Pandemic Influenza Plan - Questar III

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Appendix 5-K primary viral pneumonia, was notably increased in healthy young adults during the 1957–58 pandemic, particularly in pregnant women. Implications for the next pandemic The characteristic clinical features of the next influenza pandemic cannot be predicted. It is reasonable to assume that most affected persons will have the typical features of influenza (e.g., fever, respiratory symptoms, myalgia, malaise). However, past pandemics have varied considerably with regard to severity and associated complications. Illnesses caused by novel influenza viruses such as avian influenza A (H5N1) might predict the potential characteristics of pandemic influenza, but H5N1 has not adapted to spread easily among humans, and its presentation and severity might change as the virus evolves. Even as the next pandemic begins and spreads, the characteristic features might change, particularly if successive waves occur over several months. Given this potential for a dynamic clinical picture, it will be important for clinicians and public health partners to work together to disseminate updated and authoritative information to the healthcare community on a regular basis. 3 Tran TH, Nguyen TL, Nguyen TD, Luong TS, Pham PM, Nguyen VC, et al. Avian influenza A (H5N1) in 10 patients in Vietnam. N Engl J Med. 2004;350:1179-88. 4 Chotpitayasunondh T, Ungchusak K, Hanshaoworakul W, Chunsuthiwat S, Sawanpanyalert P, Kijphati R, et al. Human disease from influenzaA (H5N1), Thailand, 2004. Emerg Infect Dis. 2005;11:201-9 5 de Jong MD, Bach VC, Phan TQ, Vo MH, Tran TT, Nguyen BH, et al. Fatal avian influenza A (H5N1) in a child presenting with diarrhea followed by coma. N Engl J Med. 2005;352:686-91. 6 Apisarnthanarak A, Kitphati R, Thongphubeth K, Patoomanunt P, Anthanont P, Auwanit W, et al. Atypical avian influenza (H5N1). Emerg Infect Dis 2004;10:1321-4. 7 Beigel JH, Farrar J, Hayden FG, Hyer R, de Jong MD, Lochindrat S, et al. Avian influenza A (H5N1) infection in humans. N Eng J Med. 2005 Sep 29;353(13):1374-85. Source: U.S. Department of Health and Human Services. HHS Pandemic Plan. November 2005 February 7, 2006 3
Appendix 5-L Guidelines for Management of Community-Acquired Pneumonia, Including Post-Influenza Community-Acquired Pneumonia Rationale Post-influenza bacterial community-acquired pneumonia will likely be a common complication during the next pandemic and might affect approximately 10% of persons with pandemic influenza, based on data from previous influenza pandemics. Assuming that pandemic influenza will affect about 15%–35% of the U.S. population, approximately 4.4 to 10.2 million cases of post-influenza bacterial community-acquired pneumonia could occur. Post-influenza bacterial community-acquired pneumonia often presents as a return of fever, along with a productive cough and pleuritic chest pain, after an initial improvement in influenza symptoms over the first few days. Findings include lobar consolidation on chest x-ray and, in adults, sputum smear positive for leukocytes and bacteria. As with other bacterial infections, leukocytosis with increased immature forms may be present, but this finding is neither sensitive nor specific. The most common etiologies of post-influenza bacterial pneumonia are Streptococcus pneumoniae, Staphylococcus aureus, group A Streptococcus, and Haemophilus influenzae. Primary viral pneumonia, with abrupt onset and rapid progression, is more common than bacterial pneumonia in children, yet rare in adults. Physical and radiologic findings in viral pneumonia are consistent with interstitial and/or alveolar disease and include bilateral inspiratory crackles and diffuse infiltrates. Mixed viral-bacterial pneumonia is slightly more common than primary viral pneumonia, but they are often indistinguishable. Bacterial pathogens in mixed infections are similar to those found in secondary bacterial pneumonias. Droplet and Standard Precautions are currently recommended for community-acquired pneumonia of bacterial etiology. 8 Treatment of community-acquired pneumonia, including post-influenza bacterial community-acquired pneumonia will pose challenges for clinicians during a pandemic. Secondary bacterial pneumonia following influenza virus infection will be difficult to distinguish from community-acquired pneumonia that is not preceded by influenza. Current guidelines for the treatment of adult community-acquired pneumonia (CAP) during the Interpandemic Period de-emphasize the use of diagnostic testing for pathogendirected treatment and favor empiric therapy with safe and effective broad-spectrum antibacterials, especially extended-spectrum macrolides and fluoroquinolones. However, these antibacterials will likely be in short supply during a pandemic. The guidelines in this appendix are therefore designed to assist clinicians in managing patients with community-acquired pneumonia, including post-influenza bacterial community-acquired pneumonia, in a setting of high patient volume and limited clinical resources, where the pressure to treat empirically will likely be even greater than during the Interpandemic Period. For adults, the guidance draws heavily from the current draft guidelines for the management of CAP developed jointly by the Infectious Diseases Society of America (IDSA) and the American Thoracic Society (ATS). 9,10 For children, the guidance incorporates recommendations from the British Thoracic Society (BTS), 11 a published review, 12 and expert opinion. February 7, 2006 1
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February206 Pandemic Plan NewYorkSt
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Introduction Pandemic influenza occ
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example, at this time, it is realis
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Acronyms (cont.) IND IHANS IRB ISHS
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Section 1: Command and Control I. O
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Section 1: Command and Control pers
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February 7, 2006 Appendix 1-A
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Appendix 1-B The Public Health Law
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Appendix 1-B communicable diseases
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Appendix 1-C Management Office or t
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Appendix 1-E Suspension of Public M
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Appendix 1-G A Guide to New York St
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Appendix 1-G health commissioner. P
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Appendix 1-G 8. State Institutions
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Appendix 1-G b. Governor May Invoke
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Appendix 1-G may direct, pursuant t
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Appendix 1-G c. Commissioner of Gen
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Appendix 1-G Designation of emergen
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Appendix 1-G physician’s assistan
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Appendix 1-H Summary of Public Offi
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Section 2: Surveillance and Laborat
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Appendix 2-A • Surveillance Crite
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Appendix 2-A • In New York City,
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NYSDOH Novel Influenza Case Report
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Appendix 2-C to health care provide
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Virus Detection History NYS Lab Num
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Section 3: Healthcare Planning and
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Section 4: Infection Control I. Ove
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Section 4: Infection Control I. Ove
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Section 4: Infection Control A. Bas
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Section 4: Infection Control Drople
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Section 4: Infection Control o Noti
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Section 4: Infection Control E. Coh
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Section 4: Infection Control If wid
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Section 4: Infection Control should
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Section 4: Infection Control Policy
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Section 4: Infection Control o Staf
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Appendix 7-B a The drug package ins
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Appendix 7-C 7 HCWs in emergency de
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Section 8: Travel-Related Disease C
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Appendix 8-A Home or Community-Base
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Appendix 8-B Contact Identification
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Appendix 8-B • Determine the time
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Appendix 8-C Administrative Data: S
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Appendix 8-D CONTACT DAILY TEMPERAT
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Appendix 8-F Definitions: Intervent
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Appendix 8-F facility. No specific
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Appendix 8-F • Resources Required
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Appendix 8-G Business Pandemic Infl
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Appendix 8-G 4. Allocate resources
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Appendix 8-H CDC guidelines suggest
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Appendix 8-H If I am not masked I
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Appendix 8-H NYSDOH Model Influenza
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Appendix 8-H I understand that if
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Section 9: Communications I. Overvi
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Section 9: Communications and commu
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Section 9: Communications web pages
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Section 9: Communications Local Hea
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Section 9: Communications backup to
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Section 9: Communications • In th
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Appendix 9-A Public Health Risk Com
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Appendix 9-C New York State Departm
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Appendix 9-C PRE-EVENT MESSAGE MAP:
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Appendix 9-C PROTECTIVE MESSAGE MAP
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Appendix 9-C TREATMENT MESSAGE MAP:
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Appendix 9-C BUSINESS CONTINUITY PR
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Section 10: Training and Education
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Appendix 10-A NYSDOH STAFF PRIVATE
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FACILITY- BASED RNs FACILITY- BASED
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Section 11: Workforce Support I. Ov
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Section 11: Workforce Support Pande
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Section 12: Highly Pathogenic H5N1
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Section 12: H5N1 in Non-Human Anima
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Section 13: Public Health Preparedn
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Appendix 13-A NYSDOH Roles Notified
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Appendix 13-B Notifications sent by
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Appendix 13-B HAN posting is used a
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Appendix 13-C Overview of the Healt
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Appendix 13-C • Ongoing surveilla
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Table 1. Summary of HERDS Use To da
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Appendix 13-D Commerce Access and A
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Appendix 13-D Table 3. Organization
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