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 public-
health 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: 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.
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