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The Coming Avian Flu Pandemic

Looking into Lessons of the Past to Plan for the Future

Flu Terms Defined
• Seasonal (or common) flu is a respiratory illness that can be transmitted person to person. Most people have some immunity, and a vaccine is available. • Avian (or bird) flu is caused by influenza viruses that occur naturally among wild birds. The H5N1 variant is deadly to domestic fowl and can be transmitted from birds to humans. There is no human immunity and no vaccine is available. • Pandemic flu is virulent human flu that causes a global outbreak, or pandemic, of serious illness. Because there is little natural immunity, the disease can spread easily from person to person. Currently, there is no pandemic flu.

A Historical Perspective
• In the last century there were three influenza pandemics. All of them were called pandemics because of their worldwide spread and because they were caused by a new influenza virus. The 1918 pandemic was especially severe. • 1918-1919 Most severe, caused at least 675,000 U.S. deaths and up to 50 million deaths worldwide. • 1957-1958 Moderately severe, caused at least 70,000 U.S. deaths and 1-2 million deaths worldwide. • 1968-1969 Least severe, caused at least 34,000 U.S. deaths and 700,000 deaths worldwide.

The 1918 flu virus is resurrected

How virulent was the 1918 flu?
• 50 times as many virus particles are released from human lung cells a day after infection with the 1918 virus as are released after exposure to a contemporary strain called the Texas virus. • 13% of body weight is lost by mice 2 days after infection with 1918 flu; weight loss is only transient in mice infected with the Texas strain. • 39,000 times more virus particles are found in mouse lung tissue 4 days after infection with 1918 flu than are found with the Texas virus. • All mice died within 6 days of infection with 1918 flu; none died from the Texas strain.

The Coming vian lu andemic
• Deadly avian flu is “on the wing” • Carried by migratory birds across Asia in their digestive track (Avian) • H5N1, the avian flu subtype that has killed 61 people in Southeast Asia is spreading • H5N1 is on the verge of mutating into a pandemic form like that which killed 50 to 100 million people in the fall of 1918 • H5N1's human epicenter will expand into the dense overcrowded slums of Asia

Bird Migration

Nations With Confirmed Cases H5N1 Avian Influenza (May 12)

Likely Scenario: The Beginning
• In April of 2008, an outbreak of severe respiratory illness is identified in a small Asian village • In May, Twenty patients have required hospitalization at the local hospital, five of whom have died from pneumonia and respiratory failure • The flu spreads and begins to make headlines around the world. Top health officials swing into action and isolate the new viral strain in laboratories. The scientists discover that "the vaccine developed previously for the avian strain will only provide partial protection," • In June, federal health officials find airline passengers infected with the virus "arriving in four major U.S. cities,"

1st Week Spread

The Outbreak
• By July, small outbreaks are being reported around the nation. • The Killer Flu spreads rapidly from cities to rural areas. • As the outbreak peaks, about a quarter of workers stay home because they are sick or afraid of becoming sick. Hospitals are overwhelmed.

2nd and 3rd Weeks Spread

4th Week Spread

5th Week

The Endgame
• "Social unrest occurs" • "Public anxiety heightens mistrust of government, diminishing compliance with public health advisories." Mortuaries and funeral homes are overwhelmed. • 1.9 million Americans would die and 8.5 million would be hospitalized

Struggling with the flu
• Troubling weaknesses in the nation's publichealth system. • The United States relies on private companies to make flu vaccine. • Bush signed the Project Bioshield Act in 2004 yet little has been done. • Whether the threat is bioterror or flu, the lack of vigor in the health care system is become critical.

U.S. Slowly Preparing for Deadly Flu
• The United States is slowly preparing for what could become the worst disaster in the nation's history. • The flu is one of the most infectious agents to humans • A concern about avian flu has prompted the Senate to approve $4 billion for bird flu readiness. • A plan has been developed by the Bush administration to deal with any possible outbreak of the avian flu.

State Government should Prepare Now
• A large outbreak that begins in Asia would likely strike the US within weeks. • Who will get vaccines first:
– – – – – – – workers in plants making the vaccines medical personnel elderly and severely ill pregnant women transplant and AIDS patients parents of infants police, firefighters and government leaders

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

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: 1888-232-6348. 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.

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At the Tipping Point
• The California Legislature should approve an Omnibus Reporting Act • People in close or crowded contact (like college students) should become aware of the Flu. • Antiviral medications (like Tamiflu) can be taken to:
– Reduce the severity and duration of symptoms caused by infection with the influenza virus. – Shorten the length of the illness. – Control outbreaks of the flu. – Reduce the spread of the virus to people at high risk for severe complications of the flu (high-risk groups). – Reduce complications from the flu.

• Get Your Yearly immunization