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INFLUENZA
VIDEOCONFERENCE FOR TRIBES (Agenda
for a videoconference prepared by the Alaska
Videoconference participants will understand the differences and relationships between avian (bird) flu and pandemic flu Participants will understand the various influenza initiatives currently going on in Alaska. Participants will understand what information is being developed for subsistence hunters and others concerned about bird flu. Participants will understand their role and the role of tribal health corporations including ANTHC in bird flu and pandemic flu preparedness AGENDA OVERVIEW OF BIRD FLU AND PANDEMIC FLU – WHAT IS THE DIFFERENCE, WHAT IS THE RELATIONSHIP? What is Meant by Bird Flu? Bird flu refers to the avian H5N1 strain circulating in Asia and Europe. It has become endemic in wild water birds and very likely will spread to other regions during the spring migration. Is H5N1 Bird Flu in Alaska? It could reach Alaska and a comprehensive bird flu surveillance program has been developed to detect it. But it hasn’t been found here yet. What would be the risk if it reaches Alaska? • All scientists and biologists believe the risk to Alaskans from H5N1 bird flu is very minimal. • Extensive surveillance in wild birds over the last 3 years indicates it has not reached Alaska. • H5N1 bird flu is not an efficient human disease. The H5N1 bird flu strain does not readily infect humans. Over the past 3 years the H5N1 bird flu strain has infected around 170 people in a region inhabited by perhaps 500 million people. That is an extremely small attack rate. When it does infect humans it doesn’t spread to other humans. • People that have been infected have a history of close prolonged exposure to domestic poultry. To date there have been no cases associated with exposure to wild birds. Why is there so much concern among scientists and health officials about the H5N1 bird flu strain? • About half of those people diagnosed with the H5N1 bird flu have died. Once it infects humans it is very deadly. • Research on the origin of previous human pandemics (world wide epidemics) of influenza indicates they can originate from bird flu strains or as a combination of bird, animal and human flu strains. The deadly influenza strain of 1918-19 originated from a bird virus. It mutated and developed the ability to easily spread among humans and it was also very deadly. • Research also shows that human influenza strains do not readily infect birds. And bird strains like the current H5N1 bird strain do not readily infect humans. Why don’t bird strains infect humans and human strains infect birds? • Like all viruses Influenza must get inside a host cell for them to cause disease and produce new viruses. An influenza virus infects a host by attaching to a specific site on the cell wall of a bird or human. The structure of the virus that attaches to the cell wall must perfectly match the structure on the cell wall. If it doesn’t match, the virus can’t penetrate the cell and the host will not be infected. • The sites on the cell walls of birds and humans where the influenza virus attaches are different in birds and humans. That is why a bird virus can’t or very rarely infect humans and why human viruses don’t infect birds. Bird viruses have the structure needed to attach to and infect bird cells. Human viruses have the right structure to attach to and infect human cells. • And that is why the attack rate in humans from the bird H5N1 virus is so low! Could the H5N1 bird strain become a human pandemic influenza disease agent? • Yes if the H5N1 strain mutates so it develops the ability to become readily transmitted human to human it could become the next human pandemic flu strain. • So far it has not done that, and massive research and surveillance is under way to detect if this occurs – if the H5N1 bird strain mutates and becomes a human influenza virus. • Among scientists this is the biggest concern about the H5N1 bird flu strain. It is not that the current H5N1 strain poses a significant human public health risk. 170 cases in a population as large as occurs in Southern China and SE Asia is not a significant public health problem. The concern is that the H5N1 strain will change from a bird virus to a human virus. • If it does it will be a completely new strain and very well may not be anywhere as severe as the current H5N1 bird strain. What would be good advice for Alaskans who hunt and consume wild water birds? • Potentially a wild water bird migrating from Asia could be infected with the H5N1 bird strain. Or a bird in Alaska could be infected by a bird from Asia. • The risk is so small that scientists, health officials and biologists believe that benefits from harvesting wild birds greatly exceed any possible danger. Subsistence users of wild birds can take the following precautions to reduce potential exposure from wild birds. 1. Do not handle birds that are obviously sick or found dead. 2. Keep game birds cool, clean, and dry. 3. Do not eat, drink, or smoke while cleaning birds. 4. Use rubber gloves when cleaning birds. 5. Wash hands with soap and water or alcohol wipes after dressing birds. 6. Clean tools and surfaces immediately after cleaning birds: use hot soapy water, then disinfect with a 10% chlorine bleach solution. 7. Cook game meat thoroughly (155 – 165F) to kill disease agents and parasites. CURRENT INITIATIVES
AMONG STATE AND FEDERAL AGENCIES AND National Pandemic Flu Strategy: • This was published in November 2005 and defines what federal agencies will do to prepare for pandemic flu. • The strategy consists of increased surveillance, vaccine development and stockpiling of antiviral medication and funding to states to assist them in developing pandemic flu plans and programs. It can be found at: • http://www.whitehouse.gov/homeland/pandemic-influenza.html#section01
• An Alaska pandemic flu plan draft was published in January 2006. It defines how state agencies will respond to and support a pandemic in Alaska. It can be found at: • http://www.epi.hss.state.ak.us/id/influenza/fluinfo/pandemicfluplan.pdf
• A group of state agency officials and health care representatives have formed a group to coordinate plans and programs for pandemic flu in Alaska. • An Incident Management Team has also been formed. The IMT would manage operations and the response to a pandemic should one occur. • Another group of wildlife biologists, public health types and others are meeting to develop information for hunters and subsistence food users. The information will be much like what was provided above on bird flu and pandemic flu.
• A team made up of Division of Public Health, Homeland Security and Emergency Management and others are developing a curriculum to be used to prepare Alaska health and community leaders for dealing with pandemic flu should it occur. • Once a curriculum is developed the goal is to visit all major hub communities by the end of the summer. • The workshops will be a series of different topics designed to give community leaders and health care professionals what they need to manage the response to a pandemic outbreak.
• Current plans for dealing with pandemic flu involve worst case projections. These are that: o Epidemic duration will be 4 -6 weeks. o There will be no or minimal medevac support available. o There will be no outside health care staffing support available o Supplies/equipment will be available o Casualties: 50% of the population will be infected, 25% will require outpatient care, 3% will require in-patient care, 2-3 % will die! • Regional health corporations and community health care resources will be very much on their own for providing patient care and maintaining community and regional infrastructure. • Health Corporations and tribal clinics and communities will have to develop plans and programs to manage the epidemic. • The regional pandemic flu workshops are designed to help prepare communities and regions for this responsibility. • ANTHC will provide equipment and resources to the extent they are available. ANTHC will also provide guidelines to develop pandemic community and regional plans. For
more information, contact: Mike Bradley, Emergency Preparedness
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