorities required to prepare for and respond to these potential risks. Information is provided on these pages to help every sector of society, from federal, state and local government to individuals and families, participate in our national planning efforts.

The following check list should be freely distributed to any person or group that request information

City of Selma priority of needs

·          Establish a committee do deal with information and future planning

·          Identify and establish an EOC

·          Work with state and Federal agency on planning

·          Train all city employees on awareness and prevention

·          Maintain information updates on health issues

·          Establish PIO

 

 

The following checklist will serve as a guide to help the public and businesses prepare. In order understand we need to make some assumption with regards to planning. In simple terms we must plan for worst and educate for the best outcome.

 

 Pandemic Planning Assumptions

 Planning Assumptions

·          Susceptibility to the pandemic influenza virus will be universal.

·          Efficient and sustained person-to-person transmission signals an imminent pandemic.

·          The clinical disease attack rate will likely be 30% or higher in the overall population during the pandemic. Illness rates will be highest among school-aged children (about 40%) and decline with age. Among working adults, an average of 20% will become ill during a community outbreak.

·          Some persons will become infected but not develop clinically significant symptoms. Asymptomatic or minimally symptomatic individuals can transmit infection and develop immunity to subsequent infection.

·          Of those who become ill with influenza, 50% will seek outpatient medical care.

·          With the availability of effective antiviral drugs for treatment, this proportion may be higher in the next pandemic.

·          The number of hospitalizations and deaths will depend on the virulence of the pandemic virus. Estimates differ about 10-fold between more and less severe scenarios. Two scenarios are presented based on extrapolation of past pandemic experience (Table 1). Planning should include the more severe scenario.

·          Risk groups for severe and fatal infection cannot be predicted with certainty but are likely to include infants, the elderly, pregnant women, and persons with chronic medical conditions.

·          Rates of absenteeism will depend on the severity of the pandemic.

·          In a severe pandemic, absenteeism attributable to illness, the need to care for ill family members, and fear of infection may reach 40% during the peak weeks of a community outbreak, with lower rates of absenteeism during the weeks before and after the peak.

·          Certain public health measures (closing schools, quarantining household contacts of infected individuals, “snow days”) are likely to increase rates of absenteeism.

·          The typical incubation period (interval between infection and onset of symptoms) for influenza is approximately 2 days.

·          Persons who become ill may shed virus and can transmit infection for up to one day before the onset of illness. Viral shedding and the risk of transmission will be greatest during the first 2 days of illness. Children usually shed the greatest amount of virus and therefore are likely to post the greatest risk for transmission.

·          On average, infected persons will transmit infection to approximately two other people.

·          In an affected community, a pandemic outbreak will last about 6 to 8 weeks.

·          Multiple waves (periods during which community outbreaks occur across the country) of illness could occur with each wave lasting 2-3 months. Historically, the largest waves have occurred in the fall and winter, but the seasonality of a pandemic cannot be predicted with certainty.

 

Table 1. Number of Episodes of Illness, Healthcare Utilization, and Death Associated with Moderate and Severe Pandemic Influenza Scenarios*

Characteristic

Moderate (1958/68-like)

Severe (1918-like)

Illness 90 million (30%) 90 million (30%)
Outpatient medical care 45 million (50%) 45 million (50%)
Hospitalization 865,000 9,900,000
ICU care 128,750 1,485,000
Mechanical ventilation 64,875 745,500
Deaths 209,000 1,903,000

*Estimates based on extrapolation from past pandemics in the United States. Note that these estimates do not include the potential impact of interventions not available during the 20th century pandemics.

City of Selma Pandemic Influenza Planning Checklist

 

Community Preparedness Leadership and Networking [Preparedness Goal 1-Increase the use and development of interventions known to prevent human illness from chemical, biological, radiological agents, and naturally occurring health threats.]

Tasks

Not Started

In Progress

Completed

·                     Establish a Pandemic Preparedness Coordinating Committee that represents all relevant stakeholders in the jurisdiction (including governmental, public health, healthcare, emergency response, agriculture, education, business, communication, community based, and faith-based sectors, as well as private citizens) and that is accountable for articulating strategic priorities and overseeing the development and execution of the jurisdiction's operational pandemic plan.

·                     Delineate accountability and responsibility, capabilities, and resources for key stakeholders engaged in planning and executing specific components of the operational plan. Assure that the plan includes timelines, deliverables, and performance measures.

·                     Within every state, clarify which activities will be performed at a state, local, or coordinated level, and indicate what role the state will have in providing guidance and assistance.

·                     Assure that the operational plan for pandemic influenza response is an integral element of the overall state and local emergency response plan established under Federal Emergency Support Function 8 (ESF8): Health and medical service and compliant with National Incident Management System.

·                     Address integration of state, local, tribal, territorial, and regional plans across jurisdictional boundaries in the plan.

·                     Formalize agreements with neighboring jurisdictions and address communication, mutual aid, and other cross-jurisdictional needs.

·                     Ensure existence of a demographic profile of the community (including special needs populations and language minorities) and ensure that the needs of these populations are addressed in the operation plan.

·                     Address provision of psychosocial support services for the community, including patients and their families, and those affected by community containment procedures in the plan (see Supplement 11).

·                     Test the communication operational plan that addresses the needs of targeted public, private sector, governmental, public health, medical, and emergency response audiences; identifies priority channels of communication; delineates the network of communication personnel, including lead spokespersons and persons trained in emergency risk communication; and links to other communication networks (see Supplement 10).

·                     Identify for all stakeholders the legal authorities responsible for executing the operational plan, especially those authorities responsible for case identification, isolation, quarantine, movement restriction, healthcare services, emergency care, and mutual aid.

·                     Make clear to all stakeholders the process for requesting, coordinating, and approving requests for resources to state and federal agencies.

·                     Create an Incident Command System for the pandemic plan based on the National Incident Management System and exercise this system along with other operational elements of the plan.

·                     Assist in establishing and promoting community-based task forces that support healthcare institutions on a local or regional basis.

·                     Identify the authority responsible for declaring a public health emergency at the state and local levels and for officially activating the pandemic influenza response plan.

·                     Identify the state and local law enforcement personnel who will maintain public order and help implement control measures. Determine in advance what will constitute a “law enforcement” emergency and educate law enforcement officials so that they can pre-plan for their families and sustain themselves during the emergency.

·                     Ensure that the plans are scalable, to the magnitude and severity of the pandemic and available resources. Revise as necessary.

 

 

 

 

Individuals & Families Planning

You can prepare for an influenza pandemic now. You should know both the magnitude of what can happen during a pandemic outbreak and what actions you can take to help lessen the impact of an influenza pandemic on you and your family. This checklist will help you gather the information and resources you may need in case of a flu pandemic.

1.      To plan for a pandemic:

o                    Store a supply of water and food. During a pandemic, if you cannot get to a store, or if stores are out of supplies, it will be important for you to have extra supplies on hand. This can be useful in other types of emergencies, such as power outages and disasters.

o                    Have any nonprescription drugs and other health supplies on hand, including pain relievers, stomach remedies, cough and cold medicines, fluids with electrolytes, and vitamins.

o                    Talk with family members and loved ones about how they would be cared for if they got sick, or what will be needed to care for them in your home.

o                    Volunteer with local groups to prepare and assist with emergency response.

o                    Get involved in your community as it works to prepare for an influenza pandemic.

 

2.      To limit the spread of germs and prevent infection:

o                    Teach your children to wash hands frequently with soap and water, and model the correct behavior.

o                    Teach your children to cover coughs and sneezes with tissues, and be sure to model that behavior.

o                    Teach your children to stay away from others as much as possible if they are sick. Stay home from work and school if sick.

 

3.      Items to have on hand for an extended stay at home:

Examples of food and non-perishables

Examples of medical, health, and emergency supplies

o                                            Ready-to-eat canned meats, fruits, vegetables, and soups

o                                            Prescribed medical supplies such as glucose and blood-pressure monitoring equipment

o                                            Protein or fruit bars

o                                            Soap and water, or alcohol-based hand wash

o                                            Dry cereal or granola

o                                            Medicines for fever, such as acetaminophen or ibuprofen

o                                            Peanut butter or nuts

o                                            Thermometer

o                                            Dried fruit

o                                            Anti-diarrheal medication

o                                            Crackers

o                                            Vitamins

o                                            Canned juices

o                                            Fluids with electrolytes

o                                            Bottled water

o                                            Cleansing agent/soap

o                                            Canned or jarred baby food and formula

o                                            Flashlight

o                                            Pet food

o                                            Batteries

 

o                                            Portable radio

 

o                                            Manual can opener

 

o                                            Garbage bags

 

o                                            Tissues, toilet paper, disposable diapers

 

Family Emergency Health Information Sheet

It is important to think about health issues that could arise if an influenza pandemic occurs, and how they could affect you and your loved ones. For example, if a mass vaccination clinic is set up in your community, you may need to provide as much information as you can about your medical history when you go, especially if you have a serious health condition or allergy.

Create a family emergency health plan using this information. Fill in information for each family member in the space provided. Like much of the planning for a pandemic, this can also help prepare for other emergencies.

Family Member Information:

Family Member

Blood Type

Allergies

Past/ Current Medical Conditions

Current Medications/ Dosages

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Emergency Contacts Form

Contacts

Name/Phone Number

Local personal emergency contact

 

Out-of-town personal emergency contact

 

Hospitals near:              Work

 

                                  School

 

                                  Home

 

Family physician(s)

 

State public health department
(See list on www.cdc.gov/other.htm#states)

 

Pharmacy

 

Employer contact and emergency information

 

School contact and emergency information

 

Religious/spiritual organization

 

 

Social Disruption May Be Widespread

·                     Plan for the possibility that usual services may be disrupted. These could include services provided by hospitals and other health care facilities, banks, stores, restaurants, government offices, and post offices.

·                     Prepare backup plans in case public gatherings, such as volunteer meetings and worship services, are canceled.

·                     Consider how to care for people with special needs in case the services they rely on are not available.

 

 

 

 


Being Able to Work May Be Difficult or Impossible

·                     Find out if you can work from home.

·                     Ask your employer about how business will continue during a pandemic. (A Business Pandemic Influenza Planning Checklist is available at www.pandemicflu.gov/plan/businesschecklist.html.)

·                     Plan for the possible reduction or loss of income if you are unable to work or your place of employment is closed.

·                     Check with your employer or union about leave policies.


Schools May Be Closed for an Extended Period of Time

·                     Help schools plan for pandemic influenza. Talk to the school nurse or the health center. Talk to your teachers, administrators, and parent-teacher organizations.

·                     Plan home learning activities and exercises. Have materials, such as books, on hand. Also plan recreational activities that your children can do at home.

·                     Consider childcare needs.

 


Transportation Services May Be Disrupted

·                     Think about how you can rely less on public transportation during a pandemic. For example, store food and other essential supplies so you can make fewer trips to the store.

·                     Prepare backup plans for taking care of loved ones who are far away.

·                     Consider other ways to get to work, or, if you can, work at home.


People Will Need Advice and Help at Work and Home

·                     Think about what information the people in your workplace will need if you are a manager. This may include information about insurance, leave policies, working from home, possible loss of income, and when not to come to work if sick. (A Business Pandemic Influenza Planning Checklist is available at www.pandemicflu.gov/plan/businesschecklist.html.)

·                     Meet with your colleagues and make lists of things that you will need to know and what actions can be taken.

·                     Find volunteers who want to help people in need, such as elderly neighbors, single parents of small children, or people without the resources to get the medical help they will need.

·                     Identify other information resources in your community, such as mental health hotlines, public health hotlines, or electronic bulletin boards.

·                     Find support systems—people who are thinking about the same issues you are thinking about. Share ideas.


 

 

Be Prepared

Stock a supply of water and food. During a pandemic you may not be able to get to a store. Even if you can get to a store, it may be out of supplies. Public waterworks services may also be interrupted. Stocking supplies can be useful in other types of emergencies, such as power outages and disasters. Store foods that:

·                     are nonperishable (will keep for a long time) and don't require refrigeration

·                     are easy to prepare in case you are unable to cook

·                     require little or no water, so you can conserve water for drinking

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.


Get Informed

Knowing the facts is the best preparation. Identify sources you can count on for reliable information. If a pandemic occurs, having accurate and reliable information will be critical.

·                     Reliable, accurate, and timely information is available at www.pandemicflu.gov.

·                     Another source for information on pandemic influenza is the Centers for Disease Control and Prevention (CDC) Hotline at: 1-800-CDC-INFO (1-800-232-4636). This line is available in English and Spanish, 24 hours a day, 7 days a week. TTY: 1-888-232-6348. Questions can be e-mailed to cdcinfo@cdc.gov.

·                     Look for information on your local and state government Web sites. Links are available to each state department of public health at www.cdc.gov/other.htm#states.

·                     Listen to local and national radio, watch news reports on television, and read your newspaper and other sources of printed and Web-based information.

·                     Talk to your local health care providers and public health officials.

As you begin your individual or family planning, you may want to review your state's planning efforts and those of your local public health and emergency preparedness officials. Many of the state plans and other planning information can be found at pandemicflu.gov/plan/tab2.html.

Business Pandemic Influenza Planning Checklist

Plan for the impact of a pandemic on your business:

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·                     Identify a pandemic coordinator and/or team with defined roles and responsibilities for preparedness and response planning. The planning process should include input from labor representatives.

·                     Identify essential employees and other critical inputs (e.g. raw materials, suppliers, sub-contractor services/ products, and logistics) required to maintain business operations by location and function during a pandemic.

·                     Train and prepare ancillary workforce (e.g. contractors, employees in other job titles/descriptions, retirees).

·                     Develop and plan for scenarios likely to result in an increase or decrease in demand for your products and/or services during a pandemic (e.g. effect of restriction on mass gatherings, need for hygiene supplies).

Determine potential impact of a pandemic on company business financials using multiple possible scenarios that affect different product lines and/or production sites.

 

 

·                     Determine potential impact of a pandemic on business-related domestic and international travel (e.g. quarantines, border closures).

·                     Find up-to-date, reliable pandemic information from community public health, emergency management, and other sources and make sustainable links.

·                     Establish an emergency communications plan and revise periodically. This plan includes identification of key contacts (with back-ups), chain of communications (including suppliers and customers), and processes for tracking and communicating business and employee status.

·                     Implement an exercise/drill to test your plan, and revise periodically.

 

 

 

 


Plan for the impact of a pandemic on your employees and customers:

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·                     Forecast and allow for employee absences during a pandemic due to factors such as personal illness, family member illness, community containment measures and quarantines, school and/or business closures, and public transportation closures.

·                     Implement guidelines to modify the frequency and type of face-to-face contact (e.g. hand-shaking, seating in meetings, office layout, shared workstations) among employees and between employees and customers (refer to CDC recommendations).

·                     Encourage and track annual influenza vaccination for employees.

  • Evaluate employee access to and availability of healthcare services during a pandemic, and improve services as needed.

·                     Evaluate employee access to and availability of mental health and social services during a pandemic, including corporate, community, and faith-based resources, and improve services as needed.

·                     Identify employees and key customers with special needs, and incorporate the requirements of such persons into your preparedness plan.


1.3 Establish policies to be implemented during a pandemic:

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·                     Establish policies for employee compensation and sick-leave absences unique to a pandemic (e.g. non-punitive, liberal leave), including policies on when a previously ill person is no longer infectious and can return to work after illness.

·                     Establish policies for flexible worksite (e.g. telecommuting) and flexible work hours (e.g. staggered shifts).

·                     Establish policies for preventing influenza spread at the worksite (e.g. promoting respiratory hygiene/ cough etiquette, and prompt exclusion of people with influenza symptoms).

·                     Establish policies for employees who have been exposed to pandemic influenza, are suspected to be ill, or become ill at the worksite (e.g. infection control response, immediate mandatory sick leave).

·                     Establish policies for restricting travel to affected geographic areas (consider both domestic and international sites), evacuating employees working in or near an affected area when an outbreak begins, and guidance for employees returning from affected areas (refer to CDC travel recommendations).

·                                Set up authorities, triggers, and procedures for activating and terminating the company's response plan, altering business operations (e.g. shutting down operations in affected areas), and transferring business knowledge to key employees.


1.4 Allocate resources to protect your employees and customers during a pandemic:

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·                     Provide sufficient and accessible infection control supplies (e.g.hand-hygiene products, tissues and receptacles for their disposal) in all business locations.

·                     Enhance communications and information technology infrastructures as needed to support employee telecommuting and remote customer access.

·                     Ensure availability of medical consultation and advice for emergency response.

 

 

 

 


1.5 Communicate to and educate your employees:

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·                     Develop and disseminate programs and materials covering pandemic fundamentals (e.g. signs and symptoms of influenza, modes of transmission), personal and family protection and response strategies (e.g. hand hygiene, coughing/sneezing etiquette, contingency plans).

·                     Anticipate employee fear and anxiety, rumors and misinformation and plan communications accordingly.

·                     Ensure that communications are culturally and linguistically appropriate.

·                     Disseminate information to employees about your pandemic preparedness and response plan.

·                     Provide information for the at-home care of ill employees and family members.

·                     Develop platforms (e.g. hotlines, dedicated websites) for communicating pandemic status and actions to employees, vendors, suppliers, and customers inside and outside the worksite in a consistent and timely way, including redundancies in the emergency contact system.

·                     Identify community sources for timely and accurate pandemic information (domestic and international) and resources for obtaining counter-measures (e.g. vaccines and antivirals).

 

 

 

 

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1.6 Coordinate with external organizations and help your community:

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·                     Collaborate with insurers, health plans, and major local healthcare facilities to share your pandemic plans and understand their capabilities and plans.

·                     Collaborate with federal, state, and local public health agencies and/or emergency responders to participate in their planning processes, share your pandemic plans, and understand their capabilities and plans.

·                     Communicate with local and/or state public health agencies and/or emergency responders about the assets and/or services your business could contribute to the community.

·                     Share best practices with other businesses in your communities, chambers of commerce, and associations to improve community response efforts.

 

 

 

Child Care and Preschool Pandemic Influenza Planning Checklist

 

Planning and Coordination:

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·                     Form a committee of staff members and parents to produce a plan for dealing with a flu pandemic. Include members from all different groups your program serves. Include parents who do not speak English who can help contact other non-English speakers in the community. Staff of very small programs might consider joining together with other similar programs for planning.

·                     Assign one person to identify reliable sources of information and watch for public health warnings about flu, school closings, and other actions taken to prevent the spread of flu.

·                     Learn who in your area has legal authority to close child care programs if there is a flu emergency.

·                     Learn whether the local/state health departments and agencies that regulate child care have plans. Be sure your flu plan is in line with their plans. Tell them if you can help support your community's plan.

·                     Identify all the ways a flu pandemic might affect your program and develop a plan of action. (For example, you might have problems with food service, transportation, or staffing.)

 

·                     Encourage parents to have a "Plan B" for finding care for their children if the program is closed during a flu pandemic. Give them ideas about where they might seek help based on your knowledge of the local child care community.

·                     Work with those in charge of your community's plan to find other sources of meals for low-income children who receive subsidized meals while in your care. (For example, locate food pantries and meals on wheels.)

·                     Learn about services in your area that can help your staff, children, and their families deal with stress and other problems caused by a flu pandemic.

·                     Stage a drill to test your plan and then improve it as needed. Repeat the drill from time to time. Consider volunteering to help in tests of community plans.

·                     Talk to other child care and preschool programs in your area to share information that could make your plan better. Discuss ways programs could work together to produce a stronger plan and pool resources.


 

 

 

 

2. Student Learning and Program Operations:

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·                     Plan how you would deal with program closings, staff absences, and gaps in student learning that could occur during a flu pandemic.

·                     Plan ways to help families continue their child's learning if your child care program or preschool is closed. (For example, give parents things they can teach at home. Tell them how to find ideas on the internet. Talk with child care resource referral agencies or other groups that could help parents continue their children's learning at home.)

·                     Plan ways to continue basic functions if your program is closed. (For example, continue meeting payroll and keeping in touch with staff and student's families.)

 

 

 

 

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3. Infection Control Policies and Actions:

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·                     Give special attention to teaching staff, children, and their parents on how to limit the spread of infection. (For example, use good hand washing; cover the mouth when coughing or sneezing; clean toys frequently.) Programs should already be teaching these things to build habits that protect children from disease. (See www.cdc.gov/flu/school/ and www.healthykids.us/cleanliness.htm.)

·         Keep a good supply of things you will need to help control the spread of infection. (For example, keep on hand plenty of soap, paper towels, and tissues.) Store the supplies in easy-to-find places.

·                     Tell families that experts recommend yearly flu shots for all children 6 months to 5 years old and for anyone who cares of children in that age range.(See www.cdc.gov/od/oc/media/pressrel/r060223.htm.)

·                     Encourage staff to get flu shots each year. (See www.cdc.gov/flu/protect/preventing.htm.)

·                     Tell parents to let your program know if their children are sick. Keep accurate records of when children or staff are absent. Include a record of the kind of illness that caused the absence (e.g., diarrhea/vomiting, coughing/breathing problems, rash, or other). (See http://nrc.uchsc.edu/CFOC/XMLVersion/Chapter_3.xml.)

·                     Teach staff a standard set of steps for checking children and adults each day as they arrive to see if they are sick. Make it clear that any child or adult who is ill will not be admitted. (See www.healthykids.us/chapters/sick_main.htm.)

·         Have a plan for keeping children who become sick at your program away from other children until the family arrives, such as a fixed place for a sick room.

 

·                     Require staff members to stay home if they think they might be sick. If they become sick while at the program, require them to go home and stay home. Give staff paid sick leave so they can stay home without losing wages.

·                     Require ill staff and students to stay at home until their flu symptoms are gone and they feel ready to come back to work.

Communications Planning:

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·                     Have a plan for keeping in touch with staff members and students' families. Include several different methods of contacting them. (For example, you might use hotlines, telephone trees, text messaging, special Websites, local radio and/or TV stations.) Test the contact methods often to be sure they work.

·                     Make sure staff and families have seen and understand your flu pandemic plan. Explain why you need to have a plan. Give them a chance to ask questions.

·                     Give staff and students' families reliable information on the issues listed below in their languages and at their reading levels.

§        How to help control the spread of flu by hand washing/cleansing and covering the mouth when coughing or sneezing. (See www.cdc.gov/flu/school/.)

§        How to recognize a person that may have the flu, and what to do if they think they have the flu. (See www.pandemicflu.gov.)

§        How to care for ill family members. (See www.hhs.gov/pandemicflu/plan/sup5.html#box4.)

Faith-Based & Community Organizations Pandemic Influenza Preparedness Checklist

 

Plan for the impact of a pandemic on your organization and its mission:

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·                     Assign key staff with the authority to develop, maintain and act upon an influenza pandemic preparedness and response plan.

·                     Determine the potential impact of a pandemic on your organization’s usual activities and services. Plan for situations likely to require increasing, decreasing or altering the services your organization delivers.

·                     Determine the potential impact of a pandemic on outside resources that your organization depends on to deliver its services (e.g., supplies, travel, etc.)

·                     Outline what the organizational structure will be during an emergency and revise periodically. The outline should identify key contacts with multiple back-ups, role and responsibilities, and who is supposed to report to whom.

·                     Identify and train essential staff (including full-time, part-time and unpaid or volunteer staff) needed to carry on your organization’s work during a pandemic. Include back up plans, cross-train staff in other jobs so that if staff are sick, others are ready to come in to carry on the work.

  • Test your response and preparedness plan using an exercise or drill, and review and revise your plan as needed.


 

 

 

2. Communicate with and educate your staff, members, and persons in the communities that you serve:

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·                     Find up-to-date, reliable pandemic information and other public health advisories from state and local health departments, emergency management agencies, and CDC. Make this information available to your organization and others.

·                     Distribute materials with basic information about pandemic influenza: signs and symptoms, how it is spread, ways to protect yourself and your family (e.g., respiratory hygiene and cough etiquette), family preparedness plans, and how to care for ill persons at home.

·                     When appropriate, include basic information about pandemic influenza in public meetings (e.g. sermons, classes, trainings, small group meetings and announcements).

·                     Share information about your pandemic preparedness and response plan with staff, members, and persons in the communities that you serve.

·                     Develop tools to communicate information about pandemic status and your organization’s actions. This might include websites, flyers, local newspaper announcements, pre-recorded widely distributed phone messages, etc.

·                     Consider your organization’s unique contribution to addressing rumors, misinformation, fear and anxiety.

·                     Advise staff, members, and persons in the communities you serve to follow information provided by public health authorities--state and local health departments, emergency management agencies, and CDC.

·                                Ensure that what you communicate is appropriate for the cultures, languages and reading levels of your staff, members, and persons in the communities that you serve.


3. Plan for the impact of a pandemic on your staff, members, and the communities that you serve:

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·                     Plan for staff absences during a pandemic due to personal and/or family illnesses, quarantines, and school, business, and public transportation closures. Staff may include full-time, part-time and volunteer personnel.

·                     Work with local health authorities to encourage yearly influenza vaccination for staff, members, and persons in the communities that you serve.

·                     Evaluate access to mental health and social services during a pandemic for your staff, members, and persons in the communities that you serve; improve access to these services as needed.

  • Identify persons with special needs (e.g. elderly, disabled, limited English speakers) and be sure to include their needs in your response and preparedness plan. Establish relationships with them in advance so they will expect and trust your presence during a crisis.


4. Set up policies to follow during a pandemic:

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·                     Set up policies for non-penalized staff leave for personal illness or care for sick family members during a pandemic.

·                     Set up mandatory sick-leave policies for staff suspected to be ill, or who become ill at the worksite. Employees should remain at home until their symptoms resolve and they are physically ready to return to duty (Know how to check up-to-date CDC recommendations).

·                     Set up policies for flexible work hours and working from home.

·                     Evaluate your organization’s usual activities and services (including rites and religious practices if applicable) to identify those that may facilitate virus spread from person to person. Set up policies to modify these activities to prevent the spread of pandemic influenza (e.g. guidance for respiratory hygiene and cough etiquette, and instructions for persons with influenza symptoms to stay home rather than visit in person.)

·                     Follow CDC travel recommendations during an influenza pandemic. Recommendations may include restricting travel to affected domestic and international sites, recalling non-essential staff working in or near an affected site when an outbreak begins, and distributing health information to persons who are returning from affected areas.

·                     Set procedures for activating your organization’s response plan when an influenza pandemic is declared by public health authorities and altering your organization’s operations accordingly.


5. Allocate resources to protect your staff, members, and persons in the communities that you serve during a pandemic:

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·                     Determine the amount of supplies needed to promote respiratory hygiene and cough etiquette and how they will be obtained.

·                     Consider focusing your organization’s efforts during a pandemic to providing services that are most needed during the emergency (e.g. mental/spiritual health or social services).


6. Coordinate with external organizations and help your community:

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·                     Understand the roles of federal, state, and local public health agencies and emergency responders and what to expect and what not to expect from each in the event of a pandemic.

·                     Work with local and/or state public health agencies, emergency responders, local healthcare facilities and insurers to understand their plans and what they can provide, share about your preparedness and response plan and what your organization is able to contribute, and take part in their planning. Assign a point of contact to maximize communication between your organization and your state and local public health systems.

·                     Coordinate with emergency responders and local healthcare facilities to improve availability of medical advice and timely/urgent healthcare services and treatment for your staff, members, and persons in the communities that you serve.

·                     Share what you’ve learned from developing your preparedness and response plan with other Faith- Based and Community Organizations to improve community response efforts.

·                     Work together with other Faith-Based and Community Organizations in your local area and through networks (e.g. denominations, associations, etc) to help your communities prepare for pandemic influenza.