gellin Sept28 06

HHS Pandemic Influenza Preparedness Planning Bruce Gellin, MD, MPH Director, National Vaccine Program Office US Department of Health and Human Services

*Status as of: September 27, 2006

CASES

DEATHS

2003

4

4

2004

46

32

2005

97

42

2006

104

69

TOTAL*

251

147

Phases of a Pandemic: Where We Are Now

Situation Report: Avian Influenza

 Widespread and spreading prevalence in migratory birds; broad host range

 Continued outbreaks among domestic poultry  Mammalian infection (cats, pigs, etc.) lethal  Virus is evolving  Sporadic human cases (>250 reports to date) • Most in young and healthy • Case-fatality 50% • Rare person-to-person transmission

Insights from Models

Large urban centres affected first, followed by spread to less densely populated areas

U.S. Pandemic Influenza Preparedness and Response Planning National Strategy: Goals and doctrine

State and Local Plans

National Implementation Plan: Federal actions & performance measures

Healthcare Org. Plans

HHS Pandemic Plan: Health care focus preparedness & response

Business Continuity Plans

Department Implementation Plans: Actions & performance measures

Organizational Plans

Agency Operations Plans: Actions & continuity of operations

Public (Family) Plans

Principles • Federal government will use all instruments of national power • States and communities should have credible preparedness plans • Private sector should play an integral role • Individual citizens should be educated about actions to protect themselves and others • Global partnerships will be leveraged

Objectives • Provide guidance on implementation of the Strategy to departments and agencies, and a foundation for coordinated and department-specific planning • Communicate expectations of non-federal entities (S/L governments, private sector and critical infrastructure entities, individuals) • Articulate the specific roles and responsibilities of departments and agencies, and the manner in which the USG will respond to a pandemic

HHS Pandemic Influenza Plan • • • • • • • • • • •

Surveillance Laboratory Diagnostics Healthcare Planning Infection Control Clinical Guidelines Vaccine Distribution and Use Antiviral Drug Distribution and Use Community Disease Control and Prevention Managing Travel-Related Risks of Disease Public Health Communications Workforce Support: Psychosocial Considerations and Information Needs

Planning Assumptions: Health Care Moderate (1957-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

• •

50% or more of those who become ill will seek medical care Number of hospitalizations and deaths will depend on the virulence of the pandemic virus

“Workforce issues among healthcare workers, utility operators, transportation providers, or law enforcement not only create economic disruptions, they are threats to the safety and security of our nation.�

Potential Impacts of Strategies to Decrease Influenza Transmission 1. Delay disease transmission and outbreak peak 2. Decompress peak burden on healthcare infrastructure 3. Diminish overall cases and health impacts #1

Pandemic outbreak: No intervention

#2

Daily Cases

Pandemic outbreak: With intervention #3 Days since first case

CDC Guidance to State Pandemic Preparedness Plans: Exercises •

Non-pharmacological interventions and a community containment plan to help contain the spread of pandemic influenza – with emphasis on school closing decisions and discouragement of large public gatherings

•

Medical surge to accommodate influenza victims

•

Seasonal influenza vaccination clinics to exercise mass prophylaxis capabilities, including points-of-dispensing July 2006

Antiviral Drugs • Stockpile – HHS has approximately 36 million courses of antivirals on hand and/or on order.

• Strategy – Goal: 81 million courses of antivirals • 6 million courses to be used to contain an initial U.S. outbreak • 75 million courses to treat 25 percent of U.S. population – Accelerate development of promising new antiviral drugs

Estimated Current US Annual Domestic Production of Pandemic Influenza Vaccine: Supply, Capacity, and Need

People vaccinated* (Millions)

300 250 200 150 100 50 0

A

B

C

A: Current stockpile B: Current annual domestic capacity - Assumes all capacity dedicated to pandemic vaccine - Assumes NO annual influenza vaccine C: National need *Assumes 2 doses/person; 90 ug/dose

Overcoming Challenges to Pandemic Vaccine: Domestic Production of Modern Vaccine

• Expand production of current (eggbased) vaccine • Create “pre-pandemic” vaccine stockpiles • Evaluate dose-sparing technology (adjuvants, intramuscular vs. intradermal route) • Accelerate development of modern (non-egg) vaccines • Target new antigens

Current Recommendations for Prioritization of Pandemic Influenza Vaccine

Public Engagement on Pandemic Vaccine Priorities • Meetings of stakeholder organization representatives and the general public – Educated on influenza, pandemics & pandemic planning – Asked to define and prioritize values for vaccine use • Outcome – All groups defined preserving essential societal functions as the primary goal – Protecting at-risk persons was second

Vaccine Production After Pandemic Begins Vaccine Production After Pandemic Emerges (45 ug/dose) 350

Vaccine Courses (millions)

300 250

Dec. 06 Dec. 07

200

Dec. 08 Dec. 09

150

Dec. 10 Dec. 11

100 50 0 Month 1

Month 2

Month 3

Month 4

Month 5

Months After Pandemic Begins

Month 6

Seasonal Influenza Preparedness

Pandemic Influenza Preparedness

www.pandemicflu.gov www.pandemicflu.gov